Ethical Considerations for Acute Care

The context of 21st century health care, particularly in the acute hospital sector, presents many challenges to spiritually competent care in practice. Important ethical issues posed by addressing spirituality in acute health care include the following:

  • • Managing services with reduced resources, ensuring that care is managed effectively and efficiently
  • • The power relationship between vulnerable patients and health care professionals
  • • Skills and training of staff to avoid harm to vulnerable patients

Health care professionals are charged with managing services on limited resources. The task of managing pressures to discharge patients quickly can be in conflict with finding time and space to attend to spiritual needs. Shortage of staff can make it hard to provide person-centred, compassionate care that respects the dignity of the individual. Professional standards, values and philosophies require staff to adhere to ethical standards which specifically or implicitly include attending to spiritual needs.

In recent years, addressing spirituality and religious issues in clinical practice has given rise to a series of high profile contentious cases. These have made it more important for staff to develop competency in understanding the distinction between spirituality and religion. Professionals need to be educated to not abuse the power relationship between themselves and their patients. However, they also need not to be afraid to support people to address issues of meaning, purpose and connection in the context of acute illnesses. Integrating personal and professional beliefs and values requires health care professionals to avoid using their privileged position to promote causes not related to the health and well-being of the patients in their care. The case of the nurse who was suspended for offering to facilitate prayer for a patient heightened the concern about personal beliefs and their influence on practice (48). The potential for negative repercussions might also be linked to the recent unexpected omission of the word spiritual from the Nursing and Midwifery Council (NMC) Code (49). (As noted in Chapter 1, the General Medical Council requires doctors to include spiritual factors in their assessment of patients.)

Concerns have been raised regarding the protection of vulnerable patients from unskilled staff attempting to address their spiritual needs. Staff need the knowledge and skills and relevant training to provide basic spiritual care and to know when, with the patient's permission, to refer on to chaplaincy staff or members of the patient's faith group. This is necessary to ensure that harm is not caused to patients by staff members who are ill-equipped for the task (24). Coherent education and training strategies which are relevant to individual health care professionals' roles and responsibilities need to be developed and applied at undergraduate level and in Continuing Professional Development.

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