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SPIRITUAL ISSUES IN PALLIATIVE CARE Jim Rawlings, Jr., D.Min. Director, Pastoral Care UNC Hospitals Introduction Definition of Spiritual(ity) “Contemporary spirituality is eclectic and individualistic, situated on a sacred-secular continuum.” Murray, 2004

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spiritual issues in palliative care


Jim Rawlings, Jr., D.Min.

Director, Pastoral Care

UNC Hospitals

  • Definition of Spiritual(ity)

“Contemporary spirituality is eclectic and individualistic, situated on a sacred-secular continuum.” Murray, 2004

“Our search for that which gives meaning, purpose, and value to our life.”

the spiritual issues
The Spiritual Issues…
  • What does Morrie Schwartz have to say about this?

Let’s listen to some of his thoughts about dying in a piece taped with Ted Koppel on the television program Nightline just weeks before Morrie died.

What Is the Meaning of My Illness?
    • What will happen to me?
    • How will the illness proceed?
    • What will happen to my wife/husband, child(ren)?
    • How will I die?
    • Where will I die?
    • Will I be a burden?
what is the meaning of my life
What Is the Meaning of My Life?
  • A search for meaning or purpose
  • Loss of a sense of connection
  • Feelings of guilt and/or unworthiness
  • Questioning of faith/beliefs
  • Desire for forgiveness
  • Sense of being abandoned by God
spiritual needs of person
Spiritual Needs of Person
  • Need for Companionship
    • To be with spouse/partner
    • To be with children
    • To be with friends
    • To talk with others
    • To help care for others
need for involvement and control
Need for Involvement and Control
  • To have input into one’s life
  • To have information about one’s care
  • To stay as independent as possible
  • To have things in life stay constant
  • To be involved with family activities
  • To be helped by others
need for positive outlook
Need for Positive Outlook
  • To see the smiles of others
  • To laugh
  • To think happy thoughts
  • To take one day at a time
the need to experience nature
The Need to Experience Nature
  • To look outside
  • To be outside
  • To have flowers in the room
  • To have a pet nearby
the need for religion spirituality
The Need for Religion/Spirituality
  • To pray
  • To read holy scriptures
  • To read inspirational material
  • To use inspirational material
  • To go to their house of worship
  • To sing/listen to sacred/secular music
  • To experience the rituals of their faith
the need to finish business
The Need to Finish Business
  • To do a life review
  • To finish life tasks
  • To come to terms with present situation
  • To resolve bitter feelings
  • To reconcile with loved ones
the physician s role
The Physician’s Role
  • Be aware of the potential of spiritual distress when your patient is facing a life-threatening situation.
  • Listen to the patient’s concerns and their broader implications.
  • Be aware of your own attitudes, values, and assumptions regarding the spiritual dimension.
  • Consider utilizing a spiritual assessment: FICA.
  • Encourage advance care planning.
  • EPEC (Educating Physicians on End-of-Life Care), Feinberg School of Medicine, Northwestern University. Module 3: Whole Patient Assessment.Email: info@epec.net.
  • Herman, CP. Spiritual Needs of Dying Patients. Oncology Nursing Forum.2001: Jan-Feb;28(1): 67–72.
  • Lo, Bernard and et al. Discussing Religious and Spiritual Issues at the End of Life. JAMA. 2002; Vol. 287, No. 6: 749–754.
  • Mueller PS, Plevak DJ, and Rummans TA. Religious Involvement, Spirituality, and Medicine: Implications for Clinical Practice. Mayo Clinic Proceedings. 2001;76:1225–1235.
  • Tolstoy, Leo. The Death of Ivan Ilych. New York: Bantam Book, 1981.
  • Project Compassion: Local group providing end-of-life education for the community. http://www.project-compassion.org/resource.htm
  • EPEC: Educating Physicians on End-Of-Life Care. http://epeconline.net/epec/webpages/index.cfm
  • Last Acts: A historical view of the campaign to improve end-of-life care by a coalition of professional and consumer organizations. http://www.rwjf.org/newsroom/featureDetail.jsp?featureID=886&type=3
  • EPERC: End of life/palliative care resource center. http://www.eperc.mcw.edu/
  • Innovations in End-of-Life Care: an international journal of leaders in end-of-life care. http://www2.edc.org/lastacts/
  • The Carolinas Center for Hospice and End-of-Life Care. http://www.carolinasendoflifecare.org
  • The Hastings Center Reporthttp://www.thehastingcenter.org
  • The Journal of Palliative Medicinehttp://www.liebertpub.com/publication.aspx?pub_id=41
  • Palliative Medicinehttp://pmj.sagepub.com/
video resources
Video Resources:
  • PBS Video: On Our Own Terms: Moyers on Dying in America
  • ABC News Videos: Morrie Schwartz: Lessons on Living
  • Bartlow, Bruce G. MD, Johnson Books, 2000. Medical Care for the Soul.
  • Callanan, Maggie and Patricia Kelley. Poseidon, 1992. Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying.
  • Levine, Stephen, Anchor Books, 1982. Who Dies? An Investigation of Conscious Living and Conscious Dying.
  • National Academy Press, 1997. Approaching Death: Improving Care at the End of Life.
  • Rando, Therese A., Research Press, 1984. Grief, Dying and Death.
  • Sulmasy, Daniel P., O.F.M., M.D. Paulist Press, 1997. The Healer’s Calling: A Spirituality for Physicians and Other Health Care Professionals.
  • Vaux, Kenneth L. and Sara A. Vaux, Abingdon Press, 1996. Dying Well.