The Concept of Spirituality and Care for the Terminally Ill

The article deals with the importance of spirituality in the care of terminally ill patients. It is based on the assumption that the spiritual dimension is one of the basic dimensions of human existence and must be taken into account in the care of the sick. Subsequently, it presents a refl ection upon the current use of the term spirituality in the professional discourse of helping professions and points out certain diffi culties that appear in the defi nitions of spirituality. The next part presents a defi nition of spirituality which is based on both the theoretical refl ection of the concept and practical experience from a particular hospice facility.

One of the important dimensions of helping professions is the question of the meaning of life which represents a foundation for a number of other questions and also a base for access to other dimensions of human existence in the fi eld of social work, such as the psychological or social level. Th e question of the meaning of life is closely linked to the concept of 'spirituality' which has its clear meaning in religious discourse. Conversely, in the fi eld of social work (where this concept is increasingly used), its meaning is quite blurred and unclear. Th is article deals with the place of spirituality in relation to the holistic view of man and the resulting meaning of the word 'spirituality' which would correspond to its use as much as possible, and, at the same time, it would achieve a certain clarity. With regard to the relevant literature and experience with clients of social work, there will be an attempt to clarify this concept for social work. Th ese considerations will be confronted with the experience of one hospice workplace. Th e aim will not be to clarify the defi nitive place of spirituality in social work but rather to defi ne future research on the basis of available theoretical considerations and practical experience which should lead to a better understanding of the spiritual dimension of man and thus improve the level of social work.

Starting Point: the Bio-Psycho-Socio-Spiritual Dimension of Man
A holistic view of man involves multiple layers of the human being. Since antiquity, man has been understood as an intellectual being 2 which includes both the animal, the physical side (bio-), and the mental side which represents knowledge and aff ectivity (psycho-). In man, the mental side of his being is at the level of reason which is traditionally divided into the theoretical and the practical. Th is corresponds to the theoretical tendency of man to seek and know the truth and to the practical tendency to establish relationships with other people and create a friendly community. 3 Th is latter aspect is usually associated with another ancient expression for man -the social being. 4 Th e spiritual level then corresponds to the theoretical intellectual side of man. 5 Here, however, it is necessary to understand theory not as something detached from life practice but in the original sense as 'seeing' the truth. However, all individual and particular searches for a person is ultimately aimed at fi nding the overall meaning of life, to the search for the horizon of life, or simply to what transcends us, to something that one can attach to himself (whatever it may be). As far as care of the sick is concerned, a holistic model of the view of the person is being promoted today. Th is approach takes into account the fact that it is not possible to cure all diseases but the sick person can be helped. Unlike the biomedical point of view, it includes the fact that both the origin of the disease and the healing are not only a purely biological aspect of man. All dimensions of man, that is, the whole bio-psycho-socio-spiritual unity, contribute to both processes. Frankl already notes that spiritual questions are the ones that oft en arise in patients during their period of illness, and neither the doctor nor the psychologist is competent to answer them. 6 Th ese are questions that are neither biological nor psychological in nature, for they are questions of a spiritual nature. Th ey must be answered in a specifi c way. In Frankl's view, logotherapy is the way how to do it. Let us take a closer look at what the unity of the four dimensions of man means. Dočkal reminds us that although a person is a unique and indivisible whole, we can look at him from diff erent angles. Every human being is a part of nature and he is subject to the laws of nature. His body is made up of cells, tissues, etc. Th is is his biological side. However, one also perceives, experiences feelings, thinks, makes decisions. All this has its biological basis but, at the same time, these processes form a separate psychological side of life. One also does not live alone but in a community with other people. He lives in a specifi c social situation, creates his own social network. Th is social dimension therefore also belongs inseparably to every person and has an impact on his life. But there is something else which belongs to man. In various situations, a person asks about the mea ning of things, events and the meaning of life. He realises that there is something which cannot be recognised by one's own senses, something that transcends man. According to various spiritual traditions, we call this God, Cosmic Intelligence, or otherwise. Th is ability to relate to something that transcends us is the last spiritual dimension of human existence. 7 2 Cf. ARISTOTLE, Nicomachean Ethics I, 6, 1098a1-7. 3 Cf. Stanislav SOUSEDÍK, Svoboda a lidská práva: jejich přirozenoprávní základ, Praha: Vyšehrad, 2010, p. 64. 4 Cf. ARISTOTLE, Nicomachean Ethics VIII, 1, 1155a5. 5 Th e Christian refl ection of the concept of spirituality is mostly based on the fact that it is a phenomenon of reason. Emotional understandings of spirituality (and faith) occur marginally, and they are completely unsustainable. Of course, emotions are associated with faith and spirituality but the essence of faith and spirituality does not lie in them. Faith is understood as a virtue which is based on reason, and spirituality is seen as a phenomenon related to the product of abstraction, that is, to the information that can be known only through the intellectual ability to abstract the general fact from the single one. Th e emotional side belongs to sensuality, so it is focused on the specifi c and not the general. Animals also have emotions, and yet we do not observe any manifestations of spirituality in them.

