Book Reviews
The Dying Soul: Spiritual care at the end of life
Mark Cobb
2001 145 pages Buckingham: Open University Press
Gail Bateman
La Trobe University, Department of Palliative Care
Mark Cobb in The Dying Soul, explores a range of contemporary issues central to the spiritual care of the dying. His background in palliative care chaplaincy and teaching in the field allows him ready access to the core of these issues, and he raises pertinent sociological observations about the standing of spiritual care in palliative care in Britain. His theological background and experience informs this contentious title The Dying Soul. He refuses to take a secular position on the issue of death, and early in the book reminds the reader that religious and historical notions of the 'soul' are deeply embedded within our western cultural heritage despite the widespread secularisation of society during the twentieth century. This transcendence of the soul influences ethical perceptions of human meaning through notions such as truth, love, individual worth and a sense of moral purpose, notions that otherwise are diminished by nihilistic materialist and existentialist conceptions of death. He contends that it is from this transcendent ethical framework that the concept of a 'good death', hospice and in turn palliative care evolved.
Cobb explores the care of the dying as it has moved from the religious hospice back into the health care system in recent times through the medicalisation of palliative care. He describes how spiritual care is in danger of being subsumed by the rational instrumental practices associated with the medical approach, and endeavours to tease out the various interests and positions associated with spiritual care of the dying.
Cobb describes the ways in which the 'spiritual' is referred to in palliative care without a clear understanding of what this is, and who should provide spiritual care. He raises the ambiguities and multiple understandings that people have about spirituality. He also demonstrates the paucity of research and investigation that has so far gone into describing spiritual care. From this position he explores which occupational group/s are best equipped to offer this type of care to the dying person, making important distinctions about the training and the skills needed for this role.
It is quite clear from Cobb's investigation that the provision of 'good' spiritual care takes more than a cursory inclusion of spiritual needs in a nursing care model, or a hope that people will absorb spiritual insight in the course of their daily care. People's desire for spiritual support at the end of life is evident and Cobb mounts a lucid argument for this to be provided by trained professionals who have more than a vague understanding of theological, pastoral and spiritual issues in the human life journey.
This book is a useful contribution to the contemporary debates concerning the place of spiritual care within palliative care. Although writing from a British perspective, much of what Cobb discusses bears direct relevance to the issues currently being explored in Australia. What distinguishes the UK context from Australian experience in palliative care can be seen when Cobb in effect assumes the spiritual care professional to be a chaplain, and an Anglican at that! In Australia, professional spiritual care in palliative care is generally referred to as pastoral care, and ordained chaplains are only one of the categories of spiritually trained professionals who provide this care. This occupational difference however does not detract from the relevance of his discussion on many other points. Cobb ends by calling for more research in palliative care to provide evidence and develop a knowledge base for spiritual care, showing the way forward to developing a more comprehensive and professional approach to the spiritual care of the dying than the 'ad hoc' approach currently applied.
By raising and exploring the current problems associated with the neglect of professional issues related to spiritual care of the dying, this book makes a further contribution to the sociology of death literature. The medicalisation of palliative care is a current phenomenon throughout the western world. The tendering process in Victoria four years ago rationalised existing palliative care services across the state at the expense of quality care, especially spiritual and social care of the dying. The place, the nature, and the delivery of spiritual care is being debated afresh in many agencies.
This book provides useful insight into the needs of palliative care patients for quality spiritual support, and is mandatory reading for palliative care policy makers and planners. It also discusses current vexed practice issues in the spiritual care of the dying, and thus informs specialised fields such as nursing, pastoral care, health sociology, public health and health promotion of areas that need their attention. The book should also be a useful tool for pastoral and health care students by explaining the current debates and preparing them for future challenges in the field.
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