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Northeast Florida Medicine
Vol. 67, No. 1 2016
55
Palliative Care
conveys the idea of breathing, living and animation. That
which is spiritual is also defined as non-corporeal, not of
the human body and not physical. In behavioral health
settings, “spiritual” is often defined as that which gives
life meaning and is then associated with ways purpose
and significance are understood. However, many are
concerned that such a definition may provide too great
a vista for focus and clarity and, as such, render, in a
paradoxical twist, the term spirituality “meaningless.”
4
A patient being “spiritual” is often used synonymously
with being “religious.” Religion, also, has a Latin root,
religare,
which means “to restrain or hold back.” Religion
can be defined as a set of rules, practices, traditions and
beliefs used by a community of people to assign meaning,
value and purpose to life and its events, especially as these
events relate to the transcendent. Therefore, because of
the more limited scope of the term “religious,” the term
“spiritual” remains most regnant and relevant in health
care and, for palliative care in particular.
The term “existential” can be defined as “relating to that
which is in a state of existing or being.” Danish philosopher
and theologian, Soren Kierkegaard, is believed to have
originated the concept that every individual (vs. society
or religion) is solely responsible for giving meaning to
his/her life and living his/her life authentically. In other
words, we exist, proceed to encounter ourselves, grow up
in the world and ultimately define ourselves. In regards to
illness, a patient may be struggling with how the disease
process and experience affects his/her values, beliefs and
feelings about his/her own existence in the past, present
and future. If not addressed, the burden of the patient’s
illness may increase.
To proceed from the existential “being” towards the idea
of well-being is an important tenet of palliative medicine.
The Centers for Disease Control and Prevention states
that well-being “generally includes global judgments of
life satisfaction and feelings ranging from depression to
joy.”
5
American psychotherapist and former monkThomas
Moore, notes in his book,
Care of the Soul in Medicine,
that daily exposure to constant chronic illness, a patient’s
loss of physical and social capacity and, ultimately,
death, obscures consideration of well-being. In Moore
terminology, we are drawn to a distinctively different
depth (in addition to “body” concerns) as we work with
the physical capacity of our patients, intervene to restore
vigor, specialize in specific organ health and manage
pain. Therefore, if members of the health care team are
sensitized and educated, attention to spiritual concerns
becomes part of the healing/coping dialogue. This type
of conversation invites discussion of current meanings,
changing attitudes, level of inner peace and the degree
of satisfaction in one’s life. In other words, there emerges
an interest in the “soul,” which Moore clarifies as those
matters which are preciously essential for the patient.
Such matters bring about questions for the patient
involving how the process affects one’s character and
essence. A patient might question their usefulness, how
their friends, family, or community might think differ-
ently about them, or whether they have any generosity
or courage to still love and show compassion to others.
Other matters of some uncertainty that may arise could
include finding the stamina and creativity to change one’s
thinking on what quality life is for them and what is the
healthiest way to grieve perceived losses.
Health care professionals are increasingly encouraged to
develop a genuine sense of presence when with patients.
Some are able to move beyond I-It relationships (which
are separate and detached) and achieve what Jewish phi-
losopher Martin Buber terms I-Thou/I-You relationships,
in which the whole being of people are considered and
relationships are mutual and reciprocal. For many, it is
challenging to proceed, patiently and intentionally elic-
iting and receiving the many important “I-Thou” and
“I-It” relationships in the patient’s world. For most, more
challenging still is to hear and witness those relationships
and meanings shifting and changing before one’s eyes.
3
This is where the professional chaplain becomes essential.
When to Refer:
Basic screening skills, tools, techniques
Many health care agencies routinely offer chaplain or
pastoral care services upon admission or intake to a facility
or program. In palliative care programs, the chaplain is
included as an integral team member, but may not be
the team member responsible for every patient’s spiritual
history and/or screening. The basic history and screening
of spiritual, religious and existential needs of a patient is
a foundational component of quality of life for patients