The human being is made up with mind, body and spirit, although this is a simplification with educational endings. In this opportunity, we will focus on the spiritual side of the human being and it is not easy to do that.
Spirituality is related to our necessity and capacity to find what or who gives sense, propose and direction to our lives. Spirituality is not synonym of religion, it is something deeper. Spirituality includes the following dimensions: meaning, transcendence, energy, relationships and religion.
Why is it important to consider it ? Lack of spiritual welfare is associated with depression and poor tolerance to physical symptoms. The lack of meaning can be related to the wish of living. There is evidence that the spiritual welfare is a factor that protects from psychological distress. The healthcare professionals must know the patient’s believes considering the socio cultural environment. Healthcare professionals of the 21st century feel uncomfortable when they face the existential dimension due to its non scientific nature and prefers to focus in medical and technical issues or defined psychosocial issues.
It’s difficult to recognize between emotional and existential/spiritual dimensions and in fact sometimes they overlap each other. The external sign could be similar, but the underlying cause is different, and therefore the management must be adapted to the nature of the problem and it is not easy.
The pain can have physical, psychological, social and spiritual origins (total pain), there is no doubt that a morphine ampoule doesn’t relieve the spiritual or psychological pain. We know that the pain is first of all a physical issue, but it can end up in spiritual suffering. Many times not only the patient suffers, but also all the people around them. Remember that the unit to treat is patient-family.
in all the stages of live, we deal with existential and spiritual issues, but in the end, people tend to consider much more the spiritual concerns. It is when we learn to appreciate the simple things of life as family, relationships and the nature. Getting closer to death makes easier to choose between important and not important things.
The most frequent needs in the last stage of life are: giving and receiving love, forgiving and being forgiven, finding sense in the suffering, pinning all hopes on somebody or something, reaching inner peace, transcending, saying goodbye. People of faith need to enforce their relationships with God.
Our work is not to judge, but to respect and be compassionate with our patients, getting closer, being open, showing friendship and commitment. The interdisciplinary team’s role is to listen and give support while the patient finds their own answers. In fact, the three things that a patient with a terminal disease wants to listen are: “I love you”, “forgive me” and “I forgive you”. As we said, talking about spirituality is very important but not easy.
Written by:
Lilian Hidalgo, MD
Geriatrician, palliative care subspecialist
Vice President, Peruvian Society of Palliative Care (www.paliativosperu.org)
Email: lilihjcookie@yahoo.com
Twitter: @paliativos_peru
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