Existential Dimension and Spiritual Assistance in the “A. Gemelli” University Hospital in Rome: A Cross-Disciplinary and Sacramental Enhanced Dynamical Approach in Palliative Care

In the A. Gemelli university hospital in Rome, the presence of highly specialized inter-professional palliative care teams and spiritual assistants who are dedicated to their role in the service of inpatients is valuable to person-centered healthcare. Spiritual needs are commonly experienced by patients with sudden illness, chronic conditions, and life-limiting conditions, and, consequently, spiritual care is an intrinsic and essential component of palliative care. This paper focuses on the sacrament of the Anointing of the Sick to demonstrate the importance of spiritual care as an integral part of palliative care and highlights the need for all interdisciplinary team members to address spiritual issues in order to improve the holistic assistance to the patient. Over a 3-year period (October 2018–September 2021), data about the sacrament of the Anointing of the Sick administered by the hospitaller chaplaincy were collected. A total of 1541 anointings were administered, with an average of 514 anointings per year, excluding reductions related to the COVID-19 pandemic. In 98% of cases, the sacrament was requested by health personnel, and in 96% of cases, the same health personnel participated in the sacrament. These results demonstrate that, at the A. Gemelli polyclinic in Rome, the level of training that the care team has received in collaboration with the chaplains has generated a good generalized awareness of the importance of integrating the spiritual needs of patients and their families into their care, considering salvation as well as health, in a model of dynamic interprofessional integration.

The GP’s perceived role and use of language concerning the existential dimension of palliative patients

Background: Palliative patients have to cope with their disease and impending death. Knowing what this means for a patient is crucial for person-centrered care. Although guidelines state it is a GP core task to explore existential issues of palliative patients, this is not standard practice.Aim: Exploring Dutch GPs’ perceived role regarding addressing the existential dimension of palliative patients, and which vocabulary is used.Design and Setting: Qualitative study among Dutch GPs. Participants were recruited by purposive sampling and snowballing, considering gender, working experience and world view.Method: Semi-structured in-depth interviews were performed, transcribed and analysed using content analysis.Results: Seventeen GPs participated. Three themes were identified: Language, Perceived role and Practice. Interviewees generally saw it as their role to pay attention to the existential dimension of their palliative patients. However, not all knew how to define this role, or how to refer patients with existential struggles to a spiritual counsellor. The multidisciplinary Dutch guideline ‘Existential and Spiritual Aspects of Palliative Care’ seemed largely unknown. Interviewees mostly fulfilled their role in an intuitive, pragmatic way. Questions such as “What does it mean for you to be seriously ill?” or “Do you have support from someone or something?” fitted daily practice.Conclusion: This study emphasizes the importance of basic GP education in exploring existential issues. The coexistence of a professionally obliged attention and an intuitive approach seems to be in conflict. We recommend enhancing collaboration between GPs and spiritual counsellors, appropriate training, and implementation of the relevant guideline on well-known platforms.

The Origin and Functioning of Myth: Linguistic Conditions

The article identifies two approaches to determining the linguistic conditions of the emergence and functioning of the myth. The first approach assumes that the myth is a manifestation of unconscious (M. Müller) or conscious (E. Cassirer, R. Barthes) distortion of language. Within this approach it is impossible to escape from myth because the presentation of the facts of the world in language is inescapable, which is always imperfect. These distortions are meant for political influence, as according to the proponents of the conscious mythologizing of language. Philosophy is tasked with resisting such distortions and, consequently, myth creation in general. This approach seems simplified, because the myth is identified here with the linguistic form of its distribution, reduced to the analysis of distortions of language presentation. At the same time, the psychological and epistemological preconditions of the myth, its unique status in the life of communities are lost. Conditions for the development of the second approach arise through the critique of classical rationality by several influential thinkers who undermined the belief in the exclusive ability of discursive language to present the truth (F. Nietzsche, L. Wittgenstein, M. Heidegger). The second approach assumes that the myth emerges and continues to exist due to the inability of the logos to present some important aspects of reality, especially its existential dimension (P. Tillich, H. Blumenberg, L. Hatab, K. Morgan). In this case, myth and logos become alternative and at the same time closely connected linguistic ways of presenting the truth. Logos (the language of science) presents primarily abstract causal connections of essences. At the same time, mythical narratives are better than science at presenting the mysteries of origin and existence, creating a hierarchy of values for communities.

