Spiritual Care

at the End of Life

生命末期的靈性關懷

Rev. Edmond Yeung

楊友光牧師 安寧療護靈性輔導員

THANKS 感謝 • THE HOSPICE MOVEMENT

安寧療護運動 • From disease to patient

從疾病到病患者 • From single dimension to multi-dimensions

從單層面到多層面 • From body to holistic

從身體到全人

The core values of hospice (4th

AD)

安寧療護的核心價值觀 (4th

AD)

• The Gospel of Matthew, Chapter 25: “I was hungry

and you gave me food, I was thirsty and you gave

me drink. I was a stranger and you welcomed

me….I was sick and you visited me….As you did it

to one of the least of these my brethren, you did it

to me.”

馬太福音25：因為我餓了，你們給我吃，渴了，你們給我喝；我作客旅，你們留我 住；我病了、你們看顧我。這些事你們既 做在我這弟兄中一個最小的身上，就是做 在我身上了。

Dame Cicely Saunders Elisabeth Kubler-Ross

桑德斯夫人 伊麗莎白·庫伯勒-羅斯

• Palliation of the dying

person’s suffering is the

easing of “total pain”—

the combination of

physical, psychological,

social, and spiritual pain.

減緩垂死的人的痛苦是緩解“整體的痛苦”- 包括生理，心理， 人際和靈性的痛苦。

• “The primary needs of

the terminally ill are

spiritual. More than

anything else the dying

need meaning, hope and

love.”

“身患絕症者的基本需求是靈性的需要。比較其他的需要，他們更大的需要是人生的意義，希望和愛心。”

Back to Patient-centered Care

返回到以病人為中心的護理 • Thanks for the hospice movement, attending to

a patient’s spirituality has becoming

increasingly recognized as a component of

good, holistic end-of-life care.

歸功於安寧療護運動，照顧病人的靈性，已漸漸被認為是好的全人生命末期照護的一部分 。 • What is this disease? >> Who is this person?

這是什麼疾病？ >> 這人是誰？ Fleming et al, 2010

What is Spirituality?

什麼是靈性？ • The relationship of a person’s inner being to a larger

reality, however it is conceived and expressed.

是個人的內在生命與一個超自然者的關係，無論它的構思和表達是如何。 • The inner search for meaning, purpose, and

understanding of universal questions of human

existence.

這是一個人內在尋找意義，目的和對人類存在的普遍問題的理解。 -Who am I? 我是誰？

-Why am I here? 我為什麼在這裡？

-What is my purpose of life? 我人生的目的是什麼？ APPEAL Project 2006

What is Religion?

什麼是宗教？

• A system of beliefs and practices relating to a higher

power and shared by a group of people.

一個有系統的信念和實踐，是涉及到一個超自然者，並由一組人共享的。 • Provides a community for groups of people to join

together and give expression to their common beliefs,

values, and spirituality.

讓一群人聯合起來表達他們共同的信念，價值觀和靈性。 APPEAL Project 2006

Religious concerns

宗教問題 • “I need to see a priest/rabbi; can you help me?”

“我需要見一個牧師/拉比，你能幫助我嗎？” • “I would like to receive Communion, the Sacrament.”

“我想接受聖餐，聖禮。” • “Could someone get me a Bible to read?”

“有人可以給我一本聖經嗎？” • “Would you pray with me?”

“你可以跟我一起祈禱嗎？”

Spiritual Needs

靈性方面的需求 • “Why is God punishing me so much?”

“為什麼上帝這樣懲罰我？”

• “I am afraid.” “我很害怕。”

• “I feel hopeless.” “我感到絕望。” • “My family won’t come and visit me; I feel abandoned.”

“我的家人不來看望我，我感到被遺棄。” • “What do you think death is like?”

“你認為死亡是像什麼？” • “What mistakes have I made?”

“我做了什麼錯事？”

Dr. Ira Byock, 1986

• “Dying represents more than a set of problems to

be solved. It represents AN EXTRAORDINARY

OPPORTUNITY. An opportunity for review, for

restitution, for amends, for exploration, for

development, for insight. In short, it is an

opportunity for growth.”

“死亡並不止於一組亟待解決的問題。它代表一個難得的機會。一個機會去回顧，恢復，補償，探索，增長，深入見解。總而言之，這是一個成長的機會。”

The opportunity to…

一個機會。。。

• Through fear to peace 從恐懼到平安

• Through confusion to meaning 從混亂到有意義

• Through despair to hope 從絕望到盼望

• From isolation to community 從隔離到群體

(20 Common Problems in End-of-Life Care, Barry M. Kinzbrunner et al, 2002,

p.259)

through fear to peace

從恐懼到平安

• To anticipate “unknowns” generates tremendous

anxiety and fear.

意想“未知”，產生了巨大的焦慮和恐懼 • Being the lack of knowledge about physically dying.

缺乏對死亡的知識

through fear to peace

從恐懼到平安 • The paradox: one can never finish the task. The true task:

“acceptance of fulfillment, acceptance of the unfulfilled.”

矛盾：一個永遠無法完成的任務。真正的任務：“接受已經完成的，接受那無法滿足/實現的。” • “To accept the reality and the fiction….You make the

unity of your life by accepting the reality.” For many, that

unity can help to bring a sense of peace.

