Spiritual care at the end of life: whose job is it?

Interest in and recognition of the function of religious and spiritual coping in adjustment to serious illness has been growing. In particular, there has been increasing interest in the importance of understanding and valuing patients' individual spirituality as a function of providing appropriate support, particularly as part of nursing practice. This stems partly from the influence and application of palliative care principles in a range of care settings and not just hospices. Four decades of professional rhetoric have emphasised the importance of care for the 'whole' person in terms of spiritual as well as psychological, physical and social needs, without evaluating its impacts on patients or considering whether this approach is realistic in every case. Professional ideology within palliative care has been dominant in influencing a culture of openness between professional health workers and dying patients in their care, with attention to spiritual needs an increasing part of professionals' remit. New ways to both assess and address spiritual concerns as part of overall quality of life are being developed by health care practitioners as part of a package of support for people with critical and terminal illness (Randall and Downie, 2006; Watts, 2008). For this support to be meaningful, however, it is necessary to determine which dimensions of spirituality are relevant and the ways in which the human spirit can be celebrated in the face of life-threatening illness (Cobb and Legood, 2008). The ultimate value of such exploration is to make it possible for us to die the way we live (Hockey, 2002)