Spirituality at the bedside: negotiating the meaning of dying

Patients? wishes to die recall the spiritual dimension of living and dying. Since the seminal work of the pioneers of palliative care, the importance of addressing the spiritual needs of patients at the end of life has been corroborated by research. This chapter explores the ?spiritual turn? within medicine as a response to pressures external and internal to medicine, but also the critiques that address the definition and assessment of spirituality. Patients finding themselves in institutional settings and facing their life?s end are in a condition of spiritual vulnerability, navigating between hope and anxiety, resistance and acceptance, the love for life and the wish to die. Within this context, a ?thin? conceptual framework of narration and metanarration is proposed, allowing patients? wishes to die to be identified as an expression of spiritual labour and conceptualizing spiritual care as an act through which meaning is negotiated within the clinical encounter.