Rosa Alers Talavera - Spirituality and Medicine

Spirituality and Medicine in End of Life Care Questions
Name: Rosa I Alers Talavera Student ID: 801-10-0204

Date: March 9, 2019 Course: MCUA 7440
The goal of medicine is to treat patients, not diseases. Not only to understand the
physiology behind a conditions and choosing the correct management to resolve, it also
includes acknowledging the humanity of the individual. That is why the World Health
Organization (WHO) defines health as a state of complete physical, mental and social
well-being and not merely the absence of disease or infirmity. Under this premise, the
spirituality and religious belief take part of the aspects that one most take into
consideration for the well being of the patient and even more importantly when it comes
to end of life care. The freedom of thought, conscience and religion is recognize as a
human right; this protects the individuals ability to manifest their religion or belief, either
in private or public. As future physicians we need to learn techniques to approach this
subjects and integrate them to the care of our patients.
In the article “What the doctor doesn’t know” by Kevin X Lou we are presented with a
clinical scenario of a patient with an advanced stage cancer and her doctor who feels
constricted on the fact that he would not be able to save her. In this case, we see a woman
that understands that being disease free is not a possible goal of therapy and wishes to
die. She was no source of support, since her parents are dead, she is divorced and has no
children, and lost many years ago her passion which were the arts. All of these, which
give us a sense of hopelessness, should raise concern and prompt an evaluation for
depression and beyond. In cases like this is important to assess the religious beliefs and
spirituality ideals, if any, of the patient. If she belongs to a religious community they
could become the source of support she needs, if she identifies within her beliefs
resources that she finds helpful how can we help her to access them, or even funeral
arrangements. By creating a space where the patient feels comfortable speaking of his
religious beliefs, that they see that they will not be judged by showing faith we optimize
the quality of care we give; sometimes a simple gesture like praying with them (even if
you only close your eyes while they said the words) can make a difference. Tools like
FICA, HOPE and Open Invite are created to help the physician assess this aspects. It is
relevant because we can feel uncomfortable approaching while trying to avoid assuming
information wrong about the patient or simply because we do not know how to address
this subject. Tools like these shows a easy way to have this conversations and help us
understand better our patients.
In an area where beliefs and ideals might come to be particularly important is when
discussing end of life decisions. Just as we are born, we all expect to die someday; and all
though most of the times we can not control how or when, we should be able to have an
opinion on the process in the cases were life sustaining options are available. Hospitals
have Do Not Intubate/ Do Not Resucitate (DNI/DNR) protocols which are forms filled by
the patient or the next of skin (in cases where the patient is unable to decide) within the
hospital were they declines the use of life sustaining interventions. These forms expire
after each hospitalization and must be revoked to perform certain procedures. Since most
people do not plan to end unconscious in an hospital bed, many times this decisions are
made by family members who sometimes struggle identifying what would the patient
want and what they personally desire. On the other hand, advanced directives or living
wills are documents that the patient can prepare prior to being admitted to the hospital
where they can express their desires in case of being unable to take decisions. I believe
that patients with terminal illnesses, with chronic conditions that increase their
probability of requiring hospitalization and advanced care or with advanced age should
prepare advanced directive in addition to approaching the subject of end of life care with
their families. Each person should have a saying on whether or not they want their live to
be sustained in case of futility, not everyone wants to spend their last moments on Earth
connected to a tube if there is no chance they will get out or have their families go
through that type of burden. This directives can include plans for funeral arrangements, if
they agree to a religious service and from which religious denomination, among other
things.
As a conclusion I would like to mention a case I worked with in my IM junior this year.
The patient was an elderly female who had an internal cerebral hemorrhage after falling
from her feet in her bathtub. Her GCS was 3/15 ever since admission, and only preserved
a few reflexes. The clinical assessment was clear, her prognosis was poor. Still the patient
was full code, the daughter refused to sign any papers since “she did not believe in
percentages because only Him has the last word”. As a religious person I do understand
and admire her faith and tried to connect with her, with no results. Every time the subject
was touched she will mention God and change the subject. She was fixated in watching
the small instances in which the ventilator showed that the breath was initiated by the
patient as a sign of her “improvement”. She never discussed neither answer which her
mother wishes in this situation; she only referred to herself. Sadly since there was not an
advanced directive prepared we had no way of knowing. In this scenario, the daughter
religious belief interfered with our ability to transmit the information and she use them as
a shield to acknowledge a very sad reality, but maybe if we had took the time to assess
more carefully her ideals we could have achieved a better understanding. All together,
this would not have been an issue if advanced directives were done.

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Spirituality and Medicine in End of Life Care Questions

Name: Rosa I Alers Talavera Student ID: 801-10-0204

in private or public. As future physicians we need to learn techniques to approach this

subjects and integrate them to the care of our patients.

understand better our patients.

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