The Provision of Spiritual Care by Christian Physicians in Secular Medical Contexts: A Practical Theological Investigation
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National palliative care guidelines outline spiritual care as a key component of caring for terminally ill patients. However, little theological reflection exists to guide spiritual care provision by physicians. The dissertation aims to address this practical theological question: how might Christian physicians, in dialogue with theological norms and visions within their tradition, incorporate spiritual care within medical practice in a secular, academic context? The project brings into critical conversation empirical research, historical theology, and systematic theological reflection, culminating in spiritual care assessment and treatment proposals. It argues that the secular medical context is informed by a spirituality of immanence, reinforced by institutional structures. In conversation with four significant texts from the Christian tradition, the dissertation proposes an alternative Christian spirituality of medicine to guide the spiritual care practices of Christian physicians. Chapter one reviews literature related to the role of spirituality in medicine, definitions of spirituality, spiritual guidance metaphors, and contextual theology models. Chapter two analyzes the Religion/Spirituality Cancer Care (RSCC) database, a survey of 209 Boston physicians. Findings indicate that physicians acknowledge the occasional appropriateness and positive benefits of spiritual care but infrequently practice spiritual care because of structural barriers. Chapter three describes with historical detail four Christian texts that characterize the relationship between the practice of Christian physicians and spiritual care provision (Ben Sira 38:1-15; Basil’s Long Rules 55; Fourth Lateran Council canon 22; Richard Baxter’s Responsibilities of Physicians). Qualitative analysis identifies five overlapping themes: 1) the spiritual priority within illness; 2) importance of patient prayer; 3) importance of patient spiritual examination/repentance; 4) recognizing rival healing traditions; and 5) physician-clergy overlapping spiritual roles. Chapter four identifies structural barriers within the secular medical context that socialize physicians to neglect spiritual care of patients. Dialogue with the five overlapping Christian themes yields a more integral vision of the relationship between spiritual care and medical practice. The final chapter proposes a spiritual care model for Christian physicians rooted in a Christian definition of spirituality, informed by theologies of spiritual guidance, and attentive to the structural complexities of the secular academic medical context. The chapter also suggests implications for future scholarship.
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