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.     

Babies Born Dying: Just Bad Karma? A Discussion Paper

The paper examines the notion of being born dying and karma. Karma is a belief upheld by Buddhists and non-Buddhists: That is, karma follows people from their previous lives into their current lives. This raises a difficult question: Does karma mean that a baby’s death is its own fault? While great peace can be found from a belief in karma, the notion of a baby’s karma returning in some sort of retributive, universal justice can be de-emphasized and is considered “un-Buddhist.” Having an understanding of karma is intrinsic to the spiritual care for the dying baby, not only from the perspective of parents and families who have these beliefs, but also for reconciling one’s own beliefs as a healthcare practitioner.     

Emotions and Change in Spiritual Care

How does spiritual care help people change? What role do emotions play? Intercultural spiritual care helps people change their ‘lived theology/orienting system’—an emotionally-charged constellation of values, beliefs, and habitual ways of coping with stress. A case study based on the novel Affliction by Russell Banks and a film by the same title illustrates how trauma-related feelings of fear and shame pull together a lived theology for the protagonist, Wade Whitehouse, shaped by intersecting social systems of classism, sexism, and racism. His story illustrates the challenges of spiritually integrative spiritual care focused on emotionally charged lived theologies.     

The difficulties assessing spiritual distress in palliative care patients: a qualitative study

This paper reports on a focus group study aimed at exploring the difficulties that palliative care healthcare professionals encounter while assessing the spiritual distress of their patients. Three focus groups were conducted in a hospice (n = 15). Participants were all healthcare professionals working in the hospice in-patient unit. Interviews were taped and later transcribed. The data was analysed through content analysis. Emergent themes included: lack of vocabulary around spiritual issues, personal issues surrounding death and dying, training issues, fear of being unable to resolve spiritual problems, time constraints and difficulty separating spiritual and religious needs. Participants provided a number of recommendations for improving care. This pilot study has generated useful data in relation to how spiritual care of patients might be improved. Despite the abundance of academic publications and policies on spirituality, this area is not integrated well into palliative care.     

The ethics of selectively marketing the Health Maintenance Organization

Health Maintenance Organization (HMO) administrators have been accused of engaging in ‘selective marketing’. That is, through such strategies as tailoring the benefits package of the program or advertising in styles or in media that do not appeal to certain ‘undesirable’ audiences, the administrator can minimize the percentage of persons in the HMO who are heavy users of health care services. By means of analyzing what ‘insurance’ is (philosophically) and what it means for something to be a free market commodity, the author argues that, as long as American society chooses to regard health insurance as a commodity or service of the free market, the use of such strategies is within the moral rights of health administrators. The author concludes by noting some morally undesirable results of treating health insurance as a market commodity.     

Carrying the Burden: Perspectives of African American Pastors on Peer Support for People with Cancer

For African Americans facing advanced cancer, churches are trusted sources of support and ideal settings to improve access to supportive care. The Support Team model enhances community support for practical, emotional, and spiritual caregiving. We report on focus groups with pastors of 23 Black Churches and explore their perspective on the Support Team model for church members with cancer. Pastors describe the needs of church members facing cancer from a holistic perspective and recognize opportunities for synergistic faith–health collaboration. The results of this study indicate potential benefits of the Support Team model in Black Churches to reduce silent suffering among individuals facing cancer.     

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.     

Dying: A universal human experience?

This paper explores the question, “Is there a universal psychological experience suffered by all dying persons?” a question to which the popular theory of Kübler-Ross presupposes an affirmative answer. Our answer takes three steps: first, a comparison between the Kübler-Ross model of dying and that of the late medievalBook of the Craft of Dying centered upon the five Kübler-Ross “stages”; second, a philosophical critique of the terms of this comparison; and third, a revised look at the alleged similarities between the two models, providing a deeper look at the moral and spiritual assumptions behind each.     

