Spiritual Case Study Assignment

PHI-413V Lecture 1Worldview Foundations of Spirituality and Ethics

There has been an increase of interest in the role of spirituality in health care, as well as in the workplace and other fields in general. This interest has been met with a variety of responses, including an uneasiness that has historical roots. There is generally a perceived tension between science and religion/spirituality. This estrangement between the worlds of science and religion is in some ways not truly reflective of some inherent incompatibility between science and religion per se, but rather a reflection of underlying worldview tensions. The rediscovery of spirituality and its implications for health care provides recognition that the estrangement between the two worlds has not served patients’ best interests. If this is the case, then part of the task of serving patients well will require some basic worldview training in order to not only understand patients’ own backgrounds more clearly, but to also promote the fruitful interaction of science and religion in the health care setting more generally. Spiritual Case Study Assignment

Spirituality and Worldview The theoretical and practical foundations of any discipline or field take place within the wider framework of what is known as a worldview. A “worldview” is a term that describes a complete way of viewing the world around you. For example, consider religion and/or culture. For many people, their religion or culture colors the way in which they view their entire reality; nothing is untouched by it and everything is within its scope. Yet one need not be religious to have a worldview; atheism or agnosticism are also worldviews. Thus, all of one’s fundamental beliefs, practices, and relationships are seen through the lens of a worldview. The foundations of medicine and health care in general bring with it a myriad of assumptions about the very sorts of questions answered in a person’s worldview. Consider carefully the seven questions in the Called to Care textbook in order to begin grasping more clearly the concept of a worldview. Spiritual Case Study Assignment

A Challenging Ethos A fundamental thesis of this course is that two sorts of underlying philosophies or beliefs about the nature of knowledge, namely, scientism and relativism, are at the heart of this perceived tension between science and religion. Moreover, scientism and relativism help explain to some degree why this tension has not served the best interests of patients, and is even at odds with the fundamental goals of medicine and care.

Scientism is the belief that the best or only way to have any knowledge of reality is by means of the sciences (Moreland and Craig, 2003, pp. 346-350). At first glance this might sound like a noncontroversial or even commonsensical claim. However, think about this carefully. One way to state this is to say that if something is not known scientifically then it is not known at all. In other words, the only way to hold true beliefs about anything is to know them scientifically. Relativism on the other hand is the view that there is no such thing as truth in the commonsensical sense of that concept. Every claim about the nature of reality is simply relative to either an individual or a society/culture. Thus, according to this way of thinking, it might be true here in the United States that equality is a good thing, but in some Middle Eastern countries it is simply not a concern. Yet there is no ultimate truth of the matter, it is simply a matter of individual or popular opinion. In some way, truth is just what an individual or a culture decides that it is, and therefore not truly discovered, but invented. The current context of health care and medicine in the West is defined by an ethos (the prevailing attitudes and beliefs of a culture) of scientism and relativism. This ethos has exacerbated the perceived philosophical and cultural tension between science and religion. The result has been a general relativizing and caricaturing of religion, and the elevation of science as the default epistemology for all things rational or even true. While scientism may seem commonsensical or rational at first glance, a closer examination reveals glaring weaknesses. It should be noted right from the outset that scientism is not equivalent to science. This is because scientism is a philosophy about the nature and limits of science as well as the extent of human knowledge. Scientism is a philosophical thesis that claims that science is the only methodology to gain knowledge; every other claim to knowledge is either mere opinion or false. One of the most pressing dilemmas for scientism is science’s inability to make moral or ethical judgments. To understand why, consider the nature of scientific claims and their distinction from moral or ethical judgments. General scientific claims can be described simply as the attempt to make descriptions of fact. But when people make moral or ethical judgments, they do not simply make statements of fact (though that is part of it), but are evaluating those fact claims. Thus when making a moral judgment people are evaluating whether some fact is good or bad. Thus consider the distinction between the following statements:(1) 90% of Americans believe that racism is wrong.(2) Racism is wrong. Spiritual Case Study Assignment

