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Quote from "Ethical Boundaries" [Hirving]

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Quote from "Ethical Boundaries" [Hirving]

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According to the authors of one widely
cited article, “It would . . . be disrespectful and not beneficial or
supportive of autonomy to encourage patients to ‘get’ religious or
spiritual beliefs if they do not have them”

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Individual experience when religion and spirituality

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Individual experience when religion and spirituality

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The Silence of Finite Space (Naturalism)  Gail

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The Silence of Finite Space (Naturalism)  Gail

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I find many non believers fall into the "reason is the sole criterion for truth" on page 67 of Sire's book.  If it dosn't logically follow, it must not be true.  I'm afraid that the sciences can breed religion out of out kids as they leave the haven of home and enter the logically based science programs.  Christianity must be accepted in a great part by faith. The test of reason does not fit many times.

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The Silence of Finite Space (Naturalism) Gail

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From this week study, religious involvement was shown to help people suffering from disability cope with the physical impairment and the psychological challenges that comes with being dependent. According to Koenig, causes of physical disability are important when considering the possible effects that religious involvement might have. Depression causes disability, and it is also a consequence of disability.

However, evidence from many studies show promising results of the impact of religion in reducing depression and these were backed with theoretical considerations that relate religious involvement and support to improved quality of life through positive attitudes such as improved motivation, hope, and improved  perception of self.

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"There is no place in a relationship of trust or in respectful care for inauthentic spirituality. Elsewhere we have argued that it is sometimes possible to negotiate ethical compromises in ways that preserve integrity."  This quote really jumped out at me, as it infers that feigning spirituality would be a breach of the patient's trust, and this something that is often seen in a busy healthcare setting.  If one is not comfortable with addressing the patient's spiritual needs, the proper course of action is to request the services of a chaplain or a spiritual care specialist of the patient’s own choosing. There may also be other professionals who could, with integrity, help the patient.  Even if the healthcare provider is not comfortable with religion, he/she could still support the patient's choice to pray, and we could appropriately participate in spiritual practices if the patients give consent, and make that request.

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I enjoyed the reading of this chapter. What interested me the most was the studies of African Americans who despite their disability never missed church. It reminds me of a friend of my mothers who had MS. She has come to the point that she is unable to move any of her extremities. However she has such faith that despite her being bed bound, she is able to praise God.  She will go to church in her wheelchair and a transport company taking her to worship.  the quote "While most studies show that religious involvement (particularly religious attendance) may prevent the onset and progression of disability, there is almost no evidence that disability prevents religious attendance over the long term.  Disabled persons, particularly those from minority communities, make extraordinary efforts to keep on going to church - since that is where they find their support and hope/" I agree that having hope despite being physically disabled is part of our spiritual makeup as humans.

Koeing, Medicine, Religion, and Health ; pg 151

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“In the most unethical manner, therapists not guided by the principle of exploring and understanding their own beliefs, values, and needs might lead prayer in a manner which is unfamiliar and uncomfortable to the client, praying for the assumed needs of the client as well as a few of their own.”

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Thoughts from Reading - The Universe Next Door. ( Kalai )

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Thoughts from Reading - The Universe Next Door. ( Kalai )

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I like the wording by La Mettire. " Let us conclude boldly then that man is a machine, and that in the whole universe there is but a single substance with various modifications."
Among the worldview questions, I find it fascinating to learn more about "Human beings are complex "Machines'; personality is an interrelation of chemical and physical properties we do not yet fully understand."

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I enjoyed reading through everyone's Padlet responses.  Some of the key points I gleaned are as follows: 

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I work at an endocrinology clinic and we treat patients with osteoporosis, so I found the findings on the fear of falling quite interesting.
"...[the] fear of falling is a strong predictor of age-related declines in physical health and...staying active in a religious community reduces that fear...[this] may be one reason why older adults who frequently attend religious services retain their physical functioning with age." (p. 152)

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Ethical Boundaries - Preserving personal and professional integrity (Hina)

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Ethical Boundaries - Preserving personal and professional integrity (Hina)

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An essential ingredient in forming and maintaining a relationships of trust is the virtue of integrity. The ethical ideal of integrity is to be a whole person who has sincerity of purpose. Central to the pursuit of personal integrity is the examination of one’s own convictions, including beliefs about what ultimately gives meaning to human life. A life of integrity is marked by actions that match well considered beliefs. If spirituality may properly be defined as a quest for ultimate meaning, then the development of integrity is linked to spirituality, as both have to do with the core of personhood. The connection between spirituality and integrity leads to the fourth guideline. Nonetheless, Integrity is one of the for cores of credibility for a successful leader.