The Human Right to Water: The Importance of Domestic and Productive Water Rights

The United Nations (UN) Universal Declaration of Human Rights engenders important state commitments to respect, fulfill, and protect a broad range of socio-economic rights. In 2010, a milestone was reached when the UN General Assembly recognized the human right to safe and clean drinking water and sanitation. However, water plays an important role in realizing other human rights such as the right to food and livelihoods, and in realizing the Convention on the Elimination of All Forms of Discrimination against Women. These broader water-related rights have been recognized but have not yet been operationalized. This paper unravels these broader water-related rights in a more holistic interpretation of existing international human rights law. By focusing on an emerging approach to water services provision—known as ‘domestic-plus’ services—the paper argues how this approach operationalizes a comprehensive range of socio-economic rights in rural and peri-urban areas. Domestic-plus services provide water for domestic and productive uses around homesteads, which challenges the widespread practice in the public sector of planning and designing water infrastructure for a single-use. Evidence is presented to show that people in rural communities are already using their water supplies planned for domestic uses to support a wide range of productive activities. Domestic-plus services recognize and plan for these multiple-uses, while respecting the priority for clean and safe drinking water. The paper concludes that domestic-plus services operationalize the obligation to progressively fulfill a comprehensive range of indivisible socio-economic rights in rural and peri-urban areas.     

Approving the use of animals in medical education

Animals have been and will continue to be used in educational programs, but some concerns about the responsibility for assuring their proper care and humane use need to be discussed. Research animals have been regulated and monitored quite successfully by Institutional Animal Care and Use Committees (IACUC). These Committees are extending their responsibilities to cover animals used in educational programs. Three common roles of these IACUCs are described, including oversight, investigative and training responsibilities. Guidelines developed for faculty using animals at the University of Florida are presented and discussed.     

Spiritual Experiences of Muslim Critical Care Nurses

The purpose of this study was to determine the experiences and perceptions of intensive care nurses (ICNs) about spirituality and spiritual care, as well as the effective factors, and increase the sensitivity to the subject. In this study, we examined spiritual experiences, using McSherry et al. (Int J Nurs Stud 39:723–734, 2002) Spirituality and spiritual care rating scale (SSCRS), among 145 ICNs. 44.8% of the nurses stated that they received spiritual care training and 64.1% provided spiritual care to their patients. ICNs had a total score average of 57.62 ± 12.00 in SSCRS. As a consequence, it was determined that intensive care nurses participating in the study had insufficient knowledge about spirituality and spiritual care, but only the nurses with sufficient knowledge provided the spiritual care to their patients.     

Attitudes of Muslim Physicians and Nurses Toward Religious Issues

There is a growing body of evidence that suggests a positive role for religious involvement in physical and mental health. Studies have shown that attitudes of physicians toward religion affect their relationship with patients and their medical decisions, and in this way may ultimately affect treatment outcomes. Attitudes of nurses toward religion could also influence whether or not they address patients’ unmet spiritual needs. To assess attitudes of physicians and nurses toward religion and how these attitudes vary by education level and demographic characteristics, a total of 800 physicians, medical students, and nurses from some of the largest hospitals in Tehran, Iran, were approached, of whom 720 completed questionnaires (148 nurses, 572 medical students and physicians). The survey questionnaire included the Duke University Religion Index (DUREL), Hoge Intrinsic Religiosity Scale, a brief measure of Negative Religious Coping (NRCOPE), and the brief Trust/Mistrust in God Scale. Religious attitudes and practices were compared between physicians (medical students and physicians) and nurses. Regression analysis revealed that except for intrinsic religiosity, physicians were not less religious than nurses on any other dimension of religiosity. Training level (year of training) was a predictor of religiosity, with those having less training being the most religious. The findings suggest that there are few religious differences between nurses and physicians in Iran. However, religiosity may become less as the training level increases. Lack of emphasis in training on the important role that religion plays in health care may result in a decrease in religious involvement and the development of negative attitudes toward religion over time (displaced by a focus on the technological aspects of health care).     

Near-Death Experiences and Spiritual Well-Being

People who have near-death experiences often report a subsequently increased sense of spirituality and a connection with their inner self and the world around them. In this study, we examined spiritual well-being, using Paloutzian and Ellison’s Spiritual Well-Being Scale, among 224 persons who had come close to death. Participants who reported having near-death experiences reported greater spiritual well-being than those who did not, and depth of spiritual well-being was positively correlated with depth of near-death experience. We discussed the implications of these findings in light of other reported aftereffects of near-death experiences and of spiritual well-being among other populations.     

