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32 christian counseling today Vol. 21 no. 2
then I encouraged him to leave the feeding tube
in and do the best he could. If the answer was
“No,” then I would understand if he decided
to withdraw the tube, refuse further feedings or
treatments, and die a natural death.
Interestingly, a relative was in the room when
we had this discussion. As a Christian, the rela-
tive reminded me that only God has the right
to end a man’s life. I contended, saying that was
easy for him to say since he wasn’t the guy lying
in that bed, and told him that modern medicine
had the power to keep people alive indefinitely,
prolonging their suffering. He said that he
understood, but what was important was not the
technology keeping Mr. Q alive, but the decision
in his mind to hasten his own death. The rela-
tive felt that such a decision was not consistent
with what Christians believe. I acknowledged his
point and thanked him for reminding me of that,
but I still struggle with how I would respond if I
was the one in that bed.
Whether or not Mr. Q had that conversation
with God as I suggested, we will never know. I
did learn a few days later, though, that he told
his doctors he did not want any more feedings
through the stomach tube. Several days later,
I visited him at the nursing home for what I
suspected would be the last time. When I arrived,
he was close to death but had moments when
he was lucid. During one of those moments, a
relative told him to put his hand in God’s hand
and let Him take him home. I encouraged that,
too, and said, “I loved you as your doctor, and
if I don’t see you again here, then I’ll see you on
the other side.” Though barely conscious, he
reached out his hand and I took it in mine to
say goodbye. As I left the room, I saluted him,
as a soldier in a battle I hope I will never have to
fight. ✠
Harold G. Koenig, M.D., is
Professor of Psychiatry and Associate
Professor of Medicine at Duke University
Medical Center. He is also Adjunct
Professor in the Department of Medicine
at King Abdulaziz University, Jeddah,
Saudi Arabia, and in the School of Public Health at Ningxia
Medical University, Yinchuan, People’s Republic of China. In
addition, Dr. Koenig is the director and founder of the Center
for Spirituality, Theology and Health at Duke University
.
Endnotes
1 Koenig, H.G., King, D.E., & Carson, V.B. (2012). Handbook of religion and health, 2nd ed.
New York: Oxford University Press.
2 Koenig, H.G. (2015). Religion, spirituality and health: Review and update. Advances in
Mind-Body Medicine, 29, 19-26.
3 Shafranske, E.P., & Cummings, J.P. (2013). Religious and spiritual beliefs, affiliations, and
practices of psychologists. In Pargament, K., Mahoney, A., Shafranske, E.P. (eds). APA
Handbook of Psychology, Religion, and Spirituality (Vol. 2). Washington, DC: American
Psychological Association, 23-41.
4 Rose, E.M., Westefeld, J.S., & Ansely, T.N. (2001). Spiritual issues in counseling: Clients’
beliefs and preferences. Journal of Counseling Psychology, 48, 61-71.
5 Stanley, M.A., Bush, A.L., Camp, M.E., Jameson, J.P., Phillips, L.L., Barber, C.R., Zeno,
D., Lomax, J.W., & Cully, J.A. (2011). Older adults’ preferences for religion/spirituality in
treatment of anxiety and depression. Aging and Mental Health, 15, 334-343.
6 Propst, L.R., Ostrom, R., Watkins, P., Dean, T., & Mashburn, D. (1992). Comparative
efficacy of religious and nonreligious cognitive-behavior therapy for the treatment of clinical
depression in religious individuals. Journal of Consulting and Clinical Psychology, 60,
94-103.
7 Worthington, E.L., Hook, J.N., David, D.E., & McDaniel, M.A. (2011). Religion and
spirituality. Journal of Clinical Psychology, 67, 204-214.
8 Pearce, M.J., Koenig, H.G., Robins, C.J., Nelson, B., Shaw, S.F., Cohen, H.J., &
King, M.B. (2015). Religiously-integrated cognitive behavioral therapy: A new method of
treatment for major depression in patients with chronic medical illness. Psychotherapy, 52,
56-66.
9 Pearce, M.P., & Koenig, H.G. (2013). Cognitive behavioural therapy for the treatment of
depression in Christian patients with medical illness. Mental Health, Religion and Culture,
16, 730-740.
10 Available for free download and use from the Center for Spirituality, Theology and Health
Web site at
therapy-manuals.
11 Koenig, H.G., Pearce, M.J., Nelson, B., Shaw, S.F., Robins, C.J., Daher, N., Cohen, H.J.,
Berk, L.S., Belinger, D., Pargament, K.I., Rosmarin, D.H., Vasegh, S., Kristeller, J., Juthani,
N., Nies, D., & King, M.B. (2015). Religious vs. conventional cognitive-behavioral therapy
for major depression in persons with chronic medical illness. Journal of Nervous and
Mental Disease, 203, 243-251.
12 Koenig, H.G., Pearce, M.J., Nelson, B., Shaw, S.F., Robins, C.J., Daher, N., Cohen,
H.J., & King, M.B. (2015). Effects of religious vs. standard cognitive behavioral therapy on
therapeutic alliance: A randomized clinical trial. Psychotherapy Research, in press.
13 Razali, S.M., Aminah, K., & Khan, U.A. (2002). Religious-cultural psychotherapy in the
management of anxiety patients. Transcultural Psychiatry, 39, 130-136.
14 Azhar, M.Z., Varma, S.L., & Dharap, A.S. (1994). Religious psychotherapy in anxiety
disorder patients. Acta Psychiatrica Scandinavica, 90 , 1-3.
15 Center for Spirituality, Theology and Health (2015). Conventional vs. religious cognitive
processing therapy for soldiers and U.S. veterans with post-traumatic stress disorder. See
Web site:
duke.
16 Koenig, H.G., King, D.E., & Carson, V.B. (2012). Suicide, ch 8. Handbook of religion and
health, 2nd ed. New York: Oxford University Press, 174-190.
17 Kleiman, E.M., & Liu, R.T. (2014). Prospective prediction of suicide in a nationally
representative sample: Religious service attendance as a protective factor. British Journal
of Psychiatry, 204, 262-266.
18 O’Reilly, D., & Rosato, M. (2015). Religion and the risk of suicide: Longitudinal study of
over 1 million people. British Journal of Psychiatry, 206, 466-70.
19 Sansone, R.A., & Wiederman, M.W. (2015). Religiosity/spirituality: Relationships with
non-suicidal self-harm behaviors and attempted suicide. International Journal of Social
Psychiatry Apr. 10. pii: 0020764015579738. [ePub ahead of press].
20 Toussaint, L., Wilson, C.M., Wilson, L.C., & Williams, D.R. (2015). Religiousness and
suicide in a nationally representative sample of Trinidad and Tobago adolescents and
young adults. Social Psychiatry and Psychiatric Epidemiology. [ePub ahead of press].
21 Zhang, J., Wieczorek, W.F., Conwell, Y., & Ming Tu, X. (2011). Psychological strains and
youth suicide in rural China. Social Sciences & Medicine, 72, 2003-2010.
22 Wang, Z., Koenig, H.G., Ma, W., & Liu, L. (2015). Religious involvement, suicidal ideation
and behavior in mainland China. International Journal of Psychiatry in Medicine, 48, 299-316.
23 Some of the details of this case have been changed to prevent recognition of the individual
involved.