Fasting at Life's End: Exploring the Spiritual and Medical Tensions in Palliative Care

Voluntary fasting at the end of life raises complex spiritual, ethical, and clinical challenges for palliative care providers. This qualitative study explored healthcare professionals' experiences in managing patient-initiated fasting within a culturally and religiously diverse palliative care context in Saudi Arabia. Sixteen participants-including nurses, physicians, and allied health professionals-were interviewed using a phenomenological-hermeneutic approach and analyzed through reflexive thematic analysis. Four interrelated themes emerged: (1) between respect and responsibility, reflecting ethical tensions between honoring autonomy and providing care; (2) spiritual framing of fasting, where fasting was seen as a sacred act of surrender and divine preparation; (3) emotional labor and moral conflict, capturing the psychological toll of managing spiritually motivated fasting; and (4) negotiating care in cultural contexts, illustrating the lack of institutional support and the need for culturally responsive frameworks. Findings highlight the necessity of structured spiritual care integration, ethical training, and culturally sensitive protocols to support both patients' dignity and clinicians' moral integrity at life's end.