Article by Sandro Spinsanti, Founder and Director of the Giano Institute, Rome.
Knock, knock…
Palliative Care: Who’s there?
Spirituality: It’s spirituality. More precisely, the spiritual accompaniment of patients. I’m looking for a home; is there room for me here, in palliative care?
P.C.: Yes, certainly. It depends, however, on where you would like to be accommodated.
Sp.: Well, there are some accommodations I am not willing to accept (the poet would say: “What we are not, what we do not want”…). I would not like to be placed in the room that comes after care. As was often the case in the past. “There is nothing more to be done; call…”; medicine would withdraw and hand over the baton to religion.
P.C.: On that point, we agree. We in palliative care do not want to be regarded as residual either (“There is nothing more to be done; call the palliative care specialist”). We are an integral part of care and wish to be recognized as such. No spirituality, then, as a residual element squared, as a last resort to be called upon once caregivers have retreated.
Sp.: Good. That is how we companions aspire to be accepted: as part of the team that provides care according to the palliative approach.
P.C.: One detail: how are you dressed? Do you present yourselves in cassocks, religious habits, nuns’ veils…?
Sp.: Certainly, it may happen that a spiritual caregiver is rooted in a religious tradition. Indeed, many religions may appear on the care scene. The country is inhabited not only by Catholics, but also by Christians of different denominations; and by followers of numerous religions: Hindus, Sikhs, Buddhists, Muslims… Yet among us companions there are also lay people, who live and practice spirituality outside religious contexts. The garments they wear—above all their mental garments!—are strictly secular. And we address those who prefer accompaniment in precisely that form, without religious labels. Spirituality eludes definition. It does not necessarily point toward transcendence. It has to do with the most restless and intense aspects of human reality, like a stubborn remaining upon the earth without ever ceasing to rise onto tiptoe.
P.C.: Fair enough. But what qualifies you as spiritual companions? And another question: are you volunteers or professionals? Because here a secondary detail comes into play, one that can nevertheless be irritating: volunteers offer what they do free of charge, whereas speaking of professionals inevitably raises the issue of remuneration for their services.
Sp.: We are aware that motivational drive alone is not enough to engage in spiritual accompaniment. Qualification is necessary, and that requires training. One must sift out dubious motivations and fanaticism. The question of who should be authorized to organize training programmes remains open. We shall need to address it transparently.
Training is all the more necessary for professionals in spirituality. For one is not born a professional; one becomes one. This is true for clinicians; it is equally true for professionals in the human sciences (psychology, ethics… and even spirituality). There is a risk—and we are aware of it—that once a humanistic field has been “professionalized,” healthcare practitioners may feel entitled to delegate to that professional the aspects of care related to that dimension, focusing exclusively on scientific and clinical matters (after all, there is a professional whose job is to deal with those dimensions…). Maintaining a balance between a widespread sensitivity to all dimensions of care—required of every practitioner who seeks to provide personalized care—and the specific intervention of the professional, to be called upon in the more complex and problematic cases, is a daily challenge. This issue, too, must become part of training.
As for the remuneration of professionals, including those working in spirituality, Italy faces a problem that we continue to ignore. Catholic hospital chaplains are paid by the National Health Service through specific regional agreements, whereas spiritual professionals belonging to other denominations and religions are not. The situation tends to suggest the existence of a state religion, which formally does not exist. Sooner or later, we shall have to place this issue on the political agenda.
P.C.: With these preliminary clarifications, the possibility of hosting spirituality in the room of palliative care becomes more realistic. There are, however, a few “house rules” that need to be made explicit.
The first is: no proselytizing. Spirituality carries some dark shadows, largely due to certain practices of the past, when one occasionally heard people boast that in some institutions no one died without the comfort of religious rituals; or when “deathbed conversions” of individuals who had declared themselves irreligious throughout their lives were celebrated. This type of accompaniment is not acceptable.
Care does not legitimize psychological coercion that takes advantage of a patient’s vulnerability. The ethical framework that today has a rightful place in healthcare is the antithesis of paternalism, which presumes to impose upon the sick person what it considers to be their good. This is especially true when such attitudes are driven by ideologies, of the kind we see emerging in bioethical debates (for example, opposing positions concerning end-of-life issues, or the confrontation between “pro-life” and “pro-choice” perspectives). The spirituality we are willing to welcome into care does not seek to convert anyone.
Palliative care is happy to host spiritual accompaniment only if it is non-partisan and unarmed with ideology. Accompaniment is the opposite of leading someone where they do not wish to go while they are too weak to resist pressure. Accompaniment means walking alongside another person, without attempting to draw them into the comfort zone of one’s own beliefs.
Under these conditions, we can share with spirituality the room of care (free hospitality—no rent required!).