The right to end-of-life spiritual care

Abstract

Spiritual care has been part of end-of-life care since the beginning of the modern hospice movement. It is a core component of palliative care as specified by the World Health Organization, and both patients and their relatives consider spirituality to be an important part of end-of-life care. Spiritual care can help patients cope better with their illness and help them achieve a sense of well-being whilst improving quality of life. The understanding of what this means, however, varies considerably among different patients, resulting in a broad range of expectations. That is why healthcare providers need to assess the patient’s particular needs so as to offer holistic patient-centred care. Nevertheless, spiritual care is still finding its place as a practice in healthcare. Standards of practice for spiritual care are still lacking and it is still debatable who should provide such care. Healthcare providers face various challenges when it comes to providing spiritual care. Limited training and education are considered the primary barrier to spiritual care provision. These barriers can lead to an infrequent use of spiritual care at the end of life, which can result in the presence of unmet spiritual needs. When patients’ spiritual needs are not appropriately addressed, spiritual distress can occur, which can negatively influence health outcomes. The purpose of this study is to examine the legal and ethical issues involved in viewing patients as having a right to end-of-life spiritual care. This study reviews empirical evidence to examine some of the ethical issues involved in integrating spiritual care in end-of-life care. It discusses the patients’ right to spiritual care from two perspectives. The first views spirituality as a dimension of health and well-being; therefore, patients can be considered to have a right to spiritual well being as a result of their right to the highest attainable standard of health and wellbeing. The second views spiritual care as a core component of palliative care; therefore, patients can be considered to have a right to spiritual care as part of their right to receive palliative care. This study also offers practical implications on how to safeguard the patient’s right to spiritual care at the end of life. It also highlights the need for bioethics to focus more on these spiritual issues as an attempt to solve the ethical dilemma related to the pivotal question: what is good care for the dying patient? Neglecting patients’ spiritual dimension of care should be considered a bioethical issue, especially when one considers the impact this may have on health outcomes and the influence it might have on the patients’ satisfaction with care. Ethical and legal frameworks regarding implementation of spiritual care in Maltese healthcare settings are also considered.