Statement (1) is a statement of fact in the sense that it is meant to describe the way things actually are, or what is the case. Statement (2) however, makes a judgment; it makes a normative claim in the sense that it is making a claim about what ought to be the case. Statement (2) is not simply reporting or describing the facts. It is saying that it is not the way it is supposed to be. In recognizing these differences, a crucial distinction has surfaced between (1) scientific claims and (2) moral and ethical claims. Scientific claims are limited to statements of description; they are solely claims about what is the case. Moral and ethical statements are prescriptive and are evaluative claims about what ought to be the case. This has been described as the fact-value distinction to designate the difference between facts and values, values being a prescription of the way things ought to be, the moral evaluation of facts. This distinction has also been described as the “is” (fact) versus “ought” (value) distinction. Thus, because science deals with mere facts, it is not in a position to say anything about what ought to be the case. Science is relevant to moral and ethical claims in interesting ways, but prescriptive statements about what morally ought to be the case are simply beyond the bounds of science. To try to derive what ought to be the case only from what is the case is a logical fallacy. If one were to look at the world and the way things are, and then claim that it simply follows that it is the way it ought to be does not match the experience of morality. There are many events that are the case and describe what is (genocide, war, hatred, murder), but whether or not they ought to be that way is a further question that science is not in a position to answer. Thus to try to derive an ought from an is refers to what is called the fallacy of deriving of ought from an is. Much more could be said of the inadequacy of scientism, but it should be noted that moral, ethical, and religious claims all involve normative claims about the way the world ought to be. One practical effect within health care has been the subtle but pervasive view that religion is a harmless tangent to medicine and health care at best, and a superstitious and destructive distraction at worst. Recently there has been a resurgence and appreciation of spirituality within medicine in more holistic approaches to health care. For example, the Center for Spirituality, Theology and Health at Duke University was established in 1998 for the purpose of conducting research, training others to conduct research, and promoting scholarly field-building activities related to religion, spirituality, and health. The Center serves as a clearinghouse for information on this topic, and seeks to support and encourage dialogue between researchers, clinicians, theologians, clergy, and others interested in the intersection. (Center for Spirituality, 2014, para. 1)While a welcome corrective, it is easy to inadvertently buy into weaker forms of scientism and fail to appreciate the particularity of each religion by reducing all religion to a generic spirituality. For example, Burkhardt (1999) attempts to defend a generic definition of the term “spirituality” (p. 71), but Shelly and Miller (2006) point out the inadequacy of such a strategy. It is not fair or respectful to paint all religions or worldviews with the same brush under the heading of spirituality and ignore thedifferences.Thus, in the interest of philosophical clarity, religious sensitivity, and genuine care, this section will introduce fundamental concepts and challenge the contemporary ethos to make room for genuine religious dialogue.The Foundations of Christian Spirituality in HealthcareIn stark contrast to this ethos is the Christian tradition and the resources it provides for a rich conception of care. Contra scientism and relativism, the foundations of Christian spirituality in health care, includes two attitudes/theses: (1) an acknowledgement of science as a subset of knowledge in general, and a deep appreciation for science as a collective human enterprise that reflects the knowability and order of creation; and (2) the goodness and worth of this creation (in so far as it reflects God’s creative intention) with human beings bearing special dignity and intrinsic worth, reflected in the well-known bioethical principle of “respect for persons” (National Commission, 1979).The foundations of Christian spirituality in health care assume genuine knowledge of God and his purposes. Central to this foundation are the biblical Christian narrative and the person of Jesus Christ. In order to appreciate and do justice to this center, the ethos of scientism and postmodernism must be first challenged and dispelled.This first topic of this course is devoted to understanding the concept of worldview in detail and to begin to challenge the philosophies of relativism and scientism. It will also begin to lay the foundations of a broadly holistic understanding of the relationship between spirituality and health care in general, and a Christian worldview for health care in general.ReferencesBurkhardt, M. (1989). Spirituality: An analysis of the concept holistic nursing practice. New York, NY: Aspen Publishers, Inc.Center for Spirituality, Theology and Health. (2014). Retrieved from http://www.spiritualityandhealth.duke.edu/Moreland, J.P., & Craig, W.L. (2003). Philosophial foundations for a Christian worldview. Downers Grove, IL: IVP Academic.National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. (1979). The Belmont report: Ethical principles and guidelines for the protection of human subjects of research. Retrieved from http://www.hhs.gov/ohrp/humansubjects/guidance/belmont.htmlShelly, J. A., & Miller, A. B. (2006). Called to care: A Christian worldview for nursing (2nd ed.). Downers Grove, IL: IVP Academic. © 2015. Grand Canyon University. All Rights Reserved. Spiritual Case Study Assignment

