Journeying with Morrie: Challenging Notions of Professional Delivery of Spiritual Care at the End of Life

Abstract

The spiritual welfare of dying people has in recent years moved from the domain of religion to become the concern of health care professionals, particularly as part of the ideal of holism that underpins palliative care. Professional delivery of spiritual care incorporates the features of assessment, control and treatment which may involve varying degrees of intrusion into the patient's deeply personal inner self. Using a case study approach, this article explores meanings of spirituality and understandings of what is meant by the term 'spiritual care'. It argues that biographical and community approaches to spiritual care of dying people may be more congruent with the concept of the 'whole person' because this support is rooted in an intimate contextual knowledge of the dying person by the caregiver. This challenges the dominant discourses of professional expertise to embrace informal personal and collective competence in this important aspect of end of life care. Keywords: community; dying; palliative care; spirituality; spiritual care2 Introduction This article discusses the concept and practice of spiritual care in relation to those who are dying. It adopts a case study approach to explore meanings of spirituality and different types of spiritual needs in light of an increasing emphasis on the 'expert' delivery of spiritual care by the helping professions (for example, nursing, social work and counselling). The first section considers a broad literature that seeks to uncover what the term spirituality means and reveals that there is no consensus on its conceptual clarity. The next section explores spiritual care as active and applied, drawing mainly on the nursing canon that has influenced debate on this topic with its dominant focus on professional practice, particularly with respect to patients at the end of life. This will be followed by narrative that introduces Morrie to give the reader a sense of his life and his dying and my role within both. The last two parts of the article will draw together key elements of the case study to suggest that the biographical components of spiritual care may mean that, for some, this can only be successfully provided by those who have intimate and longstanding connections to the dying person. This essentially relational and ontologically based perception of spiritual care may present challenges to health care professionals whose relationship with their patients is inevitably instrumental and institutionally directed by virtue of the 'sick predicament' of the patient, placing them, as professionals, in an only brief and transitory spiritual stakeholder role (Wright, 2004).

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“…91 The author of a case study of a man with multiple myeloma contested that measuring spiritual needs is a form of depersonalization and concluded that spiritual needs were substantially situational and biographic and could only be met by someone with shared memories and in the context of long-standing and valued relationships, something, therefore, not possible for health care professionals. 94…”

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“…New ways to both assess and address spiritual concerns as part of overall well-being are being developed by health care practitioners as part of a package of support for people with critical and terminal illness (Randall & Downie, 2006;Watts, 2008a). For this support to be meaningful, however, it is necessary to determine which dimensions of spirituality are relevant and the ways in which the human spirit can be celebrated in the face of life-threatening illness (Cobb & Legood, 2008).…”