I may rage against what appears to be an increasing trend towards the legalization of physician-assisted suicide, but rage, I don’t believe is the answer.
Dr. Carol Taylor RN, PhD, is leading the charge in bioethics to encourage us in providing spiritual care to terminally ill patients. She writes about how that can return hope and meaning, despite an impending death.
As director of clinical bioethics at Georgetown University, Dr. Taylor has just published an article in one of the leading journals of palliative care, “Rethinking Hopelessness and the Role of Spiritual Care When Cure Is No Longer an Option.”
To paraphrase from the abstract of the article:
“Increasingly… clinicians fail to recognize and accept when cure… (is) no longer realistic… futile efforts at cure can fuel false hopes. The clinicians need to be “doing something” may result in treatment that violates the dignity and well-being of the patient and this can lead to the patient’s ultimate hopelessness and despair.”
Dr. Taylor makes a strong case that spiritual care which addresses certain universal spiritual needs (meaning and purpose, love and relatedness, and forgiveness), fosters hope which sits between false hopes and despair. People may not have the hope that they will survive a terminal disease, but that does not mean that they need to be devoid of hope.
Blurring the Lines Between Life & Death
There was a time when it was accepted that there was such a thing as a good death. People in those bygone times, knew that death was inevitable. There was none of our modern technology which often blurs the line between life and death. In those days, death was a certainty, as was the need to prepare for it. Today, we too often delude ourselves, with our mostly chronic diseases, that our kidney or heart or liver failure may yet be curable, or that the next round of chemotherapy will, if not cure the cancer, at least delay it significantly. That is certainly wonderful when it happens, but it is by no means the rule.
As physicians we play into this psychology. For most of us our entire training surrounds cure. Little attention and much denial has occurred over the inevitable truth that we all must die sometime. We have believed the silent but ever present denial of death, and so, if we cannot cure our patients, we believe we have somehow failed. But when we cannot cure our patients, it does not mean that there is nothing left to do. Just the opposite; there is much to do, if we are fortunate enough to have some time to do it. When we cannot cure, we may yet be able to heal.
The bulk of Dr. Taylor’s article describes how she was able to support a friend by spiritual care, despite a rocky start. She outlines how nurses, physicians, social workers, chaplains and others can foster further dimensions of hope: hope for resolution of interpersonal relationships, self-forgiveness and hope to leave a positive legacy. She describes how spiritual healing, the realization of and integration of self, moves people from a sense of brokenness to wholeness. We are all going to die, but we need not die with a feeling of brokenness.
Next week: How does this relate to the sentiment for physician-assisted suicide?
Last Updated: November 6, 2018