The spiritual dimension of hospice: The secularization of an ideal

• Published in: Social science & medicine (1982) Vol. 43; no. 3; pp. 409 - 419
• Main Author: Bradshaw, Ann
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.08.1996; Elsevier; Pergamon Press Inc
• Series: Social Science & Medicine
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Bureaucratization; Care and treatment; Clinical death. Palliative care. Organ gift and preservation; death; Death Attitudes; Dying; Empathy; Ethics; Ethics, Medical; Health care; hospice; Hospice Care; hospice palliative care spiritual care death secularization tradition; Hospices; Hospices (terminal care); Hospitals; Humans; Judeo-Christian Tradition; Medical sciences; Morality; Morals; Palliative Care; Pastoral Care; Patient Care Team; Philosophy, Medical; Religion and Medicine; Religion and science; Secularization; Sociology, Medical; spiritual care; Terminal Care; Terminally Ill; tradition; tradition; death; hospice; palliative care; secularization; spiritual care; Belief; Human; Religious attitude; Ethics; Nursing; Health staff; Palliative care; Health service; Public health; Nurse
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/0277-9536(95)00406-8

There is increasing concern that the original hospice ethos is becoming subject to routinization and bureaucratization. Authors, drawing on Weber's concept of rationalization, have suggested that this has resulted from the loss of the original charismatic impetus and the commitment to care for the terminally ill and dying as inspired by the spiritual ‘calling’. This paper argues that this original ethical ideal has been fundamental to the humane care of the dying and terminally ill. Using Alasdair MacIntyre's analysis it is suggested that as the ideal attenuates there are inevitable shifts in the ethos and culture of care. An emotivist culture in which the aesthete, the therapist and the manager are dominant characters, may seem to be occurring in palliative care. The focus on management skills and the values of efficiency and effectiveness influence attitudes to death. This brings increased medicalization, a reliance on psychosocial techniques, a predominant focus on education, research and audit and most particularly redefined attitudes to the spiritual component of care. The paper asks the question whether the original ethic has a place in preventing palliative care becoming merely a technique for professional empowerment.