The widening scope of spiritual care.

All aroundtheworldtodayweface, for better and worse, disruption and changein both religious and secular values.Andthiswastruein1963,when we,beginnersof hospices, reachedout to one anotherto find new ways of caringfor theterminally ill. For me it beganwith DameCicely Saunders’ first visit to Yale University in New Haven,Connecticutin 1963. Her lecture on palliative care with photographsof tenninally ill cancer patientsbroughtthe audienceof many disciplinesat Yale’s medicalcenterto its feet. Seeingher patientsandtheir familiesbeforeandaftersymptomcontrol openeda doorfor uswherethere hadbeenawall. Theastonishment and relief I felt was alsoon the facesof medicalstudents,nurses,doctors,social workersandchaplains. For too long all of us had been numbedand hopelessby the sightof patientsdying,not onlylosingstrength butsufferingunbearably.Weeitherdid nothing or continuedwith intensive treatmentto the end. She gaveus a senseof possibilityandaway togo. I havehadanunshakableurgein the pastsix yearsto encouragehealthcare professionalsand clergy of various sects and denominationsinvolved in careof thosefacing deathto developa dialoguewith one another,and hear eachother’s views on spiritual support.1The ideacameto me from conferencesheld at NaropaInstitute by TibetanBuddhists,in whichexchange betweenEastern and Western theologiansled to appreciationof one another’sphilosophiesandrecognition of commonthemes. As the interdisciplinary natureof hospicecare madeit imperative for doctors,nurses,clergy, psychiatrists, social workers, administrators,dieticiansandartdirectorstoworktogether as a team,differencesin ideasand/or actioncalledfor awillingnesstostruggle togetherand so resolvethesedifferenceswithin an institution and in colleagialforumsonthe outside. In the United States the spiritual facetof the individual is complexand has many sides. Our religions are diverse,ourlife stylesareincreasingly materialistic.ThesolidChristianfoundation St. Christopher’sHospicehas was a model that manythoughtinappropriatefor ourculture.We knewour spiritualbasewasshakybutit tooktime to appreciatehowmuch. The Christianreligiousfoundation was essentialto Dame Cicely Saunders. However, she encouragedthe groupatYale to geton with its hospice dreamsevenwithoutareligiousfoundation.Shesaid, “Don’t startahospice unlessyou haveto, “but shealsosaid, “I couldn’t havedone it without my spiritual foundation.”Shesawthepossibility of St. Christopherwithin the Christianfaith but saidto mein 1986, she wasn’t sure it could spanother religionsor secularspiritualsources. Howandwhydid thehospicemovementarisein thefirstplace?Clearly, I can speakwith more authorityon the hospicemovementin theUnitedState, butI haveonly impressionsof ourmentor institution, St. Christopher’sHospice; its impetus,its religiousfoundation, its philosophy. BeforeDameCicelySaundersconceivedSt. Christopher’sHospice,her life wastouchedby World WarII. She wasnotin themilitary, butsheleftacademiafor thepracticeprofessionmost concernedwith relief of suffering, nursing.Her professionalinterestexpanded,shebecamea social worker, and then a physician. Her education gaveherthe skills to relievephysical suffering,herChristianspiritexpanded herview of suffering in the imageof Christ’ssuffering. I only conjecturethatshewas also influencedby thelivesofrefugees, prisonersandvictims of theholocaustas was Anna Freud, JohnBowlby and Viktor Frankl.The first translationof Franki’s Man’s Searchfor Meaning, publishedin 1959, derived from his own experiencewith the constant threat of his exterminationand the exterminationof hisroommatesin the concentrationcamp. He experienced and observedhow meaningof life is sustainedand unavoidablesuffering endured.He turned that horrible incarcerationandgenocideinto deeper understandingof the dynamics of survival.2 The destructionand repressionof religionsthatwent with World WarII counteredthe Christianethos.At least two Poles movedher deeply. David Tasma, amongthe first patients she FlorenceS. Wald, RN, MS, is Clinical Professorat the YaleUniversitySchoolof Nursing,NewHaven,Connecticut.