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Abstract
Case studies provide interesting windows into issues confronting patients in today's health care system. We present two cases from our clinical experiences involving spiritual and ethical issues arising in the care of patients facing life-threatening illnesses. We also present two methods that introduce ways of talking about spiritual and ethical issues, the HOPE mnemonic and a clinical ethics paradigm for organizing and analyzing ethical issues in the clinical context from a principled perspective. As growing numbers of older adults seek health care in the face of life-threatening illnesses, many will make decisions based upon values associated with their religious or spiritual beliefs.