Three choices for death

Ethicists and lobbyists for euthanasia have added qualifiers like "direct" and "indirect" to the word. Nonetheless, they still mean killing. E. Catherine Moroney, SSA, is a doctor of public health and a trustee of Greater Victoria Hospital Society in Victoria, British Columbia, and chairperson of its Patient Health Care Committee.

Care of the dying: a Catholic perspective. Part IV: Theological, moral, and pastoral response--the transformation of suffering. Catholic Health Association

People struggle to find meaning in suffering and death. In a culture that cannot depend on religious insights into suffering to address the deeper questions (e.g., Why me?), all kinds of interventions, even euthanasia and assisted suicide, may seem inevitable. Catholic healthcare providers can respond by offering patients, families, and care givers a vision of how suffering can be understood. Based on the power of divine love to transform suffering and death from absolute evils to personal triumphs, the moral principles the Catholic Church upholds can provide a hopeful perspective for healthcare professionals who care for the dying. Three principles support Roman Catholic teaching on conserving health and life: sanctity of life, God's dominion and human stewardship, and the prohibition against killing. These principles by themselves are insufficient as a moral or pastoral response to the care of the suffering and dying. Action is also required. Moral virtues must be reflected in ethical behavior and in pastoral practice so that we may enact our Christian vision in the face of suffering and death. Attention to our character as providers and our ethical practices is of grave importance in these days when euthanasia and assisted suicide are being promoted so aggressively. To carry on Jesus' healing mission by responding to human suffering and death, healing communities must embody virtues that bear convincing witness in both a personal and a corporate manner regarding the care of the dying. Three characteristics of a virtuous community stand out: interdependence, care, and hospitality. By being a virtuous community, we may be able to address many of the concerns that motivate people to consider euthanasia.(ABSTRACT TRUNCATED AT 250 WORDS)

Pastoral care: finding a niche in ethical decision making

The last three articles within this section of Cambridge Quarterly have focused on organizations or disciplines outside the mainstream of bioethics that are making inroads within the field. This issue's article may be viewed as a departure, but it is not-my thesis is that despite the active presence of the clergy in the ethics field, individuals involved in pastoral care are often thought by health professionals, as well as by a sizeable number of pastors themselves, to not be within the mainstream of ethical decision-making for patients.

Providing spiritual support: a job for all hospice professionals

This research examines spirituality as an aspect of professional practice. A questionnaire on spirituality was sent in 1991 to the hospice directors in New York, New Jersey, and Pennsylvania. The findings strongly indicate that spirituality is important in the hospice setting and plays a prominent role in the treatment of patients. Also, hospice programs were found to be supportive of the spiritual component of care. The spiritual approaches used by the respondents were the more traditionally religious ones such as listening to the patient talk about God or referring to clergy. Approaches such as meditation or guided imagery, which are not necessarily related to religion, were used less frequently. Clergy in the study placed greater importance on spirituality in hospice work and used more traditionally religious approaches than did non-clergy. While some professional caregivers choose to leave spiritual matters to clergy, the findings reveal that many non-clergy hospice professionals are assisting patients with spiritual concerns.

Spiritual health of oncology patients. Nurse and patient perspectives

Although nurses describe their professional uniqueness as care of the whole person, the spiritual needs of patients often have received little attention. Therefore, this descriptive, cross-sectional survey was designed to investigate the spiritual health of oncology patients and how well oncology nurses assess spiritual health. To achieve these aims, parallel nurse (r = 0.92) and patient (r = 0.89) Spiritual Health Inventories (SHI's) were distributed to a convenience sample of 40 nurse-inpatient pairs from two hospitals. Twenty three patients with primary lung cancer and twenty seven registered nurses responded (n = 50). Analysis of SHI scores of the 21 nurse-patient pairs indicated that these nurses inaccurately assessed their patients' spiritual health (p less than 0.05), and that patient and nurse subjects preferred different spiritual caregivers. Patient respondents reported a normatively high level of spiritual health, positively related both to age (p less than 0.02) and physical well-being (p less than 0.014). Afro-American and Caucasian nurse respondents rated the spiritual health of patients higher than nurses of Asian origin (p less than 0.006).

Counselor of quality

Coping with cancer from the patient's or counselor's viewpoint means that strengths and resources depend on assessing predominant problems and acting appropriately to alleviate them. It does not always mean resolution of problems, but it does require understanding where the pressure points are that lead to more distress. Thus, counselors anticipate as well as understand actual distress; visualize various outcomes of different interventions, medical or otherwise; and narrow the gap between what is hoped for and what might be possible. Pastoral counseling needs a viewpoint that maintains morale in the utmost phase of terminal illness. Facing mortality is difficult for the counselor as well as significant others. Therefore, they must deal directly with bereavement and potential loss, if possible, indicating their willingness to confront ultimate questions, even without answers. Overall, the purpose of quality counseling is in the counselor: limitation is not futility. The job of counseling is not to figure out the universe or explain the unexplainable. Rather, the purpose of counseling is to help a suffering individual to come back within the range of normalized behavior and to become acceptable and credible. In this way, out of the web of vulnerability can come further strengths and resources.