2020
Human existence includes all of the above dimensions in one. Th ey cannot be separated and dealt with individually because they are all interconnected and interact with each other. Th e fact that this is the case and that it must be taken into account in connection with the disease is also shown in the well-known defi nition of health given by the World Health Organization (WHO): 'Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infi rmity. ' 8 However, this defi nition lacks a spiritual component, the importance of which, on the other hand, is increasingly mentioned today. Each of these dimensions is also addressed through other needs that one needs to meet. In a situation of illness, when a person is limited in the ability to fulfi l his needs independently, this context must be taken into account. Especially, it should be recognised by those who care for the patient, and who make sure that none of the emerging needs are neglected.

Diffi culties in Defi ning the Term 'Spirituality'
Sheldrake states that spirituality is a rather vague concept in the current discourse. And even if it is nowadays based on Christian religious roots, there is a connection with the deepest values and meaning that one seeks in life. 9 It is therefore a certain vision of fulfi lling human possibilities. It is crucial in social work because it infl uences the way people cope with certain life situations. According to Furman, spirituality is a 'Search for meaning, purpose, and morally fulfi lling relations with self, other people, the encompassing universe, and ultimate reality however a person understands it'. 10 Th ese words capture a certain helplessness over the vague boundaries of the term spirituality. It is therefore necessary to seek a narrower defi nition. Our approach is based on a comparison of professional texts in this fi eld and the specifi cation of the concept so that it can be used in diff erent contexts (cultural, religious) while respecting the individual specifi cs of the approach to this phenomenon in the case of individual people. 11 We can start, for example, from an experiment presented by Canda and Furman in this matter. Th ey point out certain common features of the defi nitions of spirituality: 12  it relates to what is higher than ourselves;  man understands himself and his world as something partial, as part of a higher unity;  it concerns inner experience;  it is subjective, irrational, and intuitive.
Opatrný, in line with the above-cited eff orts to defi ne or at least to approach the meaning of the term 'spirituality' , states that in a situation of illness, pain, or near death, patients have deep existential questions and seek relevant answers. 13 Th e patient needs to give meaning to his life in illness, to cope with fear for himself and his loved ones, to think about his own life, to cope with the wrongs he has suff ered, to come to terms with his loved ones, etc. All of this becomes part of the needs of the patient to which it is necessary to respond. It cannot be downplayed by cheap phrases that everything will be good and there is no need to think about these things. Th e solution to these existential questions actually concerns human spirituality. It may or may not have a religious dimension.
When we talk about religion, it is necessary to clarify what is meant by this word and what is its relationship to spirituality. For our purposes, the defi nition of religion as an organised and systematic eff ort to give God respect, obedience to the law, ceremonies, etc. will be suffi cient.
In the classical ethics of virtues, religion, religiosity, or piety is understood as a virtue belonging to justice. Righteousness gives to everyone what belongs to him, and religion is a concretisation focused on God -it gives to God what belongs to him. Th e emphasis here is on what is somehow external. Spirituality is, on the other hand, about the internal plane. It is a relation to the transcendental reality and an eff ort to communicate with it somehow and to understand it more deeply than at the level of duties given by justice.