Death, Dying, and Grief

Introduction

Death and dying are a bitter part of the reality of life in general, and a particularly common experience for those called to health care. The nature and meaning of death is not simply biological or scientific, but rather involves deep philosophical and religious questions. Once again, medical technology has changed the scope, quality, and experience of death (or at least the dying process). It has even prompted a changing of the very definition of death.Death in the 21st CenturyOne of the incredible benefits of modern science and its application in medical technology has been the ability to extend physiological life. In the 1960s, the development of CPR, ventilators, and the like allowed never before seen intervention in the process of dying, such that a “millennia-old general understanding of what it meant to be dead” (Veatch, Haddad, & English, 2010, pp. 390-391) was transformed. In the field of biomedical ethics, the very definition of what it means to be dead is a controversial topic. In continuing with a fundamental theme running throughout this course, it should be noted that while the pathophysiological and scientifically detectable signs of death are crucial in this debate, they should not be taken to be determinative or comprehensive. This debate still crucially depends on the philosophical background of one’s anthropology (i.e., view of personhood) and in the resulting interpretation of these scientific and physiological signs. The medical definition of death is not a purely or irreducibly scientific question. Spiritual Case Study Assignment

Worldview and the Meaning of Death

On a worldview level, the question of the medical definition of death is just the tip of the iceberg in terms of the broader significance and ultimate meaning of death. Whether or not there is any meaning to death and what it might be is a question of one’s worldview. Questions regarding whether or not there will be ultimate moral accountability for the way one lived life and whether there is an afterlife are key questions in this regard. The very phenomenon of the loss of (at the very least) physiological and perhaps conscious integrity and activity is a fact of life that calls for explanation.Once again, an accurate understanding of religion and worldview is required. Furthermore, the distinctions among each religion must be appreciated and not collapsed into one another. The way in which both technology and religious background color the experience and meaning of death (both in dying and grieving) must also be appreciated. Whatever rituals or practices a religious or cultural group engages in are informed by a view regarding the nature and meaning of death that fits within an overarching worldview narrative.Death in the Christian WorldviewDeath takes on a particular meaning when seen within the Christian narrative. It is, in fact, not the greatest evil that could befall a human being and is furthermore transformed in the light of the resurrection of Jesus Christ. The Christian teaching that “God died” essentially transforms the way in which death is seen and experienced (Sanders, 2007, pp. 6-8). Death is certainly a tragedy and an evil, but it is now a conquered enemy. It is a conquered enemy because in the Christian biblical narrative, death is a perversion of God’s original design plan. And yet, the Christian God constantly redeems that which is broken. Spiritual Case Study Assignment

Loss and Grief

Death is a particularly traumatic and difficult experience for both family and caregivers. Understanding the process and stages of grieving is immensely beneficial for caregivers to assess the well-being of patients and families. There are numerous resources that can be of tremendous benefit for both caregivers and family. One of the most influential is the work of American psychiatrist Elizabeth Kubler-Ross. Perhaps the most influential insight of her work was to notice certain patterns or stages in the human experience of grief, especially after the loss of a loved one in death. She called these the five stages of grief. Briefly, they include the following: (a) denial, (b) anger, (c) bargaining, (d) depression, and (e) acceptance (“Understanding Grief,” 2015).Expectations regarding an afterlife will in large part determine the manner in which patients and families welcome or spurn the prospect of death. Furthermore, the way in which a person experiences the stages of grief will be in the context of their worldview. Christian theologian Nicholas Wolterstorff’s (1987) memoir, Lament for a Son, is a personal reflection of his own personal grief after losing his 25-year-old son in a mountain climbing accident. As he engages with his own grief and experience, it becomes clear that everything is ultimately seen in the light of God’s loving control and the ultimate hope of resurrection. Spiritual Case Study Assignment

