Spiritual Care at the End of Life

Abstract

Dying patients have more than medical needs. In fact, what they feel most sharply, whether or not they are religious, are spiritual concerns. Christian theological virtues of faith, hope, and charity, properly interpreted and translated to reflect universal concerns with which they are connected, provide a starting point. Those who care for nonmedical needs of dying must attend to their patients on at least four different levels at once--emotional, ethical, religious, and For years, spiritual level had been considered part of other three. Many caregivers simply identified spiritual with religious or tacitly assumed that ethical or emotional issues covered other-than-bodily concerns of dying. But recently we find religious people protesting that their spiritual needs are not met by their religion, nor by anything in ethics or psychology, and nonreligious people raising questions about issues they call Not long ago in these pages, in fact, John Hardwig challenged bioethicists to look more closely at spiritual care.[1] At life's end, he observed, dying usually return to long-neglected questions about what really counts in life. Many see little meaning in their narrowed and shortened future as they are forced to deal with friends and family in new and embarrassing ways. Where formerly they helped to lift burdens from shoulders of others, they have now become a burden. They feel betrayed by their own bodies. They picture themselves as cast out from society of healthy. They can be overwhelmed by their feelings of isolation and abandonment, even self-hatred, fear, and anger. True, most caregivers recognize these needs as spiritual, but few know how to respond to them effectively, whether they are family members of a dying parent or professional pastoral care workers. Caregivers need words and ideas to guide attention they pay. Field instructors in training programs need to clarify how spiritual needs of dying relate to their emotional, ethical, and religious needs. Hospice administrators need criteria for hiring effective caregivers. For all these domains of care, we need a more precise articulation of What is The Spiritual? To move discussion a step toward that precision, I suggest we think of spiritual as involving ways we transcend ourselves that are not based on reason alone. Or to chisel more precision out of that amorphous term reason, we can think of spiritual as that realm of our living that goes insights and values that we can easily explain. I don't mean to suggest that reason has no place in spirituality. We strategize, we plan, we analyze, we weigh pros and cons, we test our ideas on experience, we use logic to make sure we're being consistent and clear. But people facing death are concerned less with what they can account for and more with their hopes, their companionships, and all happy, baffling decisions they made that opened up to them a richer and deeper life. It seems to me that this is what we mean when we refer to the spiritual. We are speaking of ultimate meaning. We are speaking of all ways we are drawn toward a beyond throughout our lives despite fact that we never fully understand it. I'm thinking of transcendent events: How art and music symbolize harmonies that we seek. How falling in love means taking risks that a rational assessment would not warrant. How I might realize that expression There's more to this than meets eye is actually true about everything. How questions about God and eternity occur even to militant atheists. Poetry can convey it: Like pond-bound fish under global vaults of air, Speckled by beams from up our sight, Whence luster menaces yet entices, What shall we make of light? Several sages, widely separated in history, identified three remarkably similar ways we approach these transcendent meanings. …