Religious spirituality can thus be the key to emerging existential questions in times of illness. It helps to fi nd answers and to cope with the diffi culties which are connected with the disease. However, if religion is misunderstood in some way, it can eventually exacerbate the common diffi culties of the disease. If the disease is understood, for example, as God's punishment, then, in addition to all existential questions, there will be many more thoughts about this punishment regarding why one deserves such punishment. 14 Th e connection between existential issues and spirituality is quite obvious. 15 It is certainly worth noting that existentialism, which appears in the context of the developed Enlightenment and its secular discourse, replaces the religiously understood spirituality, that is, the spiritual life of the believer in contact with God. Kierkegaard is usually considered to be the fi rst great existentialist 16 who was still a deeply believing Christian thinker but his dealing with questions of spiritual life and his relationship with God clearly has philosophical and not directly theological features fi tting into classical spiritual-theological schemes. It is actually a kind of Christian spirituality in a clearly secularised discourse. For Kierkegaard, it is still authentic traditional spirituality but at the non-church level, i.e., at the level of the individual. For later existentialists, it is either religiously or confessionally indefi nite (Jaspers), 17 or clearly atheistic (Sartre). 18 Th e fact that spirituality concerns both a person who lives religiously and a person who is secularised is one of the reasons for the blurriness and vagueness of this term. We can also add a warning that although religion is most oft en understood as Christian (less oft en as Jewish or, more recently, as Islamic) in our cultural background, there are many more kinds of religious spirituality, which further contributes to the vagueness of this term. Since the most important form of religious spirituality in our context is Christian spirituality, we will focus on the Christian refl ection on this concept, and then we will try to defi ne spirituality as clear and distinct as possible, At the same time, we want to keep the term open to religious (Christian and non-Christian) and purely 10 2020 secularised use. A small terminological and factual comment needs to be added here. Th e term spirituality is based on Christianity, and in our environment Christianity is also the most typical and widespread religion. Th erefore, it is understandable that most of the domestic literature on spirituality (and, to a large extent, this applies to the literature of our broader cultural Euro-American sphere) is in some way connected with Christianity. At the same time, however, it is true that spirituality is found in various modifi cations in other cultural circles, in other religions, and, to a large extent, also in secularised and non-religious areas. In this text, in the search for a clear and functional defi nition of spirituality, we do not limit ourselves to Christian spirituality. Within illustrative examples and used terminology, though, we logically preserve the Christian context as it is more understandable in our environment and it can be experienced more clearly in comparison with, for example, animism or Hinduism.
Although the term spirituality has Christian roots, it has not been in theological discourse for long. In theological literature we fi nd terms such as 'piety' or 'spiritual life' mostly. Th e term 'spirituality' appears more abundantly later, i.e., in the last fi ft y years. 19 Today, Christian spirituality is not understandable to most people, yet there is a growing interest in it. 20 Some authors explain today's increased interest in spirituality as a consequence of the secularisation of society. 21 Th anks to this, the spiritual dimension of man was suppressed. Today, one seeks new fulfi lment of this dimension. John Paul II also noticed this as well. In the encyclical Redemptoris missio he states that Our times are both momentous and fascinating. While on the one hand people seem to be pursuing material prosperity and to be sinking ever deeper into consumerism and materialism, on the other hand we are witnessing a desperate search for meaning, the need for an inner life, and a desire to learn new forms and methods of meditation and prayer. Not only in cultures with strong religious elements, but also in secularized societies, the spiritual dimension of life is being sought aft er as an antidote to dehumanization. 22 And because spirituality is no longer something that is usually passed down in the family from generation to generation, accepting some spirituality is mostly a matter of personal choice. It is no longer the rule that one accepts some comprehensive system of a certain spirituality. One rather forms one's own mosaic of fragments of various spiritual off ers. Th is is evidenced not only by the large number of religious societies in the Czech Republic which provide a certain identity to Czech believers, but also by the huge proportion of people who declare themselves to be believers without belonging to a religious society and people who refuse to answer such a question (assuming that the reason is, to a large extent, the intimacy of the question and the inability or unwillingness to say these things openly to the community and the church. It is oft en not even about its truthfulness but rather about its usefulness. Today, Christian spirituality must come to terms with such a conception of spirituality. Christian spirituality off ers one comprehensive system bound to the communion of the Church with the fullness of the spiritual life. Th is makes it diff erent from the abovementioned spirituality. If we want to defi ne Christian spirituality in more detail, we can say that it is a living Christianity. Th is means taking over and carrying out the vocation of Jesus Christ into our own lives -it includes both individuals and the ecclesiastical community. It is therefore a personal relationship with God. Its eff ect is following Jesus Christ. 