THE SPIRITUAL DIMENSION OF HOSPICE - THE SECULARIZATION OF AN IDEAL

There is increasing concern that the original hospice ethos is becomin g subject to routinization and bureaucratization. Authors, drawing on Weber's concept of rationalization, have suggested that this has resul ted from the loss of the original charismatic impetus and the commitme nt to care for the terminally ill and dying as inspired by the spiritu al 'calling'. This paper argues that this original ethical ideal has b een fundamental to the humane care of the dying and terminally ill. Us ing Alasdair MacIntyre's analysis it is suggested that as the ideal at tenuates there are inevitable shifts in the ethos and culture of care. An emotivist culture in which the aesthete, the therapist and the man ager are dominant characters, may seem to be occurring in palliative c are. The focus on management skills and the values of efficiency and e ffectiveness influence attitudes to death. This brings increased medic alization, a reliance on psychosocial techniques, a predominant focus on education, research and audit and most particularly redefined attit udes to the spiritual component of care. The paper asks the question w hether the original ethic has a place in preventing palliative care be coming merely a technique for professional empowerment. Copyright (C) 1996 Elsevier Science Ltd