Journal of Palliative Care

By J. F. Seely, MD
University of Ottawa Institute of Palliative Care (Ontario, Canada)

The spiritual care of the dying is one of the one of the greatest challenges in palliative care There is little general agreement on what is meant by the various terms used to describe the spiritual domain of human existence and even less agreement by what is meant by spiritual care in the context of palliative care. By its very nature, the spiritual domain does not lend itself easily to study or analysis.

Most authors include spiritual care along with the physical, emotional and social elements of care in the common mantra that describes the field of palliative care, but the spiritual issues have yet to receive the same analytical, descriptive or research attention as the other three areas. Nonetheless spiritual distress needs to be addressed in providing palliative care to the whole individual. And as we become better and better at controlling physical and emotional symptoms, spiritual concerns increasingly come to the fore.

The current infatuation with euthanasia and assisted suicide as options for the terminally ill speaks, to the spiritual void in our society. It is ironic that because we are not able to control able to control or understand life in the face of death, many would rather end life prematurely and on their own terms than squarely face the spiritual or existential concerns that are at the heart of their distress.

The lack of a comprehensive approach to spiritual care has hampered progress in confronting these issues. Thus this new book by Christine Longaker is very welcome. Christine Longaker is a long-time student of Sogyal Rinpoche, author of "The Tibetan Book of Living and Dying" who has also written a fine introduction to the text. Longaker writes with a strong Buddhist perspective though she takes pains to show how the practices of Tibetan Buddhism may be applied from the perspective of other religions. An experienced hospice worker who helped to establish the Hospice of Santa Cruz County in California over 20 years ago, she is now working with Sogyal Rinpoche to develop a Spiritual Care for the Living and Dying Program, which aims to bring about a "quiet revolution in the whole way we look at death and care for the dying, and the whole way we look at life and the care for the living."

The book is written for patients facing death, for their families, and for professional and volunteer caregivers involved in the care of the dying. Yet it also has a great deal to say to the wider audience of those who wish to live more fully in the present and better prepare for their own eventual death. As Rinpoche writes in the foreword: "if we can only learn how to face death, then we'll have learned the most important lesson of life; how to face ourselves and so come to terms with ourselves, in the deepest possible sense, as human beings."

The heart of the book is Longaker's description of what she calls the "four tasks of living and dying"--understanding and transforming suffering; making a connection, healing relationships and letting go; preparing spiritually for death; and finding meaning in life. Longaker explores each task in detail giving practical advice on how to be more sensitive to the needs of the dying, to help patients seeking to make sense of what is happening to them and begin to find healing in the face of death.

She emphasizes that in order to provide spiritual care to the dying, we as caregivers must ourselves embody a spiritual commitment in their lives. Through our manner of being with patients we caregivers are able to help them on their spiritual journey. "Spiritual care is an expression of our inherent compassion and wisdom; thus it is our entire way of being." Developing a "good heart through life enables us to heal our relationships with others, bring peace into this troubles world, and meet death without fear."

Spiritual practice in the context of this book is about ways of demonstrating support and compassion, and about ways of incorporating various Buddhist practices such as tonglen into the clinical arena to benefit ourselves and our patients. As Longaker points out, the spiritual caregiver also can support patients and families find meaning and heal relationships. She sidesteps the issue of providing a precise definition of spiritual care, emphasizing instead that spiritual care involves both a traditional religious approach to spirituality and an existential approach focused on finding meaning.

Facing Death and Finding Hope is not about generalities, wishful thinking, good intentions. It is an intensely practical book with sound clinical advice. Longaker avoids formulas for quick fixes to existential or spiritual problems. Rather she expands readers understanding of the suffering of the dying while providing examples of methods that they can try to become more effective caregivers. The book is strongly recommended for all who are working or interested in improving care of the terminally ill.