SPIRITUALITY IN PC.

Learning Objectives
By the end of the session, participants should be
able to:
1. Describe possible signs of spiritual problems
2 Describe signs of spiritual health among the
2.
terminally ill
3 Describe strategies for spiritual care and
3.
support for those who are terminally ill

Quality Palliative Care for All

 Introduction
1. When the true nature of terminal illness strikes and
sinks,
i k many peoplel are overwhelmed
h l d with i h absolute
b l
helplessness and could view life as cruel or as unjust
fate.

2. The feelings they harbor include: vulnerability,

powerlessness, frustration, anger - No one hears our
pra ers and pleadings.
prayers pleadings

3. Religion and spirituality play a role in coping with

ill
illness ffor many patients
ti t / ffamily
il members
b

4. Is Terminal illness a p
punishment from God?

Quality Palliative Care for All

 Introduction
• Every human being has the duty and right
to preserve and maintain his/her life,
physical mental health and spiritual
integrity.
• In the Christian view,, these duties and
rights derive from God, the creator, before
whom man/woman are the stewards and
custodian, not the absolute owners of their
y
life destiny.
 Ethical Code
• From these basic duties and rights derive the
responsibilities of all engaged in medical care,
who must therefore respect each patient.
• Thus the moral task of the hospital/institution is
dominated by respect for human life and for the
dignity of the human person.
• The human person, at every stage of life is
entitled
i l d to the
h protection
i off morality
li andd llaw as
life is vulnerable in its beginning and its ending.
 Death as Mystery
• Theologians, psychologists, pastors have
struggled
gg with the meaning g of death for
generations.
• Dame Cecily Saunders, founder of the Hospice
M
Movement b
believed
li d iit was iimportant to h
help
l
people live and prepare for death in a way that
would bring respect and dignity both to the dying
person and to his/her family, friends.
• Today, the dying process has been moved from
the comfort and privacy of home to the
impersonal hospital environment.
 Death as Mystery
• Theologians,
g , psychologists,
p y g ,p
pastors have
struggled with the meaning of death for
generations.
• Dame
D C
Cecily
il SSaunders,
d ffounder
d off the
h HHospice
i
Movement believed it was important to help
people live and prepare for death in a way that
would bring respect and dignity both to the dying
person and to his/her family, friends.
• Dying process has been moved from the comfort
and privacy of home to the impersonal hospital
environment.
environment
 Denial of Death
• In Western society, there is a denial of death - youth is
g
glorified.
• In older African society, old age/ natural death is a
positive cultural value and is ritualized accordingly.
• Dot.com
Dot com African generation seem to be absorbing
culture of denial of death.
• For many doctors death is a failure, i. e, surgeons, which
results
lt in
i th
they di
distancing
t i th themselves
l ffrom th
the patient.
ti t
• For many patients there is an expectation that a cure will
be found for all diseases and all medical conditions.
• People are living longer than in a previous generations.
 We die as we have lived
• ‘‘To
To be brought close to the bone through
the adversity of illness, the closeness of
death and the knowledge that we are not
in control of the situation, is to come close
to the essence of who we are are, both as
unique individuals and as human beings’’.

