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Reintegrating Care for the Dying, Body and Soul

Published online by Cambridge University Press:  01 July 2010

Michael J. Balboni  and
Tracy A. Balboni
Tracy A. Balboni
Affiliation:
Dana-Farber Cancer Institute, Harvard Medical School
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Extract

Modern medicine owes many of its founding principles to a spiritual heritage. However, passage through the Enlightenment and entry into a secular, pluralistic health context have yielded an estranged relationship between care of the body and care of the soul.1 Scientific medicine now holds the primary role in care of the body while religious communities are solely responsible for care of the soul. The needs of both body and soul are in many respects served well by this specialization and division of labor, but ultimately, of course, human experience is not susceptible to such a simplistic dichotomization. The lack of integration of spiritual and material care of the human person in contemporary life has led to increasingly evident tensions, most notably in the mechanization and isolation of the experiences of illness and dying.2

Type
ARTICLES
Information
Harvard Theological Review , Volume 103 , Issue 3 , July 2010 , pp. 351 - 364
Copyright
Copyright © President and Fellows of Harvard College 2010

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References

1 Important historical and sociological accounts describing this divide include: Jonathan B. Imber, Trusting Doctors: The Decline of Moral Authority in American Medicine (Princeton, N.J.: Princeton University Press, 2008); Ronald L. Numbers and Darrel W. Amundsen, Caring and Curing: Health and Medicine in the Western Religious Traditions (New York, N.Y.: Macmillan, 1986); Guenter B. Risse, Mending Bodies, Saving Souls: A History of Hospitals (New York: Oxford University Press, 1999); Roy S. Porter, “Religion and Medicine.” Companion Encyclopedia of the History of Medicine (ed. W. F. Bynum and Roy S. Porter; 2 vols.; New York: Routledge, 1994) 2:1449–68.

2 Rolfe S. Morrison et. al., “Clinical Problem-Solving. When Too Much Is Too Little,” New England Journal of Medicine 335 (1996) 1755–59.

3 Harold G. Koenig, Medicine, Religion, and Health: Where Science and Spirituality Meet (West Conshohocken, Pa.: Templeton Foundation Press, 2008); Kenneth I. Pargament, The Psychology of Religion and Coping: Theory, Research, Practice (New York: Guilford Press, 1997).

4 Andrea C. Phelps et al., “Religious Coping and Use of Intensive Life-Prolonging Care Near Death in Patients with Advanced Cancer,” Journal of the American Medical Association 301 (2009) 1140–47.

5 Tracy A. Balboni et al., “Provision of Spiritual Care to Advanced Cancer Patients: Associations with Medical Care and Quality of Life near Death,” Journal of Clinical Oncology 28 (2010) 445–52.

6 Craig C. Earle et al., “Trends in the Aggressiveness of Cancer Care near the End of Life,” Journal of Clinical Oncology 22 (2004) 315–21.

7 Bonnie Zhang et al., “Health Care Costs in the Last Week of Life: Associations with End-of-Life Conversations,” Archives of Internal Medicine 169 (2009) 480–88.

8 Tracy A. Balboni et al., “Religiousness and Spiritual Support among Advanced Cancer Patients and Associations with End-of-Life Treatment Preferences and Quality of Life,” Journal of Clinical Oncology 25 (2007) 555–60; Maria A. Sullivan et al., “Effects of Religiosity on Patients' Perceptions of Do-Not-Resuscitate Status,” Psychosomatics 45 (2004) 119–28; Gala True et al., “Treatment Preferences and Advance Care Planning at End of Life: The Role of Ethnicity and Spiritual Coping in Cancer Patients,” Annals of Behavioral Medicine 30 (2005) 174–79; Peter H. Van Ness et al., “Religion, Risk, and Medical Decision Making at the End of Life,” Journal of Aging and Health 20 (2008) 545–59.

9 Alexi A. Wright et al., “Associations between End-of-Life Discussions, Patient Mental Health, Medical Care near Death, and Caregiver Bereavement Adjustment,” Journal of the American Medical Association 300 (2008) 1665–73.

10 Unpublished patient quote recorded in the Religion/Spirituality and Cancer Care Study database, Dana-Farber Cancer Institute, Boston, 27 March, 2008.

11 Daniel P. Sulmasy, “Spiritual Issues in the Care of Dying Patients: “… It's Okay Between Me and God,” Journal of the American Medical Association 296 (2006) 1390.

12 A few notable exceptions include: John Fenestil, Mrs. Hunter's Happy Death: Lessons on Living from People Preparing to Die (New York: Doubleday, 2006); Marva J. Dawn, Being Well When We're Ill: Wholeness and Hope in Spite of Infirmity (Minneapolis, Minn.: Augsburg Books, 2008); Daneen G. Warner, Life, Death, and Christian Hope (New York: Paulist Press, 2009); Susan J. Dunlap, Caring Cultures (Waco, Tex.: Baylor University Press, 2009); John Swinton and Richard Payne, Living Well and Dying Faithfully (Grand Rapids, Mich.: Eerdmans 2009); and Rob Moll, The Art of Dying: Living Fully into the Life to Come (Downers Grove, Ill.: Intervarsity 2010).

