Spiritual Care Ethical Dilemmas

Introduction

Spiritual Care can be very important when it comes to patient-centered care. Rebecca L. Polzer Casarez and Joan C. Engebretson published a study on how spiritual care can cause ethical dilemmas in the health care setting. A Ethical dilemma can be defined in Dee McGonigle and Kathleen Garver Martian’s Nursing Informatics and the foundation of knowledge (2015) as “a difficult choice or issue that requires the application of standards or principles to solve. Issues that challenge us ethically” (McGonigle &Martian, 2015, p. 528). Spiritual Care has been around since the beginning of time, and with the introduction of the medical model of care it now poses a dilemma to health care workers (nurses and physicians), as well as patients. Casarez and Engebretson thoroughly discuss spiritual care within the clinical practice in their article.

Summary

Casarez and Engebretson (2012) discovered four themes throughout their research, first was the ethical concerns of omission, second the ethical concerns of commission, third conditions for spiritual care and lastly strategies to

integrate spiritual care into practice. Omission of spiritual care includes the omission of the basic ethical principles such as autonomy, beneficence, non-maleficence, and justice (Casarez & Engebretson, 2012). Reasons for the omission are based off of the personal beliefs to the healthcare workers toward spirituality, as well as their openness to others spirituality. Casarez and Engebretson (2012) look into how inclusion of spirituality into a patients care can help make it more holistic and improve the patients ethical principles by reducing the barriers to culturally competent care, and expanding their knowledge about the different spiritualities they may come across.
The second theme they found in their study was concerns of commission.

This is when spiritual care is not put into practice correctly (Casarez & Engebretson, 2012). The health care provider possibly misreads how the patients spirituality can be applied to their car or the health care provide attempts to implement their own spiritual beliefs onto the patient. Casarez and Engebretson (2012) go into depth with descriptive and prescriptive uses of spiritual care (p. 2102). Descriptive is using the patients spirituality to benefit their care, while prescriptive is putting a “spiritual goal” into the patient plan of care (Casarez & Engebretson, 2012). Healthcare providers may not be totally competent when it comes to the spirituality of the patient Casarez and Engebretson (2012) discuss how healthcare provides do not have appropriate training to provide spiritual care for their

patient.
Certain conditions can lead to the use of spiritual care. Depending on if the provider is spiritual or not and if the patient is dying or has receive a diagnosis for a terminal illness. The last theme they found was how to go about incorporating spiritual care into the clinical setting. The general consensus is that it should be more descriptive and revolve around the patients desire to incorporate it into their care, and less prescriptive decreasing “spiritual goals” in the clinical care setting.
Clinical Practice
Casarez and Engebretson (2012) stressed the importance of being culturally competent and how adding spirituality allows for a complete and holistic approach to patient care. Taking into account the patients wishes towards their care and allowing incorporation of them with decease the ethical dilemmas associated with beneficence, autonomy, non-maleficence and justice. Respecting individuals spiritual needs and allowing them to express their needs without any negative views. Self awareness will help provide the best care possible (Casarez & Engebretson, 2012, p. 2105) Knowing personal boundaries of spiritual beliefs allows the health care provider to have increased understanding for other peoples views on spirituality.