Palliative care and vulnerability of self.

Abstract

When we are exposed to patients and significant others' existential issues in palliative care, we not only come close to their vulnerable selves, but also most often come in contact with our own selves. Or, as Avery Weisman states, 'Healing is bilateral' (Weisman (1993: 16). This refers to the interpersonal processes most often involved when someone suffering is comforted or consoled. When we mediate comfort and consolation, the sufferer may not be the only one affected. The comforter may also be comforted and even transformed through the shift of perspective in the consoling event (Norberg et al., 2001). However, facing vulnerability of self and others takes courage, and thus, may be risky. In palliative care there are numbers of issues to be dealt with which can be hazardous or uncertain for the palliative care provider and as a consequence - regardless of its significance for the patient - may be hidden, avoided or neglected in practice. Such issues are highlighted in this section of this special issue on palliative and supportive care: sexuality, intimacy, guilt, shame, grief and spirituality. Coming closer to such phenomena may likely enhance practical wisdom. In this way the contributors present insights of significance for palliative care team members to prudently and wisely act with sensitivity in the palliative care of the very ill and dying and the significant others involved (Ohlen, 2002).A common thread in the papers of this section is the presence of existential issues. The first article by Amanda Hordern and Annette Street explores how sexuality and intimacy is communicated in palliative care. Through a reflexive inquiry of Australian patients with cancer and their health professionals these authors reveal how intimacy and sexuality is avoided in palliative care encounters and transformed through the use of neutralized terms by professionals. Talking with patients about their vulnerability due to lack of intimacy following advanced cancer might be very challenging. However, the main results of the study present an image of professionals who unintentionally act powerfully while dialoguing with patients. A minor part of the result presents negotiated communication with potential of providing an empowering dialogue.Two papers explore spirituality: Kittikorn Nilmanat and Annette Street from a Buddhist stance, and Maria Arman from a Christian view point. The first of these report an ethographic case study of Thai family members to patients with AIDS. In the Buddhist context, the AIDS sickness became linked to a belief in karma, and components of the spiritual journey asociated are presented. The second study reports an interpretive inquiry based on reflexive dialogues with nurses working in anthroposophic palliative care in Sweden about nuances of 'bearing witness' as an act of caring. …