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Courses – McGill University

Dr. A. Missagh Ghadirian — McGill Courses

Dr. Ghadirian is presently teaching a course in Spirituality and Ethics in Medicine at McGill University, Faculty of Medicine.

Spirituality and Ethics in Medicine: a new approach to compassionate care

OVERVIEW

Compassionate care of the sick and suffering is the prime purpose of the doctor-patient relationship.  In our multicultural society where diversity of religious tradition is common, many patients’ attitudes toward physicians and treatment are influenced by their personal beliefs and values.  They expect to be understood not only with respect to their pathology but also to their cultural and spiritual views on health and healing.

Medical science with its unprecedented discoveries and progress has expanded our knowledge and sharpened our skill to diagnose and treat patients.

But acquisition of moral values and compassionate care in relation to a patient goes beyond scientific endeavours.  It is an art grounded in faith and spiritual understanding of the true nature of human beings.

Is it possible to have harmony between science and spirituality?

Physicians are understandably reluctant to play the role of clergy in the practice of medicine nor do patients expect them to act as clergy.  But many patients feel that their doctors, who are perceived as their most important healers, should be able to relate to and acknowledge their moral values.  They believe that doctors should be able to empathize with them regardless of the religious persuasion from which they come.  Lacking such knowledge and insight may not only be embarrassing but also may undermine the trusting relationship between physician and patient.

Do certain religious beliefs conflict with medical ethics?

For most religious patients, their decision to accept or reject treatment is influenced by their beliefs.  In fact, some patients may refuse to follow certain medical or surgical procedures because they see them as being in violation of their beliefs.  This creates a situation in which the physician’s decision to comply with a patient’s wish puts him/her in sharp conflict with the ethics of medical practice.  How is a physician supposed to react in such a dilemma?

What is the meaning of suffering?  What is a spiritual perspective on death and dying?

In palliative care or in the intensive care unit where  patients face imminent death and dying, they often have questions which are grounded in their cultural and religious teachings.  The fear of death is very real; some may perceive it as an impending punishment from God, while others are scared of total destruction and break with their loved ones.  How can physicians provide comfort and reassurance if they have no empathic insight or compassionate skill to alleviate such existential crises?  And when the patient dies, how will the physician convey the news to the family?

Is there any relationship between mental health and spirituality?

These and many other challenging issues will be of great interest to explore.

 

Suggested literature on Spirituality and Medicine

Available online:

Astrow, A.B., Sulmasy, D.P.:  Spirituality and the Patient-Physician Relationship JAMA. 291:2884, 2004.

Breitbart, W. et al. “Depression, hopelessness, and desire for death in terminally ill patients with cancer”, JAMA 2000; 284 pp. 2907-2911.

Breitbart, W. et al. “Reframing hope: meaning-centered care for patients near the end of life”, J. Pall. Med. 2003; 6(6). pp. 979-988.

Chibnall, J.T., Duckro, P.N. Does exposure to issues of spirituality predict medical students’ attitudes towards spirituality in medicine? Academic Medicine. 7:6:661, June 2000. Assn of American Medical Colleges, US.

Csikszentmihalyi, Mihaly. If We Are So Rich, Why Aren’t We Happy? American Psychologist. Vol. 54 (10) October 1999, pp. 821-827.

Daalman, T.P., VandeCreek L.: Placing religion and spirituality in end-of-life care. JAMA, 284: 19:2514-2517, Nov. 2000.

Flannelly, K. et al. “A systematic review of religion and spirituality in three palliative care journals, 1990-1999”, J. Pall. Care. 2004; 20(1) p. 50-56.

Fortin, A.H., Barnett K.G., Medical School Curricula in Spirituality and Medicine. JAMA.291: 2883, 2004.

Ghadirian, A-M.: Is spirituality relevant to the practice of medicine? J. Medicine and Law. (27) 229-239, 2008 (available only in web curriculum)

Grabovac, A.D., Ganesan, S.: Spirituality and religion in Canadian psychiatric residency training. Can J. Psychiatry, 48 (3) 171-175, 2003.

