• Hans-Henrik Bülow, Charles L Sprung, Konrad Reinhart, Shirish Prayag, Bin Du, Apostolos Armaganidis, Fekri Abroug, and Mitchell M Levy.
• Department of Anaesthesiology and Intensive Care, Holbak Hospital, Smedelundsgade 60, 4300 Holbak, Denmark. hhbulow@dadlnet.dk
• Intensive Care Med. 2008 Mar 1; 34 (3): 423-30.

ObjectiveRecent research has shown that the religious affiliation of both physicians and patients markedly influences end-of-life decisions in the intensive care unit in the Western world. The world's major religions' standings on withholding and withdrawing of therapy, on hastening of the death process when providing pain relief (double effect) and on euthanasia are described. This review also discusses whether nutrition should be provided to patients in a permanent vegetative state, and the issues of brain death and organ donation.DesignThe review is based on literature research and a description of the legislature in countries where religious rulings do influence secular law.ResultsNot all religions have distinct rulings on all the above-mentioned issues, but it is pointed out that all religions will probably have to develop rulings on these questions. The importance of patient autonomy in the Western (Christian) world is not necessarily an issue among other ethnic and religious groups, and guidelines are presented with methods to uncover and deal with different ethnic and religious views.ConclusionMany religious groupings are now spread world-wide (most notably Muslims), and with increasing globalization it is important that health-care systems take into account the religious beliefs of a wide variety of ethnic and religious groups when contemplating end-of-life decisions.

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