References

Sanders, F. (2007). “Chalcedonian categories for the gospel narrative.” In F. Sanders & K. Issler (eds.), Jesus in trinitarian perspective. Nashville, TN: B&H Academic.Understanding grief and loss: An overview. (2015, October 26). Retrieved from http:// http://healgrief.org/understanding-grief/Veatch, R. M., Haddad, A., & English, D. (2010). Case studies in biomedical ethics. New York, NY: Oxford University Press.Verhey, A. (2011). The Christian art of dying: Learning from Jesus. Grand Rapids, MI: Wm. B. Eerdmans Publishing Company.Wolterstorff, N. (1987). Lament for a son. Grand Rapids, MI: Wm. B. Eerdmans Publishing Company.© 2015. Grand Canyon University. All Rights Reserved. Spiritual Case Study Assignment

Biomedical Ethics in The Christian Narrative

Introduction

The reality of religious pluralism (the view that there are many different religions with different teachings) does not logically imply any sort of religious relativism (the view that there is no such thing as truth, or that everything is a matter of opinion). There are genuine distinctions between religions and worldviews. Given this fact, it is imperative that one be tolerant of differences and engage civilly with those of different religions or worldviews. It might be tempting to think that one is being tolerant or civil by simply rolling all religions into one sort of generic “spirituality” and to claim that all religions are essentially the same. But this is simply false. Once again, there are genuine and important differences among religions; these differences are meaningful to the followers of a particular faith. To simply talk of some sort of a generic “spirituality,” while maybe properly descriptive of some, does not accurately describe most of the religious people in the world. Furthermore, this terminology often reduces religion to a mere personal or cultural preference, and it ignores the distinctions and particularity of each. The point is that such a reductionism is not respectful of patients. It should also be noted that atheism or secularism are not simply default or perfectly objective (or supposedly scientific) starting positions, while religious perspectives are somehow hopelessly biased. Every religion or worldview brings with it a set of assumptions about the nature of reality; whether or not a particular view should be favored depends upon whether or not it is considered true and explains well one’s experience of reality.Biomedical EthicsBioethics is a subfield of ethics that concerns the ethics of medicine and ethical issues in the life sciences raised by the advance of technology. The issues dealt with tend to be complex and controversial (i.e., abortion, stem cell research, euthanasia, etc.). In addition, bieothics usually also involves questions of public policy and social justice. As such, the complexities of bioethical discussion in a pluralistic society are compounded. There have been several different approaches to bioethical questions put forth that have to do with the theory behind ethical decision making. Three positions have been prominent in the discussion principalism (also known as the four principle approach), virtue ethics, and casuistry. For this lecture, it will be useful to outline principalism and to describe the general contours of a Christian approach to bioethical issues. Spiritual Case Study Assignment

Principalism is oftern referred to as the “four-principle approach” because of its view that there are four ethical principles that are the frame work of bioethics. These four principles are the following, as spelled out by Tom L. Beauchamp and David DeGrazia (2004):

1. Respect for autonomy − A principle that requires respect for the decision making capacities of autonomous persons.

2. Nonmaleficence − A principle requiring that people not cause harm to others.

3. Beneficence − A group of principles requiring that people prevent harm, provide benefits, and balance benefits against risks and costs.

