Représentation du spirituel dans les soins palliatifs. Proposition d'un repère et d'une méthodologie pour sa définition

Actors in the field of palliative care struggle to define the spiritual. For a majority of them, it lies in spiritual needs and suffering, with corresponding expectations and representations. For a minority, it is a reality of another kind, only accessible via feelings and it brings intense joy and banishes the fear of dying. The content of the latter perception of the spiritual is similar to the one - more fundamental and universal - of spiritual experience. We shall thus choose it as the reference to take into account successive representations of the spiritual. This experience is the inexpressible and intense feeling of an absolute perfection, a joy without a cause or object, the perception of another world, more certain than the usual world, emancipated from time and so from dying. In accordance with palliative care philosophy, choosing this reference helps keep beliefs and dogmas at bay, in order to favour what can be checked. In our opinion, what manifests itself in spiritual experience constitutes the spiritual in the strict sense. It is not another world but the same world experienced at a deeper level. As it accompanied by no representation, it is thus indefinable. One can only agree about its existence. When it is not expressed, this human characteristic manifests itself through what we call the spiritual in the broad sense of the term with, among other things, spiritual needs and suffering. This traditional and broad conception of the spiritual should allow us to characterize it better and, therefore, improve accompaniment of patients in this field.