Duquesne University Duquesne Scholarship Collection Electronic Theses and Dissertations Spring 5-6-2016 The evelopmeD nt of a New Model for Assessing African-American Spirituality in Palliative Care John C. Welch Follow this and additional works at: https://dsc.duq.edu/etd Recommended Citation Welch, J. (2016). The eD velopment of a New Model for Assessing African-American Spirituality in Palliative Care (Doctoral dissertation, Duquesne University). Retrieved from https://dsc.duq.edu/etd/1542 This One-year Embargo is brought to you for free and open access by Duquesne Scholarship Collection. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of Duquesne Scholarship Collection. THE DEVELOPMENT OF A NEW MODEL FOR ASSESSING AFRICAN- AMERICAN SPIRITUALITY IN PALLIATIVE CARE A Dissertation Submitted to the McNulty College and Graduate School of Liberal Arts Duquesne University In partial fulfillment of the requirements for the degree of Doctor of Philosophy By John C. Welch April 2016 Copyright by John C. Welch 2015 THE DEVELOPMENT OF A NEW MODEL FOR ASSESSING AFRICAN- AMERICAN SPIRITUALITY IN PALLIATIVE CARE By John C. Welch Approved December 10, 2015 ________________________ ________________________ Gerard Magill, PhD Henk ten Have, MD, PhD Vernon F. Gallagher Chair for the Director, Center for Healthcare Ethics Integration of Science, Theology, Professor of Healthcare Ethics Philosophy and Law (Project Director) Professor of Healthcare Ethics (Committee Member) ________________________ _____________________ Elochokwu Uzukwu, ThD Henk ten Have, MD, PhD Professor Director, Center for Healthcare Ethics Department of Theology, (Center Director) McAnulty College and Graduate School of Liberal Arts (Committee Member) James Swindal, PhD Dean, McAnulty College and Graduate School of Liberal Arts Professor and Dean of McAnulty College (Dean) iii ABSTRACT THE DEVELOPMENT OF A NEW MODEL FOR ASSESSING AFRICAN- AMERICAN SPIRITUALITY IN PALLIATIVE CARE By John C. Welch April 2016 Dissertation supervised by Henk ten Have, MD, PhD Research has shown that African-Americans are least likely to receive adequate palliative interventions leading to concerns about the quality of health care in general and palliative care in particular for this population. Acknowledging patient preferences are essential in administering quality health care especially when a patient’s condition is terminal. But when African-Americans are least likely to complete living wills or durable power of attorneys for health care and more likely to continue to request life sustaining treatments when near death, conflicts between patients and medical professionals can result. Recognizing patient spirituality and addressing their spiritual needs can help the patient, family or surrogate decision-maker come to terms with, if not make sense of, their life-threatening illness and eventual mortality. This may be especially salient for African-Americans because of their history of victimization of racial discrimination and ensuing overwhelming challenges with sometimes tragic consequences. Models and approaches used to assess the spirituality of African-American patients must be culturally iv appropriate and performed by professionals with interpersonal communications skills and an awareness of how their implicit bias can impede the integrity of the clinician-patient interaction. v DEDICATION I dedicate this body of work in memoriam to my grandmother Bernice who believed in me and made the first investment in my education from the beginnings of my school days through college and to my father John and to my mother Della in memoriam for giving me life. Lastly, and most importantly I dedicate this dissertation to my wife De Neice who supported me every step of the way and prayed me through to the end of this journey. To my four children, Aja, Jordan, John Christopher, and Ian, my grandchildren Ayauna, Genesis, and Aiden, the one in utero who is fully known by God, I pray that I have inspired you to reach as far as you can and believe you can attain the ultimate in whatever you pursue with God’s help. vi ACKNOWLEDGEMENT I take this opportunity to acknowledge and thank Dr. Henk ten Have, my dissertation advisor, Dr. Gerard Magill, the department chair, and Glory Smith for their patience and support in seeing me through this journey. Special thanks to my supportive colleagues at Pittsburgh Theological Seminary who prayed for me and kept me on task and to Allison Pope, our seminary Head of Library Public Services whose eye for detail was a lifesaver for me. vii Table of Contents Abstract .............................................................................................................................. iv Dedication .......................................................................................................................... vi Acknowledgement ............................................................................................................ vii Chapter 1. Introduction ............................................................................................... 1 Chapter 2. The Development of Palliative Care .......................................................... 29 2.1 The History and Background of Palliative Care ..................................................... 29 2.2 Definition of Palliative Care ...................................................................................... 36 2.3 The Role of Spirituality in Palliative Care ............................................................... 42 2.4 The Ethics of Palliative Care ..................................................................................... 46 2.4.1 Personal Autonomy and Palliative Care .............................................................. 48 2.4.2 Physician Responsibility and Palliative Care ...................................................... 53 2.4.3 Justice and Palliative Care ................................................................................... 56 2.5 Palliative Care and the African-American Perspective of Medical Ethics ........... 60 2.6 Palliative Care Program Development among African-American Populations ... 63 2.7 Palliative Care and other Ethical Challenges .......................................................... 64 2.8 Conclusion .................................................................................................................. 67 Chapter 3. African-Americans, Race and Health Care............................................... 77 3.1 The Historical Development of Race and Racism ................................................... 77 3.1.1 “Race,” Its Etymology and Evolution ..................................................................... 78 3.2 History of Mistreatment of African-Americans ...................................................... 86 3.2.1 Slavery – the Beginning of American Dehumanization .......................................... 88 3.2.2 Negroes and the Revolutionary War ................................................................... 97 3.2.3 Post-Civil War Reconstruction .............................................................................. 100 3.2.4 African-American Life in the Twentieth Century ................................................. 108 3.3 Races, Bias, Mistreatment and Under-treatment in Health Care for African- Americans .............................................................................................................................. 117 3.3.1 Ripe Conditions for Medical Mistreatment in 18th and 19th Century America ...... 117 3.3.2 The Genesis and Pervasiveness of Medical Mistreatment ..................................... 120 3.4 African-American Physicians, Medical Schools and Medical Societies .............. 132 3.4.1 African-American Physicians Advancing Amid Adversity ................................... 132 3.5 Conclusion ................................................................................................................ 141 Chapter 4. Spirituality and Religion in Healthcare .............................................. 154 4.1 Defining Spirituality ................................................................................................ 154 4.1.1 Differentiating Spirituality and Religion ............................................................... 159 4.2 African-American Spirituality ................................................................................ 165 4.2.1 Historical Background ........................................................................................... 166 4.2.2 African-American Spirituality in the 20th Century ................................................ 175 4.3 Spirituality and Healthcare .............................................................................. 182 4.3.1 Medical Professionals and the Provision Spiritual Care ................................... 186 4.4 Positive and Negative Impacts of Spirituality on Medical Decision-making ...... 192 4.5 Conclusion ................................................................................................................ 195 Chapter 5. Screening and Assessing Spirituality and Religion ................................ 206 5.1 The Role of Spiritual Assessments .......................................................................... 206 5.2 Patient-centered Care .............................................................................................. 208 viii 5.2.1 Human