Jean Shinoda Bolen…. Close to the Bone

 Spirituality
• Henri Nowen, the Dutch Priest writes, ‘‘When
we think of the people who have given us
hope and who have increased the strength of
our soul,, we will discover that they
y were not
the advise givers, neither were they the
moralists but people who were able to
articulate
i l i words
in d and d actions
i the
h human
h
condition, the human condition in which we
participate and who encouraged us to face
the painful realities of life’’
 Spirituality
• ‘‘In every human being there seems to be a
spiritual
i it l di
dimension,
i a quality
lit th
thatt goes b
beyond
d
religious affiliation that strives for inspiration,
reverence awe,
reverence, awe meaning and purpose even in
those who do not believe in God.
• The spiritual dimension tries to be in harmony
with the universe, strives for answers about the
infinite and comes essentiallyy into focus in
times of emotional stress, physical illness, loss.
bereavement and death’’.
• Spirituality
Spirituality…. Involves that deeper inner
essence of who we are … it is the act of
looking for meaning in the every deepest
sense and looking for it in a way that is
most authentically ours
ours.
 Spiritual Care is
• Something we ALL give when we give
our full attention
• By the quality of our presence,
presence
• By accompaniment
• By companionship.
 Spiritual needs can be
particularly acute at
• different
Time of change . times
times.
• Recognition
g of ageing.
g g
• Time of illness.
• Terminal illness
illness.
• In bereavement.
• As death approaches.
 Religious
g Needs.
• To be able to connect with faith
community.
• To be able to celebrate with the faith
community.
• To have access to local religious leaders
leaders.
• To have access to a ‘quiet place or space’.
• To
T have
h customs
t and
d rituals
it l respected.
t d
 Responding to Religious
Needs
• Celebrating religious services
services, prayers
prayers,
feasts etc
• Facilitating the person in maintaining
contact with his/her local faith community.
• Facilities
F iliti ffor ththe observance
b off rituals
it l and
d
customs.
 Spiritual Assessment
• What are his / her source of hope
• What gives meaning / purpose to the patient’s
patient s
life.
• Does the patients religious tradition nourish the
individual or has it added to his/her concern.
(burden ie, guilt, shame)
• What does the chaplain/minister mean to the
patient.
• How supportive is the local culture / community
or
does it isolate the patient / person?
 Spiritual
p Distress
• Why me??
• Whyy is God doing g this to me?
• Is God punishing me?
• I have been a g good p person,, why y have I g
got
cancer, HIV?
• Look at all the bad p people
p and nothing g happens
pp
to them!
• Life is so unfair, I have just retired and look at
what is happening to me…
• I have so many projects / plans…….the family
needs me…..etc
 Spiritual Despair.
• There is no point in going on
on….
• My life has meant nothing….
• G d will
God ill never fforgive
i me….
• There is no God and no life after….
• I want to end it all now….
• Danger of suicide (EUTHANASIA!)
 Response to Spiritual Pain
• Listen, listen, listen
• Be present with honesty and nakedness
• With openness and flexibility
• Need to recognize our own spiritual roots
and journey
• Be present with all of who you are, not just
th spiritual
the i it l bit
bits.
• Be aware of our own mortality.
 Review of Life
• People who are approaching death find that life
review
i h
helps
l ththem validate
lid t what
h thhas h
happened d
during life time.
• Going
G i backb k tto the
th place
l th
they were b
born, visit
i it
graves of relatives.
• Looking through old letters / photographs
photographs.
• Reconciling broken relationships, with God, with
family with community
family, community. An experience of
forgiveness is very important at this stage.
 Continued.
Continued
• ( In catholic tradition it may be a return to
sacraments /church after many years,
confession)
• ((For other Christians,, it might
g mean special
p
prayers, fellowships…)
• Can I forgive myself for the mistakes of my life…

• Desire to see myy siblings/

g children once more.

• It could also involve writing a will.

How to help (Dr Kubler
Kubler- Ross)
The following summary and guidelines may be helpful:
Disclosure:
• The patient is told or knows somehow. In the
beginning, hope, which is always present, is for a
cure.