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The Confounding Questions raised by Naturalism- Joan

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The Confounding Questions raised by Naturalism- Joan

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Prior to the course, I did consider Deists and Naturalists as one large group of "Good People" who found their ethics and solace in the material world rather than in God. Sire's definition  of Naturalism in response to seven basic questions (SUMMARY OF NATURALISM RESPONSE) : What is real?  MATTER, BECAUSE THERE IS NO GOD. What is the world around us? THE COSMOS, A CLOSED SYSTEM. What is a human?  A MACHINE WITHIN THE SYSTEM. What happens at death? THE END OF EXISTENCE. How do we know? THROUGH HUMAN REASON AS PART OF HUMAN NATURE.How do we know right and wrong? THROUGH AN AFFIRMATION OF A PERSONAL VISION.  What's the meaning of history? A LINEAR STREAM OF EVENTS WITHOUT AN OVERARCHING PURPOSE. and What are the core commitments of the world view? NO GOD, NO SPIRIT, NO LIFE BEYOND THE GRAVE.

The development of the world view and the flaws that the Soviet Union's experience show that at the bottom of Marxism, there needs to be a spirit of altruism (?Deism) for the worker to work for the common good rather than her material advancement.

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«anything that helps to prevent depression or
accelerate its resolution will likely affect a person’s ability and desire
to function mentally, socially, and physically» (Medicine, Religion, and Health - Where Science and Spirituality Meet, Koenig Harold G.).
This were R/S can play an important role.

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The Essential integrity of the Professional- Sophia Brown

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The Essential integrity of the Professional- Sophia Brown

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In the article Ethical boundaries of spiritual care by Winslow and Wehje- Winslow the important point was raised that on the point of the essential integrity of the professional that the professional should who cares for the spiritual needs of the patients should firstly seek to understand their own spirituality and secondly, participate in the spiritual care consonant with professional integrity. In essence it means that "to own selves be true" , we are therefore not able to give what we do not have. We therefore have to prepare ourselves and know our own boundaries

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"The essential ethical characteristic of professional health care is a
relationship of trust with the patient (and the patient’s family, if present). Trust is established when the health
care professional makes a commitment to seek the patient’s
wellbeing and protect the patient from harm. Trust is lost when
considerations other than the patient’s wellbeing are allowed to
take priority. A crucial element of trust is respect for the patient as a person. Respectful care begins with a willingness to learn about the needs and the resources of the patient as a whole person" (Winslow & Wehtje-Winslow, 2007).

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“Ethical Boundaries”- Kalpana “Ethical Boundaries of the Spiritual Care” are based on the main principle of Respect for the patient and professional integrity. According to the research, spirituality in health care has proved significant positive benefits on the coping mechanism and outcome measures in patients. The ethical boundaries are put for the spiritual health care professionals to understand the differences between the religion and spiritual need of the patient. It’s not about the rituals and practices of different faith but the need of the human for hope and meaning to their existence in times of health crisis. Thus, ethical boundaries with respectful care of the patient will enable healthcare professional to build a relationship of trust with the patient and the patients family. This trust is made strong when the health care professional aims towards the wellbeing of the patient. Respect for the patient means respecting and valuing the differences in the beliefs, religion background of the patient and to treat the patient as a whole person and not according to their religion or beliefs.I believe that when a professional spiritual health care provider does not respect the patient as a whole or does not understand the spiritual need but rather try to impose their own or judge the patient according to their believes will definitely shut the patient from discussing the need or getting help for spiritual care. I hope that these ethical guidelines should be implemented and followed in all the hospitals nationwide for the benefit of the patients.

