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PATIENTS
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SPIRITUAL SUPPORT
Spiritual Consolation
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The Spiritual Perspective Brings Solace
Ganga Prem Hospice is a spiritually orientated, non-profit hospice for terminally ill cancer patients and will provide spiritual support to cancer patients and their loved ones in the form regular programmes, discourses and counselling.

The spiritual advisors at Ganga Prem Hospice will, if desired, provide the opportunity to patients, families, staff and volunteers to share and consider their thoughts and understanding of their inner Spirit and of a Higher Power. We hope that this opportunity will help lessen the grief and fear connected with the impending death and make it more peaceful and meaningful to us all.

“He who remembers Me in the last time, as he leaves his body, goes to Me without a doubt.”
(Srimad Bhagavad Gita)


 
 
 
 

The mystics of all religions and spiritual traditions tell us again and again that death is only for the physical body, not for the Soul.

“Truly, it is only this (the body) that dies when the Soul departs from it. The Soul never dies.”
(Upanishad)


The saints speak of death as a wonderful transition from this limited and finite existence to an eternal and infinite immortality.

“So beautiful appeared my death knowing whom I would kiss, I died a thousand times before I died.”
(Rabi’ah)


Death is something perfectly normal, something that we all see every day and something that will inevitably happen to every living being at some time or another. The scriptures tell us it is something very simple and natural.

“Just as a man discards worn out clothes and takes other new clothes so does the embodied Soul discard worn out bodies and takes other new bodies.”
(Srimad Bhagavad Gita)


Death pertains only to the body, which like a machine, is subject to wear and tear, dysfunction and eventually complete breakdown. The Soul, however, is unborn and undying, eternal and immortal. For those people who learn to identify themselves with the Soul instead of the body or for those who have taken refuge in a Higher Power death does not hold so much fear.

“Where, O Death, is your victory? Where is your sting?”

(Bible)


Spirituality in Palliative Care

By Dr Dominique Cassidy MD, FMH

Dr Dominique Cassidy is an FMH specialist in psychiatry and psychotherapy. At present she works as a consulting doctor in psycho-oncology and liaison psychiatry at Valais State Hospital in Switzerland.  She is also an intermediary teacher at the School of Medecin of Lausanne, for the module: "Spirituality, Religion and Medecin", 

Dr Dominique Cassidy MD, FMH

an instructor in "Therapeutic Meditation", mindfullness meditation programmes for psychiatric patients and an instructor in "Conscious Centering", burnout prevention program based on meditation, yoga, aikido and spiritual inquiry for healthcare practitioners.

Spirituality and medicine are two words that until recently were not thought of as compatible; they belonged to two different worlds that would not meet. Times have changed in recent years however and now western medicine has started to study the impact of the spiritual dimension and include it in the basic care of patients. This article provides an introductory overview of this topic. It includes a historical perspective, and a description of some of the ways spirituality is conceptualized and practised in a therapeutic context.


Historical Background

There was a time in European culture when medicine was part of, and at the service of, religion. Medicine was based on the truths recognized by the church, and religion explained both the cause and the solution to illnesses. The first hospitals were known as "hostels of God," and monks and nuns were the primary caregivers in those institutions.

After the Renaissance however, around the 16th century, as science started to prove the limitations of religious beliefs concerning the laws of nature, medicine and spirituality began to face each other in opposition: progressively God was left out of medical care, monks and nuns were replaced by nurses, and the whole of the spiritual dimension was increasingly denied or simply forgotten.

Times are now changing once again and science is becoming increasingly interested in spirituality. In the last 40 years, a growing number of studies, both in medicine and neuroscience, have demonstrated the impact of the spiritual dimension on health and well-being. In addition, scientists have become curious regarding spiritual practices such as meditation, and the number of studies around this topic has grown exponentially over the last decade. More and more doctors and nurses are now prescribing meditation to complement the usual allopathic treatment.

In 2005, the World Health Organization replaced the old ‘bio-psycho-social model’ describing the different aspects of humans, with the ‘bio-psycho-social and spiritual model’, incorporating the anthropological view that the spiritual dimension is constitutive of our humanity. Spirituality is now understood as one of the basic components of our human experience, and therefore it is an aspect that needs to be included both in scientific research and, more importantly, in the care of patients.