The spirituality of dying. Pastoral care's holistic approach is crucial in hospice

Attention to the spiritual dimension of a person is essential in a holistic approach to hospice care. Although other hospice team members may be involved in matters of faith with patients, chaplains are the primary professionals concerned with the transcendent nature of life and the integrative role that spirituality plays in care for the dying. Understanding spirituality in a person's living and dying requires an understanding of religion and theology. Religion is meant to connect us to a caring community and to give us a place on which to stand--a tradition. Theology is a search for meaning. Spirituality is "the life principle that pervades a person's entire being ... and generates a capacity for transcendent values." The body cannot be touched without the spirit's being affected, and vice versa. Efforts to help patients toward wholeness necessitate helping them accept freely their whole lives. The chaplain is not limited to nor bound by religious language. The needs of the patient should determine the use of prayer or God-talk. Listening is one of the greatest spiritual gifts a chaplain can give a suffering patient. Being a companion is often all the chaplain can do. Pastoral care personnel are also sensitive to the needs of the hospice staff. The chaplain does not so much fulfill a role as represent a perspective based on concern and solicitude for the whole person, the whole family unit, the whole staff.

Preferences for spiritually related nursing interventions among terminally ill and nonterminally ill hospitalized adults and well adults

The purpose of this study was to determine terminally ill and nonterminally ill hospitalized patients' preferences for spiritually related nursing interventions and to identify differences between the two groups. Additionally, preferences of well adults were examined in comparison to the hospitalized groups. Clinical knowledge in nursing as well as empirical work provided background for the study. Three hundred adults participated in the study by responding to structured and open-ended questions about specific nursing interventions that they thought would help meet their spiritual needs. Significant differences were found across the groups, including a higher preference for more direct, spiritually related nursing interventions and more negativity about the nurse's role in caregiving as expressed by the nonterminally ill group.

Learning the ten step QA process for use in pastoral care departments. Part II

In the March/April issue of the Journal of Quality Assurance, Vol. 13, No. 2, pp. 10-15, the authors presented the first half of a ten step model used to teach the QA process to pastoral care directors and chaplains. Workshop members participated in a series of simulated exercises for a fictitious acute care facility, "St. Good Hart Health Center." This article continues with steps six through ten, including the definition and explanation of each step, St. Good Hart's story line, directions and illustrations, and the key QA issues that emerged from the process.

Spirituality: integral to quality care

Caring is the medium through which nursing knowledge, skill, and touch are operationalized. Caring is a profound act of hope (White T. 1986. Unpublished data) that contributes to the spiritual well-being of others. In order to assure quality care, the impact of identifying and meeting patient spiritual needs must be taken into account.

Pastoral care representation on the hospital ethics committee

A recommendation for pastoral care representation on hospital ethics committees (HEC) is commonplace in the literature, but the rationale for this recommendation (and the actual practice) often is assumed or unarticulated. The authors propose a holistic anthropology which acknowledges the bodily, psychological, and spiritual aspects of all persons as a starting point for discussing the reasons for pastoral care representation. The spiritual aspect of the human person is described together with the role of the clinical chaplain on the HEC. The qualifications, skills, and training required for the HEC representative are also provided.

The importance of spirituality in hospice work: a study of hospice professionals

Only recently has the spiritual aspect of care received attention in our professional literature. In order to explore the relationship between spirituality and job satisfaction for professionals employed in the hospice field, the authors sent questionnaires to hospice directors in New York, New Jersey, and Pennsylvania. The findings strongly indicate that hospice professionals are a spiritual group, being more spiritual in their personal lives than in their professional work. Professionals who described themselves as more spiritual also experienced greater satisfaction in hospice work. Job-related satisfaction, however, was dependent on factors other than spirituality. The findings support the contention that spiritual care is too critical to be left to clergy.

The professional chaplain

In this technological age, when hospitals run the risk of becoming frightening and impersonal places, pastoral care departments have an obligation to ensure that they provide high-quality, professional service. One of the common themes of contemporary mission statements is the call for "holistic care"-- meeting the physical, emotional, social, and spiritual needs of patients. A second theme is the importance of providing high-quality care. In the past 20 years, the National Association of Catholic Chaplains has developed education and accreditation programs that have led to stronger, more effective pastoral care service and education. Although credentialing is not a panacea for all problems and conflicts, when persons work at developing personal, professional, and theological competencies, they are more successful in resolving conflict. In fact, well-prepared, certified chaplains enhance all aspects of the healthcare ministry. Finally, the effort to improve pastoral care provides an opportunity for all involved to "live the mission." Today's greater emphasis on team ministry allows the pastoral care department to be a model of community and dialogic relationship for the rest of the healthcare facility.