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“Ethical Boundaries”- Kalpana “Ethical Boundaries of the Spiritual Care” are based on the main principle of Respect for the patient and professional integrity. According to the research, spirituality in health care has proved significant positive benefits on the coping mechanism and outcome measures in patients. The ethical boundaries are put for the spiritual health care professionals to understand the differences between the religion and spiritual need of the patient. It’s not about the rituals and practices of different faith but the need of the human for hope and meaning to their existence in times of health crisis. Thus, ethical boundaries with respectful care of the patient will enable healthcare professional to build a relationship of trust with the patient and the patients family. This trust is made strong when the health care professional aims towards the wellbeing of the patient. Respect for the patient means respecting and valuing the differences in the beliefs, religion background of the patient and to treat the patient as a whole person and not according to their religion or beliefs.I believe that when a professional spiritual health care provider does not respect the patient as a whole or does not understand the spiritual need but rather try to impose their own or judge the patient according to their believes will definitely shut the patient from discussing the need or getting help for spiritual care. I hope that these ethical guidelines should be implemented and followed in all the hospitals nationwide for the benefit of the patients.

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James W. Sire: The Universe Next Door when writing about Naturalism, “As Feurbach saw it, God is a projection of human potentiality, an expression of our unrealized ideals. Religion functions perniciously, since as soon as we invent God we devote ourselves to pleasing our imaginary construction instead of working to overcome the shortcomings that led to the invention in the first place.”

This passage made me reflect on Winslow & Winslow’s Ethical Boundaries of Spiritual Care discussion of their third guideline. Does a patient’s own understanding or perception of their religious traditions create dissonance or dysfunctional forms of coping when facing distress or illness? The authors write that “Sometimes, the ministry of a spiritual care leader who is acceptable to the patient may assist the patient in finding a more helpful grasp on his or her beliefs.” In a naturalism context, it would seem that the spiritual care leader in this case would simply be influencing the patient through their own “imaginary” projection of religion-based ethics. If that is the case, as Sire wrote above, are we missing the patient’s true “shortcomings that led to the invention in the first place”?

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Understanding Patient Boundaries: A fine line

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Understanding Patient Boundaries: A fine line

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The case of Caroline Petrie, a nurse who was fired from her job for offering to pray for one of her patients comes to mind when issues of ethical boundaries in spiritual care are discussed. http://news.bbc.co.uk/2/hi/uk_news/england/somerset/7863699.stm
Sharing or expressing your faith within a healthcare setting is a delicate gamble, often it pays off. Sometimes, patients are offended at the mere thought. It is important for healthcare professionals to thoroughly assess patient views on spirituality and proceed in a course that is respectful of the patient, despite personal beliefs.

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Amr Abdelaziz.

The religion has a great impact on our emotions and behaviors; upon the researches; Measure of physical disabilities are related to greater rates of depression and other negative emotions, and the religions have a great positive effects on negative emotions and able to cope with the behavior disturbances that came after disabilities or with chronic illness.

On one hand, The religion might make a difference in patients with chronic disabilities and chronic medical illness especially those younger patients with huge stress after disability or chronic diseases.

On the other hand,  people with health problems and disabilities are seeking the religion and spirituality for strength and comfort to cope and handle their stress and fear from the disabilities.

So anything that helps to prevent depressions or negative emotions will affect the person’s ability and desire to function mentally, socially and physically, and the religion is quite pretty option for those are suffering from the disabilities and chronic diseases to be able to return to the normal life with a positive way.

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Respectful care of the patient involves the following important guidelines:
1. A healthcare professional should understand a patient's spiritual needs and if he has no knowledge, he should try to get more information through various resources.
2. Patient's values should be put forth and importance should be given to patient's expressed wishes with regards to his spiritual needs.
3. Healthcare providers should not promote any particular religion or beliefs or practices and must preserve professional integrity.
4. Healthcare professionals should have a sound knowledge and understanding of their own spiritual beliefs as it opens up the way for respect and care for someone else's spiritual beliefs.
5. Participation in spirituality should be parallel to professional integrity.

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Ethical Boundaries of Spiritual Care (Mette)

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Ethical Boundaries of Spiritual Care (Mette)

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Winslow and Winslow,  outline 5 guidelines in their article Ethical Boundaries of Spiritual Care  All 5 guidelines are vital in the treatment of the whole patient. Guideline 4 particularly spoke to me: Health Care Professionals who care for the spiritual needs of patients should seek to understand their own spirituality.  As I am entering my third decade of clinical practice, I find this guideline essential to prevention of burn out, and my mental and physical health.