A Dangerous Movie? Hollywood Does Psychoanalysis

After the appearance of David Cronenberg’s film A Dangerous Method in 2011, dealing with the relationships of Sigmund Freud, C. G. Jung and Sabina Spielrein, Dr. Donald Ferrell published: A Dangerous Method, A Film Directed by David Cronenberg: An Extended Review (Ferrell 2012) in the Journal of Religion and Health. Upon its publication, Dr. Ferrell’s article was nominated for a Gradiva Award by the National Association for the Advancement of Psychoanalysis. On November 1, 2013, the Association for the Psychoanalysis of Culture and Society held its annual conference at Rutgers University, New Brunswick, NJ. Dr. Billie Pivnick, a member at large of the Board of Directors of the APCS and also on the Editorial Board of the Journal of Religion and Health, persuaded the 2013 Conference Program Committee that Cronenberg’s film would make an interesting subject for discussion for conference participants. To that end, Dr. Pivnick invited Dr. Ferrell, C. G. Jung Institute of New York, Dr. Steven Reisner, Coalition for an Ethical Psychology, and Dr. Martin Silverman, Training and Supervising Analyst and Supervising Child Analyst at the Institute for Psychoanalytic Education, NYU College of Medicine, Training and Supervising Analyst at the Center for Psychotherapy and Psychoanalysis of New Jersey, and Associate Editor of The Psychoanalytic Quarterly to serve as panel members to discuss: A Dangerous Movie? Hollywood does Psychoanalysis. Presentations on Cronenberg’s film and the early history of psychoanalysis were given by Drs. Ferrell and Reisner, followed by a response to their presentations by Dr. Silverman. Dr. Pivnick chaired the session. The articles presented here were given originally at the APCS conference by Dr. Ferrell and Dr. Silverman. Dr. Reisner declined the invitation to submit his presentation for publication. Dr. Silverman’s remarks were based not only on the presentation given by Dr. Ferrell at the session on A Dangerous Movie?, but also on his close and careful reading of the extended review of Cronenberg’s film Dr. Ferrell published in the Journal of Religion and Health, as well as Dr. Reisner’s presentation. It was appropriate for Dr. Silverman to serve in his capacity as discussant since he had earlier published a critical review of A Secret Symmetry. Sabina Spielrein Between Jung and Freud by Aldo Carotenuto (Silverman 1985).     

Achieving a Maximum Level of Vaccination for Medical Students: a Rigourous Ethical and Legal Framework Procedure

The Faculty of Medicine and Health Sciences (FMHS) of the University of Sherbrooke has observed year after year, that certain students have not started and or completed their immunizations for common infectious diseases, which in effect makes them inadmissible for their clinical internships in healthcare establishments. The program administrators have posed a series of questions on the best way to proceed with these students as, a certain number remain reluctant to vaccination. They are often confronted with ethical dilemmas, are not necessarily comfortable with their rights and responsibilities and wish to be guided throughout the process. This article aims to put forth a procedure that would be put in place to support the administrators in a way for them to obtain a more favorable vaccination level for all of their students in the most reasonable amount of time possible. The interest of the procedure is to move forward in a few simple and well defined steps that are supported by a rigorous legal framework, while respecting the rights and freedoms of the students. It is also designed so that it could be replicated in other faculties of medicine.     

THE CONCEPT OF ‘PSYCHOLOGICAL SAFETY’ – A PSYCHOANALYTICALLY‐INFORMED CONTRIBUTION TOWARDS ‘SAFE,SOUND & SUPPORTIVE’ MENTAL HEALTH SERVICES

It is not controversial to say that we live in an era of unprecedented preoccupation with the notion of ‘risk’ in our public mental health services, not to mention other areas of public life. Notions of ‘risk’ and ‘safety’ have long been at the heart of current government policy on mental health as epitomized by the guidance document entitled Modernising Mental Health Services: Safe, Sound & Supportive (Department of Health [DoH] 1998 Department of Health. 1998. Modernising Mental Health Services: Safe, Sound and Supportive, London: Department of Health.  [Google Scholar]). This is partly a consequence of the continuing switch of emphasis by both major political parties over the last 20 years or more away from hospital or in‐patient care and towards community‐based services. This is not the place, however, to focus on the political context. However, in clinical terms what really is the difference between a ‘safe’ or ‘secure’ mental health service and an ‘unsafe’ or ‘insecure’ one? The more I have been invited to think about this question, the more complex and unfamiliar the territory has revealed itself to be.     

