Apa itu Spiritualitas?
• setiap manusia, religius atau tidak, memiliki kerohanian
• Spiritualitas meliputi tujuan dan makna keberadaan seseorang
• itu melibatkan hubungan dengan, dan persepsi, orang-orang dan semua hal dan peristiwa lainnya
• itu unik untuk setiap orang
• itu didirikan dalam tradisi budaya, agama dan keluarga, dan dimodifikasi oleh pengalaman hidup
• itu adalah dasar untuk sikap, nilai, kepercayaan, dan tindakan individu
o untuk orang-orang yang beragama, spiritualitas biasanya tercakup dalam agama mereka, tetapi spiritualitas dan agama bukanlah hal yang sama
What is spiritual or existential distress?
! questions pertaining to spiritual and existential issues may arise as the
result of any life event, but occur most frequently (probably invariably) in
response to terminal illness
! spiritual and existential problems are an important source of clinical
suffering
o they may cause or aggravate pain and psychosocial problems
o they can cause an anguish all their own
! recognition and successful management of spiritual and existential
problems is an important part of palliative care
Spiritual and existential problems encountered by the terminally ill can be
broadly grouped
! relating to the past
o how the patient sees their life, work, relationships, achievements,
failures
o value and meaning of a person’s life
o worth of relationships and effect of failed relationships
o value of previous achievements or sense of not achieving anything
o painful memories or shame
o guilt about failures, unfulfilled aspirations
! relating to the present
o disruption of personal integrity
o physical, psychological and social changes
o increased dependency
o meaning of a person’s life
o meaning of suffering
! relating to the future
o impending separation
o hopelessness
o meaninglessness
o concerns about death
! relating to religion
o strength of their faith
o whether they have lived according to, and not disgraced, their faith
o existence of after-life
How is spiritual or existential distress manifest?
! it is most often manifest as physical or psychological problems
! pain or other symptoms unresponsive to appropriate therapy should alert
the clinician to the possibility of unrecognized spiritual or existential
problems
! the patient may remain sad, withdrawn or ‘depressed’ when all physical
and psychosocial suffering have been relieved
! it is seldom expressed verbally unless the patient is asked about spiritual
issues and invited to talk about them. There usually follows immense
relief.
! when asked about spiritual matters, most patients assume you are talking
about religion. It is important to stress that at some time in life everyone
asks existential questions—Why do people suffer? Is there a God who
cares? Is my illness because of what I did in my life?
How do you deal with spiritual or existential distress?
! reassure the patient that
o everyone has spiritual problems at some stage in their life
o everyone asks the same questions—Why this? Why that?
o everyone tries to find reasons for all that has happened in their life
and is happening now
o that you regard their spiritual/existential concerns every bit as
important as every other aspect of their care and will be taken very
seriously
o that unlike other aspects of their suffering, there may not be
answers to spiritual/existential questions
" but ventilating some of the Why questions can make the
physical problems seem less
! patients vary greatly in their desire to pursue spiritual/existential issues
o some will not discuss it
o others just need the presence of a sympathetic person to listen (not
necessarily a religious person or a pastoral care worker)
! spiritual care is person-centred and begins at the level of the patients’ own
insight
! most people are helped by knowing that the questions and doubts that are
troubling them are shared by many others
What is Religious Faith?
! religion is the relationship between an individual and God, characterized
by belief in, reverence for, and desire to please that God
! for patients who profess a religious faith, their spirituality is usually closely
allied with their religion
! patients with religious faith are less likely to have unmet spiritual concerns
if their religious needs are met
! patients with religious faith may have as much pain as any other patient
but may report it less because their faith may confer some stoicism
! in the palliative care setting, a person’s faith, no matter how strong or
weak, will influence, and be influenced by, everything they experience
as death approaches
Can religious faith help the dying?
! most faiths teach that biological death is not the end of life
! believers are comforted
o that there is something after death
o that their wrong doings can be forgiven and their good deeds be
credited
o that God will look after those left behind
o that God is forgiving rather than condemning and punishing
! families sharing the same faith
o may help them cope better looking after a terminally ill relative
o may be a source of comfort to the dying patient, confident that faith
will help those left behind
! people with a deep religious faith often find it grows as death approaches
! for those with a less well-developed/less tested faith, impending death can
be a major challenge to their faith
Can religious faith cause problems for the dying?
! religion does not make living or dying easier, though it may make both
meaningful
! religion does not provide all the answers people seek
! people with unrealistic expectations of their religion are usually
disappointed
o some people expect miracles
o some expect answers to unanswerable questions
o some expect immediate and sympathetic answers to their prayers
! when these are not forthcoming they may
o blame their religion or even their God
o direct their anger or disappointment against clergy and/or their
professional carers
How should religious issues be handled in palliative care?
! there should be unreserved respect for an individual’s religious beliefs and
practices
o the patient or family should be asked about religious matters
including prayer, diet, and routines of personal hygiene
o sacred practices including prayer, sacraments, anointing with oils,
the burning of incense, periods of fasting or self-denial, special
diets, baptism and many others are both respected and facilitated
! the manner in which individuals practice their religion must be respected
! a patient’s religious needs are assessed on an individual basis
o no two people of the same faith are likely to have exactly the same
religious needs
o facilitate arrangements for their priests and teachers to visit them
o support them when their faith feels inadequate for what they are
experiencing
! reassure them that the rites of their religion and culture will be fully
respected after their death
! many patients, having previously denied any religious faith, may change
as their illness worsens, and be comfortable talking about religious and
spiritual matters with doctors or nurses but may be reluctant to do so
with clergy or religious personnel