Integrative Assessment Tool - Upaya Zen Center

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SHIFTS IN CHAPLAINCY 10 If your health should decline, how does your faith - or other resources - prepare you for what is ahead? Palliative Care Chaplaincy The historical relationship between spiritual and palliative care goes back to the Middle Ages when monasteries offered hospitium, a safe resting place for weary, and sometimes dying, travelers. The ancient monks’ mission was to save souls. Although today’s standards of spiritual care reflect the changes the role of chaplain has undergone over the centuries, the mission of palliative care – of which spiritual care is an important component - remain the same: to make dying easier. The medical profession still treats its role as an art as much as a science, relying on philosophical principles like the rule of double effect, attributed to the 13 th century Roman Catholic philosopher Thomas Aquinas. Even if there is a foreseeable bad outcome, like death, it is acceptable if it is unintended and outweighed by an intentional good outcome – the relief of unyielding suffering before death. To avoid misunderstanding, it has to be said that most comfort measures do not hasten death in any way. Because of the comfort palliative care can provide, patients’ requests for euthanasia diminish. Spirituality is a dimension of palliative care, and spiritual well-being, too, stands in inverse relationship with desire for hastened death, suicidal ideation and hopelessness. Research has already been cited that demonstrates religion and spirituality to be a crucial coping skill protecting the patient against end-of-life despair, and that spiritual care greatly comforts
SHIFTS IN CHAPLAINCY 11 terminal patients. Even though, as discussed previously, some people’s interpretation of doctrine can also cause spiritual pain to arise. One provision of the House health care bill passed in November 2009 recognizes that palliative care may include treatment “furnished for the purpose of alleviating pain or discomfort, even if the use may increase the risk of death.” Constant vigilance concerning abuse is appropriate, for example to monitor whether terminal sedation is administered because of pressure from family, economic reasons or simply out of convenience. In their recommendations, the Institute for Healthcare Improvements (IHI) lists “learn how to provide care that is death accepting” as optimum practice. Ars moriendi, ‘the art of dying’ (a term originating in the Middle Ages) in modern times could refer to palliative care efforts to restore death to its sacred or significant place, in contrast to it being a technological or management issue. Florence Nightingale reintroduced the notion of holistic care in the 19 th century. The Sisters of Charity, the same Order that established St. Vincent in New Mexico in 1865, opened the first hospices in Ireland and France. Dame Cicely Saunders was a key figure from the 1940’s onward and pioneered the hospice movement in England. In the USA Elizabeth Kubler-Ross captured the interest of a large lay audience with her research on the stages of dying. Between 1986 and 1996 the Elizabeth Kubler-Ross Institute in El Rito was part of the Northern New Mexico College. For linguistic reasons, the French Canadians chose to name their hospice service in Montreal ‘palliative’ care when it was established in 1974 (palliative from Latin palliare, to cloak or cover; care that palliates, i.e. alleviates or relieves suffering). The author’s ‘Integrative Assessment Tool’ contains an ‘end-of-life planning’ section. It takes into consideration the particular concerns of palliative care patients and helps the chaplain
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Integrative Assessment Tool - Upaya Zen Center

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