Attitudes Toward Spirituality and Spiritual Care among Iranian Nurses and Nursing Students: A Cross-Sectional Study

Addressing spiritual needs is taken into account as an integral part of holistic health care and also an important component of nursing practice. The aim of present study is to evaluate attitudes toward spirituality and spiritual care among nurses and nursing students at Semnan University of Medical Sciences in Iran. In this cross-sectional study, all nurses (n = 180) working in the teaching hospitals affiliated to Semnan University of Medical Sciences as well as senior nursing students (n = 50) selected by the census method. Finally, 168 individuals meeting the inclusion criteria were evaluated as the study sample. The data collection instrument was the Spirituality and Spiritual Care Rating Scale. The mean and standard deviation scores of attitudes toward spirituality and spiritual care among nurses and nursing students were 59 ± 10.9, and the scores obtained by the majority of study population (64.3%) ranged between 32 and 62 which were at a moderate and relatively desirable level. Nurses and nursing students working in aforementioned hospitals reported positive attitudes to spirituality and spiritual care. Given the importance of spiritual care and also the moderate level of spirituality and spiritual care among nurses and nursing students in this study, institutionalization of the concept of spirituality, provision of an appropriate context to deliver such care, and also implementation of interventions in order to improve spiritual care along with other nursing skills were assumed of utmost importance.     

The Effect of Genetic Counseling for Adult Offspring of Patients with Type 2 Diabetes on Attitudes Toward Diabetes and its Heredity: A Randomized Controlled Trial

The aim of this study is to investigate the effect of diabetes genetic counseling on attitudes toward diabetes and its heredity in relatives of type 2 diabetes patients. This study was an unmasked, randomized controlled trial at a medical check-up center in Japan. Subjects in this study are healthy adults between 30 and 60 years of age who have a family history of type 2 diabetes in their first degree relatives. Participants in the intervention group received a brief genetic counseling session for approximately 10 min. Genetic counseling was structured based on the Health Belief Model. Both intervention and control groups received a booklet for general diabetes prevention. Risk perception and recognition of diabetes, and attitude towards its prevention were measured at baseline, 1 week and 1 year after genetic counseling. Participants who received genetic counseling showed significantly higher recognition about their sense of control over diabetes onset than control group both at 1 week and 1 year after the session. On the other hand, anxiety about diabetes did not change significantly. The findings show that genetic counseling for diabetes at a medical check center helped adults with diabetes family history understand they are able to exert control over the onset of their disease through lifestyle modification.     

A Clinical Intervention in Chronic Pain and Insomnia with a Combined Model of Treatment: A Test of Concept

Co-occurring chronic pain and insomnia are common in a clinical setting. Cognitive–behavioral theoretical (CBT) frameworks exist for both conditions independently. The purpose of this study was to address the problem of co-occurring chronic pain and insomnia with an integrated CBT model based on empirical support. One-hundred eleven individuals (age range 21–65 years) meeting the general criteria for chronic pain and insomnia were included in this study. Participants completed a demographic form, the Dysfunctional Beliefs and Attitudes about Sleep—16-item version, Insomnia Severity Index, Sleep Hygiene Index, Sleep Associated Monitoring Index, Pain Catastrophizing Scale, Pain Disability Questionnaire, Modified Somatic Perceptions Questionnaire, Hospital Anxiety and Depression Scale, and Multidimensional Scale of Perceived Social Support. Significant positive bivariate relationships were observed for pain catastrophizing (PC) and dysfunctional beliefs and attitudes about sleep (DBAS), as well as somatic awareness and sleep-associated monitoring. Two backward stepwise regression models were utilized to determine a model for predicting insomnia severity and pain disability respectively using a combination of sleep and pain-associated measures. Insomnia severity was predicted by DBAS, PC, and somatic awareness. Pain disability was predicted by PC, DBAS, depression, and social support. Maladaptive thought patterns related to pain and insomnia and associated features appear to have a synergistic effect on both insomnia severity and pain disability and support a combined cognitive–behavioral model.     

How Stable is the Well-Being of Australian Mothers Who Care for Young Children with Special Health Care Needs?

Ninety-seven percent of children who have special health care needs are cared for by their mothers. These mothers cite that their informal care work can be intrinsically rewarding, however, the role is not without substantial difficulties and consequences. We investigated differences in the health and well-being of mothers whose young children do and do not have special health care needs. Quantitative data are drawn from Growing Up in Australia: The Longitudinal Study of Australian Children. This study employs a matched-case control methodology to compare the experiences of a group of 292 mothers whose children are identified as having long term special health care needs to those mothers whose children are typically developing at two time points; Wave 1 (2004) and Wave 3 (2008). The findings support previous research that mothers of children with special health care needs have poorer general health and mental health than mothers whose children do not have special needs. Mothers of children with special health care needs also perceived life as more difficult. Longitudinally, this study also shows that maternal well-being remains relatively stable during the years when children are transitioning to formal schooling. Implications for policy makers, practitioners and early childhood professionals are discussed.