24 Th e term spirituality is also oft en used when one wants to refer to various forms of Christian consecrated life (e.g., Franciscan or Dominican spirituality). Both of these combine the fact that spirituality is understood as one's own inner experience of the relationship with God. It is individual and there are diff erences between individuals. Th is individually varying experience of spirituality, an inner relationship with God, is connected to a certain external boundary defi ned by the fundamental contents of the truth of faith and the external framework that is given by the Church as an institution with its own organisational structure and external manifestations. Personal spirituality should not confl ict with these boundaries given by the Church. Within these boundaries, though, there is plenty of room for a completely diverse and authentic personal experience of the relationship with God. 25

Th e Analogous Nature of the Term 'Spirituality'
Spirituality can thus be characterised as an analogous concept 26 which is applied in diff erent contexts in diff erent ways. Th is variability stems mainly from diff erences in the understanding of the word 'spiritus' , i.e., 'spirit' , which is the root of the word 'spirituality' . In the Christian sense, this spirit is the Spirit of God. Spirituality is then a way of life in the Holy Spirit, according to the Holy Spirit, or from the Holy Spirit. It is actually about experiencing a relationship with God, in other words, it is about spiritual life. In a more relaxed sense, that spirit may simply be the meaning of life, in other words, a perspective that may not be purely religious. It concerns something that transcends man. If we go even further, spirit can mean the human spirit. In that case, spirituality becomes the way how a person experiences himself, his relationship to the world, to other people, etc. Here, however, in connection with the abovementioned bio-psycho-socio-spiritual dimension of man, a question arises. One can ask how spirituality diff ers from a psychological state (in terms of experiencing oneself) or a social state (in relation to others and the world). In the following text, therefore, we will use the second meaning of the word 'spirituality' , that is, the term that understands transcendence more generally, as a kind of horizon that transcends man and gives him some meaning. Th is meaning of spirituality (in its generality) includes even the fi rst described meaning, that is, the classical religious understanding of spirituality. It is so broad that it can be used for the spirituality of a secularised person as well. Such a person is in the process of seeking but does not move within a clearly defi ned framework of Christian religious life. In the book cited above, Opatrný states the 'forms and degrees' of spirituality. 27 Th ese are: 1. general spirituality (general ability and need of a person to relate to something which transcends him); 2. general spirituality associated with existential issues (the abovementioned spirituality associated with the activation of certain issues which are typical for borderline situations, e.g., a very seriously ill person); 3. spirituality with a share of 'religious memories' (the spirituality of a person who, at an older age, uses his memories of religious experience obtained during youth and which is usually associated with an organised religion); 4. the spirituality of one's own spiritual world (the typical state of a person who refuses to declare as an unbeliever and at the same time does not identify with any existing religion -this is oft en expressed as a belief in 'something above us'); 5. the spirituality of a more or less unknown religion (the spirituality of a person professing an exotic, little-known, but for some reason interesting or attractive religion, about which he has only brief information); 6. the spirituality of sects (usually small distinct groups, mostly tied to a charismatic leader, which oft en raise disproportionate hopes among people in marginal situations); 7. spirituality of healers (oft en connected to the spiritual background of healers or movements); 8. the spirituality of a person integrated in some 'big religion'; 9. false spirituality (approaches that are not really spiritual but pretend to be that way, e.g., used in an eff ort to manipulate a sick person more easily, etc.); 10. superstitious spirituality (superstitious interpretation of various situations).
Such a division is certainly useful for the practical refl ection upon various mental settings with regard to the subject of spirituality. However, it is more about forms and less about degrees. Th e individual forms can interfere or coexist. We therefore propose the following attempt concerning a typology of spirituality with an emphasis on the gradation of the intensity or delimitation of the concept of spirituality which thus shows its analogous nature. In each degree (in every type) of spirituality, we then present an attempt to capture the basic attitude of man towards spirituality in one word, and to defi ne the appropriate degree of spirituality. denial of the spiritual dimension of man naturalism In fact, this is a negation of spirituality, i.e., an attitude that rejects anything that transcends man. It can also be described as immanentism, an attitude that negates anything transcendent. Very oft en it is presented as atheism, though, this is not entirely appropriate. Many persons who present themselves as atheists do not reject transcendence as a whole as they only deny a clearly defi ned personal God. failure to address the spiritual dimension of man indiff erence Th e attitude of a person who does not reject transcendence but, at the same time, does not look for it. So we are still outside the realm of spirituality but from the attitude of direct rejection we come to indiff erence.