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" The essential ethical characteristic of professional health care is a relationship of trust with the patient and the patient’s family. Patients, made vulnerable by their illnesses, count on their carers to be trustworthy. Trust is established when the health care professional makes a commitment to seek the patient’s wellbeing and protect the patient from harm. Trust is lost when considerations other than the patient’s wellbeing are allowed to take priority."

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Ethical Boundaries of Spiritual Care (Juliette) 

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Ethical Boundaries of Spiritual Care (Juliette) 

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The ethical responsibilities of caregivers who are attuned to patients’ spiritual resources and needs were addressed in the article on Ethical Boundaries of Spiritual Care by Winslow and Winslow (2007). Answers provided dealt with the respectful care of the patient, and the essential integrity of the professional. Religion generally encompasses the teachings and rituals of various faith traditions. Spirituality, however, comes from the human need for hope and meaning. Trust is established when the health care professional makes a commitment to seek the patient’s wellbeing and protect the patient from harm.

Five ethical guidelines were provided that dealt with the current understanding of professional ethics with illustrations of what respectful care requires of caregivers with integrity:

1. In order to provide respectful care, health care professionals should seek a basic understanding of patients’ spiritual needs, resources, and preferences.

2. Respect for the patient requires that health care professionals follow the patient’s expressed wishes regarding spiritual care.

3. Health care professionals should neither prescribe spiritual practices nor urge patients to relinquish religious beliefs or practices.

4. Health care professionals who care for the spiritual needs of patients should seek to understand their own spirituality.

5. Participation in spiritual care should be consonant with professional integrity.

Guided by ethical reflection, health care professionals may better serve patients who desire spiritually nurturing health care. In an age of sophisticated medical care and interventions, patients still want spiritually nurturing health care. The value of providing whole-person care should lead health care professionals to meet both physical needs as well as the needs of the human spirit seeking meaning and purpose.

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Depression, Naturalism and Nihilism (Ashwin)

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Depression, Naturalism and Nihilism (Ashwin)

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"Patients, made vulnerable by their illnesses, count on
their carers to be trustworthy.
Trust is established when the health
care professional makes a commitment to seek the patient’s
wellbeing and protect the patient from harm. Trust is lost when
considerations other than the patient’s wellbeing are allowed to
take priority.
A crucial element of trust is respect for the patient as a person.
One recent study of patients’ attitudes to spiritual care found that
patients must feel respected by their physician in order to risk
discussing spiritual issues."

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I found it interesting that hospitals must have spiritual assessment of patients. I also agree with Pellegrino’s words, “To ignore, override, repudiate, or ridicule the patient’s values is to assault the patient’s very humanity. This affront aggravates the disintegration of the person already there as a result of illness” I find this very true in todays day and age.

The conclusion of the article provided also struck a cord with me especially “The value of providing whole-person care should lead health care professionals to offer care not only for physical needs but also for the needs of the human spirit in search of meaning.”

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Ethical boundaries and reflection on chapter 10 of Koenig

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Ethical boundaries and reflection on chapter 10 of Koenig

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Brian Verville, DPT
In the Ethical Boundries paper I found it insiteful that they recognize the importance of building and establishing a trusting relationship as well as to build a trusting relationship the patient needs to feel respected as a person. Part of building such a relationship is to focus on the whole person. To take time to understand the patients needs outside of the physical elements of illness. I also found that #4 Health care professionals who care for the spiritual needs of patients should seed to understand their own spirituality. It is through understanding ones own self that we can then truly Help others. there is an understanding and rule that when you are flying on a plan and they address the group. They say that in the event of a decompression the air mask will drop. Make sure you put on your own mask first then you can assist others with their mask.... If we don't  take care of ourselves we are not going to take care of others.. This is true in this case as well in that we would not be able to begin to understand someones spiritual needs if we do not have an understanding of our own needs in this area.

