SPIRITUAL ISSUES IN PALLIATIVE CARE

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SPIRITUAL ISSUES IN PALLIATIVE CARE

• Jim Rawlings, Jr., D.Min.
• Director, Pastoral Care
• UNC Hospitals

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Introduction

• Definition of Spiritual(ity)
• Contemporary spirituality is eclectic and
  individualistic, situated on a sacred-secular
  continuum. Murray, 2004
• Our search for that which gives meaning,
  purpose, and value to our life.

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The Spiritual Issues

• What does Morrie Schwartz have to say about this?
  
• Lets listen to some of his thoughts about dying
  in a piece taped with Ted Koppel on the
  television program Nightline just weeks before
  Morrie died.

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• What Is the Meaning of My Illness?
• What will happen to me?
• How will the illness proceed?
• What will happen to my wife/husband, child(ren)?
• How will I die?
• Where will I die?
• Will I be a burden?

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What Is the Meaning of My Life?

• A search for meaning or purpose
• Loss of a sense of connection
• Feelings of guilt and/or unworthiness
• Questioning of faith/beliefs
• Desire for forgiveness
• Sense of being abandoned by God

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Spiritual Needs of Person

• Need for Companionship
• To be with spouse/partner
• To be with children
• To be with friends
• To talk with others
• To help care for others

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Need for Involvement and Control

• To have input into ones life
• To have information about ones care
• To stay as independent as possible
• To have things in life stay constant
• To be involved with family activities
• To be helped by others

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Need for Positive Outlook

• To see the smiles of others
• To laugh
• To think happy thoughts
• To take one day at a time

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The Need to Experience Nature

• To look outside
• To be outside
• To have flowers in the room
• To have a pet nearby

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The Need for Religion/Spirituality

• To pray
• To read holy scriptures
• To read inspirational material
• To use inspirational material
• To go to their house of worship
• To sing/listen to sacred/secular music
• To experience the rituals of their faith

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The Need to Finish Business

• To do a life review
• To finish life tasks
• To come to terms with present situation
• To resolve bitter feelings
• To reconcile with loved ones

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The Physicians Role

• Be aware of the potential of spiritual distress
  when your patient is facing a life-threatening
  situation.
• Listen to the patients concerns and their
  broader implications.
• Be aware of your own attitudes, values, and
  assumptions regarding the spiritual dimension.
• Consider utilizing a spiritual assessment FICA.
• Encourage advance care planning.

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References

• EPEC (Educating Physicians on End-of-Life Care),
  Feinberg School of Medicine, Northwestern
  University. Module 3 Whole Patient Assessment.
  Email info_at_epec.net.
• Herman, CP. Spiritual Needs of Dying Patients.
  Oncology Nursing Forum. 2001 Jan-Feb28(1)
  6772.
• Lo, Bernard and et al. Discussing Religious and
  Spiritual Issues at the End of Life. JAMA. 2002
  Vol. 287, No. 6 749754.
• Mueller PS, Plevak DJ, and Rummans TA. Religious
  Involvement, Spirituality, and Medicine
  Implications for Clinical Practice. Mayo Clinic
  Proceedings. 20017612251235.
• Tolstoy, Leo. The Death of Ivan Ilych. New York
  Bantam Book, 1981.

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Resources

• Project Compassion Local group providing
  end-of-life education for the community.
  http//www.project-compassion.org/resource.htm
• EPEC Educating Physicians on End-Of-Life Care.
  http//epeconline.net/epec/webpages/index.cfm
• Last Acts A historical view of the campaign to
  improve end-of-life care by a coalition of
  professional and consumer organizations.
  http//www.rwjf.org/newsroom/featureDetail.jsp?fea
  tureID886type3
• EPERC End of life/palliative care resource
  center. http//www.eperc.mcw.edu/
• Innovations in End-of-Life Care an international
  journal of leaders in end-of-life care.
  http//www2.edc.org/lastacts/
• The Carolinas Center for Hospice and End-of-Life
  Care. http//www.carolinasendoflifecare.org

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Journals

• The Hastings Center Report http//www.thehastingce
  nter.org
• The Journal of Palliative Medicine
  http//www.liebertpub.com/publication.aspx?pub_id
  41
• Palliative Medicinehttp//pmj.sagepub.com/

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Video Resources

• PBS Video On Our Own Terms Moyers on Dying in
  America
• ABC News Videos Morrie Schwartz Lessons on
  Living

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Books

• Bartlow, Bruce G. MD, Johnson Books, 2000.
  Medical Care for the Soul.
• Callanan, Maggie and Patricia Kelley. Poseidon,
  1992. Final Gifts Understanding the Special
  Awareness, Needs, and Communications of the
  Dying.
• Levine, Stephen, Anchor Books, 1982. Who Dies? An
  Investigation of Conscious Living and Conscious
  Dying.
• National Academy Press, 1997. Approaching Death
  Improving Care at the End of Life.
• Rando, Therese A., Research Press, 1984. Grief,
  Dying and Death.
• Sulmasy, Daniel P., O.F.M., M.D. Paulist Press,
  1997. The Healers Calling A Spirituality for
  Physicians and Other Health Care Professionals.
• Vaux, Kenneth L. and Sara A. Vaux, Abingdon
  Press, 1996. Dying Well.