Hinshaw, D.B. “Spiritual needs of the dying patient” J. Am. Coll. Surg. 2002; 195 p. 565-568.

Hodges, S.: Mental health, depressions, and dimensions of spirituality and religion. [Article] Journal of Adult Development. 9(2): 109-115, 2002 Apr.

Kaut, K.P.: Religion, spirituality and existentialism – Near the end of life. Am. Behavioral Scientist, 45(2): 220-234, 2002.

Kissman K., Maurer L.: East meets West – Therapeutic aspects of spirituality in health, mental health and addiction recovery. International Social Work. 45(1): 35-43, Jan. 2002.

Koenig, H.G.: Religion, spirituality and medicine: How are they related and what does it mean? Mayo Clinic Proceedings, 76(12): 1189-1191, 2001. 

Koenig, H.G.: Taking a Spiritual History. JAMA. 291:2881, 2004.

Latimer, E.J.: Ethical care at the end of life, CMAJ, June 30, 1998 (158) 13: 1741-1747.

Lo, B. Ruston, D., Kates L.W.: Discussing religion and spiritual issues at the end of life – A practical guide for physicians. JAMA, 287(6): 749-754, 2002.

Mansfield, C.J., Mitchell. J., King D.E.: The doctor as God’s mechanic? Beliefs in the southeastern United States. Social Science & Medicine, 54: 399-409, 2002.

Marrow, R: Dying, mourning, and spirituality: A psychological perspective. Death Studies, 23: 495-519, 1999.

McSherry, W., Draper, P., Kendrick, D.: The construct validity of rating scale designed to assess spirituality and spiritual care. International Journal of Nursing Studies. Vol. 39 (7): 723-734, Sep. 2002.

Miller W.R.: Researching the spiritual dimensions of alcohol and other drug problems. [Review] Addiction. 93(7): 979-990, 1998 Jul.

Modjarrad, K: Medicine and Spirituality JAMA. 291: 2880, 2004.

Mueller, P.S., Plevak, D., Rummans, T.A.: Religious involvement, spirituality and medicine: Implications for clinical practice. Mayo Clinic Proceedings 76: 1225-1235, 2001.

O’Hara, D.P.: Is there a role for prayer and spirituality in health care? Medical Clinics of North America, 86: (1): 143, 2002.

Ortiz, L.P.A., Langer, N.: Assessment of spirituality and religion in later life: Acknowledging clients’ needs and personal resources. Journal of Gerontological Social Work. Vol. 37 (2): 5-21, 2002.

Puchalski, C.M.: Spirituality and health: The art of compassionate medicine, Hospital Physician, pp. 30-36, March 2001.

Puchalski, C.M.: Spirituality and end-of-life care: A time for listening and caring. Journal of Palliative Medicine, 5(2): 289-294, 2002.

Rhi, B.Y.: Culture, spirituality, and mental health, Psychiatric Clinics of North America, 24 (3): 1-9, 2001.

Seybold, K.S., Hill, P.C.: The role of religion and spirituality in mental and physical health. [Article] Current Directions in Psychological Science. 10 (1): 21-24, Feb. 2001.

Sims, A.: The cure of souls: psychiatric dilemmas. Int. Reviews of Psychiatry. 11:97-102, 1999.

Slife, B.D., Hope, C., Nebeker, R.S.: Examining the relationship between religious spirituality and psychological science. [Article] Journal of Humanistic Psychology. 39 (2) 51-85, 1999.

Stotland, N.L.: When religion collides with medicine. Am. J. Psychiatry, 156 (2): 304, Feb. 1999.

Sulmasy D.P.: A. Biopsychosocial-Spiritual Model for the Care of Patients at the End of Life. The Gerontologist. 2002 May: 42:24-33.

