Clarifying Spirituality in Hospice and Palliative Care: Existential Pain and Spiritual Care Approaches Open Access

Glover, Avery (2017)

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Based on my discussions with patients and families and observing their interactions with hospice practitioners, especially medical practitioners, I find that there is a problem in the way that we talk about spirituality and death. Patients and families bring with them what I think are more traditional religious and cultural views on dying that entail an interactive relationship both before and after death. Yet these views clash with modern medicine that ties death to a final point in time. The mainstream medical notion of death poses dire existential challenges for patients and families and neglects a social dimension to dying. I believe that any spiritual approach should tackle this fundamental issue with dying in the modern era. In this opinion piece I hope to clarify what we mean by spirituality and what purpose it serves in hospice care. Over the past 6 months I've read the relevant literature from a diverse set of fields including pastoral care, sociology, psychology, and biomedicine. I have identified two major trends that I will call the postmodern and psychological approaches to spirituality. I will draw quotes from several representative sources in order to illustrate how they conceptualize spirituality and design their spiritual interventions. I divide this work into three chapters. In the first, I dive into the medical treatment of dying and illustrate the problems that arise in this setting. I draw on historical sources from the hospice movement to show that issues with dying that existed in the mid to late 20th century are still prevalent today. I then turn to the postmodern and psychological approaches in chapters two and three, respectively. After clarifying hospice notions of spirituality and its interventional methods, I then ask whether these spiritual care approaches address the existential problems posed by medical treatment.

Table of Contents

I. The Modern Existential Plight & the Call for Spiritual Care 1

II. The Postmodern Approach to Spirituality 17

III. The Psychological Approach to Spirituality 41

Epilogue 58

Bibliography 60

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