Palliative care, with its predominant focus on the process of death and dying, is relatively advanced in its emphasis on caring for the spirituality of patients, and many tools have been developed to support caregivers in addressing these topics with patients. This trend is now extending to teaching hospitals and in general medicine, and medical students are being introduced to spiritual care during their studies.

Definition of Spirituality, Religion and Religiosity

Spirituality, religion and religiosity are words quite often confused as the being the same, therefore great effort has been made to clearly define them in a way that allows healthcare professional to communicate around this subject.

Spirituality:
There have been many attempts to define spirituality, and each of them address two different aspects: the question of life's purpose and the connection to that which is transcendent. "Spirituality implies a universal questioning about intent and the meaning of life, and belongs to the essence of humanity's search for transcendent values.

Religion:
Religion is the structured belief that addresses spiritual questions through ethical and philosophical view points, including the notion of a faith in God.

Religiosity:
Religiosity is the practice a person is involved in as a way to explore and express their religion or spirituality.

What are the studies saying?

  • Studies have shown that a great majority of patients want to speak of their spirituality/religion with their doctor. However, a minority of doctors feel comfortable doing so. Doctors feel unprepared to have such talks with their patients. They don’t have time to do so, and lack sufficient understanding to actually recognize which patients have such needs.
  • Some studies with geriatric patients show that those patients whose spiritual needs had been addressed during their hospitalization needed less time to recover and presented a reduced risk of relapse in general.
  • Studies have demonstrated the positive impact of a balanced spiritual life on health and well-being, as well as the negative impact of spiritual distress, the name given to a state of suffering regarding one's spiritual life.

Spiritual Care

1. Spiritual evaluation
Specific questionnaires have been developed for doctors and nurses to enquire about the spiritual lives of their patients and to determine if specific attention is required. Questionnaires can give the caregiver a general outline to follow, but of course a more experienced professional will progressively approach those topics spontaneously during the meeting with the patient.

The first questions are introductory and can be part of a general health inquiry:

- Are you a spiritual and/or religious person?
- What is the importance of that dimension in your life in general?
- Do you have religious or spiritual practice(s)? Do you belong to a spiritual or religious community?
- Has your religion or spirituality been a source of support during your illness? Would you like or need to speak to me about it?

Those next questions lead to a deeper evaluation, through four specific aspects:

The meaning of one's life
- What is/has been giving meaning to your life?
The core values of the individual
- What is truly important to you? What have you learned from challenging situations? What values gives you strength?
The connection with what is essential or transcendent
- What do you believe in? At what moment do you feel at peace or fulfilled? What supports you in moments of despair?
The coherence of one's spiritual identity
- Do you feel valued, loved and supported? Are you at peace with yourself? Is there anything unfinished in your life?

2. Spiritual distress

The concept of spiritual distress has been long confused with symptoms of depression, and although it is true that some symptoms overlap, there is a tonality about spiritual distress that needs to be understood and addressed specifically.
We speak of spiritual distress when the patient is expressing struggling or suffering with one or more of these issues:

  1. Loss of meaning in Life: "Why me? My life is a failure. Nothing matters anymore."
  2. Loss of value: "I do not know what is good or bad. I feel betrayed, by others, by life, by God."
  3. A loss of connection with transcendence: "I do not believe in God anymore. I have no contact with what used to be essential to me. Nothing inspires me anymore."
  4. Loss of spiritual identity: "I am no one anymore, I've no more goals nor role in life. I feel abandoned and alone. I cannot forgive myself. I'm not at peace with myself."


Who gives spiritual care?

In many hospitals, doctors and nurses can refer a patient to a specialist in spiritual care. Often these are from a religious or theological background, and are trained to meet people with their religious or spiritual needs. If they are not available, much can still be done by the primary caregiver, to the degree that they feel comfortable to go in this direction with their patients.
Unlike a lot of western medicine, spiritual care is not defined by any specific intervention, nor by any strict guidelines. The primary qualification for spiritual care is to be grounded in one's own spiritual life, and to express a quality of being that allows for an authentic and deep encounter with patients.

