The Psychiatric Institute of Washington, D.C., Inc.

AIDS is a life-threatening illness and, as is the case with all life-threatening illnesses, the spiritual beliefs of patients may influence their well being at the end of life. Patients' spiritual beliefs can offer comfort or be a source of distress. Health care professionals face ethical dilemmas, as they work with patients whose religious or spiritual idioms are incongruent with their own beliefs and traditions. The discussion in this case focuses on increasing health care professionals' sensitivity to the diverse spiritual needs of their patients. Guidelines are provided for assessment and interventions, as appropriate.

Since the release of naltrexone for general use, we have offered it to approximately 300 narcotics-addicted patients admitted to our 4-week intensive treatment program at the Psychiatric Institute of Washington. Despite active persuasion, only 15 patients agreed to take the drug, and 11 started the outpatient phase of treatment. Only 3 of the 11 remained on naltrexone for more than 2 months. Negative local community attitudes toward all pharmacologic treatments, a strong focus on total abstinence by the recovering patient group, and self-elimination of poor candidates in this unselected population appear to be important factors in the poor acceptance of naltrexone.