SPIRITUALITY AND END OF LIFE CARE

SPIRITUALITY AND END OF LIFE CARE

WE CAN HELP BY SIMPLY BEING PRESENT

Although we have not yet discussed the subject of death and end of life decision makings, I would like to take this great opportunity to address the role of the clinician and share my feelings about the ill and dying patients. A sudden death is very different from someone that is chronically ill and expecting to die. When you die suddenly you do not have time to think, feel or express any feelings about death. In the contrary, when a person knows that will die than he/she has the ability and choice to prepare spiritually, religiously and culturally.
We as health care professionals have the opportunity to assist our dying patient with their decisions by just “simply” being present and allow the patient to practice their cultural and spiritual beliefs, and if possible take place and act when appropriately along with them.
Religious, spiritual, and cultural beliefs and other practices play a significant role in the patient’s life that is seriously ill and dying. In addition to providing an ethical foundation for clinical decision making, spiritual and religious traditions provide a conceptual framework for understanding the human experience of death and dying, and the meaning of illness and suffering.
Most patients derive comfort from their religious/spiritual beliefs as they face the end of life, and some find reassurance through a belief in continued existence after physical death. However, religious concerns can also be a source of pain and spiritual distress, for example, if a patient feels punished or abandoned by God.
A common goal for the dying patient, family members, and the health care professional is for a meaningful dying experience, in which loss is framed in the context of a life legacy. Such an experience includes support for the patient's suffering, the avoidance of undesired artificial prolongation of life, involvement of family and/or close friends, resolution of remaining life conflicts, and attention to spiritual issues that surround the meaning of illness and death. Clinicians can and should help dying patients find meaning and hope through recognition of the spiritual dimension of their experience. Although they may lack the expertise to address spiritual concerns in depth, healthcare professionals should be able to discuss spirituality with their patients and identify those in spiritual distress so that appropriate referral may be made to spiritual care providers. These include chaplains, community-based clergy, spiritual directors, pastoral counselors, and culturally based healers.
An important component of spiritual care has to do with the relational aspect of the healthcare professional-patient partnership. All clinicians should strive to deliver relationship-focused care that is delivered in a compassionate, caring manner. Compassion means "to suffer with", and to render compassionate care requires a commitment on the part of the healthcare professional to be a partner with the patient in the midst of their suffering.
This means: Being fully present and attentive to the patient during the time that the healthcare professional has with that patient.
Creating an atmosphere of trust where patients and their family members can share their deepest concerns. Instead of focusing on agenda-driven conversations about treatments and outcomes, being more open to the patient and listening to his or her concerns, beliefs, hopes, fears, and dreams. The focus of care should be on the whole person, including the physical, emotional, social and spiritual aspects of the individual. Treatment plans should be formulated that incorporate what is important to the patient.
An important component of this exchange is listening fully to the patient's story: who they are, what they value, how they make decisions, who is important in their lives, what gives their lives meaning, and how they understand illness and dying. Giving voice to patients who cannot speak for themselves. This comes from either knowing the patient from previous clinical encounters, or learning enough about him or her from family, friends, and/or their spiritual or religious communities to be able to defend what is important to them, even if it conflicts with what may be the recommended evidence-based course of action.
Focusing on the inherent dignity of all people regardless of their physical condition. Providing the patient and his or her family with opportunities for closure, forgiveness, and the best quality of life that can be achieved.
Some patients may request that the healthcare professional pray with him or her. The extent to which this is possible depends on the clinical setting and circumstance and the individual beliefs of the patient and healthcare professional. Clinicians or other healthcare professionals should never feel obliged to pray with patients; some clinicians and healthcare professionals may feel comfortable with the requests, while others may not. A clinician or healthcare professional should never coerce a patient into praying or into accepting the prayers of the clinician. That could potentially violate the trust a patient places in the clinician and be outside the boundaries of legitimate medical practice.
Spiritual and religious beliefs, values, and practices play a significant role in the lives of patients who are seriously ill and dying.
Some important considerations for physicians and other healthcare professionals regarding spirituality include the following:
For patients facing the end of life, spiritual care is interdisciplinary collaborative care, and requires the participation of all members of the healthcare team. Clinicians should clarify the patient's concerns, beliefs, fears, and spiritual needs, and be sensitive to comments that may indicate spiritual distress. Active listening and supportive dialogue may help patients work through existential issues and find peace. Patients who are in spiritual distress should be referred to certified and trained spiritual care professionals such as chaplains, spiritual directors, pastoral counselors and clergy.
All clinicians should strive to deliver relationship-focused care that is delivered in a compassionate, caring manner. This includes being fully present and attentive to the needs of the patient and all aspects of the patient's suffering—the physical, emotional, social and spiritual, and creating an atmosphere of trust where patients can share their deepest concerns. Clinicians should be knowledgeable about and sensitive to the individual death practices and customs that characterize the major world faiths. Attending funeral services for patients who have died may mean a great deal to the family, but may also bring closure to the healthcare professional.

In closing, I would like to thank Linda MacDonald Glenn, my professor, teacher and inspirer who made all this possible for us to voice our feelings, thoughts and expertise to the world. In addition, thanks to all fellow classmates for being there at all times of the good, the bad and the ugly.

Furthermore, thanks to University of Health Sciences (UHSA) that brought us all together. Indeed, UHSA is education to the world and providing doctors beyond borders.

John Aidonis, BC-FNP

Medical Student, UHSA

February 25, 2008.