3. Qualities or practices of ‘being’ necessary for spiritual care

- To provide an attentive presence and a loving curiosity with the patient.
- To inquire gently with a quality of listening that allows the patient to express him/herself freely without adding personal beliefs, judgments or opinions.
- To provide accompaniment without directing or trying to influence the patient in his/her quest.
- To inquire about the patient's life, what has helped in the past, what is a source of strength, what has been the most valuable in his/her life etc.
- To inquire about remorse, unresolved issues, and the theme of forgiveness.
- To ask what the patient would still like to accomplish or leave for his/her loved ones.
- To listen, touch, laugh, provide communal prayer, presence, and silence.
- To stimulate religious or spiritual expressions (spiritual or religious practices, reading, meeting with one's religious or spiritual guide, being in nature, listening to music, writing...)

Relationship tips for healthcare professionals

Most patients, when addressing spiritual issues, do not ask for our opinion, but want to be heard, understood, and loved. Ideally, in the meeting with a caregiver, they can meet themselves, clarify what has been obscured, and evolve on their own path. To allow that, the caregiver must recognize, and stay away from his/her own beliefs, needs and doubts, so that they do not interfere with the patient’s personal process. If one is not clear about one's own challenges, the tendency in the encounter with the patients will be either to deny their suffering as a way to avoid one's own, or to quickly come up with some solution, as a way to relieve oneself from our own unresolved doubts. In both situations, the space needed by the patient is filled by the anxiety of the caregiver.

To meet someone at this level requires that the caregiver get in touch with and cultivate his/her own spiritual ground. The qualities listed bellow can support such a process:

Presence: the ability to remain still, available; lovingly listening.
Humility: to recognize and accept and embrace that often: "I do not know" or "I cannot understand" and "I am not able".
Non-judgment: recognizing the ‘judging mind’ that prevents true listening, and choosing to go beyond it to meet the other.
One’s own relationship with death: How would I respond to the prognosis of my own death? How would I spend my last months? What are my own beliefs around death?
The meaning of one’s work: What inspires me? What do I love about my work?
Deepening of our own spiritual life: meditation, prayer, reading...

Conclusion

Spirituality is now being is being slowly recognised  and reintegrated as one of the basic aspects of human existence. Incorporating spirituality into medical care requires that it become liberated from a long history of mistrust, and that healthcare providers express greater willingness to address spiritual questions for themselves and with their patients.

This movement is opening a new chapter in western medicine: spirituality speaks of the aspect of our experience that cannot be grasped by the mind, that cannot be measured by instruments and for which nothing tangible can be prescribed. Medicine that includes such an element will necessarily have to open itself to the ‘Mystery of Life’, and will hopefully be enriched by a sense of awe and humility. Each step, therefore, taken in the direction of including the spiritual dimension in hospital or hospice care, and each step taken in the direction of teaching and encouraging healthcare professionals to explore in this direction, is a step towards a fuller, deeper and more humane medicine.

Seeing Them Off

By Dr Ramesh Bijlani

Dr Ramesh Bijlani retired as a Professor from the All India Institute of Medical Sciences where he established a patient care facility for conducting yoga-based lifestyle modification courses for prevention and management of chronic disease. He uses yoga as a tool in mind-body medicine.

Dr Bijlani at the GPH World Hospice Conference 2008

"The most surprising thing in the world is that everybody knows that death is inevitable and yet behaves as if he were immortal", says Yudhishter in the Mahabharata.

To this one might add that we also behave, and misbehave, with our near and dear ones as if they were immortal. The result is that if they leave us suddenly without warning, leaving no possibility of even saying "sorry", we are left with life-long regret. The situation is not much better if they give us a few months or years of notice by developing an incurable disease such as cancer. The caregivers of such patients face several difficult questions:

Whether to tell the patient the truth?
How much of the truth to tell and how to tell it?
To do all that is possible for prolonging the life of the patient or to withhold those heroic measures which are likely to only prolong misery?
How much of a choice to give the patient in choosing the treatment?
What the approach should be to alternative systems of medicine?
Whether to add modalities such as distance healing, faith healing and distance healing?...

The list is endless and the answers debatable.

There is not much debate anymore on whether to tell the patient the truth. Even if efforts are made to hide the truth from the patient, the patient knows it anyway. In any case, the truth must be told; the only question is how. A few important principles are that the news should be broken only when there is ample time available to talk to the patient. All hope should not be taken away from the patient, and the patient should feel fully supported. It is cruel to break bad news to the patient in a hurry and leave the patient all alone to digest its implications. Regarding not taking away hope, it might be asked how hope can be given when there is no hope while still sticking to the truth. The fact is that there is no situation in which there is no hope. Remissions may be rare in some cancers, but are known in virtually all cancers. Furthermore, the remissions are not arbitrary: they are more likely among those who expect them and psychoneuroimmunology offers a plausible explanation for the phenomenon. That is why Bernie Siegel, the famous cancer surgeon, says that one should beware of giving false 'no hope'.