degrees of spirituality
openness Th is is an area where one can really talk about spirituality. Openness is the attitude of a person who is convinced of the transcendent dimension of life or, at least, presupposes it. Usually, the attitude of life is the search for 'something above us' and 'beyond us' .
religiosity Th is is an attitude which recognises some 'god' who is above us. One has already a very simple idea about this god. So it is about the development of that openness towards questions into some kind of answer. However, the concept of God, or more precisely transcendent reality, is clarifi ed very little and does not constitute a basis for socialising with like-minded people.
confessional spirituality An attitude where the concept of a recognised transcendent reality is already quite clear (in our cultural circle, therefore, one can usually speak of God with a capital letter G). It is shared by a large number of people so that a certain confessional classifi cation can be expected. At the same time, we understand confessional classifi cation broadly, i.e., not only as Christian one, but religiously in general. Man at this stage has a relatively clear concept of God which is shared by some religious or even church community. Within the framework of confessional spirituality, it is still possible to distinguish diff erent types of intra-church spirituality. Th is is no longer a question of defi ning the subject of spirituality in more detail, i.e., of the transcendent reality to which one relates. It is rather about the approach to religious life within the framework of the abovementioned confession and its delimitation. Examples are various spiritualities within Catholic Christianity: Franciscan, Charismatic, Benedictine, etc.
Th is table shows the degrees of spirituality. One can have diff erent attitudes towards their mutual relations. If we start from the confessionally-oriented Christian understanding of spirituality, then one can see a kind of progress towards fullness in that graded concretisation. If we take into account another religion, we could use this view but the terminology would change in some respects, of course (for example, instead of Franciscan and Benedictine spirituality, we would talk about Hasidic and liberal spirituality, or about diff erent directions within Islam, etc.). Th e core would be preserved, and only the scenery in which the term spirituality is experienced and discussed would change. In some cases (certainly from a secular, non-religious point of view, but perhaps also from some specifi c religious perspectives), these degrees would not be degrees leading to a better grasp and experience of spirituality as they would merely represent the degrees with the use of the term spirituality. Th ese would not be degrees varying from less perfect to more perfect. It can be assumed that the person of our cultural circle will be infl uenced by Christianity when thinking about this typology. However, this view is not necessary for the typology itself.

Manifestations of Spirituality in Practical Social Work
Th e presented defi nition and typology of spirituality is general and can be used not only in social work, but also in other areas. In social work, of course, it can also be used for various target groups. But not for all of them is spirituality equally important and presented as a topic. One of the target groups which is highly sensitive to the question of spirituality will undoubtedly be the care of the dying. Th is typology of degrees of spirituality was also based on a discussion about spirituality in the care of dying which took place during a workshop attended by representatives of theology, psychology, social work, and pastoral work. Some of the participants were workers in the hospice facility. It is actually a generalisation of experience with diff erent types of clients who have entered the Hospice of St Jan Nepomuk Neumann in Prachatice. As part of the documentation, 28 this hospice also records some data important for the fi eld of spirituality. 29 Considering the Czech situation, the collection of these data is a relatively unique approach. Th ere are also certain, and to some extent expected, problems associated with this. Although the type of data collected over the years is the same and comparable, it is not clear whether this selection was chosen appropriately. Because it is a relatively unique set of data which has been obtained during the past two decades, and which can no longer be improved or modifi ed, we use it for further refl ection. It should lead, among other things, to suggestions about how to collect similar data in the future, what to change, add, etc. Th e improvements could lead to better results over time and have a positive impact on the practical work of workers in the helping professions. Th e abovementioned typology of spirituality can therefore be compared with these data. Th en we can determine whether the documentation is useful for pastoral work within the hospice facility. Th ese are, above all, questions about religion, a request for contact with a clergyman, a willingness to talk with a nun, a request for prayer, and (in the case of a Catholic) reception of the sacraments.
