Tearful stories from people who could not visit an aging parent will likely be one of the memories associated with COVID-19. Suffering or dying alone, without the usual support networks, has also been a reality for persons with other illnesses. That is spawning new conversations about what is essential in both healing and dying.
A broader understanding of health care may be one of the constructive legacies of COVID-19. It is reinforcing the importance of mental health and palliative care, both of which have received increased attention in recent years. Basics, such as a shelter, access to washrooms for the homeless, and nutritious food are no longer taken for granted. Largely missing from the discussion in Canada is the importance of spiritual care, especially at end-of-life or critical care moments.
Should spiritual care be deemed essential care in some cases or all cases? I heard about a case of rules being broken to allow a woman dying from cancer a visit from her pastor. In other seemingly similar cases such requests have been denied. Family may be the closest connection, but it cannot be assumed that family can or will provide spiritual care. In some institutions, nurses and doctors are providing spiritual care as best they can. From the perspective of patients, practices are inconsistent. Anecdotal evidence suggests even less access to spiritual care for questioning patients than for patients with strong connections to a recognized religion.
Part of the problem is lack of clarity about what spiritual care really means, and some suspicion that it is not scientific enough for clinical health care settings. There are also legitimate concerns about manipulation of vulnerable people by religious leaders intent on deathbed conversions. The difference between spiritual care and mental health care is also questioned. Sometimes they are combined in psycho-spiritual care, or vaguely described in terms like “meaning-oriented counselling” or “comfort care.”
Spiritual care attends to a person’s spiritual or religious needs as he or she copes with illness, loss, grief or pain. Whether acute or chronic, illness raises questions about the meaning and purpose of life, losses, guilt and forgiveness, and relationships with divine or transcendent realities, to which patients may give different names. Dealing with those questions is widely recognized as part of the healing process. Spiritual care can be provided by different actors, such as chaplains, pastors who go into health care settings, or doctors and nurses as part of a more holistic approach to primary care.
The benefits of spiritual care for physical and emotional health are being documented in a growing body of research. The findings are not a surprise to Bible readers. Research shows that spiritual care reduces known barriers to healing and good health, such as guilt feelings, anger toward others, or self-rejection. It also has positive impacts for trust, hope, being at peace with losses, and ability to cope with changes. Findings show that being able to talk about doubts and fears, without judgement, is important for patients without formal religious affiliations, as well as for those who declare such affiliations. Impacts are stronger when care aligns with a patient’s beliefs or doubt, rather than preaching to or attempts to covert people in their sick-beds.
An opportunity for churches
Research findings have been slow to translate into recognition in health policy and practice. Attending to spiritual needs is now identified as one of the core domains in patient care by the World Health Organization. It is often acknowledged in codes of conduct or core value statements of health care institutions in Canada, but it is harder to find spiritual care explicitly named or intentionally integrated into practice. It is often discretionary rather than essential care.
In one research study of religion and spirituality in cancer care, 74 percent of nurses and 60 percent of doctors recognized its importance, but identified major barriers to providing such care. Time, training, confidence and clarity about whether it is part of a care-giver’s mandate are all factors that lead to inconsistent access to spiritual care from a patient point of view.
It is noteworthy that spiritual care is more prominent in policies and good practices for indigenous health care, part of what are called the “distinctives” of indigenous health care. Non-indigenous persons have the same need. Perhaps more holistic approaches to health care is one area where non-indigenous practices can learn from indigenous practices.
Lessons from COVID-19 are beginning to get attention. In my view, advocacy by faith-based organizations to recognize access to spiritual care as essential in health care might be an important, well-timed, achievable initiative.