Refleion on Chapter 10 I have found the common trend throughout this book to be that R/S builds a sense of belonging, has a social aspect to being involved and assists with coping.  All of which I believe in. Also having a higher level of R/S helps to decrease depression which is not only can be a cause of physical disablity but also can result from and often does result from physical disability. In the elderly for example when they lose the ability to drive people tend to have a sense of loss of ID and independence. I can surely see how being involved in a religious community and have a social outlet can lessen the depression and loss of feeling of self worth. I also like how He explains that research is unable to be fully explained in that people tend to TURN to religion as they become more physically disabled or ill.  It reminded of a quote from one of the videos we watched a few weeks ago when someone said there are no Atheists in the Fox hole.   I would also like to see him or someone take a deeper look at the affects R/S on younger population in areas of physical and emotional disability.

Brian

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“Earning Trust in relationship with patient”-Sarathy

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“Earning Trust in relationship with patient”-Sarathy

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When the patients are in need of spiritual care, earning trust is not that easy when someone is having chronic illness or severely affected. Even in normal day to day care, if the patient is not trusting in our care, then cooperation from patients is not possible. To gain trust from patient, health care provider should have commitment to seek patient’s well- being and protect them from harm.

Critical element of trust is respecting a patient as a whole person.  According to Cohen and colleagues, health care professionals are constrained to “treat the patient as a whole person”.  Respectful care begins when health care provider shows willingness to learn about patients’ needs and its resources.

I have an example to explain this, of course this patient has chronic illness but not at end of life situation. When he came to facility at the beginning we had a very rough time in understanding his behavior, but after had a chat with him as a team and talked about his needs and we divided our care within team, afterwards, we gained his trust, now he listens to us, he works towards his goals with his full potential, he is making excellent progress. Gaining his trust was not attained initially, so he was not cooperating at all. I feel the same thing well suits to spiritual care too.

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"In order to provide respectful care, health care professionals should seek a basic understanding of patients’ spiritual needs, resources, and preferences.
Just as it would be inappropriate to give physical care without an understanding of a patient’s diagnosis and the goals of treatment, it would be inappropriate to proceed with spiritual care that does not take into account the distinctive beliefs and values of the patient. "

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"Health care professionals who care for the spiritual needs of patients should seek to understand their own spirituality."

I do agree with the article. One of the highlights of the article was asking the patients questions about spirituality. We, as therapists, with good practice and an understanding of our spirituality might be able to assess patient’s religious and spiritual needs by asking those four questions and it must be a part of our routine patient interview. As mentioned in earlier posts, there might be times when the patient might not be aware of their spiritual needs until they are asked about it.

I do believe if the disability is debilitating, it can lead to depression. As patients become more and more depressed, they have less and less motivation to rehabilitate and become less fully engaged in their own recovery. In cases like these, faith and spirituality can play a big role in getting hope and a sense of direction towards life. I agree with Koeing about fear of falling is a and declines in physical health. He compared fear of falling with a daily activity like attending religious services. Another take home message from the article was health care professionals should seek a basic understanding of patients’ spiritual needs, resources, and preferences which I will try to include in my practice.

Shikha

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Rays of hope (Pugazhenthi Narasimhan-Pugi):  "As hope reappears and depression lifts, motivation increases and patients feel more like exercising and involving themselves in self-care types of activities that will ultimately slow the development of chronic disability or speed recovery from it".Koenig, Harold G.. Medicine, Religion, and Health: Where Science and Spirituality Meet (Templeton Science and Religion Series) (pp. 148-149).

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Rays of hope (Pugazhenthi Narasimhan-Pugi):  "As hope reappears and depression lifts, motivation increases and patients feel more like exercising and involving themselves in self-care types of activities that will ultimately slow the development of chronic disability or speed recovery from it".Koenig, Harold G.. Medicine, Religion, and Health: Where Science and Spirituality Meet (Templeton Science and Religion Series) (pp. 148-149).

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This chapter makes an important link between coping behavior and physical disability and states, "throughout this book, I have emphasized the importance of religion as coping behavior. Therefore, it should not be surprising that, by helping patients to cope, religious beliefs and behaviors might help reduce the depression that results from disability."

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It is surprising to me that after infection and parasitic disease the leading cause of disability is major depression. This just shows how often we may overlook the mental causes of disability and that in general, mental health can be an "invisible" and under-recognized illness with functional limitations. Regular religious practice may help to lessen the effects of disability, including those caused by mental illnesses (Chapter 5).