End-of-life preferences for atheists.

Atheists represent an understudied population in palliative care medicine. Although professional and regulatory organizations require an individualized plan of care for each patient and family, little is known about atheist preferences for end-of-life (EOL) care. The aims of this pilot study were twofold: (1) to explore the EOL preferences for atheists, and (2) to apply a threefold model of spiritual care (intrapersonal, interpersonal, and natural interconnectedness) to assess the appropriateness of potential interventions for a group of atheists. Eighty-eight participants completed either an online or paper survey. Analyses of open-ended and closed questions were consistent with prior studies on EOL preferences, including components of a ;;good death.'' The results related to the first aim of the study, to explore EOL preferences, suggests that participants view of a good death was expanded to include respect for nonbelief and the withholding of prayer or other references to God. Strong preference for physician-assisted suicide and evidence-based medical interventions were central themes from participants. The second aim of the study, to apply a threefold definition of spirituality--which includes intrapersonal, interpersonal, and natural focus--appears appropriate in planning interventions for atheists at EOL. Participants expressed a deep desire to find meaning in their own lives (intrapersonal), to maintain connection with family and friends (interpersonal), and to continue to experience and appreciate the natural world (natural interconnectedness) through the dying experience. Additional research is necessary to explore the preferences for this understudied group. Further clarification of the use of the term "atheist'' is also necessary to ensure that the inclusion of all individuals with nontheist beliefs are represented in future research efforts.