The hospice: Humane care for the dying

The hospice movement arose as a reaction to the dehumanizing atmosphere of acute-care hospitals, where excessive utilization of life support equipment deprived dying patients of a meaningful vision of their destiny. Respecting the spiritual quest of the terminally ill for wholeness and dignity, the hospice concept prescribes the rendering of compassionate and pastoral care by a benevolent community of family, health care staff, friends, and clergy. Approximately 800 hospice programs are currently evolving in the United States. St. Mary's (formerly Hillhaven) Hospice in Tucson, Arizona, offers the most comprehensive program of services, including home care, inpatient care, and artistic media through which the dying express their creativity. Numerous demonstration projects funded by several government agencies, principally the Health Care Financing Administration (HCFA), are expected to result in legislative actions eliminating barriers to reimbursement of the cost of hospice services by Medicare, Medicaid, and other third-party payers. Existential analysis reveals the value of religion and spiritual support in enabling the dying to banish anxiety and muster the hope requisite for fully appreciating the authentic meaning of their destiny.     

Pastoral care of the dying patient

Conclusion and Summary The ministerial role appears to involve four basic aspects or functions: personal, counseling, pastoral, and theologizing. In order to be a minister, one must be available as a fellow human, with some psychological skill, able to share spiritual or religious activity, and willing to articulate theologically to himself the meaning of his experiences for his personal faith. These aspects of the ministerial role are exemplified in the encounters of divinity students with disabled and dying patients. Because of the challenge that life presents to sincere faith, and because one or more of the four functions are often stressed in an isolated way, offensive stereotypes of the minister are pervasive. p ]Abhorrence of being identified as such a person made the ministerial candidates in this report reluctant to act or even speak in any religious way. The desire to become a psychologist or counselor and avoid theological topics, strong in the beginning, tended to disappear toward the end of the year. These phenomena were seen as natural phases of sequential growth in the struggle to understand the needs of other persons for a minister. As shift from self-concern to concern for the other occurred, the students became more open to learning from the patients how human and religious needs can be served without desecration to either.     

Spiritual growth through care of the dying

One of the most difficult issues with which clergy must deal is that of theodicy, the reconciliation of a good God with evil in this world. The case of L.R. is that of a good thirty-nine-year-old man dying of cancer. This paper examines the role of the clergy in working with the dying patient, traditional responses to the questions of theodicy, and a proposal for an adequate contemporary solution to the issue of theodicy. One key factor in caring for the dying is the mutual spiritual growth of the dying patient and the clergy care giver.     

Utilizing hospice for visitation of comatose patients: field education for pastoral care students

This article provides a reflection on how three educational organizations utilized a hospice setting for field experience to provide spiritual care with comatose patients. It outlines how three students, who formed a collegial group, prepared for the experience, completed and documented assigned visits, summarized outcomes, and discussed some implications for ministry with terminally ill comatose patients.     

Masculine and feminine voices: Making ethical decisions in the care of the dying

Drawing on the example of one specific Ethics Committee, the author delineates feminine and masculine styles of ethical decision making and work with the dying as two sides of what it means to be humanistic in patient care. The author draws particularly on the work of Carol Gilligan to differentiate feminine from masculine approaches.     

Assessing offenders: dying for reprieve

As is true for those who face death, the trauma of arrest and conviction for a crime and subsequent imprisonment takes the individual through a series of psychological stages, In the offender, these defenses are to some extent prescribed by the culture. The nature of and the person's adaptation to this process has not been previously recognized and argues for an assessment approach that emphasizes developmental rather than static formulations. Examination and treatment implications are discussed.     

The benefits of anticipatory grief for the parents of dying children

Abstract

The authors develop a strategy for intervening into rigidly homeostatic systems. Central to the task is the identification of system rules, which often reveal themselves around “nodal themes.” The authors describe four types of nodal themes and offer clues to identifying them within families. Finally, they suggest ways of using system rules and nodal themes in the development of paradoxical interventions.     

The blame of dying young

The American Journal of Psychoanalysis -     

The final challenge: ageing, dying, individuation

This paper is about the psychotherapy of a woman who passed from what Waddell (1998) would term 'older age' to 'later life', by which latter I mean the inevitable decline into dying and death. However unwelcome these developments may be to the individual, they are none the less activities of the soma, and therefore activities of the self-deintegrates. Much of the work of the psychotherapy centred around the task of enabling the patient to relate to and accept the bodily and emotional correlates of this process, which she tended to want to disown and deny by means of a split between mind and body along the lines of a long-standing internal depressive relationship. Permitting her contact with herself allowed her a much greater sense of internal company and peace, and arguably facilitated an easier process of dying, involving a self reconciled with itself rather than one at odds. Technically, the approach involved a greater concentration on the intrapsychic relationship rather than on the relationship between patient and analyst, and this is briefly discussed in terms of the work of Armando Ferrari who had himself died, shortly before the paper was first presented, and to whom therefore it is in part a homage.