4. Justice − A group of principles requiring fair distribution of benefits, risks and costs. (p. 57)

For every bioethical question, one must seek to act according to these principles. For each case there will be details, circumstances, and factors that must be taken into account. The process of applying these principles to each unique case is referred to as specification and balancing. That is, these principles in and of themselves are abstract with no particular content or concrete application. One must specify the particular context and details of a case or dillema in order to concretely apply these principles and arrive at concrete action guiding results (i.e., individuals need to know how to apply these principles to specific cases and circumstances). But secondly, the task of balancinginvolves figuring out how each of the four principles ought to be weighted in a particular case. One needs to determine which of the four principles deserves the most priority in any given case, especially in cases in which there are conflicts between the principles.Though there is disagreement and diversity about whether or not principalism is the best theory and method of addressing bioethical questions, these four pricniples and this methodology have become foundational for bioethical reflection. One common misunderstanding about these principles, and most other bioethical methodologies or theories, is that they can stand on their own and comprise a neutral or secular system of solving ethical issues. However, this is a serious misunderstanding. Though these principles describe well much of the current cultural consciousness about right and wrong (and so describe what Beauchamp and Childress call the “common morality” that all human beings ought to hold to), they do not have enough moral or concrete content on their own apart from prior assumptions and worldview considerations.Thus, one might come at the four principles from a Buddhist perspective, or an Islamic perspective, or an atheistic perspective and achieve vastly different results. The moral content and concrete application of the four principles would not simply depend on the particular details of a case, but also on the worldview from which one is approaching the moral question to begin with. The same is true of causitry as well. The point is that when one utilizes the principalist approach to bioethical dilemmas, it will always also incorporate broader worldview considerations and never be purely neutral or unbiased.The Christian NarrativeWhile it is not possible to survey every possible religion, the description below will at least attempt to do justice to the biblical narrative and Judeo-Christian tradition.The Bible is a collection of 66 books written over thousands of years in several different languages and in different genres (e.g., historical narrative, poetry, letters, prophecy), yet there is an overarching story, or big picture, which is referred to as the Christian biblical narrative. The Christian biblical narrative is often summarized as the story of the creation, fall, redemption, and restoration of human beings (and more accurately this includes the entire created order). Concepts such as sin, righteousness, and shalom provide a framework by which the Christian worldview understands the concepts of health and disease.Briefly, consider the following summary of each of the four parts of the grand Christian story:

Creation

According to Christianity, the Christian God is the creator of everything that exists (Gen 1-2). There is nothing that exists that does not have God as its creator. In Christianity, there is a clear distinction between God and the creation. Creation includes anything that is not God–the universe and everything in it, including human beings. Thus, the universe itself and all human beings were created. The act of creating by God was intentional. In this original act of creation, everything exists on purpose, not accidentally or purely randomly, and it is good. When God describes his act or creating, and the creation itself as good, among other things, it not only means that it is valuable and that God cares for it, but that everything is the way it is supposed to be. There is an order to creation, so to speak, and everything is how it ought to be. This state of order and peace is described by the term “Shalom.” Yale theologian Nicholas Wolterstorff (1994) describes Shalom as, “the human being dwelling at peace in all his or her relationships: With God, with self, with fellows, with nature” (p. 251). Spiritual Case Study Assignment

Fall

Sometime after the creation, there occurred an event in human history in which this created order was broken. In Genesis 3, the Bible describes this event as a fundamental act of disobedience to God. The disobedience of Adam and Eve is referred to as the Fall, because, among other things, it was their rejection of God’s rule over them and it resulted in a break in Shalom. According to the Bible, the Fall had universal implications. Sin entered into the world through the Fall, and with it, spiritual and physical death. This break in Shalom has affected the creation ever since; death, disease, suffering, and, most fundamentally, estrangement from God, has been characteristic of human existence.

Redemption

The rest of the story in the Bible after Genesis 3 is a record of humanity’s continual struggle and corruption after the Fall, and God’s plan for its redemption. This plan of redemption spans the Old and New Testaments in the Bible and culminates in the life, death, and resurrection of Jesus Christ. The climax of the Christian biblical narrative is the atoning sacrificial death of Jesus Christ, by which God makes available forgiveness and salvation by grace alone, through faith alone. The death of Christ is the means by which this estrangement caused by sin and corruption is made right. Thus, two parties, which were previously estranged, are brought into unity (i.e., “at-one-ment”). For the Christian, salvation fundamentally means the restoration of a right and proper relationship with God, which not only has consequences in the afterlife, but here and now. Spiritual Case Study Assignment