Cancer also presents difficult dilemmas regarding the extent to which every new advance in treatment should be used, and the types of treatment that may be combined. Broadly speaking, there are three modalities of treatment: surgery, radiotherapy and chemotherapy.

Surgery, whenever possible, is a good option because it reduces the tumour load and gives the body’s immune mechanisms a chance to overpower the cancer cells that may still be lurking here and there in the body.

Radiotherapy and chemotherapy, however, are double-edged weapons. They destroy tumour cells, but they also damage the rapidly dividing normal cells; hence their side effects. Among the rapidly dividing cells are also the cells of the immune system. It is not always easy to determine whether the benefit expected from radiotherapy or chemotherapy exceeds the harm they might do by weakening the immune system. Further, a social and moral dimension is added to the issue because chemotherapy is often very expensive. If the family refuses chemotherapy, they may feel guilty that they are not doing everything possible to prolong the life of the patient. On the other hand, if they somehow manage the chemotherapy, they might face bankruptcy for the sake of giving the patient doubtful prolongation of poor quality life. If these decisions are taken without any discussion with the patient, an important aspect of the truth regarding his illness is being hidden from him. On the other hand, if the patient is consulted on these points, it may be difficult to avoid in the patient the perception that the family is not doing enough for him in order to economize on the expenses.

In chronic disease, relatives, friends and other well wishers have a tendency to suggest unconventional remedies such as alternative systems of medicine, diet therapies, touch therapy, spiritual healing and so on. Sometimes they even suggest specific practitioners or spiritual masters and support their advice with anecdotal evidence. This happens all the more in diseases such as cancer. It is difficult for any family to act on all such advice. Which path to follow would, and should, depend on what they, particularly the patient, have faith in. Even if the treatment has no specific beneficial biological effect attributable to its chemistry, it would at least act as a placebo if the patient has faith in it. Placebos are currently looked upon with a great deal of respect because first, they can work wonders; and secondly, if the placebo is an inert substance, it will have no side effects. However, it is not prudent to depend only on an alternative therapy unless practitioners of scientific medicine have washed their hands of the patient, or at least the patient and the relatives have taken a conscious decision not to avail of scientific medicine anymore.

While all the above questions and several other mundane considerations inevitably enter the picture in a disease such as cancer, the most comforting and creative approach comes from the spiritual worldview.

The spiritual worldview not only helps us accept the disease as an expression of the Divine Will, but also enables us to look at the disease positively. The usual way to look at the disease is as a problem to be solved, a battle to be fought, and an enemy to be conquered. From the spiritual point of view, however, the disease is a powerful teacher. It is an opportunity with an extremely high potential to stimulate the spiritual growth of the patient and his caregivers. Since spiritual growth is the true purpose of life, the disease helps them fulfill the purpose of life. All events and circumstances can serve as opportunities for spiritual growth. While ordinary everyday life gives opportunities for taking only one small step at a time towards the fulfillment of the purpose of life, traumatic events such as cancer are opportunities for taking several big and rapid strides. A person going through the experience of cancer for a couple of years, and his caregivers, can grow spiritually more in those few years than in several decades of ordinary life. The transforming effect of this growth outweighs the physical and emotional hardship faced by the family. The effect of the transformation is to bring the family closer, and to make them much more capable of loving, caring and sharing. The transformation also equips them to face any future vicissitudes of life with equanimity. They discover peace and joy within themselves, and learn how to access these inner resources. They get liberated from their dependence on external circumstances for their happiness. Hence their happiness becomes event-proof and shock-proof. Their overwhelming concern for recovery from the disease is replaced by the need to redirect life in order to make life more meaningful and fulfilling. Thus, the disease that seems to be a curse becomes a blessing in disguise. Interestingly, with this attitude, not only does the remainder of life become more meaningful, the remainder also seems to get longer. There can be no better way of seeing off our loved ones than to thank them for the opportunity they bring us even while preparing to leave, and to make good use of the opportunity.

 
 
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