The end of life is often a confusing and fearful time for the dying person and their loved ones. Spirituality and/or religion often come to the forefront during the dying process. Religious and spiritual beliefs, for instance, play an important role as a coping resource in the face of a life-threatening or terminal illness. Beliefs are often related to how a patient interprets the meaning and prognosis of a particular diagnosis. Strong religious or spiritual faith may cause negative life events, such as the diagnosis of a terminal illness, to be seen as opportunities for spiritual growth. By turning to a source larger than oneself, religious and spiritual beliefs can help reduce the discomfort and the anxiety caused by illness and the threat of death. Patients who are more religious or spiritual are more likely to accept their illness and find some positive meaning in its diagnosis. Contrary to the popular understanding that religious and/or spiritual beliefs provide only a passive means of coping, such beliefs may actually empower an individual to take action (such as fighting against an illness). Furthermore, in situations in which death is imminent, giving up some control may in fact be a healthy form of coping. However, these are rarely isolated late life events but rather a continuation of a coping style that develops and is utilized across the life span, from childhood through old age. It should also be noted that strong religious or spiritual beliefs may not always be beneficial as an individual faces death. Negative psychological outcomes are often linked to the ways in which people view their relationship to God. Patients coping with a terminal illness, for instance, might become angry with God and worsen their psychological health. Furthermore, certain religious doctrines may engender particular negative emotional states (such as guilt, shame, or anxiety) and negative attitudes and beliefs that may, in turn, impact negatively on physical and mental health. Religious or spiritual beliefs may create religious or spiritual turmoil in dying patients who perceive their illness as a punishment or abandonment by God and find themselves worrying and concerned about their eternal outcomes. Again, it is important to note that the positive and negative effects of religion and spirituality on psychological health may vary across the life span and may also vary by ecological factors, ranging from the self to the broader cultural context.
Older adults, among whom death is an expected and often planned-for occurrence, may have long grappled with the dual issues of spirituality and mortality. Thus, for such individuals, spirituality at the end of life is likely to provide comfort and acceptance. Children and adolescents faced with death, however, must address these issues prematurely. Due to many youth-oriented societies (such as in the United States) and the atypicality of childhood deaths, as well as adults' attempts to "protect" children from issues of death, many children confronted with their own mortality and/or the death of others may possess unrealistic and distorted views of the process.
The stress response of a child resulting from the news of a fatal illness is a transaction between the child (their age and/or cognitive and emotional developmental level) and the situation (family factors, type of illness, etc.). Very young children have some understanding of death. For example, many 4-year-olds think that dead things can become alive again spontaneously, for instance, by praying. Between the ages of 5 and 7, children transition from the Piagetian preoperational stage of thinking to the more advanced stage of concrete operational thinking; they begin to process abstract concepts but they need concrete examples to understand these concepts. Thus, their understanding of death also changes as they begin to understand the irreversibity, the nonfunctionality, and the universality of death. The family's religious beliefs may be a particularly salient situational factor that affects a child's cognitive understanding and emotional response to death. In order to make sense of what has happened to them, even children who are not from a religious home may use God as an all-purpose explanatory construct.
Issues of faith arise in even very young children. Slightly older e.g., (school-age) children may elaborate the concept of death with many religious and cultural meanings. Especially for those children who come from religious homes, these beliefs may offer comfort. Although some children might lose faith in God as they face death (either their own or the death of a loved one), most children from religious homes perceive God as a savior throughout their struggle with death. The efficacy of religious beliefs as a coping method in children can be seen in their interest and beliefs in life after death. It is interesting that although heaven is often mentioned among dying children, hell rarely is. On the other hand, while many school-age children may believe in and/or understand the concept of life after death, for some this idea may not be comforting if they fear facing this afterlife alone. Children experience less anxiety when allowed to openly acknowledge and discuss their fears and spiritual concerns.
Facing death in adolescence may present even more challenges. Due to the development of hypothetico-deductive reasoning in many adolescents, philosophical issues of life, death, and reality become more salient even among healthy adolescents. The acquisition of religious belief systems is an important component of the development of identity, which is a key task in adolescence. Adolescents facing mortality often experience intensified spiritual and religious concerns. The contemplation of a prognosis may force the adolescent to consider some aspects of religion, even if these aspects were rejected upon previous consideration. Like younger children, adolescents begin to consider life after death. Through spirituality and religion, adolescents also attempt to find answers to questions and meaning in suffering. Not only must these adolescents come to terms with death, but they must also make sense of dying young or before their time. Just as in childhood, if such cognitive searching and discussion is discouraged, emotional isolation may deepen.
In conclusion, many children and adolescents (as well as older adults) want and seek out formal religious and spiritual discussions as they near death or confront the death of loved ones. Especially in palliative care settings, spiritual care is vital to a holistic approach to caring for dying individuals and their families. In these settings, it is important to recognize and foster spirituality as well as to understand the importance of religious convictions and practices. Not only do different religions offer different views of death, but conceptions of death and dying change across the life span and vary on a range of cognitive and ecological factors, from the individual and family to society and culture.