Restoration

The final chapter of this narrative is yet to fully be realized. While God has made available a way to salvation, ultimately the end goal is the restoration of all creation to a state of Shalom. The return of Jesus, the final judgment of all people, and the restoration of all creation will inaugurate final restoration.The Christian Ethical Approach − An OutlineWhile the principalist approach may be used by the Christian as a general methodological tool for bioethical reflection, the general contours of a Christian approach to ethics (not only bioethics) may be described as a mix of deontoogy and virtue ethics (Rae, 2009, p. 24). Given the reality that there is a God who exists and has created the world with a moral structure and and purpose, what is truly right and good is a reflection of the character and nature of the God of the Bible. The ethic that follows from the holy and loving nature of God is deontological because it will include principles and rules regarding right and wrong.These principles can be known in two main ways: in the form of divine commands, as recorded in the Bible (take for example the 10 commandments), and in the structure of the world, from which a natural law (about right and wrong, not legal matters) can be detected. The biblical ethic will also involve elements of virtue ethics. The perfect man and moral exemplar (though much more than only a man and an exemplar) in the Christian tradition is Jesus Christ himself. The Christian is to not only obey God’s commands, but to be transformed into his image. Jesus Christ is the perfect representation of such a life; Christian’s thus ought to embody the virtues and character of Jesus himself. The attaining of these virtues will not only be a matter of intellectual knowledge of right and wrong, but an active surrender and transformation by means of God’s own Holy Spirit. Furthermore, the wisdom to navigate all the complexities of ethical dillemas and apply biblical and natural law principles appropriately will be a consequence of a person’s character and the active guidance of the Holy Spirit. Spiritual Case Study Assignment

Worldview and the Christian NarrativeThe way in which Christianity will answer the seven basic worldview questions will be in the context of the above narrative. In the same vein, a Christian view of health and health care will stem from the above narrative and God’s purposes. Of course, the pinnacle of this framework is the person of Jesus Christ. Thus, for Christianity, medicine is called to serve God’s call and purposes, and everything is done in remembrance of, and in light of, Jesus’ ultimate authority and kingship.

ReferenceBeauchamp, T. L., and DeGrazia, D. (2004). “Principles and principalism” in Philosophy and medicine vol. 78. Handbook of bioethics: Taking stock of the field from a philosophical perspective. Dordrecht: Kluwer Academic Publishers.Rae, Scott B. Moral (2009). Moral choices: An introduction to ethics. (3rd ed.). Grand Rapids, MI: Zondervan.Wolterstorff, N. (1994). “For justice in Shalom.” In W. G. Boulton, T. D. Kennedy, & A. Verhey (eds.), From Christ to the world: Introductory readings in Christian ethics. Grand Rapids, MI: Wm. B. Eerdmans Publishing Company. Spiritual Case Study Assignment

© 2015. Grand Canyon University. All Rights Reserved.

 

Case Study: End of Life Decisions

George is a successful attorney in his mid-fifties. He is also a legal scholar, holding a teaching

post at the local university law school in Oregon. George is also actively involved in his teenage

son’s basketball league, coaching regularly for their team. Recently, George has experienced

muscle weakness and unresponsive muscle coordination. He was forced to seek medical

attention after he fell and injured his hip. After an examination at the local hospital following his

fall, the attending physician suspected that George may be showing early symptoms for ALS

(amyotrophic lateral sclerosis), a degenerative disease affecting the nerve cells in the brain and

spinal cord. The week following the initial examination, further testing revealed a positive

diagnosis of ALS. Spiritual Case Study Assignment

ALS is progressive and gradually causes motor neuron deterioration and muscle atrophy to the

point of complete muscle control loss. There is currently no cure for ALS, and the median life

expectancy is between three and five years, though it is not uncommon for some to live 10 or

more years. The progressive muscle atrophy and deterioration of motor neurons leads to the loss

of the ability to speak, move, eat, and breathe. However, sight, touch, hearing, taste, and smell

are not affected. Patients will be wheelchair bound and eventually need permanent ventilator

support to assist with breathing. Spiritual Case Study Assignment

George and his family are devastated by the diagnosis. George knows that treatment options only

attempt to slow down the degeneration, but the symptoms will eventually come. He will

eventually be wheelchair bound, and be unable to move, eat, speak, or even breathe on his own.

In contemplating his future life with ALS, George begins to dread the prospect of losing his

mobility and even speech. He imagines his life in complete dependence upon others for basic

everyday functions, and perceives the possibility of eventually degenerating to the point at which

he is a prisoner in his own body. Would he be willing to undergo such torture, such loss of his

own dignity and power? George thus begins inquiring about the possibility of voluntary

euthanasia. Spiritual Case Study Assignment