The management of dyspnea.

Traditionalhealthcare,asnow practicedin non-Westernationsandinourownnationbeforethe adventof modem,scientific medicine,placesemphasison treatingthewholeperson.Thetraditionalhealeris amemberof the community.Heis both doctorandpastorto thesickperson.Religiousritualsareanintegralpartof hiscare.Theyareusedtocleanse,heal, andreconcile. Thehealeris skilled atfinding waysto integratethefamily, the community,andotherrelationsinto hishealingefforts as a supportsystemfor the sickperson.Thehealerseesaspartof hisjob creatingaloving, caringenvironmentwhich allowsthe communityto sharein andfacilitate theprocessof healingin aholistic way. Modernmedicinehastendedto introduceapproachesto carewhicharenot in keepingwith traditionalvalues.Theincreasing specializationof modemmedicinehas shiftedthe focusaway from the wholeperson,hisfamily, andcommunity.It has createdanassemblyline approachto healthcaredelivery,wherethepossibilitiesfor referralto evermorespecializedspecialists seemtohaveno limit. Whereastraditionalcaretreatsthe wholepersonwithin hissocialenvironment,modemmedicinetends to treat him asanindividual,asjustanothercase,orevenasmerelyadisease. Hospicesarethe only organizedeffort seekingto integratethe benefitsof modernmedicinewith traditionalvalues.As we enterthe lastdecadeof theTwentiethCentury,the successandacceptanceof ahospiceconceptwhichintegratesspiritual care with modem,scientificmedicineis vital to the well-being,not onlyof theterminally ill, but all ill persons.Hospiceclinicians canteachpractitionersof modernscientific medicinehowto combinephysiologicalandreligious-moraldiagnosisto achieve holistic care. Butbeforehospicecanteachthis, it mustfirst demonstratecompetencein thisregard.Thereis a awide gulfandmanypitfalls betweenclaimingto provideholistic care,andactuallydoing it. Unlessexplicit efforts aremadeandresourcesareallocatedtoholistic, spiritualcare,hospicepractitionersrisksufferingthesamenemesisthathasafflictedmodemscientificmedicine. In this issue,Milton Hay makesabeginningwhenhewritesthat,‘Becauseterminalillnessmayprecipitateaspiritual crisis, all hospiceteamprofessionalsbearsomeresponsibilityfor maldngaspiritual assessment anddirectinginterventions.”We feel thathisview shouldbe statedmorecategorically: