Soul Service: A Hospice Guide to Emotional and Spiritual Care for the Dying - A Deeper Level of Consciousness to Dying

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Recommendations for End-of-Life Care Training

In the third year of training, most medical students typically take hours of coursework in the area of reproductive medicine, embryology, prenatal care, labor and delivery and neonatal care. Four-to-six weeks rotations are required in obstetrics and pediatrics. Yet there are no required classes and clinical rotations on topics of grief, care giving, palliative care and spirituality relating to the end-of-life. Today’s medical schools offer a curriculum that is antiquated and better suited to the 1940’s and 1950’s when most doctors delivered babies and routinely took care of infants. Yet, only about 50 percent of the American population will have children, and 100 percent will die. It is time to change how our doctors and nurses are trained in this important area of death and dying. While it is valuable to take some death and dying courses during their training, physicians also need to have learning opportunities such as rotations within hospices, nursing homes and assisted living facilities to practice their skills.
The newly emerging specialty area of palliative care should also be included as mandatory in the training of our upcoming medical personnel. Atlanta palliative care specialist Dr.Melissa Schepp states, “I think if I had my magic wand, I would make it so that every caregiver knew a little bit about the basics of palliative care.Basically, that comfort is paramount regardless of whether you are going for a cure or not. We need to pay more attention not just to pain management but to  good pain management.”
 Back in 1997, Harvard Pilgrim Health Care,Inc. organized a two-day National Consensus Conference on Medical Education for Care Near the End-of-Life. In a report prepared by Kelsey Meneham, Rx: More Training Urged for Physicians Treating Dying Patients, for the Robert Wood Johnson Foundation, (, the eighty –five medical professionals attending the conference recommended that:
  • Care at the end of life should be taught as a core professional task throughout the continuum of medical education.
  • In all phases of training, students should be exposed to dying patients and to interdisciplinary teams of clinicians and other healthcare professionals who can teach and model the humanistic functions of medicine and who are skilled in palliative care.
  • Although the preclinical years have an important role in teaching about end-of-life issues, undergraduate educators should also focus training in the clinical years where key attitudes and life-long practice patterns are learned.
  • To succeed in improving end-of-life care, medical schools must train and hire more educators to provide and demonstrate state-of-the-art palliative care. These educators are needed to serve as teachers and role models for medical students, residents, fellows, medical school faculty, and physicians-in-practice.
Teaching end-of life care to physicians should focus on four major goals: developing appropriate communication skills; acquiring essential technical knowledge for treating symptoms and relieving pain; learning to address the psychosocial,cultural, and spiritual needs of patients and their families; and developing the ability to reflect on personal attitudes about this work.
The late Dr. M. Scott Peck, in his work Denial of the Soul: Spiritual and Medical Perspectives on Euthanasia and Mortality (New York: Harmony Books, 1997) suggested acourse of training for medical professionals that includes:
  • The concept of mortality and what it means to be mortal would be discussed.
  • How death is denied in general in our society and the Kübler Ross stages in particular, would be studied.
  • Among other books, he would recommend reading Joseph Sharp’s book Living Our Dying: A Way to the Sacred in Everyday Life.
  • There would be a discussion of the afterlife and various belief systems about it.
  • Students would explore various religions, including those that believe in karma and reincarnation.
  • Discussion and exploration about ideas about the soul would occur.
  • Considerable time would be spent on the ego and its involvement with the practice of medicine.
  • Secular as well as religious ideas about meaning would be explored.
  • There would be time for various ethical theories, with emphasis on ideal observer theory.
  • There would be an exploration about distinctions between natural and human evil and how a supposedly loving God might permit these painful things.
  • The euthanasia debate in all its ramifications would be included.
As health care practitioners you can request that your hospital offer training programs and continuing education courses that are required as mandatory for all hospital physicians and nurses.Suggest that they can follow the guidelines as outlined by Dr. Peck and the Harvard backed recommendations. As alumni of medical and nursing schools you can write to your school administrators to get them to re-examine the need for mandatory end-of-life care training to the students. Through incorporation of mandatory coursework in palliative, emotional and spiritual care and rotations with the terminally ill, our U.S.medical and nursing schools can be updated to a better level of service.
Additional Information:
In a survey done for research for my book, Soul Service: A Hospice Guide to the Emotional and Spiritual Care for the Dying ( Balboa Press, 2013) we contacted 122 medical schools and 34 of the top 50 U.S. News and World Reports nursing schools to determine what the U.S. training is currently in palliative,emotional and spiritual care to the dying. Only 8 medical schools and none of the nursing schools offered this coursework as mandatory, 16 had elective courses in these areas.
Medical schools that are currently offering mandatory coursework  in palliative,emotional and spiritual care to the dying include:
1.   Stanford UniversitySchool of Medicine
2.   Johns Hopkins UniversitySchool of Medicine
3.   Mayo Clinic College of Medicine
4.   University of South Carolina School of Medicine
5.   Texas A&M Health Science Center College of Medicine
6.   Eastern Virginia Medical School
7.   Keck School of Medicine of University of Southern California
8.   David Geffen School of Medicine at UCLA
About Soul Service SoulService is a book that speaks to the medical professional, lay person,dying person and family member about treating the dying from a holistic perspective. It provides a detailed navigation to spiritual and complementary care as well as assists with the process of how to choose a hospice. Soul Service serves as a useful resource guide to the myriad of organizations that are currently available to assist with the dying process.

1 Comment to Recommendations for End-of-Life Care Training:

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