Walsh, K., King, M., Jones, L., Tookman, A., Blizard, R.: Spiritual beliefs may affect outcome of bereavement: prospective study. British Medical Journal, Vol. 324: 1-5, 29 June 2002.

Yawar, A: Spirituality in medicine: What is to be done? Journal of Royal Society of Medicine. 94: 529-533, 2001.

 

Other literature not online (useful and optional):

Benson, H.: Timeless Healing.  Fireside Book published by Simon & Schuster, New York, 1997. (Medicine’s Spiritual Crisis, p. 99, The Faith Factor and Spiritual Experience p. 149.

Cassell, E.J.: The Nature of Suffering and the Goals of Medicine. 2nd Ed. Oxford University Press, New York, 2004.

Frankl, V.E.: Man’s Search for Meaning. Pocket Books, New York, 1963.

Frankl, V.E.: The Doctor and the Soul. Bantam Books, New York, 1969.

Fromm, E.:  The Art of Loving. Bantam Books, 1970.

Ghadirian, A-M.:  Alcohol and Drug Abuse – A Psychosocial and Spiritual Approach to Prevention, George Ronald, Oxford, English, 91-147, 2007.

Ghadirian, A-M., Ageing – Challenges and Opportunities (section on Spiritual Dimensions). George Ronald, Oxford, England, 74-85, 1991.

Hinshaw, D.B.: “Spiritual issues at the end of life” Clin in Fam. Pract. June 2004; 6(2), pp. 423-440.

Hayes, T., Fisher B.J., Hill, R.A., Cassiday, T.J.: Life, Death and Immortality. Baha’i Publishing Trust, Wilmette, Illinois, 1994.

Kearney, M., Mount B. Spiritual care of the dying patient. In: Chochinov H., Breitbart W., eds. Handbook of psychiatry in palliative medicine. New York: Oxford University Press; 2000. p. 357-73.

Koenig, H.G.: Handbook of Religion and Mental Health. Academic Press, New York, 1998.

Koenig, H.G.: Religion and mental health: Evidence for an association.  International Review of Psychiatry. Vol. 13 (2) 101, May 2001.

Koenig, H.G., McCullough M.E., Larson, D.B.: Handbook of Religion and Health, Oxford University Press, Oxford, New York, 2001.

Kübler-Ross, E:  Death – The Final Stage of Growth.  Prentice-Hall, Inc., Englewood Cliffs, New Jersey, 1975.

McWright:  The essence of spiritual care: a phenomenological enquiry.  Palliative Medicine, 16: 125-132, 2002.

Mount, B.M., Lawlor, W., Cassell E.J.:  Spirituality and health: Developing a shared vocabulary.  Annals RCPSC, 35: (5): 303-308, 2002.

Murchie, G:  The Seven Mysteries of Life. Houghton Mifflin Co., Boston, 1978. (The Body-Mind Relations p. 258. The Change Named Death p. 520.

Osler, W.:  The faith that heals, British Medical Journal, i: 1470-1472, 1910.

Puchalski, C.M., Romer, A.L.: Taking a spiritual history allows clinicians to understand patients more fully.  Journal of Palliative Medicine, 3 (1): 129-137, 2000.

Puchalski, C.M.: The critical need for spirituality in our health care system. New Theology Review, November 2001, pp. 9-21.

Puchalski, C. et al. “Spirituality, religion and healing in palliative care”, Clin. Ger. Med. 2004; 20. p. 689-714.

Seeman, T.E., Dubin, L.F., Seeman, M.: Religiosity, spirituality and health.  A critical review for the evidence for biological pathways.  Am psychol. 16:131-147, 2003.

Sims, A: “Psyche” – Spirit as well as Mind? British Journal of Psychiatry, 165: 441-446, 1994.

Tillich, P.: The Courage to Be. Yale University Press, New Haven & London, 1952.

Warner, E.: The role of belief in healing. Can Med. Assoc. J., 128: 1107-1110, 1983.