Monday, June 29, 2009

‘the ethical dimensions of patient care’ -- #46

4. Defining/distinguishing ‘spirituality’ and ‘religion’:

I suggest that caregivers begin with this premise – i.e., all individuals are more than the insights made possible through various empirical analyses. In the health care sphere, this premise implies that patients are more than potential or actual illnesses and accidents; professionals, more than highly skilled scientists/technicians. To consider this ‘more’, a vocabulary and a manner of discourse -- in addition to scientific/clinical language -- are required. I have found that most (perhaps all) individuals have, with varying levels of sophistication, such vocabulary and manner of discourse. Such vocabulary and manner of discourse disclose, in the most elemental and inclusive way, each individual’s spirituality. An individual’s spirituality reaches, shapes, and sustains his/her integrity (i.e., wholeness, oneness, character).

The definition of ‘spirituality’ that has worked well over the years for me in opening discussions of this subject with health care professionals is:
‘Spirituality’ has to do with the sort of person a patient is, with the basis upon which her life has integrity and balance. A patient reveals her spiritual identity when she shares her core beliefs and life values and when she explains how she sustains these beliefs and values. Feelings of fear, loneliness, and guilt as well as happiness, contentment, and wonder are windows into a patient’s spirituality.
Some caregivers may question the absence of the word ‘God’ or a reference to a divine transcendence in this definition of spirituality. This definition represents an attempt to define spirituality so as to minimize the risk of eliminating individuals as ‘spiritual’ by definition. I strongly recommend against making either a reference to a divine transcendence or a claim of experience of/with a divine transcendence prerequisite to being considered ‘spiritual’. Instead, the transcendence that, in my judgment, is prerequisite to a fully inclusive approach to spirituality is the human spirit (i.e., the ‘more’ about human beings for which empirical analysis/explanation alone does not account). I am proposing (1) that this transcendent realm is present in/with all patients and (2) that this transcendent realm is very relevant to empirically-driven health care professionals who are expected to assess their patients’ spiritual wellbeing. With this transcendence – i.e., the human spirit -- in common, patients experience and express their spirituality in ways special/peculiar to each one (including but not limited to those who interpret their spirituality in terms of experience of/with a divine transcendence).

The definition of ‘religion’ that has worked well over the years for me in opening discussions such as this one is:
‘Religion’ has to do with the way many patients experience and express their spirituality. They center their lives on worshipful devotion to ‘God’ as a mystery that transcends human beings and the world. They are encouraged in their communities of faith to live this way through the study of sacred writings, the affirmation of core beliefs and life values, the sharing of inspirational stories, and the celebration of special rituals.
Some caregivers may express concern that this definition of religion is decidedly institutional in wording. There are certainly less institutional ways to define/nuance ‘religion’. However, in order to meet the Joint Commission regulations for assessing patients’ spiritual wellbeing and in light of the likely assumptions many caregivers hold re ‘religion’, it seems to me that an institutional definition of religion accomplishes the primary objective of distinguishing religion as a subset of the larger phenomenon of spirituality.

I suspect that a significant number of physicians and their support staff as well as most of their patients are more familiar with the following association of spirituality and religion:

‘Religious’ subdivides into --
‘Spiritual’ (a favorable assessment according to the particular religion’s criteria)
‘Not spiritual’ (an unfavorable assessment according to the particular religion’s criteria)

rather than:

‘Spiritual’ subdivides into --
‘Religious’ (in experience and expression)
‘Non-religious’ (in experience and expression)

The definition of and approach to spirituality followed by a hospital, in a clinic, and by a medical team need to be inclusive of all the patients for whom care is being delivered. Not all patients are religious. Not all patients are affiliated with a particular religion. Not all patients are members of any one sub-division of one particular religion. And crucial non-religious aspects of every patient’s spirituality are missed when ‘being spiritual’ is viewed as interchangeable with or a subset of ‘being religious’. Concerning these missed windows into a patient’s spirituality, here are some examples:

a morning/evening walk
participation in community/civic organizations
a refreshing hobby (e.g., photography or gardening or hiking or . . .)
participation in volunteer community service activities
reminders of life-changing experiences
travel opportunities
inspiring music
the company of a pet
a thought-provoking book
a favorite art gallery or museum
social pleasures (e.g., a glass of wine or a pleasant dinner or a theater outing or a sports event or . . .)
a special friend