• L C Kaldjian, J F Jekel, and G Friedland.
• Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8033, USA.
• AIDS. 1998 Jan 1;12(1):103-7.

ObjectiveTo describe the role of spiritual beliefs in HIV-positive patients' end-of-life decisions.DesignInperson, cross-sectional survey.SettingAn HIV/AIDS floor of an urban, university teaching hospital.PatientsNinety hospitalized HIV-positive patients.Main Outcome MeasuresPrior discussions about advance directives, possession of a living will (written advance directive), fear of death, professions of hope and purpose in life, religious beliefs and practices, guilt about HIV infection, and perception of HIV as punishment.ResultsOf 104 eligible patients, 90 agreed to be interviewed. Twenty-four per cent of patients had discussed their resuscitation status with a physician and 17% possessed a living will; 44% of patients felt guilty about their HIV infection, 32% expressed fear of death, and 26% felt their disease was some form of punishment. Prior discussions about resuscitation status were less likely in those who perceived HIV as punishment (P=0.009) and more likely in those who believed in God's forgiveness (P=0.043). A living will was more common in those who prayed daily (P=0.025) and in those whose belief in God helped them when thinking about death (P=0.065). Fear of death was more likely in those who perceived HIV as punishment (P=0.01) or felt guilty about having HIV (P=0.039), and less likely in those who read the Bible frequently (P=0.01) or attended church regularly (P=0.015). Outcome measures did not vary significantly according sex, race, HIV risk factors, or education level.ConclusionsIn this HIV-positive population, spiritual beliefs and religious practices appeared to play a role in end-of-life decisions. Discussions about end-of-life decisions may be facilitated by a patient's belief in a forgiving God and impeded by a patient's interpretation of HIV infection as punishment. Health-care providers need to recognize patients' spiritual beliefs and incorporate them into discussions about terminal care.

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