Spirituality and End-of-Life Care

Howard Spiro, M.D.

A while back the Hastings Center published a long lament about why changing end-of-life considerations had so bogged down.  The collected observations are all wise if not always consistent with views the authors had expressed many years ago, but to change is the stuff of wisdom.

But there was, as sadly usual, little consideration that what practicing physicians know provides a penumbra around the process of dying, and that is our inherited culture of religion and spirituality.  To say that I don't know why physicians and ethicists so ignore these matters would be to ignore the influence of science and rationality on medical practice and on  thinking.  Six decades of a life in medicine have underlined the advances made by science and technology, in contrast to the circular considerations of religion and philosophers, which return as they must to their beginnings. To be sure, physicians have long enjoyed the reputation of agnostics; there are few who would affirm a belief in a personal God.  Yet there must be many more who are comforted by religious music, poetry and even divine addresses.

Science has so dominated medical practice that back in the 1950s hospital chaplains began to avoid patients and somewhat diffidently to explore psychological matters far more confidently than spiritual wants.  This paralleled a change in doctors’ views of the unseen.  In our conferences, we wanted the surgeons’ presence and the radiologist to show us pictures of what we were treating along with the pathologist to show us the organs themselves. What we could not see we did not care about.

And that I believe is the problem with exhortations about end-of-life care, that they too often ignore the spiritual baggage that we all bring with us.  We may or may not have had a firm religious background, but we are moved by music as much as by metaphor, and by the unseen and ineffable as much as by what can be traced and even measured.

Published: July 21, 2007