Spiritual care at the end of life: meaning and practice

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 paper 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. 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).