13 See Farr A. Curlin and Daniel Hall, “Strangers or Friends? A Proposal for a New Spirituality-in-Medicine Ethic,” Journal of General Internal Medicine 20 (2005) 370–74. Curlin and Hall suggest that the term “wisdom” is to be preferred over “competence” especially in the context of religious dialogue in a health care setting. They argue that “competence” is an inappropriate term for spiritual care in the medical setting because it emphasizes spiritual care as a therapeutic technique, acquired through technical training, and performed by certified professionals. In contrast, Curlin and Hall suggest that “wisdom” more ideally describes what should occur between care-giver and patient because its aim is the ultimate good of patient and care-giver, acquired through practice embedded in a tradition, and embodied within a moral friendship.

14 Tracy A. Balboni et al., “Religiousness and Spiritual Support,” 555–60.

15 Farr A. Curlin et al., “Religious Characteristics of U. S. Physicians: A National Survey,” Journal of General Internal Medicine 20 (2005) 629–34.

16 This case example occurred during a patient interview for the Religion/Spirituality Cancer Care Study, Dana-Farber Cancer Institute, Boston, 27 March 2008.

17 Christina Puchalski et al., “Improving the Quality of Spiritual Care,” 885–904. Suggested questions for health care workers include: 1) Do you have spiritual beliefs that help you cope with stress? 2) What importance does your faith or belief have in our life? 3) Are you part of a spiritual or religious community? 4) How would you like me, your healthcare provider, to address these issues in your healthcare?

18 John W. Ehman et al., “Do Patients Want Physicians to Inquire about Their Spiritual or Religious Beliefs if They Become Gravely Ill?” Archives of Internal Medicine 159 (1999) 1803–6; Dana E. King et al., “Beliefs and Attitudes of Hospital Inpatients about Faith Healing and Prayer,” Journal of Family Practice 39 (1994) 349–52; Karen Steinhauser et al., “Factors Considered Important at the End of Life by Patients, Family, Physicians, and Other Care Providers,” Journal of the American Medical Association 284 (2000) 2476–82.

19 Darci L. Graves et al., “The Role of Spirituality in Patient Care: Incorporating Spirituality Training into Medical School Curriculum,” Academic Medicine 77 (2002) 1167.

20 Koenig, Medicine, Religion, and Health.

21 Joel James Shuman and Brian Volck, Reclaiming the Body: Christians and the Faithful Use of Modern Medicine (Grand Rapids, Mich.: Brazos Press, 2006).

22 Christopher P. Vogt, Patience, Compassion, Hope, and the Christian Art of Dying Well (Lanham, Md.: Rowman & Littlefield Publishers, 2004).

23 These resources have been described in greater detail by Fenestil, Mrs. Hunter's Happy Death; Christopher P. Vogt, Patience, Compassion, Hope, and the Christian Art of Dying Well (Lanham, Md.: Rowman & Littlefield Publishers, 2004); and Moll, The Art of Dying.

24 Articles advocating a professionalized healthcare chaplaincy include: Tim Ford and Alexander Tartaglia, “The Development, Status, and Future of Healthcare Chaplaincy,” Southern Medical Journal 99 (2006) 675–79; Larry VandeCreek and Laurel Burton, “Professional Chaplaincy: Its Role and Importance in Healthcare,” The Journal of Pastoral Care 55 (2001) 81–97. Sociological study observing professionalization tendencies includes Raymond de Vries et al., “Lost in Translation: The Chaplain's Role in Health Care,” Hastings Center Report 38 (2008) 23–27.

25 Puchalski et al., “Improving the Quality of Spiritual Care,” 885–904.

26 James M. Roberts et al., “Factors Influencing Views of Patients with Gynecologic Cancer about End-of-Life Decisions,” American Journal of Obstetrics & Gynecology 176 (1997) 166–72; Gerard A. Silvestri et al., “Importance of Faith on Medical Decisions Regarding Cancer Care,” Journal of Clinical Oncology 21 (2003) 1379–82; Karen Steinhauser et al., “Factors Considered Important at the End of Life by Patients, Family, Physicians, and Other Care Providers,” Journal of the American Medical Association 284 (2000) 2476–82.

27 In one recent study, 85% of cancer patients reported to have had at least one religious or spiritual need. The same study reported that 53% were seeking a closer connection with God, 47% were seeking forgiveness, and 28% felt abandoned by God. See Sara A. Alcorn et al., “ ‘If God Wanted Me Yesterday, I Wouldn't Be Here Today': Religious and Spiritual Themes in Patients' Experiences of Advanced Cancer,” Journal of Palliative Medicine May (2010) 581–88.