Psychology, spirituality, and end-of-life care: An ethical integration?

Abstract

Abstract With an increased focus on multidisciplinary care, psychologists are being called to work within palliative care teams. Spirituality is often a salient issue for palliative individuals, and has significant implications with respect to psychological functioning. This paper discusses incorporation of spirituality/religion into psychological end of life care, with a focus on biopsychosocial-spiritual model of health, and consideration of spirituality/religion as an aspect of cultural diversity. Discussion also surrounds ethical integration of spirituality/religion into psychological assessment and treatment, as well as recommendations for clinical training. An overall theme of this article is that attending to spiritual needs of palliative individuals is important to fulfill one's ethical responsibilities as a psychologist. Thus, seeking ways to ethically integrate these concepts into psychology training and practice remains an essential endeavour. Do we not have a right, as we are dying, not only to have our bodies treated with respect, but also, and perhaps even more important, our spirits? Shouldn't one of main rights of any civilized society, extended to everyone in that society, be right to die surrounded by best spiritual care? Can we really call ourselves a civilization until this becomes an accepted norm? What does it really mean to have technology to send people to moon, when we do not know how to help fellow human beings die with dignity and respect? (Sogyal Rinpoche, 1992, p. 209) This quote from Rinpoche illustrates how process of is not simply physical, but also encompasses one's psychological and spiritual beings. It is therefore of little surprise that notions of quality of dying and a death are of prime importance for majority of palliative patients (Steinhauser et al., 2000). To assist patients in their quest for a death, physicians, psychosocial professionals, and caregivers need to be aware of unique concerns and values of patients facing death. This paper focuses on incorporation of religion and spirituality into psychological end of life care. Specifically, discussion surrounds value of a holistic biopsychosocial-spiritual model of health, impact of spirituality/religion on mental health, and conceptualization of these issues as an aspect of cultural diversity. Next, it explores how these constructs might be ethically integrated within psychological assessment and treatment. Finally, recommendations for clinical training in this area will be made. A recent survey on what constituted a death for Americans found that 89% of respondents felt that it was important to be at peace with God, 85% endorsed importance of praying, and 61% of respondents felt that discussing existential distress and meaning of was a critical aspect to a good dying process (Steinhauser et al., 2001). Congruent with these findings, World Health Organization (2003) has acknowledged spiritual care as an integral component in palliative care. The World Health Organization defines end of life care as the active total care of patients whose disease is not responsive to curative treatment... [when] control of pain, of other symptoms, and of psychological, social, and spiritual problems is paramount. As can be seen from these findings, spiritual issues become particularly salient during terminal stage of life. The role of health care providers in assisting a good quality of experience has become progressively more important, as has moved out of home and into institutions. Currently, approximately 75% of Canadians die in hospitals or long-term care facilities (Nelson & District Hospice Society, 2005). Thus, physicians, nurses, psychologists, and other health care workers are increasingly called to work with individuals who are dying. Multidisciplinary teams are becoming standard of care for palliative patients (Cummings, 1998), and psychologists may play a variety of different roles within this team context, including: advocate, counsellor, educator, evaluator, and researcher (Werth, Gordon, & Johnson, 2002). …