Introduction

This section introduction explores the imaginative dimension of mobility in two West African countries, Sierra Leone and Liberia. Building on literature that highlights the existential dimension of movement and migration, the authors explore three socio-cultural patterns that inform representations of im/mobility: historical continuities and the longue-durée perspective on mobile practices, the association of geographical mobility with social betterment, and the interaction between local aspirations and the imaginary of global modernity. The three individual contributions by Bedert, Enria and Ménard bring out the work of imagination attached to im/mobility both in ‘home’ countries and diaspora communities, and underline the continuity of representations and practices between spaces that are part of specific transnational social fields.

Confrontation and Conflict

The First World War revealed an existential dimension of citizenship that remains hidden in peacetime. Hostilities between states intensify the politico-social significance of citizenship and raise awareness of citizens’ duty to put their lives at risk for the good of their home country. The war introduced an epoch in which the political and social importance of citizenship in the everyday lives of Europeans increased greatly, as did, however, its delimiting and exclusionary impact as well. The extreme depletion of the reservoir of—male—conscripts sharpened the dividing line between the sexes and, during large-scale conquests, incited conflicts between ethnic and national loyalties, between ethnicity and nationality, as was seen, for example, in the areas occupied by Germany in France and Russia. The emerging European civil war, which would become a world civil war, had one of its battlefields in the immensely contradictory and conflict-ridden history of citizenship.

Utopie und Lebenszeit in der Aufklärung

The aim of this article is to outline how Hans Blumenberg’s conception of lifetime and world time (Lebenszeit und Weltzeit, 1986) can help to elucidate a substantial problem of utopian literature and its development from the 16th to the 18th century: utopias always try to illustrate the ways by which the single members of a political community harmonise with the community as a whole. The congruence of private good and common good, private interest and common interest, private will and general will is a main task of 17th and 18th century political philosophy. Blumenberg’s book, however, allows us to focus on the existential dimension of this harmonisation: under which circumstances may the single members become so wise and virtuous within their lifetimes that they always know about and comply with the common good? 18th century utopias seem to find answers to this question in theories of moral sense, common sense and aesthetic education.

What Are ‘Health and Wellbeing’?

What is health? What is wellbeing? Various definitions of health explored: a common-sense definition first. The health of middle-aged men and the effectiveness (or otherwise) of health and wellbeing programmes (including smartphone apps) in the workplace. US occupational physician, Dr Ray Fabius’ finding that such programmes work only in workplaces with a culture of health. Definition of health: the WHO’s definition (‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’), rejected as an unworkable tool; and one proposed in The Lancet in 2003 as ‘the ability to adapt’. Radically, this definition sees a patient in the context of their current life; the doctor’s role is to help the patient adapt to their prevailing condition. The social determinants of health. Dr Machteld Huber’s definition in The BMJ: ‘health is the ability to adapt and self-manage’. Her subsequent research and definition of six domains in which health manifested. Patients and nurses gave all six about equal weight, but policymakers rated bodily functions as much more important. Doctors rated the spiritual/existential dimension lower than patients. Patient-centred model of medical practice proposed that gives equal weight to all six. Moving towards a positive concept of health. Maslow’s ‘hierarchy of needs’ from his 1943 paper ‘A theory of human motivation’ explained. Professor Martin Seligman, former president of the American Psychological Association, and the concept of flourishing. Seligman’s five components of wellbeing in the PERMA model. Author’s definition of positive health.

Hans Van Manen

The Dutch avant-garde choreographer Hans van Manen (b. 1932) is frequently recognized as a game changer and pioneer for his fusion of ballet techniques with elements from dance theater, and for his scrutiny of ballet’s conventional use of authority, power, and patriarchy. Yet it still remains difficult to describe the “mysterious experience” one gains while watching his ballets, an experience characterized by an intriguing tension between formal austerity and dramatic expression—a type of “less is more.” In this chapter, Van Manen’s ballets are at once abstract and emotive; they are uncomplicated, tightly composed works of pure dance, and yet they are deeply social and political, with a clear emancipatory agenda. In short: Hans van Manen’s choreographies have an existential dimension, and can be described as abstract miniature dramas.

Creating Being

Heidegger is well known for his arguments that architecture “shelters being,” and allows us to “dwell” in order that we may “think” in his special ontological sense of the term. This chapter takes serious these reflections on the relationship between the built environment and the question of the meaning of Being. Without endorsing such views wholesale, the argument is that there is indeed an existential dimension to buildings—how could there not be?—and therefore that architects have a special responsibility to consider this issue of Being in their work.