Spiritual care within palliative care

Spiritual care is neither a single intervention nor an independent discipline within palliative care, but must be seen as an integrated and indispensable part of a proper palliative care system.

We humans experience life as a three-dimensional reality; we perceive ourselves as individuals: 

• in the physical dimension of our body
• equipped with the cognitive and psychological dimension of our mind that enables us a) to think, b) to feel, harbour and express emotions and c) to control our thoughts and actions by its willpower/volition 
• in the spiritual dimension of our soul.

Each individual lives in the social context of relationships to other individuals and groups.
Health may therefore be defined as physical, psychological, social and spiritual wellbeing, meaning to be in well-balanced eutonic state of feeling and being well in body, mind and soul and in one’s social relations.

Where one or more of these constituents of health are compromised, we suffer individually and in our social context. Our human dimensions are inter-dependant, ie they will be mutually affected by an imbalance. There are psycho-somatic disorders caused by psychological distress (like fear) and vice-versa bodily symptoms (like pain) will cause psychological discomfort. Social problems (like poverty or interpersonal frictions) will not only cause psychological suffering, but may negatively influence our state of physical health as well.  A patient often suffers spiritually as a consequence of the lack of physical, psychological and social wellbeing. S/he may feel abandoned or even punished by whatever higher being (godhead) or transcendent powers s/he believes in.

Different definitions of ‘psyche’ have led to quite some confusion. Many pastoral workers, eg ministers of religion, therefore consider it their (primary or only) task and role to render psychological or psycho-social assistance to their flock trying to alleviate their fears or to restore their interpersonal relationships. Although a pastoral worker/minister of religion must not neglect these dimensions at all, her/his primary task (and speciality) is to attend to a suffering person’s soul. I would like to define ‘soul’ as the ability, place and power of each individual to get into contact, establish and maintain a relationship and harmony with whatever transcendent powers or higher being s/he believes in. Different faith-systems of course have different views of transcendence and it would go too far for this paper to reflect on these. Some religions believe in one or several godhead/s, some faith-groups believe in good and/or evil spirits, some in a philosophical system of atheistic goodness and righteousness etc.

If we want to render a truly holistic palliative care we must not just administer physical care (attending to the medical, nursing and nutritional needs), psychological care (attending to the emotional, occupational and educational needs), social care (attending to the patient’s interpersonal and economical needs), but also spiritual care (attending to the needs of her/his soul).

Rendering spiritual care it is absolutely essential and indispensable:

• to come to know and tolerate if not respect and value each individual’s philosophy of life, world view and religious views
• to refrain from judging, from trying to correct such views, philosophies or ideologies, or even from trying to proselytise.

The aim of spiritual care is to create an atmosphere, time opportunity and personal freedom for the patient to enable her/him to practice her/his religion and – if necessary – to restore her/his harmony with her/his religious aims and ideals or godhead. The patient may request the assistance of a minister of religion of her/his faith, may desire to perform acts of divine worship, s/he may want to participate in religious services, prayers, meditation, offerings, chanting or whatever spiritual exercises or practices her/his religion entails. It must take high priority for us to enable and facilitate these as far as reasonably possible.

Good spiritual care may be the crown and completion of our palliative care, more so because it is preparing the individual for the eschatological event of his passing into – what most religions believe in – life after death and palliative care is all about enabling the patient to live her/his life in dignity and comfort – not just until “the end” – but forever.