A Spiritual Response to the Challenge of Routinization: A Dialogue of Discourses in a Buddhist-Initiated Hospice

Abstract

The hospice vision of providing democratic and humane care of the dying needs to be operationalized in the "real world" of health care bureaucracies. It is at this interface between idealists and the demands of mainstream health care that hospice organizations experience compromise, diversion, and an ongoing threat to their singleness of purpose. This discussion explores this process of routinization through research findings on a hospice organization known as Karuna Hospice Service (KHS). Such findings suggest that, although this hospice inevitably defers to the bureaucratic demands of the system, KHS's spiritual discourse does offer some protection to the formalizing and dehumanizing demands of routinization. Such research findings are provided as a contribution to exploring and documenting the ways in which hospices are negotiating this difficult and important ideological challenge. It is argued that effectively meeting such a challenge is of central importance for the survival of the hospice movement.

Fluctuating awareness of treatment goals among patients and their caregivers: a longitudinal study of a dynamic process

“…Current views emphasize that encounters take place over time and involve the patient, the family, and the medical team [11]. The potential value of an ongoing relationship is suggested by our finding that time to death is associated with increasing clarity of understanding, which may also grant the opportunity to discuss religious and spiritual issues as well as medical and health matters [30]. Timmermans [21], Mamo [22], and Valdimarsdottir et al [15] all found that the process of developing an awareness of dying is a gradual one for family caregivers.…”

Autonomy, Discourse, and Power: A Postmodern Reflection on Principlism and Bioethics

“…Such a spiritual discourse was found to be actively creating and supporting both the discursive space for holistic care of the dying and a subjectivity for a compassionate and tolerant hospice worker. Not only was the KHS way of "speaking the world" seen to attract and support individuals who sanction a loving, caring and gentle way of relating to each other and the families they work with, it also informed a client subjectivity based on a psychosocial-spiritual interpretation of their needs (McGrath, 1996;1997a;1997b;1998a;1998b).…”

Another form to fill in! Clients’ reflections on the hospice use of questionnaires

“…The early work of James and Field called attention to a concern about the counter-productive dimension of the bureaucratic pressure inherent in regular use of instrumentations [12]. The move towards routine incorporation of standardized assessment tools is seen as a negative outcome of the process of routinization, a process by which the compassionate, holistic ideology of the hospice movement is undermined by the increasing bureaucratic pressure to 'measure' and 'quantify' [12,20]. The challenge for hospice and palliative care organizations is seen to be one of maintaining adherence to the core values of humane patient-and family-centred care, in the face of the pressure towards routinization and bureaucratization [20,21,35].…”

“…The move towards routine incorporation of standardized assessment tools is seen as a negative outcome of the process of routinization, a process by which the compassionate, holistic ideology of the hospice movement is undermined by the increasing bureaucratic pressure to 'measure' and 'quantify' [12,20]. The challenge for hospice and palliative care organizations is seen to be one of maintaining adherence to the core values of humane patient-and family-centred care, in the face of the pressure towards routinization and bureaucratization [20,21,35]. This is difficult at a time when hospices need to demonstrate the use of standardized tools for accreditation purposes, and are increasingly forced to justify their activity in terms of measurable and cost-efficient outcomes [21].…”