“Why are evangelical Christians and conservative Catholics overrepresented among those who experience higher levels of guilt, regret and uncertainty in the face of impending death?”

That’s a question a friend who works as a spiritual health-care provider at a Winnipeg, Man., hospital asked recently.

His question was prompted by being at the deathbeds of some very religious people who were deeply afraid of what would happen after they died.

He mentioned an older woman who had lived a full, productive and largely joyful Christian life.

“She was a very good person to whom God was mightily important,” he said. Yet, as death approached, she was worried that she wasn’t good enough to be accepted into heaven.

Or, as my friend put it, “the ‘blessed assurance’ of which she’d sung so confidently for decades had evaporated into question marks.”

Another devout Christian, who had also lived a full life of service for others, also worried about his worthiness as his life neared its end. He worried about the things he had failed to do.

My friend wondered: Why was he now worried mostly about the things he should have done instead of being content with the many good things he had accomplished?

My friend realized not every devout believer felt that way. “Yet it seems to be generally true that the most devout of conservative Christians have a tougher time . . . at the end of life,” he said. “They respond with guilt and self-loathing to a greater extent than those of more liberal practice, or, indeed, those with no declared religious affiliation.”

His comments made me curious. Was it true?

A review of 100 studies by researchers at the University of Oxford, published in the journal Religion, Brain and Behavior, found mixed results. Eighteen percent of the studies indeed did find that some religious people struggle with death. According to one of those studies, these tend to be people who believe in a demanding and vindictive God and who may have received a lifelong dose of sermons about hell fire and punishment awaiting those who don’t measure up.

Some of the studies accounted for this by distinguishing between what they called intrinsic religiosity — where belief motivates behavior — and extrinsic religiosity, where behavior bolsters beliefs.

Those who had intrinsic faith tended to be more at peace about dying, compared to extrinsic believers who worried they weren’t doing enough to please God.

The review also found another group of people who approach death with a sense of peace: Atheists. Which isn’t surprising; if you don’t believe in an afterlife, in heaven or hell, then there’s nothing to worry about either way.

But back to my friend. Why does he think those people who were very religious were fearful of death?

For him, “guilt is the common denominator. And fear.” This may be because their “spiritual formation likely included more of an emphasis on hell than in many other traditions, and a sense that ‘I have to get it right’ in order to avoid damnation and experience paradise.”

For them, it was hard “to truly relax in the arms of grace when you’ve spent much of your religious life emphasizing holy living.” At the bedsides of people who feel this way, his goal is to “remind them that the steadfast love of the Lord endures forever. . . . God can be trusted.”

John Longhurst, of Winnipeg, Man., is director of resources and public engagement at Canadian Foodgrains Bank.