None of Your “Darn” Business!—Taking a Spiritual History while Preserving Your Professional Boundaries, Your Rapport, and Your Pride (332)

Abstract

Following on the recommendations of the National Consensus Project, a Consensus Conference of spiritual leaders and palliative care professionals will publish a white paper this fall calling all professionals to address the spiritual dimension of every patient. While this has obvious implications for board-certified chaplains, it also has long-reaching implications for every clinician working in healthcare, especially in palliative care and hospice. At the time of this proposal, the Consensus Conference white paper is still in draft form, but they are likely to recommend that every professional in palliative care and hospice address the spiritual dimensions of patient care. This is based off of the generalist-specialist model set forth by Handzo and Koenig, but raises the level of expected involvement of clinicians from a cursory screening of spiritual distress to a more involved spiritual history. Though many clinicians have become quite adept at discussing spiritual matters with their patients, still many hesitations, objections, and outright disagreements still exist. Fortunately, several well-established instruments exist to guide even the most reluctant clinicians in interviewing their patients for possible spiritual needs. While most of the ethical and sensitive religious considerations of spiritual care will still rightfully fall to the board-certified chaplains, there are still issues that are the concern of any clinician working within the spiritual dimensions of care. Understanding the ethical boundaries of proselytization extend beyond conversion to a formal religion to include any coercion of a dominant worldview whether overt or simply by inference upon vulnerable populations. This does not, however, preclude healthcare providers from claiming their own authority against religious or spiritual beliefs that are blatantly unhealthy, harmful, or even fatal. Handling these issues with compassion and understanding also requires a working knowledge of how religious and spiritual beliefs can influence important medical decisions, as seen in recent literature.