Moral agency and spirituality in palliative care

Abstract

Moral agency is a prerequisite for a full autonomous decision, meaning that the agents have the intrinsic capacity to understand their actions and to be accountable for the consequences of these actions. Palliative care patients have the moral right to build their capacity to decide, so that they are truly empowered to make choices. However, moral and spiritual distress are common at the end-of-life, which may arise if there is a threat to the individual's integrity and disruption of one's belief system, consequently leading to the deterioration of the patient's moral agency. The aim of this paper is to determine if spirituality may be an important tool for the empowerment of palliative care patients and if moral agency can be enhanced by a diligent spiritual advocate. Spiritual awareness, self-knowledge, and specific training are key elements for the spiritual advocate to address patients' spiritual needs and distress in a neutral and non-directive way, to promote autonomy, well-being, and quality of life. Thus, patients' dignity and right for self-determination are respected, thereby supporting empowerment, reducing suffering, respecting patients' individuality, and engaging moral agency. Palliative care patients should be able to fully exercise their autonomy. This strategy might be very appealing for adequate advance care planning, whatever the choices of the patient, as well as to prevent distress, hopelessness, and the lack of meaning that many terminal patients experience.

Refusal of medical treatment by older adults with cancer: a systematic review

“…Low educational and economic status was considered a significant variable in treatment refusal, maybe due to difficulty in accessing health services or lack of knowledge about disease (18). Patients perceive and experience illness, care, and death according to their culture, values, beliefs, life experiences and meaning of life (34). Thus, it is argued that spirituality, culture, the socioeconomic status and policies of access to healthcare may influence patients' healthcare decision-making (35).…”

Spirituality and religion in residents and inter-relationships with clinical practice and residency training: a scoping review

“…In addition to these aims, healthcare professionals should also be encouraged to approach issues of SR with the aim of empowering the patient. 74 By assuming the role of a spiritual advocate, physicians can promote patients’ moral agency and maintain the centrality of patients’ concerns throughout the course of illness and treatment. 74 …”

“… 74 By assuming the role of a spiritual advocate, physicians can promote patients’ moral agency and maintain the centrality of patients’ concerns throughout the course of illness and treatment. 74 …”

“…In addition to these aims, healthcare professionals should also be encouraged to approach issues of SR with the aim of empowering the patient. 74 By assuming the role of a spiritual advocate, physicians can promote patients' moral agency and maintain the centrality of patients' concerns throughout the course of illness and treatment. 74 In terms of curriculum, pedagogical modules related to SR were more commonly found in palliative medicine residency programmes 55 than other residency programmes.…”

“…74 By assuming the role of a spiritual advocate, physicians can promote patients' moral agency and maintain the centrality of patients' concerns throughout the course of illness and treatment. 74 In terms of curriculum, pedagogical modules related to SR were more commonly found in palliative medicine residency programmes 55 than other residency programmes. This could reflect the increased severity of illness and end-of-life scenarios seen in palliative medicine, 75 greater willingness and acceptance of patients and clinicians to address topics related to SR, 76 or even the desire of residents to optimise the care and management of patients during the course of their illness.…”