Peter Kevern 2011

1. Who can give ‘spiritual care’? A consideration of the ethics of discussing spiritual values with patients Peter Kevern 2011

2. The Problem: Health care workers are reluctant to discuss spiritual issues with patients because of concerns about: • Competence. • Autonomy. • Neutrality. (Curlin & Hall 2004)

3. This is a particular problem for ‘spiritual values’ because (a) By definition, the 'spiritual' is not empirical. (b) as 'values', it relates to matters understood to be of core (though not necessarily 'ultimate') concern. So e.g. A nurse who engages in a conversation on spiritual values with a patient enters unknown territory, and high-profile cases (such as that of Caroline Petrie where a complaint was occasioned by the ‘religious’ behaviour of a nurse) have increased the sense that it is full of ethical and professional pitfalls (Alderson 2009).

4. One proposed solution . . . is to find common ground in the conduct of the interaction rather than its content (Pesut 2010, Carr 2010) But can you have an interaction without content? And if not . . . • Who gets to talk about it? • And how?

5. Religion and spirituality in a secular, European context. Getting to grips with the issues Regardless of religious conviction, we all share a context that is • Secular: a shared belief is not assumed • Pluralist: whatever we believe, we will encounter others who believe differently

6. Therefore, all our belief is ‘postcritical’ in one of 4 ways (Duriez & Hutsebaut 2003): Include transcendence Literal affirmation (orthodoxy) Restorative interpretation (second naivete) Received religion Literal Symbolic Reductive interpretation (relativism) Literal disaffirmation (secular crit) Exclude transcendence

7. This provides us with a grid of possibilities: Possibilities for therapeutically-useful nurse-patient encounter on spiritual values.

8. . . . which identifies 4 key groups of practitioners: • Inflexible literalists, who should not be encouraged to undertake spiritual care outside their own group ! • Pragmatic literalists, who subordinate their beliefs to the ethics of care, and who may be articulate and competent in spiritual care of those who themselves have open beliefs • Those who have a ‘postcritical’ approach, being clear of what they believe but open to others, who may be the natural all-rounders and • Those who value belief, but sit lightly to it (relativists), who may need to be positively encouraged to attempt spiritual care.

9. References Alderson, A. (2009) Nurse suspended for offering to pray for elderly patient's recovery , The Telegraph Online, obtainable from http://www.telegraph.co.uk/health/healthnews/4409168/Nurse-suspended-for-offering-to-pray-for-patients-recovery.html Carr , T.J.(2010) Facing Existential Realities: Exploring Barriers and Challenges to Spiritual Nursing Care Qualitative Health Research 20:1379–1392 Duriez, B. and Hutsebaut, D, (2003) A slow and easy introduction to the Post-Critical Belief Scale: Internal structure and external relationships in Hutsebaut, D. Handbook of the Psychology of Religion Pesut, B. (2010)Ontologies of nursing in an age of spiritual pluralism: closed or open worldview? Nursing Philosophy 11: 15-23