THE PRACTICE of geriatric medicine covers a surprising amount of ground. This includes general medicine, gerontology (the sciences of ageing), rehabilitation, palliative care and expertise in specific diseases of ageing, such as dementia and stroke, but our practice stretches us in other ways as well.
Many of our patients are compromised in expressing their wishes by dementia, so an interest in ethics goes with the territory. Indeed, much of the published Irish research in medical ethics stems from departments of geriatric medicine.
Yet I broached new territory last week when delivering on a request to talk about spirituality and health at the Eucharistic Congress. For me personally, I was reminded of the line in TS Eliot’s Four Quartets that “each venture is a new beginning, a raid on the inarticulate”.
I quickly realised that I was raiding not only my own inarticulacy but also an even deeper inarticulacy in the Irish medical profession.
Spirituality is internationally recognised as an important aspect of healthcare: the majority of US medical schools include a module on spirituality in the medical curriculum, and the General Medical Council in the UK has helpful guidance on personal beliefs and spirituality for patients and doctors alike.
Yet outside of palliative care, there is virtually nothing in the Irish medical literature, or that of the Irish Medical Council. Possibly as a counter-reaction to the unhealthy dominance of the Catholic Church on Irish intellectual life in Ireland until recent times, the atrocious mishandling of the child abuse scandals by senior church men and the frequently rancorous tenor of media discourse (some commentators remind me of the food critic in a TC Boyle story who has lost all her tastebuds and consequently gives every restaurant a drubbing), this is an area of medical practice defined by silence and absence of discussion.
A victim of this is the understanding that spirituality is a broad concept applicable to those of all faiths and none, and that regardless of our own personal beliefs we need to develop ways to support expression of this aspect of our shared humanity in healthcare settings.
There are many definitions of spirituality, nearly all of which focus on meaning, hope, transcendence and a relationship with a higher being or force, such as nature or God.
Common among many accounts is the concept of communion – with self, others, nature, and for some, with a God.
In the preparation of my talk I learnt much from the international medical literature, and particularly innovative approaches such as the fascinating Dignity Therapy. But I equally learnt much from finding out what was going on in my own hospital.
Although aware of a pastoral presence, the formal linkages are few, and an interdenominational team is providing a remarkable service which deserves wider recognition.
No longer does one “call for the chaplain” in Tallaght hospital when patients are in extremis: the pastoral care team, lay and religious, pro-actively visit the wards and make contact with patients in the context of a listening and sympathetic ear, and on the basis of consent.
This welcome sense of access to all is consistent with a holistic vision of care, one which has a broader reach than predominantly for those who are near death.
From this first level of pastoral care, patients can then access the sacramental aspects as they wish.
For example, for Catholics, a thrice-weekly round by 70 volunteer ministers of the Eucharist is available to those who desire it, with a take-up of about two-thirds of the patients over the course of the year.
This two-stage approach – spiritual support for all and access to sacramental support for those who wish for it – provides a matrix within which healthcare workers can negotiate, particularly for those working in settings without the good fortune of having formal pastoral care, such as general practice.
Delivering these thoughts at the Congress itself was both stimulating and interesting, with a lively and critical audience.
The wider programme was fascinating, and I felt comfortable in a setting which included Mark Hederman’s entertaining and wise talk on James Joyce and Catholicism.
It is likely that good medical and nursing care in Ireland often incorporates unspoken pastoral elements, but we need to do better as Irish doctors in our research and education so as to develop a therapeutic articulacy and a better understanding of the appropriate framing of spiritual needs in healthcare.
Prof Des O’Neill is a consultant in geriatric and stroke medicine.