The interface of medicine, spirituality, and ethics : a case study of the McGill programs in whole person care

Academic and medical institutions are responding to rising critiques of mainstream, scientific medicine (biomedicine).One response is the establishment of centers and programs devoted to whole person care.I assess the response of the McGiIl Programs in Whole Person Care (WPC) to these critiques, particularly its incorporation of spirituality into medicine.Through textual hermeneutics, participant observation, and semi-structured interviews with faculty members, I argue that WPC is constructing its own worldview and normative framework.It does this by selectively drawing from the religious traditions of ancient Greece, Buddhism, and Christianity, interpreting these selections in terms of Jungian psychology, and sometimes secularizing them.My aim is to better understand the theory and praxis of whole person care in McGiIl University's Faculty of Medicine as a case study but also the ethical issues it raises.I conclude by providing points of reflection for institutions wishing to incorporate these health ideas and practices into conventional medicine. RésuméLes institutions académiques et médicales réagissent aux critiques de plus en plus fréquentes visant la médecine scientifique traditionnelle (biomédecine), d'où l'établissement de centres et de programmes voués au "soins holistiques" ("whole person care").J'évalue la réaction des McGiIl Programs in Whole Person Care (WPC) à ces critiques, plus spécifiquement son intégration de la spiritualité en médecine.Par le biais d'herméneutique textuelle, d'observation de participants et d'entrevues semistructurées avec des membres de la faculté, je suggère que le WPC est en train d'établir une vision du monde et une structure normative qui lui sont propres.Il fait ceci en s'inspirant d'aspects particuliers des traditions religieuses de la Grèce antique, du bouddhisme et du christianisme et en interprétant ces aspects selon la psychologie jungienne ainsi qu'en les laïcisant dans certains cas.Je vise à mieux comprendre la théorie et la pratique du "soins holistiques" dans la Faculté de Médecine de l'Université McGiIl en tant qu'étude de cas, mais aussi de mieux comprendre les problèmes éthiques qu'elles posent.Je conclus en offrant des points de reflection pour d'autres institutions qui souhaiteraient incorporer ces idées et pratiques ayant trait à la santé dans la médecine conventionnelle.I would like to extend my deepest gratitude to Dr. Katherine Young of the Faculty of Religious Studies for her insight, guidance, and support throughout my graduate studies and the thesis writing process in particular.Her interests, especially in cross-disciplinary research, enthusiasm, and continual encouragement have been inspiring and altogether afforded me the opportunity to explore my own diverse research interests.I am, furthermore, indebted to the faculty members at the McGiIl Programs in Whole Person Care, both past and present.They have been so accommodating in my requests, openly receptive of my ideas, and volunteered so much of their time.I only hope that my work will impart to them what they have so graciously and genuinely given me.I would also like to thank my fellow graduate students particularly the biomedical ethics group, Kassy Wayne, Véronique Bergeron, Hayden Bernstein, and William Affleck, for their ever-engaging ideas and support.And last but never least, I am grateful for the unabating love and support of my family and friends.Without them, none of this would have been possible.CHAPTER 1: General Concepts and TheoriesIn general, the goal of WPC is to "create a focus for healing and whole person care" ("Newsletter 1.1" 1).The interpretation and theories associated with these two concepts are pivotal to its mandate, initiatives, and practices.This chapter explores the influence on the concepts by authors such as Eric Cassell, Michael Kearney, Viktor Frankl, Martin Buber, and Carl Jung (Mount and Hutchinson 17).I begin by examining definitions and distinctions of WPCs core concepts.Following this, I focus on the principles of the healing process.Throughout this chapter, I argue that the theories of WPC are unequivocally rooted in spirituality, which is consistent with its major aim to redress the paucity of concern for the spiritual dimension in medicine. DefinitionsCentral to the theory of WPC are the following concepts: whole person care, disease, illness, curing, healing, wounding, suffering, and wholeness.Below, I delineate WPCs definitions and descriptions of these terms particularly highlighting important distinctions among them. Whole Person CareAccording to the initial core faculty members consisting of Mount, Boston, and Cohen,9 "whole person care" refers to the following:The active total care of patients ... [c]ontrol of pain, of other symptoms, and of psychological, social, and spiritual problems, is paramount.(Mount, Boston, and Cohen, "Proposal" 15) An approach to care that considers the patient and family, taken together, as the unit of care and involves the total care of patients, through the control of pain and other symptoms, and attention to psychological, social, and spiritual problems.It replaces the preoccupation with disease that is characteristic of the biomedical model with a broader perspective, that of experienced illness, suffering, and quality of life.(Mount, Boston, and Cohen, "Appendix V") .See Appendix 1 for short biographies of the WPC faculty members in general and the initial cohort in particular. Suffering and WholenessAccording to Cassell, suffering arises out of a perceived threat to one's personal integrity and continues until the impending threat is abated, eradicated, or a sense of integrity is otherwise reconstituted (Nature 32).13 In other words, a personal perception or experience of an impending threat to individuals' sense of wholeness and integrity creates a shift towards a sense of suffering and anguish.And for Cassell, not only can the affliction of disease engender a threat to personhood and hence result in suffering but so too can its corresponding treatment (Nature 29).Therefore, suffering can result out of a threat to any aspect of individuals' sense of self, meaning, or integrity (Hutchinson, "Transitions" 273).This threat may arise, for instance, when individuals perceive a discrepancy between their personal expectations for themselves and that of bona fide reality (Mount, Lawlor, and Cassell 305).Now although WPC defines the term suffering in considerable detail, particularly through Cassell' s interpretation, a definition of wholeness remains elusive.This is quite surprising since 1) the concept of wholeness constitutes the foundation on which WPC defines healing and wounding, 2) WPC provides explicit definitions of all other terms constitutive of the healing dialectic, 3) Mount argues for As discussed in chapter one, Kearney's work has been foundational in the inception and development of WPCs theories of healing and whole person care.But, he has additionally been pivotal in the formulation of WPCs programmatic initiatives.In 2002 and 2003, WPC hosted Dr. Kearney in the capacity of a two-year, part-time visiting professorship (Mount and Kearney 657).It was during this time that Kearney was able to apply his theoretical contributions to the practical undertakings and endeavours of WPC.

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