Clinical Buddhist Chaplain based Spiritual Care in Taiwan

台灣臨床佛教宗教師的靈性照顧

陳慶餘(Ching-Yu Chen)

《安寧療護雜誌》 17卷3期 (2012/11) Pp. 300-309

https://doi.org/10.6537/TJHPC.2012.17(3).5

摘要

本土化靈性照顧起自1995年台大醫院緩和醫療病房開辦，接受蓮花基金會及一如精舍先後委託研究計畫，進行佛法在臨終關懷的應用及本土化靈性照顧模式的探討，2000年開始培訓臨床佛教宗教師，至2008年成立台灣臨床佛學研究協會，開創臨床宗教師的服務網絡，進一步以「臨床佛教宗教師為基礎」的靈性照顧模式，進行國際學術交流。相對於西方，本土化靈性照顧有三項特點：（1）靈性指的是每個人都具有的內在力量，屬於自力；（2）靈性課題分為原發性及次發性靈性課題；（3）臨床佛教宗教師的專業在於傳授各種法門，且包括病人的死亡準備與來生期待，以及家屬預期性悲傷輔導等服務。因此，我們定義本土化靈性為：「對正法的感應、證悟與理解能力，是一種生命力，心智成熟的表現」，強調以病人為師，病人不僅是接受者，也是示現者。合格的臨床佛教宗教師，需接受結合佛法應用在臨終關懷的理論與實際的完整培訓課程。以臨床診治為例，依據「四聖諦」原則，分述如下：（1）從病情發展的過程，根據「五蘊」將病人的各種苦，分為身體、心理、家庭、人際和靈性五方面，區分出靈性的「苦」；（2）依「十二因緣法」，評估四聖諦當中「集」的部分；（3）根據「四念住」來設定照顧計畫的目標（「滅」的部分）；（4）最後將各種靈性的苦因歸類為六大靈性課題，依照病史的逐日記錄，整理分為主觀、客觀的臨床表現，來評估其靈性課題的種類，並做成照顧計畫，其中最重要的是法門傳授。法門執行分為念佛法門、皈依法門、禪定法門、臨終說法與助念、懺悔法門、眾善法門等，觀察並記錄法門的療效（「道」的部分）。本土化靈性照顧的五階段架構，分別為病情告知、死亡準備、感應靈性，依持法門與成佛之道。經過培訓的臨床佛教宗教師參與安寧緩和醫療第一線照顧，解除病人靈性上的受苦，有助於靈性境界的提升與死亡恐懼的減少。病人在依持法門之下超越世間法，啟發內在力量、提升生活品質而達到善終。法師並對家屬提供生死教育，化阻力為助力，減少預期性的悲傷，也提振安寧團隊成員的士氣。總之，佛法在安寧緩和醫療的運用是建立本土化靈性照顧的特色。

關鍵字

安寧緩和醫療 ； 臨床佛教宗教師 ； 靈性照顧 ； 佛法

並列摘要

Taiwanese indigenous spiritual care began in 1995 when the Hospice & Palliative Care Unit of National University Hospital was first established. The Unit received research grants to study the possibility of applying Buddha dharma in terminal care, then a training program for clinical Buddhist chaplains was launched in 2000. Taiwanese Association of Clinical Buddhist Studies was established in 2008 to provide the service network of clinical Buddhist chaplains. Taiwanese indigenous spirituality based on Buddhism is thus defined as: ”the ability to respond to, to realize and to understand the right dharma.” It is a life power, and it manifests the maturity of the mind. It emphasizes to regard patients as demonstrator, not only receiving care but also presenting how to face death.Qualified clinical Buddhist chaplains are required to successfully complete a rigorous training program consisting of classroom instructions as well as bedside practicum on applying Buddhist principles and practices to terminal care. According to the Four Noble Truths, clinical diagnosis and treatments can be stated as follows: (1) spiritual suffering is identified from the sickness categorized into physical, psychological, family, social and spiritual aspects according to the ”Five Skandhas”; (2) the Truth of the ”Origin” of Suffering is evaluated according to the ”Twelve Causes and Conditions”; (3) the goal of care (cessation of suffering) is planned according to ”Four Dwellings in Mindfulness”; (4) The effects of the practice of the Buddhist methods are carefully evaluated and recorded (the Truth of ”Path”).There are five stages in the framework of Taiwanese indigenous spiritual care, namely, truth telling, death preparation, spiritual responses, following and practicing Buddhist methods, and becoming a Buddha. In hospice and palliative care units, clinical Buddhist chaplains who have completed the proper training provide direct bedside care to terminal patients, resolve patients' spiritual sufferings, elevate their spiritual states and reduce their death fears. By following the Buddhist practices, patients transcend the worldly dharma, discover their internal power, improve their life quality and achieve good death. Buddhist chaplains also provide life and death education to family members, transform obstacles into assistance, reduce forthcoming grief, and elevate the morality of the hospice and palliative care team. To sum up, the application of Buddha Dharma in hospice and palliative care is truly a unique feature of Taiwanese indigenous spiritual care system.

並列關鍵字

hospice palliative care ； spiritual care ； clinical Buddhist chaplain ； Buddha dharma