Examining the “Black Box” of Spirituality in Ontario Advance Care Planning Resources: A Multimodal Critical Discourse Analysis

Abstract

This thesis responds to a two-fold problem observed in the literature regarding spirituality and bioethics: that spirituality in Advance Care Planning (ACP) has been inadequately explored in the Ontario context, and that any comprehensive examination of the multidimensional and complex “black box” of spirituality in ACP must also address the interwoven themes of death and values, as well as the undercurrents of conflict in bioethics regarding spirituality’s inclusion. This thesis responds to this problem by examining the Advance Care Planning Ontario (ACPO) website utilizing a Multimodal Critical Discourse Analysis (MCDA) approach rooted in the paradigm of Critical Discourse Analysis/Critical Discourse Studies (CDA/CDS) focusing on the main research question: how is spirituality situated in resources found on the ACPO website? This study was undertaken in two parts: first, an analysis of the website using MCDA tools of inquiry inspired by Machin and Mayr (2023); and second, a coding process using Braun and Clarke’s (2022) reflexive thematic analysis focusing on both discourses related to spirituality, death, and values; and also the ideological assumptions observed in these discourses. Findings suggest spirituality being situated peripherally and vaguely with little articulation of its diversity. Additionally, a discourse of immanence regarding spirituality, values, and death was observed with a focus on physical aspects of ACP with little opportunity for engagement on transcendent spiritual themes in decision-making. Ideological assumptions observed impacting spirituality’s situatedness included secular, instrumental, rational, utilitarian, individualistic, and medical-legal assumptions—leanings that may exclude diverse ways of knowing and limit inclusion of diverse spiritualities in ACP. Future recommendations include a central and integral role of spirituality in all its diversity, a fuller acceptance of multidimensional aspects of death and dying central to many spiritualities, and the development of opportunities for spiritually integrated value reflection in ACP processes that invite deeper reflection regarding transcendent themes.