Religion and Spirituality Overview

Religion and spirituality intersect with 21st century biomedicine in a wide range of complementary and conflicted ways. To many, religion and spirituality are cultural understandings of health, healing, disease, suffering and death. Religious healing (e.g. prayer, the use of religious healers) is often used in conjunction with and sometimes in place of biomedical interventions. Religious traditions sponsor biomedical institutions (e.g. Catholic hospitals and long-term care facilities) and biomedical practices in religious institutions (e.g. parish nursing and health screenings at churches, temples, and mosques); secular hospitals sponsor chaplaincy programs. Recent scientific/medical research suggests complex relationships (e.g. therapeutic) between religion and health. The American Association of Medical Colleges has affirmed the importance of spirituality to medical education by developing a set of related goals and learning objectives. [1]

The growing medical interest in religion and spirituality results from

The increasing understanding of the effects of religious/spiritual practices, beliefs, and feelings on health and healing,
The expanding recognition of the importance of medical and cultural --including religious --pluralism, and
The heightening patient demand for holistic/whole-person care.

To the extent that complementary and alternative medicine (CAM) represents the many healing beliefs and practices outside conventional allopathic medicine, religion and spirituality are an important dimension of CAM. NIH-NCCAM recognizes this religious/spiritual dimension in its definition of CAM, defining it as inclusive of both alternative medical systems (e.g. Oriental, Ayurvedic, Tibetan) and mind-body interventions (e.g. prayer, meditation) and in its support for research in this arena. [2]

Definitions

Definitions of "religion" and "spirituality" abound and often overlap and converge. Koenig, McCullough, and Larson have attempted to operationalize these terms for scientific research, resulting in the following definitions and table of distinguishing characteristics:

"Religion is an organized system of beliefs, practices, rituals, and symbols designed (a) to facilitate closeness to the sacred or transcendent (God, higher power, or ultimate truth/reality) and (b) to foster an understanding of one's relationship and responsibility to others living together in a community."

"Spirituality is the personal quest for understanding answers to ultimate questions about life, about meaning, and about relationship to the sacred or transcendent, which may (or may not) lead to or arise from the development of religious rituals and the formation of community." [3]

Table 1.1 Characteristics distinguishing religion and spirituality [4]

*Religion*	*Spirituality*
Community focused	Individualistic
Observable, measurable, objective	Less visible and measurable, more subjective
Formal, orthodox, organized	Less formal, less orthodox, less systematic
Behavior oriented, outward practices	Emotionally oriented, inward directed
Authoritarian in terms of behaviors	Not authoritarian, little accountability
Doctrine separating good from evil	Unifying, not doctrine oriented

Religion's effects on health have been subject to more scientific study than spirituality's, due in part to the greater difficulty in measuring spirituality. In contrast, spirituality, and in particular, patient spirituality, has received greater attention in clinical practice. Thus although the characterization is rough, medical/scientific research typically attends to "religion" while clinical practice typically attends to "spirituality."

Spirituality and Clinical Practice

In the name of compassionate and whole-person care and in reaction to the dehumanizing effects of technological medicine, the physician's role in the spiritual care of patients is now being explored and developed. Spiritual beliefs and values often shape one's understandings of health, disease, and healing and thus can influence health care decision-making as well as one's ability to cope with illness, dying and death.

Resources:

Christina M. Puchalski. The role of spirituality in health care. (PDF) Baylor University Medical Center Proceedings 2001; 14; 352-357.
Christina M. Puchalski. Spirituality and health: the art of compassionate medicine. (pdf)Hospital Physician, March 2001
George Washington University Institute for Spirituality and Health
University of Minnesota Center for Spirituality and Health
Harold G. Koenig. Spirituality in patient care: why, how, when and what. Philadelphia: Templeton Foundation Press, 2002. HHSL: WB 885 K78s 2002]
Jeanne McCauley, M. Christopher Gibbons and John Hopkins Community Physicians.Give me strength [VHS video recording]: spirituality in the medical encounter. FSP Media Communications: 2001 HSL Book Stacks WM 61 G539 2001. 27 min.
Elizabeth Gehrman. What They Carry. Tufts Medicine (Summer 2002): 10-15.

Spiritual Histories and Assessments:

Various history and assessment tools help physicians identify patient religious/spiritual beliefs and practices. These spiritual histories are either incorporated into a social history or done independently.

Puchalski C. Romer AL. Taking a Spiritual History Allows Clinicians to Understand Patients More Fully." Journal of Palliative Medicine. 3(1):129-37, 2000.
Maugans TA. The SPIRITual history. Archives of Family Medicine. 5(1):11-6, 1996 Jan.
Griffith, James L. and Melissa Elliott Griffith, Encountering the Sacred in Psychotherapy: How to Talk with People About Their Spiritual Lives. Tisch Library RC455.4.R4 G75 2002

Professional and ethical considerations

Post SG. Puchalski CM. Larson DB. Physicians and patient spirituality: professional boundaries, competency, and ethics.Annals of Internal Medicine. 132(7):578-83, 2000 Apr 4.
Sloan RP. Bagiella E. VandeCreek L. Hover M. Casalone C. Jinpu Hirsch T. Hasan Y. Kreger R. Poulos P. Should physicians prescribe religious activities? New England Journal of Medicine. 342(25):1913-6, 2000 Jun 22.