SPIRITUALITY AND MEDICINE IN END-OF-LIFE CARE

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Spiritual hope can help people deal with chronic and life-threatening illnesses ... and/or belief in God, family, naturalism, rationalism, humanism, and the arts. ...

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SPIRITUALITY AND MEDICINE IN END-OF-LIFE CARE

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Slide 1:SPIRITUALITY AND MEDICINE IN END-OF-LIFE CARE Dr. Mike Marschke

Slide 2:Historically Religion and medicine were intertwined in most cultures throughout time In early Renaissance, though, with the Church confronting Galileo, medicine became more scientific, with religion posing barriers Presently, 98-99% of Americans have some belief in a higher being, though it is lower in physicians. Though medicine focuses on science, suffering and death are still inevitable. This focus on science can turn humans into subjects. Religious practice can make a difference – studies show better health with religious practice, even outside prayer impacting outcomes.

Slide 3:Questions of the dying Why did this happen to me? What will happen to me after I die? Why would God allow me to suffer this way? Will I be remembered? Will I be missed?

Slide 4:Spirituality can help find meaning to one’s suffering Spirituality can find hope in the midst of despair

Slide 5:Physician’s role 65-95% of patients would like to address spiritual issues with their doctor Less than 10% actually do address it

Slide 6:Hope and Healing Hope can change over time – hope for cure, hope for time, hope for peace… Healing involves the whole individual, sense of self, along with your surrounding relationships – a wholeness of the individual Spiritual hope can help people deal with chronic and life-threatening illnesses Illness in general can be a very spiritual journey for the individual, especially at the end of life.

Slide 7:Definition of Spirituality for the Assoc. of Amer. Med. Colleges Spirituality is recognized as a factor that contributes to health in many persons. The concept of spirituality is found in all cultures and societies. It is expressed in an individual’s search for ultimate meaning through participation in religion and/or belief in God, family, naturalism, rationalism, humanism, and the arts. All of these factors can influence how patients and health care professionals perceive health and illness and how they interact with one another.

Slide 8:Spirituality is about the search for transcendent meaning. Religion is a formal set of beliefs and practices of a community that is searching for a transcendent meaning in a defined way.

Slide 9:Spiritual History F = Faith and belief – “Do you consider yourself spiritual?” “What gives your life meaning?” I = Importance – “What importance does your faith or belief have in your life?” “What role do you beliefs play in your health?” C = Community – “Are you part of a spiritual or religious community, and how are they of support to you?” A = Address in Care – “How would you like me to address these issues in your health care?” -developed by Dr. Christina Puchalski at GWISH

Slide 10:Spiritual History Goal – to LISTEN empathetically: listen to their fears, hopes, beliefs. - Can open up communication about how a person wants to die. - Helps bring compassion back to medicine, taking care of the whole individual. - Helps to bring dignity to medical care, improving patient trust. - Can help to relieve suffering. - Certain religious believes may impact medical decisions.

Slide 11:Spiritual History- scenarios Mr. T is a 65 year old black gentleman with lung cancer, failing chemotherapies. He is in the hospital with dyspnea. You want to discuss DNR issues with him. After describing what resuscitation is, you state that in his condition, it is extremely unlikely to succeed. You ask him what he thinks about all this. He replies: “Well, I want you to do what you can. I trust that God will decide when it’s my time.” What is your response?

Slide 12:Spiritual History- scenarios Ms. B is a 46 yr. old hispanic woman with renal failure, partial blindness, and admitted for a foot infection from diabetes. She now is needing dialysis. On discussing this with her, you ask how she is doing? She replies: “I don’t know. I keep wondering why all of this is happening to me.” What is your reply?

Slide 13:Avoid pitfalls Don’t try to solve the questions Know your boundaries Don’t try to provide premature reassurance

Slide 14:Spiritual History - scenario Mr. C. is a 76 yr old white man admitted with a severe GI bleed. He passed out on the way to the ER and remains unconsious, possibly also having a stroke. Initial work-up reveal a low blood pressure and a hemoglobin of 6. You prepare to transfuse him emergently. His wife sees this and steps in saying: “No way are you giving him a blood transfusion. Jehovah’s witnesses cannot get someone else’s blood.” What questions do you ask?

Slide 15:USE YOUR RESOURCES!

Slide 16:DON’T PREACH!

Slide 17:SEARCHFOR YOUR OWN MEANING “To heal a person, one must first be a person” Kass and Holland in “Educating Competent and Humane Physicians” Indiana univ press, 1980“To heal a person, one must first be a person” Kass and Holland in “Educating Competent and Humane Physicians” Indiana univ press, 1980

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