Care of the Dying Patient

9. Spirituality and End-of-Life Care - Scott E. Shannon and Paul Tatum

115 9 Spirituality and End-of-Life Care Scott E. Shannon and Paul Tatum Prior to the modern medical era, spiritual issues were central to care of the dying. During the fourth century AD, hospices founded by religious orders for pilgrims and travelers became centers to care for the sick. The core values of these hospices are often attributed to the Gospel of Matthew , chapter 25: “I was hungry and you gave me food, I was thirsty and you gave me drink. I was a stranger and you welcomed me. . . . I was sick and you visited me. . . . As you did it to one of the least of these my brethren, you did it to me.” With the rise of modern medicine, the focus shifted from treating symptoms to curing diseases, and secularization separated the care of spiritual issues from medical care. In reaction to the suffering of the dying that resulted from the de-emphasis on symptom care and the prolongation of life during attempts to cure disease, the modern hospice movement arose. A key aspect of early modern hospices was the spiritual care of the dying. St. Christopher’s, the landmark hospice founded in South London by Dame Cicely Saunders, still emphasizes the “religious foundation” of the hospice in its Aim and Basis Statement. The very purpose of palliative medicine is to ease suffering . Easing suffering means more than easing the physical pain of disease. Palliation of the dying person’s suffering is the easing of what Saunders called “total pain”—the combination of physical, psychological, social, and spiritual pain.1 116 Care of the Dying Patient Thanks to the hospice movement, attending to a patient’s spirituality has become increasingly recognized as a component of good, holistic end-of-life care. Spirituality Defined Caregivers and authors of medical literature differ on how to define spirituality. Much of the difficulty stems from trying to define it in nonreligious terms in order to be inclusive . Though spirituality and religiosity have long been viewed as distinct concepts even within religious circles, spirituality has historically been defined in religious terms that involve an immaterial component of human nature and its relationship to a deity. In efforts to be more broadly inclusive, most discussion of spirituality in the medical literature has viewed it simply as a human being’s search for meaning. This definition may not be fully true to the origin of the word and its past use. It has been, however, a pragmatic definition for medicine in that it captures much of the practical essence of traditional spirituality while not excluding the nonreligious or philosophical naturalist. In their comprehensive work Handbook of Religion and Health, Harold Koenig, Michael McCullough, and David Larson have proposed a more nuanced definition of spirituality as distinct from religion, yet acknowledging its common relationship to religion. They define spirituality as “the personal quest for understanding answers to ultimate questions about life, about meaning, and about relationship to the sacred or transcendent which may (or may not) lead to or arise from the development of religious rituals and the formation of community.”2 The Consensus Conference of Spiritual Care and Palliative Medicine sponsored by the Archstone Foundation recently published its report on spiritual care as a dimension of palliative care. The Consensus Conference defines spirituality as “the aspect of humanity that refers to the way 117 Spirituality and End-of-Life Care individuals seek and express meaning and purpose and the way they experience their connectedness to the moment, to self, to others, to nature, and to the significant or sacred.”3 In concert with the medical literature, this essay will use the simple definition of spirituality as “one’s personal search for meaning,” recognizing as suggested by Koenig, McCullough, and Larson that this often occurs within a religious context. The Importance of Spirituality in Medical and End-of-Life Care There is a rapidly growing body of medical literature relating to the blending of religion and/or spirituality with medicine. One clear message from this body of literature is that patients in the United States consider religion and spirituality to be important in their lives and a part of how they deal with their medical experiences. Examples can be drawn from a wide array of medical disciplines. In a 1994 study of family practice inpatients in North Carolina and Pennsylvania , 94 percent agreed that spiritual health was as important as physical health.4 In...