SPIRITUALITY AND MEDICINE IN END-OF-LIFE CARE

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SPIRITUALITY AND MEDICINE IN END-OF-LIFE CARE

• Dr. Mike Marschke

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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.

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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?

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• Spirituality can help find meaning to ones
  suffering
• Spirituality can find hope in the midst of despair

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Physicians role

• 65-95 of patients would like to address
  spiritual issues with their doctor
• Less than 10 actually do address it

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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.

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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
  individuals 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.

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• 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.

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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

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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.

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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 its my time.
• What is your response?

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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 dont know. I keep wondering why
  all of this is happening to me.
• What is your reply?

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Avoid pitfalls

• Dont try to solve the questions
• Know your boundaries
• Dont try to provide premature reassurance

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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. Jehovahs witnesses cannot
  get someone elses blood.
• What questions do you ask?

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• USE
• YOUR
• RESOURCES!

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• DONT
• PREACH!

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• SEARCHFOR YOUR
• OWN MEANING