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Abstract
The issues of spirituality and ethics are evoked in a case of an 89-year-old woman resident in a nursing home who refused nutrition and hydration. Clergy representing Catholicism, Protestantism, Judaism, Hinduism and Islam were asked to respond to questions regarding the choice to end life and spiritual resources to help the patient. The clergy agreed that the patient is in a spiritual crisis but her autonomy should be respected, and spiritual resources should be expended to enhance meaning. The ethical dilemma for the social worker, as for the clergy, is whether to support the patient's freedom to end her life or persuade her to continue to live. The dilemma is based on conflicting social work values of self-determination and the preservation of life. Three ethical principles are in conflict: respect for autonomy, the duty to prevent harm, and beneficence. At the end of the process of ethical deliberation, the social worker must be prepared to accept the patient's decision.