Katrina Scott, an oncology chaplain who spoke at the Yale Bioethics Summer Institute, cited data that in the US, 32% of people under 30 years of age have no religious affiliation—versus only 9% of Americans over the age of 65 years who do not identify as religious. For Scott, this raises the question: Who will provide personal support for the rising number of non-religious patients at the end of life, since end-of-life care is often tied to religious community?
Mourning traditions in many religions, such as the Buddhist transference of merits or the Jewish tradition of shiva, are characterized by community involvement. Christian churches emphasize community support through times of hardship (including terminal illness and mourning) based on the biblical concept that all Christians are united as members of the body of Christ. (For an example of how the Bible portrays this theme, see 1 Corinthians 12). Following this reasoning in his 1982 book Death and Dying, Lutheran Daniel E. Lee states, “Sometimes caring communities spring into being spontaneously, as when friends and neighbors respond to each others’ needs. Sometimes they are carefully planned and organized, as with hospice programs. Sometimes they are a little of both. Whatever the approach, churches can and should play a role in developing caring communities.”
According to Scott, discussion is currently underdeveloped as to what kinds of spiritual/emotional support services atheists, humanists, and agnostics would like to be available to them during end-of-life care. One 2007 study conducted by Marilyn Stoner surveyed atheists on end-of-life preferences and found: “…intrapersonal, interpersonal care, or time with family and friends, and maintaining connection to the natural world, including time outside and with pets—were consistent requests from participants.” In order to meet the request for interpersonal contact cited as one of the top requests in this study, Scott suggests that the rising number of non-religious end-of-life patients will need to seek increased support through family ties, in the absence of the church community that many religious patients tend to have. She also hopes to see further development of altruistic interpersonal services such as the “No One Dies Alone” movement, in which volunteers sit at patient bedsides to speak, hold hands, or simply be present as patients approach the end of life.
Beyond providing personal support, the concept of community is also influential at the policy level for end-of-life medical care. In a 2010 article titled “The role of religion in the debate about physician-assisted dying,” William Stempsey makes a case for ethical opinions derived from religious beliefs by zeroing in on the concept of community influence for both secular and religious citizens of the United States and Europe: “The public policy decisions we make about assisted dying say much about how we see ourselves as a community and for religious people religious community may be central and irreducible to a more general conception of community.” Although rising calls for the secularization of policy debates can be heard through much of the developed world, other voices call for the preservation of space for religious ethics in public discourse, particularly in the context of ethically divisive issues such as physician-assisted dying.