Paul Tournier, Learn to Grow Old, 1972

“要接受現實和虛構的......你接受現實，好讓你的生活得到一致。“對於許多人來說，這一致可以幫助帶來平安的意念。

through fear to peace

從恐懼到平安 • Be present.

臨在 • Provide guidance in a gentle and compassionate fashion

用溫和的和富有同情心的方式来提供指導 • Listen to their concerns and address them directly and

sincerely as possible. Help them learn what is “normal”

in their current situation.

聽取他們的意見，直接，真誠地解決這些問題。幫助他們了解在他們目前的狀況什麼是“正常”。

through confusion to meaning

從混亂到有意義 Sickness as: 疾病是： •A punishment for past wrongdoing.

過去不當行為的懲罰 •The source of that guilt

罪惡感的來源 •A fate, a random occurrence

是命運，一個偶然發生的事 •A sign of some personal failure

個人失敗的標誌

through confusion to meaning

從混亂到有意義 •Walter Brueggemann (1986) describes,

“helping people entering into an experience of exile, to be

in exile, and then to depart out of exile,” “only grief

permits newness.”

•Brueggemann (1986)說：“幫助人們進入到流亡的經驗，經歷流亡，然後離開那流亡”，“只有悲傷容許新的見解。”

through despair to hope

從絕望到盼望

An entirely unique experience:

一個完全獨特的體驗： •Living until taking part in some significant event.

活到能夠參與一些有意義的活動 •May be the sense of a life well lived

可能是活出一個有意義的生活 •A sense having contribution to the world or to

someone

感到對世界或某人有貢獻

through despair to hope

從絕望到盼望

•To support patients as they find, explore, redefine, or

change the source of their hope

支持病人，為他們發現，探索，重新定義，或者改變他們的希望之源 •Allowing patient to take the lead in identifying his or

her unique and preferred source of hope

容許病人帶頭來確定他或她的獨特和希望的來源

from isolation to community

從隔離到群體

• Assisting creative closure 協助創意的結束

• Memorial box 紀念盒

• Role-playing 角色扮演

• Write a final letter 寫一封最後的信 • Making a tape recording of one’s confession

為一個人的自白錄音 • Results: reconciliation, healing, sense of a

community. 結果：和好，醫治，群體感

Spiritual Care 靈性的照護 • Empathetic Presence

同理心的陪伴 • Normalization of Patient/Family Experience

病人/家屬的經驗正常化 • Life Review

生命回顧 • Exploration of Sources of Hope & Meaning

探索盼望和意義的來源

http://endlink.lurie.northwestern.edu

Spiritual Care 靈性的照護 • Affirmation of Sources of Strength & Comfort

確認力量和安慰的來源 • Reframing

重新架構 • Diversional & Life-Affirming Activities

另類與肯定生命的活動 • Prayer, Rituals & Observance of Religious Practices

祈禱，儀式和宗教習俗

http://endlink.lurie.northwestern.edu

Spiritual Care from YOU

你如何提供靈性照護 • Listen more than talk

多聽少說話 • Practice being present

練習陪伴 • Avoid judgment of beliefs, practices, or emotional

responses

避免論斷信仰，習俗，或情緒反應 • Refrain from proselytizing or imposing your own beliefs

避免傳教或強施自己的信念

http://endlink.lurie.northwestern.edu

Spiritual Care from YOU

你如何提供靈性照護 • Avoid discussion of religious doctrine, dogma, and

complicated theological questions

避免討論宗教教義，教條，或複雜的神學問題 • Avoid religious clichés

避免宗教陳詞濫調 • Respect patient and family spiritual framework and

practices

尊重病人和家屬原本的靈性架构與習俗

http://endlink.lurie.northwestern.edu

Spiritual Care from YOU

你如何提供靈性照護 • Respect patient and family privacy in this area

尊重病人及家屬在這方面的隱私 • Let the patient and family invite you to participate in their

religious observances or practices rather than you initiating

prayer, ritual, scripture reading, etc.

讓病人和家屬邀請你參加他們的宗教儀式或做法，而不是由你開始祈禱，宗教禮儀，或讀經等 • Coordinate and collaborate as a member of the

interdisciplinary team

作為一個多元化團隊的成員，與成員協調和合作 http://endlink.lurie.northwestern.edu

Conclusions 結論 • Each person’s end-of-life experience is unique and

individual.

每個人的臨終經驗是獨特的，個人的。 • A symphony vs. a second-grader’s first piano lesson.

交響樂與二年級學生的第一次鋼琴課。 • The finale is as important as the overture.

音樂的結奏與序曲一樣的重要。 • “I live differently, but not less.” Paul Tournier (1972)

我的生活是不同的，但不是缺欠的。Paul Tournier (1972)

Serenity Prayer寧靜禱文 God

grant me the

SERENITY

to accept the things

I cannot change,

COURAGE

to change the things

I can, and the

WISDOM

to know

the difference.

主啊！ 求祢賜我穩靜的心，

去接納我所 不能改變的事物；

賜我勇氣， 去改變那有可能改變的；

並賜我智慧 去認識這兩者的差異。

Advice from a LAKE

一個湖的忠告 • Be clear

• Make positive ripples

• Look beneath the surface

• Stay calm

• Shore up friendship

• Take time to reflect

• Be full of life

Ivan Shanan

•要清晰 •作出積極迴響 •看破表面化 •保持冷靜 •維護友誼 •花時間來反思 •充滿生活氣息