1. State of Denial:

The refusal to believe that one has a terminal illness. ‘Not

me, the diagnosis
g must be wrong.’
g it is a healthy
y
shock- absorber.’
 State of Denial:
Dos… Dont’s…
• Remember that the need for
denial exists in every patient at • Don’t encourage denial
times but more so at the
beginning of a serious illness.
• Listen patiently, not
confirming or denying
statements – the patient may
need this time to adjust
mentally
t ll – let
l t the
th facts
f t speakk
for themselves.
• Allow defenses – don’t point
outt contradictions.
t di ti
•Sustain realistic hope in order
to prevent a sense of
abandonment.
b d t
•Be alert fro prolonged denial
 2. Anger
Starting to accept the inevitable but feeling
angry at self, relatives, medical and hospital
personnel who are healthy and at God who
Do: Don’t:
allows him to die. (‘Why me?’)
•Try to understand by •Don’t argue.
imaging self in the same •Don’t judge.
position. •Don’t take personally.
•Allow and help patient •Don’t abandon patient
express anger – then he
will realize that he is
cared for.
•Visit regularly.
regularly
Quality Palliative Care for All
 Bargaining
g g
• Do:
• Join
J i iin the
h bbargaining
i i
• help to be realistic in the bargaining.

In the further stages,

stages hope is not so much a
seeking for a cure but a search for
meaning in what is happening
happening.
 4. Depression
Sadness and a sense of g great loss.
(a) Reactive depression:
Sadness over past and present
losses, e. g. job, bodily organs.
DOs
Don’t:
•Listen patiently.
•Don’tt abandon
•Don
•Help in meeting unmet
responsibilities.
•Boost self esteem by
praise.

Quality Palliative Care for All

 (b) Preparatory Depression:
Sense of sadness over impending loss of
lif off significant
life, i ifi t relationships
l ti hi and d
significant roles.
N
Necessary tto prepare for
f final
fi l state
t t off
Dos Acceptance and Peace.
Don’ts
•Be there – then the ptn • Don’t encourage him
knows he is not to look on the bright
f
forgotten.
tt side
id – this
thi wouldld
•Allow expression of hinder contemplation
sorrow
sorrow. of impending death
•Search for meaning -
make sense out of it all
all.
Quality Palliative Care for All
 Acceptance
p
• A time of peace……’void of feelings’

• Explain this stage to the family

family…….help
help them to ‘let
let go’
go

Fullfilment
• ‘I am ready to go now’
• Sometimes either sense of calling or talking to loved
ones who have died.

• Our task on being companions is to remember that

they
y are living
gppersons—livingg towards death. Thus
always treat people as the living persons they are.
 Hope
• Studies indicate that hope persists right
through serious illness. Even the most
p gp
accepting patients hope
p for a remission, a
cure ,the discovery of a new drug or a
miracle.

• Studies also indicate that when HOPE was

dropped in a state of final acceptance
death was and is very close.
 SPIRITUAL CARE OF THE
DYING
• Listening with a third ear to the story of the
person
• Listening for the feelings so as to validate
them
• Listening to see if faith is present
• If there is belief in God, what image of God
is part of this persons story.
• Listen for some sense of hope /providence
/ guidance.
 Prayer With the Dying
• Generally - short prayers with pauses.
• Prayer of protection
• Prayer of silence
• Prayer of memories
• Prayer of gratitude
• Prayer of trust.
 How can I live without you.
• This is the painful expression of a
man/woman who stands by a loved one
who is dying.
• In spite of the length of the illness, death
remains shocking in a profound way
• The mourner feels lost and unable to go
on with life.
• One often hears………..I will follow you
soon.
 Thoughts of Bereaved
• ‘’II stood before the mystery of death
death,
stunned into silence, wanting to stop the
process This cannot be so
process. so. But reality
was there. Then numbed by the shock, I
said goodbye and dazed
dazed, I walked away to
begin the search for meaning, for symbols,
for words
words, that would tell the reason why
why.’’
 Conclusion
• ‘’The spirituality of those who care for the
dying and the suffering
suffering, must be the
spirituality of the companion, of a friend,
who walks alongside
alongside, helping sharing
sharing, just
sitting empty handed when he / she would
rather run away. y It is the spirituality
p y of
presence, of being alongside, watchful,
available, of being there’’
Dr Sheila Cassidy- Sharing the Darkness.
 Closing Thought
Thought.
‘’You
You matter because you are you.
you
You matter until the last moment off
Y
your life, and we will do all we can
not only to help you die peacefully,
peacefully
but also to live until you die.’’
Dame Cicely Saunders.