Van Amburg R. Am J Occup Ther. 1997; 51(3):186-190

Prepared by: : Mary Anne Schleinich

Received during: Journal Club, Tertiary Palliative Care Unit, Grey Nuns Community Hospital

Abstract:

Spiritual fulfillment in the professional role of occupational therapy practitioner is hindered by the ethical consideration of maintaining an objective client-therapist relationship. Objectivity is a disengaged perspective that depersonalizes human relationships. It operates on the tacitly performed, reductionistic assumption that all truth can be structurally represented and verified. However, to obtain meaning from truth is to adequately interpret experience through dialogue. Meaningful experiences are hermeneutical in nature and require engaged, sympathetic relationships to be spiritually manifested.

Comments:

Strengths/uniqueness:
This thought provoking article makes a case for the inadequacy of methodology that relies on scientific objectivity. When measuring efficacy of service, the author asserts that the meaning of treatment for both patient and provider must be included. The article insightfully describes "sympathy" vs "empathy", as well as the role of working with one's own interpretations in order to create an engaged context in which meanings are revealed. Van Amburg provides much material for reflecting on how one practises medicine.

Weakness:
Van Amburg writes from a philosophical perspective, making for a very dense article. Some terms, such as transference, and phrases are given short script. Philosophy favors the use of language to convey meaning - and readers in palliative care are wise to notice other modes of expression when verbal language fails.

Relevance to Palliative Care:
This article is highly relevant to palliative care, where patients and families (not to mention staff), are confronted with experiences that often challenge them to re-interpret meanings, to find new ways of living (with dying, for example). The palliative care environment influences persons to reflect on their immediate desires, and the meaning of their lives. Meanings have the power to reduce suffering. The quality of our work in palliative care is reflected in our ability to facilitate and attend patients and families to engage in their search for meaning in the "palliative chapter" of their lives.