Religion, Medicine and Spirituality: What We Know, What We Don’t Know and What We Do

Religion and spirituality have been linked to medicine and to healing for centuries. However, in the early1900’s the Flexner report noted that there was no place for religion in medicine; that medicine was strictly ascientific field, not a theological or philosophical one. In the mid to the latter 1900’s there were several laymovements that started emphasized the importance of religion, spirituality and medicine. Lay religious movementsfound spiritual practices and beliefs to be important in how people cope with suffering and find inner healingeven in the midst of incurable illness. The rise of Complementary and Alternative Medicine as well as theHospice movements also influenced attention on the spiritual aspect of medicine. The Hospice movement, foundedby Dr. Cecily Saunders, described the concept of "total pain"--- i.e. the biopsychosocial and spiritual aspects ofpain and suffering. Since the 1960’s there has been increased research done in the area of religion and healthand spirituality and health. Most of the studies are association studies which demonstrate and association ofreligious or spiritual beliefs and practices and some healthcare outcomes. More recently, studies on meditationhave demonstrated significant improvement in health care outcomes and suggest meditation as a therapeuticmodality. There are also numerous surveys that demonstrate patient need for having spirituality integrated intotheir care. Finally, a recent study demonstrated that patients with advanced illness who have spiritual care havebetter quality of life, increased utilization of hospice and less aggressive care at the end of life. In spite of all thesestudies, we still do not have a biological evidence base for mechanisms of beliefs and practices. There is considerablecontroversy over whether spirituality and religion can or even should be measured as criteria for integrationinto clinical care. Many believe that healthcare professionals have an ethical obligation to attend to all dimensionsof a person’s suffering, including the psychosocial as well as the spiritual and that ethical obligation is sufficientto require integration of spirituality into clinical care. Over the last twenty years, there has been an increase inthe number of required courses in spirituality and medicine in US medical schools giving rise to a new field ofmedicine. In February of 2009, a national consensus conference developed spiritual care guidelines forinterprofessional clinical spiritual care. These guidelines as well as the educational advances, research andethical principles have supported the newly developing field of spirituality and health.