Spirituality in health care

Abstract

The discourse of spirituality-in-health-care (SIHC) exhibits a number of features that are not always present in the academic literature. One founding principle is that extravagant metaphysical claims can be made without having to be defended and in the expectation that they will not be challenged. These claims include the fundamental premise of SIHC discourse: everybody is spiritual, or has a spiritual dimension (the universality premise). While metaphysical claims are typically made in the absence of evidence or argument, a series of familiar epistemological tropes is used to secure an inviolate space in which challenges from a naturalistic perspective can be rendered otiose. At this point, SIHC discourse splits into two on mainly demographic grounds: an inflationary version in the USA and a deflationary version in the UK. Two distinctions between ‘spirituality’ and ‘religion’ are adopted: inner/outer and broad/narrow, respectively. One interesting consequence of this demographic split is that the evidence for positive health outcomes as a result of religion/spirituality may apply only to the USA (and other religious countries), given the extent to which American culture is saturated with religion. Authors who adopt the broad/narrow distinction extend the denotation of ‘spirituality’ – what is to be deemed as an instance of either ‘spiritual need’ and ‘spiritual care’ – as much as possible in order that the universality premise will seem more plausible in a relatively secular society. This amounts to a classification project, an exercise in persuasive definition, in which the relevant ‘deemings’ require no defence, and in which a semantic bridge is constructed between the inflationary and deflationary poles. As a consequence, a discursive space is created and maintained for religious sensibilities in health care. The classification project is, for that reason, a broadly theological one.