5.1 ‘Respect’ is foundational to effective assessment of patients’ spiritual needs. The root meaning of respect – i.e., ‘to look back or to look at again and again’ -- is very vivid. There is very little benefit from attempting to assess a patient’s spiritual centeredness or spiritual distress if the professionals responsible for the patient’s care do not genuinely respect the patient.
5.2 It should not be taken for granted that health care professionals possess the skill/art of truly respecting their patients. I suspect that many caregivers have been born into and/or raised in fairly conservative religious and social settings. I was. In the religious and social setting into which I was born and in which I was raised, I remember being taught to doubt the motives and to avoid taking seriously the ideas of all others who differed from ‘us’. In time I came to see this instruction as instruction in disrespecting others. Variations on instruction in disrespecting others are implicit, if not explicit, to some degree in virtually all organized constituencies or spheres in our society (including the medical sphere).
5.3 ‘Respect’ does not mean ‘cater to’. It does mean ‘take very seriously’. This clarification calls attention to the rather complicated process by which the attending physician and medical team work with the patient and family/friends in decision-making.
5.4 The following sets of questions illustrate the skill/art physicians and other health care professionals need in order to be fully informed about and respectful of hospitalized patients who are experiencing spiritual distress:
Where do you call ‘home’? Are there individuals to whom you feel especially close? Are you a member of any groups or organizations that have significantly influenced your beliefs and values, your hopes and dreams?
- Has a particular religion influenced what you believe and value? (If so) what would you want us to know about your religious experience that would help us take better care of you? (If not) what would you want us to know about the source of your beliefs and values that would help us take better care of you?
- What gives your life meaning and purpose? What effect do your beliefs and values have on how you view being sick? (or injured?) What effect is your illness (or injury) having on your attitude toward life? Do you have any special memories -- including painful ones -- that you think we should know about as we care for you?
- Do you have family members or friends who are especially supportive at this time? Do they live near enough to be present while you are in the hospital? Would you like for us to meet them?
- Are you concerned that being in the hospital will interfere with your ability to participate in any activities that are especially important to your spiritual well being? How can we help you continue these practices while you are in our care?
- Do you feel encouraged? discouraged? Do you have specific hopes and goals that we should know about as we care for you? Would you want us to look for any special literature or other resources that might be encouraging to you while you are in the hospital?
- Do you have any questions or concerns that may be keeping you from having confidence in those of us who are caring for you in the hospital? If so, please share them with one of us. Having your trust is critical to our efforts to care for you.
5.5 Adding the responsibility of assessing patients’ spiritual needs increases the likelihood that caregivers will often be in a position to share their beliefs and values with patients. Healthcare professionals who interpret the responsibility to assess and respond to their patients’ spiritual needs as liberty to look for opportunities to evangelize or proselytize patients risk failing to respect or to be truly present with their patients. Their beliefs and values may lead them to prejudge the spiritual needs of patients whose beliefs and values differ from their own. Their attention span may narrow. Their diagnosis and/or management can be adversely influenced. Also, considerable diversity regarding spirituality and religion is usually found among the numerous professionals involved in a patient’s care. Liberty to evangelize or proselytize patients would not be restricted to the attending physician. Instead, all the professionals involved in a patient’s care -- including consultants, residents, medical students, nurses, social services personnel, et al -- could assume the same liberty, thus potentially putting patients in confusing as well as pressured situations. In order to guard against disrespecting patients and weakening their trust, caregivers should limit the way they share their beliefs and values with patients to discussions (1) they would summarize in the patient’s chart and (2) the medical team would consider part of the patient’s care.
CONCLUSION
I realize I have asked you to ‘think above the bar’, above the effort needed to achieve the minimum necessary to satisfy Joint Commission regulations. If there is a ‘take home’ from this pause in your busy and exhausting day, perhaps it will be that you will leave with an additional angle by which (1) to ponder the art of practicing medicine and (2) to measure your agreement that medicine ought not only be the most scientific of the humanities, but also the most humane of the sciences.
