South Florida Hospital News
Thursday October 18, 2018
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December 2005 - Volume 2 - Issue 6

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End-of-Life Care Goes Beyond Medicine

Devout Roman Catholic, Orthodox Jew, born-again Christian, Muslim, Buddhist—hospice physicians bring their spirituality to the bedside. "You can’t help it," says Harry Davin, M.D., VITAS medical director in Cincinnati. "It’s there, in your background, like your personality."

Most doctors today identify more with scientists and CEOs than with counselors and clergy. If you set bones or open up chest cavities, you may do so without much thought to spirituality—your own or your patients’. End-of-life care is different.

"Hospice doctors hear it all the time," acknowledges Freddie Negron, M.D., medical director for VITAS in Miami-Dade County, Florida, "‘It takes a special kind of doctor to do hospice work.’ And yes, it does. The difference is spirituality. Along with the science of being a good physician, hospice calls for an inner strength. It invokes your belief systems, probably to the max."

Justos Cisneros, M.D., VITAS medical director in San Antonio, believes his Christian faith makes him a better hospice physician. "It’s very powerful, if you are in the business of death and dying," he says, "to be a person of God."

Few would argue with him. "As we get closer to the end of the road," Dr. Davin says, "spirituality gets more important. Patients who have a faith and are comfortable with it have much less angst about dying." Dr. Cisneros has found that "if fear levels are high, faith levels are low—or nonexistent. I like to see where a patient’s faith is," he says. "Then I can see where his heart is, where his strength is."

Dr. Davin recalls a terminally ill patient who was an accomplished musician, a brilliant man—and an atheist. "He was scared to death," says Dr. Davin. "I couldn’t relieve his pain no matter what I prescribed. We call that existential suffering."

"Even if the patient is an agnostic," concurs Dr. Negron, "death calls for some belief systems."

The strength that comes with spirituality is not reserved for patients. "People who believe in an afterlife or a higher power have less fear," Dr. Davin points out, "and doctors who believe are more humane in their treatment."

Dr. Negron would add that that faith needs to have mellowed with age and experience. "In medicine we are committed to being compassionate, but nowhere is that more evident than in hospice," he says. "You can’t have a rookie or young doctor in hospice. In order to care for others, the real hospice candidate has to have had the life experiences that allow him or her to embrace spirituality." Case in point: watching his father die on hospice has had a significant effect on Dr. Negron’s own work with the terminally ill and their families.

End-of-life care goes beyond science—something even the federal government acknowledged when it mandated in the Medicare hospice benefit that hospice teams include social workers, volunteers and chaplains. "As people get closer to death, they demedicalize," says Dr. Cisneros. "You discuss emotions and spiritual aspects of who they are. Unfortunately, most doctors remain medically oriented, because that’s what’s comfortable."

What hospice physicians find comfortable is harder to define. Dr. Davin appreciates the freedom he has to "hold hands with a patient for an hour or two when that is what’s called for, without throwing my schedule out the window."

Dr. Negron cites another kind of comfort care.

"A patient in a private room with end-stage emphysema was worried about his dog," he recalls. "So I gave an order for a neighbor to bring Fido to his room until the moment of his death. The nurses cried; they couldn’t fathom the level of compassion in that room. But we did good medicine, and we allowed the emergence of his belief systems. We promoted a good death."

Rev. Dr. Martha Rutland, director of Clinical Pastoral Education at VITAS Healthcare Corporation, Miami, FL, can be reached at 305-350-5946 or martha.rutland@vitas.com.
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