Ethical issues of incorporating spiritual care into clinical practice.
OBJECTIVE
The aim of this article was to analyse the scholarly discourse on the ethical issues of incorporating spirituality and religion into clinical practice.


BACKGROUND
Spirituality is an important aspect of health care, yet the secularisation of health care presents ethical concerns for many health providers. Health providers may have conflicting views regarding if and how to offer spiritual care in the clinical setting.


METHODS
Discursive paper.


RESULTS
The discourse analysis uncovered four themes: ethical concerns of omission; ethical concerns of commission; conditions under which health providers prefer to offer spiritual care; and strategies to integrate spiritual care. Ethical concerns of omission of spiritual care include lack of beneficence for not offering holistic care. Ethical concerns of commission are coercion and overstepping one's competence in offering spiritual care. Conditions under which providers are more likely to offer spiritual care are if the patient has a terminal illness, and if the patient requests spiritual care. Strategies for appropriate spiritual care include listening, and remaining neutral and sensitive to spiritual issues.


CONCLUSIONS
Health providers must be aware of both the concerns of omission and commission. Aristotle's golden mean, an element of virtue ethics, supports a more moderate approach that can be achieved by avoiding the imposition of one's own personal beliefs of a religious persuasion or beliefs of extreme secularisation, and focusing on the beneficence to the patient. Relevance to clinical practice.  Key components for health providers in addressing spiritual concerns are self-reflection, provision of individualised care, cultural competency and communication.
School of Nursing, University of Texas Health Science Center at Houston, TX 77030, USA. rebecca.l.casarez@uth.tmc.edu
Rebecca L
RL
Polzer Casarez
Joan C
JC
Engebretson
D006801:Humans; D009732:Nursing Care / Q000941:ethics*; D029181:Spirituality