Th e year 2010 was chosen for the fi rst analysis as it represents approximately the middle of the period of data collection in the named hospice. Th ere are 216 records in the given year. Of these, 79% contain information that shows an awareness of the spiritual dimension of man. 30 Th is is a positive answer to one or more questions that mapped the interest in conversation with a nun, contact with the clergy, prayer, or in the reception of the sacraments. Of those who were aware of the spiritual dimension in this sense, 88% were interested in conversation with a nun, 62% were interested in prayer, 48% wanted to see a priest, and 35% were interested in receiving the anointing of the sick. An interview with a nun clearly represents contact with a person who, on the one hand is a caregiver, but on the other hand she is known in another role. It can be reasonably assumed that the client sees the nun as a spiritual person who, unlike the priest, is not so much connected with institutional religion from which Czechs are relatively strongly distanced. What role may play in the fact that it is contact with a woman, who naturally evokes a kind of maternal care and trust, rather than a man is an interesting question. However, it cannot yet be answered on the basis of available information. Th ere was less interest in prayer, which can be understood as a certain gradation in the perception of the spiritual dimension of life, or a lower readiness to go deeper than in the case of conversation with a person. Prayer is related to God. In this area, clients might not feel as confi dent and comfortable as when talking with a person. Th e interest in contact with the clergy is even lower, which may indicate the abovementioned distance from institutional religion. One third of people received the sacraments. It is not a small number but it represents the lowest interest of the above possibilities. Th e reason could be that only a Catholic is particularly interested in the sacraments as they are part of his faith and religious life. Furthermore, the fact that it is one of the above possibilities (that is, a clear identifi cation with a very specifi c type of religious life and spirituality) may play a role. So it is logical that fewer people are interested at this level in comparison to a much more general and less binding form of spirituality, which is represented by a conversation with a nun. Th e length of 28 Th e studied documents were processed in compliance with the conditions of personal data protection and according to legal standards. 29 During admission, hospice clients fi ll in an introductory questionnaire. Th e information also includes their religious confession, the importance of faith for them, and whether they want any contact with the clergy (they may change this later). Furthermore, the pastoral staff of the hospice keep a more detailed record of the spiritual needs of patients. Th ey briefl y record the needs of individual clients during hospitalisation and their response to these needs. 30 Let us add that the largest number of applicants was of the Roman Catholic faith (80%), non-Catholics accounted for 8% and the remaining 12% were people without religion, or the religion could not be determined).
hospitalisation of patients also played a role. Especially in the case of a very short hospitalisation, the possibility of receiving the sacraments was not even available to the patient. Th e last circumstance that can be read from hospice records is the frequent postponement of the sacrament of the sick. Patients oft en responded to the off er that it is too early for this sacrament. Apparently, the perception of the sacrament of the sick as a 'last anointing' still persists here. It is quite clear that the level at which hospice clients are interested in addressing their spiritual issues and needs is graded. But one needs to be aware of several important points here.
1. Answers do not necessarily refl ect the level of the spiritual life of clients, and they may be infl uenced by other factors. A negative answer can be caused, for example, by distrust of people, but one can somehow experience spiritual life on a very private internal level. However, there is probably no fundamental reason to assume that this is a large distortion. 2. Rejection of all these off ers can probably be interpreted as denial or indiff erence, though, no distinction can be made between them. 3. Th e gradation of the desire for individual possibilities of spiritual accompaniment also points to a certain gradation in the depth of consciousness and in the practical experience of spirituality. 4. Th e percentage of people who have shown awareness of the spiritual dimension of life is relatively high. It can be assumed that this fact refl ects not only the experience that people are more open to spiritual issues in the marginal situation at the end of life, but also the fact that the largest proportion of clients are people born in the 1920s to 40s. At that time (in comparison with today), teaching of religion was still quite common, and people were confronted much more with religious life even if they did not participate in it. 31 Th e question is how the situation will develop when the hospice's clients are mainly people born in the 1960s and 70s. One possibility is a radical decline in interest in spirituality in general. Another option is that a high degree of interest in spirituality will be maintained but it will be accompanied by a much steeper decline in interest in various ways of spiritual accompaniment (including all degrees from a conversation with a nun to the sacrament).

Preliminary Conclusions
In this text, we have tried to outline the problematic nature of the existing defi nitions of the term spirituality in the fi eld of helping professions. We pointed out the vagueness and blurriness of this concept. Aft er our own research, we have off ered our own, somewhat clearer defi nition of spirituality which leaves room for a very broad understanding of this concept. However, we still consider this defi nition to be only a draft and we will realise further research in the hospice of St J. N. Neumann in order to verify and specify it. In particular, qualitative research will now follow in which we will examine (through interviews with hospice staff ) whether their clients can be classifi ed into these diff erent degrees of spirituality. Th en it will be needed to look for ways to work with clients at diff erent levels of spirituality. It can be assumed that the manifestations of spirituality of a person open to the transcendent dimension of life will be diff erent in intensity and concrete expression from the manifestations of a person anchored in a particular religion. Working with the spiritual needs of believing clients is in a way easy because these spiritual 31 Although the abovementioned number of people who formally profess a religion is relatively high, there were relatively few practising Christians among them. It is still necessary to keep in mind a quite high probability that these people were baptised and, to some extent, religiously socialised in childhood. needs can be clearly described. In the case of clients whose spirituality is not so clearly defi ned it is more diffi cult. Th ey may not be clear on their spiritual needs, and there will be a need for staff or families to learn to perceive and fi nd out about these needs in order to meet them.