Healthcare Policy

SPIRITUALITY IN THE MEDICAL WORLD

In general, the medical profession, and healthcare overall, is populated largely by secular humanists. In spite of the emotional involvement in issues of life and death, and illness and suffering, few physicians, and other healthcare providers, take into consideration the spiritual needs prompted by the situation. We’ve all heard physicians refer to “the liver in room 203,” ignoring that the liver resides in a human being with feelings. Doctors fail to delve into the patient’s psyche’ in times of tragedy and sadness, and fail to recognize how spirituality can impact serious illness. Providing patients with spiritual support is not at the top of the physician’s list of priorities.

Nowhere is this more evident than in what I call secular-based, non-religious affiliated community hospitals, hospitals included in public university and medical school complexes, and government facilities. With the separation of church and state having been firmly established over the past fifty years, spirituality has been ignored and eliminated as a powerful force for healing and overall improved healthcare outcomes.

I had the good fortune to practice in a Catholic hospital which was run by nuns, and staffed by two, and at times three, priests. The active pastoral care department housed a beautiful chapel and had full-time and part-time Protestant ministers on staff. They were so busy they had a full-time secretary to oversee their activities. Their presence was obvious as priests made frequent visits to patients and were always available for prayer, counseling, and last rites. Priests and nuns were very visible day and night. Many patient wards had nuns with nursing degrees staffing the unit. Each day at noon and at 8:00 pm, the end of “visiting hours,” over the public address system, one of the priests or pastors gave a brief devotional and prayer. The feeling of spirituality and the importance of a religious presence, be it Catholic or Protestant, was very evident. 

That brings me to a recent article in JAMA. It was titled “Spirituality in Serious Illness and Health,” and deals with the incorporation of spirituality into the care of ill and dying patients and presents high quality evidence for including spirituality in the outcomes of serious illness as part of a “patient-centered” approach to care. The study comes from researchers at Harvard and is an analysis of 371 articles dealing with serious illness.

“Spirituality (is) the way persons seek and experience ultimate meaning, purpose, and transcendence (eternal, infinite, preeminent) …. Has been viewed as central to health….and personal, interpersonal, or ultimate beliefs and values….it is most identified with a faith tradition….spiritual peace….while encompassing beliefs and practices of religious communities….and can arise through vocation, family, or nature.” It is the way people see the world and others through the filter of what is deemed appropriate by God. It is the belief in God, and the decision to conduct our lives to glorify Him. It is the hope and assurance of a better spiritual life after our physical life has ended.

The emphasis on and inclusion of spirituality in the care of seriously ill and dying patients has decreased in recent decades despite evidence linking spirituality to improved health outcomes. This article strongly points out the need and value of incorporating spiritual care into the treatment of seriously ill patients, into the training of specialty practitioners, the education of interdisciplinary teams caring for the seriously ill. Adding spirituality fosters the personal touch approach that is so important to those clinging to life.

The article reported that multiple studies provided strong evidence of a connection between seriously ill patients and spirituality and identified the following points:

  1. 71%-99% of seriously ill patients viewed spirituality as important.
  2. Spiritual needs are common during serious illness.
  3. Spiritual care is desired by 50%-96% of patients with serious illness.
  4. Spiritual care can influence medical decision making in cases of serious illness
  5. Spiritual needs of patients with serious illness are frequently unaddressed within medical care.
  6. Spiritual care in the medical care of serious illness is associated with better end-of-life outcomes.
  7. Spirituality had a significant association with well-being and quality and satisfaction of life.
  8. Unaddressed spiritual needs are associated with a poorer quality of life.
  9. Religious service attendance was associated with a lower risk of mortality. More frequent attendance led to even lower risk. 
  10. 77% of studies showed religious service attendance reduced the incidence of depression and was the most effective in preventing suicide.

Spiritual care may include visits from hospital clergy, one’s own minister and church members, or local community spiritual representatives. Sharing prayer and expressing feelings with those just mentioned is powerful. However, the most powerful spiritual expression comes from prayer and sharing of feelings with the treating physician. Discussing the spirituality of serious illness and death and praying together at this time is the most meaningful treatment the physician can provide. This is patient-centered treatment strengthened by spirituality and recognizing the  completeness of the human spirt. He/she is not just “the liver in room 203,” but “the person with the liver in room 203” who has feelings and a soul, and through spiritual care is at peace with his/her dire situation.

Reference: Balboni TA, VanderWeele TJ, et al. Spirituality in Serious Illness and Health. JAMA 2022 July 12;328(2):184-197. 

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