1. JOURNAL OF PALLIATIVE MEDICINE
Volume 6, Number 3, 2003 Editorial
© Mary Ann Liebert, Inc.
Spirituality and Medicine
MYLES N. SHEEHAN, S.J., M.D.
W H AT ’S UP WITH SPIRITUALITY AND MEDICINE ?
Numerous articles in the medical and pop-
ular press and other media have presented a va-
in spiritual counseling. That is unrealistic. But, as
this paper points out, talking to a person about
the areas of their life affected by illness is a rea-
riety of different viewpoints on the role, if any, sonable expectation of physicians.
that spirituality should play in caring for pa- Third, the presentation of spiritual issues in
tients.1,2 The article by Lo et al.3 in this issue is end-of-life care comes within a context of ac-
an excellent example of straightforward and rea- cepted ethical analysis and good common sense.
sonable recommendations for physicians and Physicians who are not comfortable with a re-
other caregivers who may find themselves a bit quest for prayer should not compromise their be-
bewildered and uncertain when confronted by re- liefs. Be polite, do not lie, and be straightforward
quests for prayer and religious ceremonies in the about alternatives. Those comfortable with prayer
context of caring for patients with life-threaten- and religious ceremonies can take part if invited.
ing illness. This paper, and a recently published Physicians should facilitate the need for end of
companion piece, provide practical guidelines for life religious ceremonies for patients and their
physicians in discussing religious and spiritual is- families. That does not mean they need to run
sues and are fine examples of solid, non-strident them! But asking patients and/or their loved ones
introductions to how spirituality and medical if there is something that is important to them
care can comfortably coexist.4 from their religious and spiritual tradition is not
What makes this paper (and its companion) only appropriate, it is part of basic human de-
worthy of attention and study? cency. Listening, caring, and consoling either in
First, spirituality and religion are treated as hu- one’s own way or with a referral to a skilled chap-
man experiences that do not magically disappear lain is not a conflation of religion and medical
in the doctor’s office or the hospital. Persons have practice. In all contexts, Lo and colleagues make
a variety of different ways in which they find, or clear that it is not appropriate to impose one’s be-
fail to find, transcendent meaning. In the context liefs on patients. That obligation also extends to
of life-threatening illness, those spiritualities, of- physicians and other caregivers who are atheists
ten but not always expressed in particular reli- or agnostic.
gious beliefs, can be extremely important for the As mentioned, this paper comes at a time of in-
person and the person’s family as they try to face creasing interest in spirituality in medical care.
what may be a very difficult or threatening time. There are many ways to define spirituality. But
Lo’s paper gives good examples of how spiritual all the definitions aside, spirituality often in-
beliefs can surface as requests for prayer or a re- cludes prayer, both spontaneous and highly for-
ligious ceremony that may be considered impor- mal, and ritual, again with varying degrees of for-
tant for a person who is dying. mality. Whether physicians or anyone else like it
Second, this paper makes clear that physicians or not, it is clear that many persons have a need
are not expected to do everything nor should they for prayer, worship, or other ways in which they
compromise their own beliefs. Some caregivers, can sense the transcendent. An awareness of that
especially physicians, express dismay at a per- common human need may improve the way we
ceived expectation in some of the current interest care for persons in general, but particularly when
in spirituality and medicine that they need to not threatened by a serious illness. “Improve” needs
only excel in medical care but also be competent to be understood as patients and their families
429

2. 430 SHEEHAN
feel cared for, experience compassion, and find suit of treating the cancer.8 If doctors can be too
some relief in the existential distress that often ac- focused on disease to attend to physical symp-
companies life-threatening illness. Spirituality toms and psychological distress in caring for per-
and attention to prayer and ritual can be seen as sons with serious illness, then one can extrapo-
improving medical care without necessarily look- late that some physicians may be spectacularly
ing to cures, regression of physical symptoms, or clueless when it comes to dealing with a patient’s
something that is akin to faith healing. spiritual experience. Some patients needlessly
The soundness of the approach of Lo and may suffer spiritual distress when it could have
coworkers is found in striking the right note be- been recognized and resources found for help. I
tween two potential extremes. For some, spiritu- would suggest that recognizing spirituality as
ality can be presented as a treatment modality part of human experience affected by illness is an
similar to other therapeutic agents. Thus, some integral component of caring for persons.
would suggest it leads to less death, early dis- What does this suggest for orthodox, scientific
charge, and other outcomes that are traditionally medicine?
used to assess a new pharmacologic agent or sur- First, it means that rigor and the use of the dis-
gical procedure. For others, spirituality is a dan- ease model construct for diagnosis and treatment
gerous dilution of scientific progress. Any hint of continues to have a central role. There is a need
it suggests Elmer Gantry is loose in the hospital. for more, though. A much-needed proposal is to
And although both of these extreme positions on consider a research agenda that would look at
spirituality and medicine are held by sincere, outcomes and spirituality in ways that are
thoughtful, and good people, there can be a hint broader than suggesting that prayer is a thera-
of religious fanaticism at times in those who see peutic agent.9 It is time to design studies to an-
spirituality as a treatment modality and a pa- swer questions like whether individuals experi-
tronizing, pseudo-intellectual bigotry on those ence less distress, feel they received better care,
who react with horror at a seeming invasion of and adhere to standard medical regimens more
the spiritual into the realm of the clinical. often if attention is paid to spiritual issues that
There are serious issues at stake in the consid- arise in their illness.
eration of spirituality in medicine. Taking prayer Second, it is time to avoid bigotry. Bigotry, in
and religion seriously, as Lo and his colleagues academic medicine? I am afraid the answer is yes.
have done, is an important step in recognizing Large numbers of Americans describe themselves
that physicians and other caregivers not only as spiritual and many are formally religious.6 I
treat disease but care for persons who are suffer- believe that this may make some physicians and
ing in a variety of ways. Kleinman 5 notes that dis- other highly educated caregivers very uncom-
ease is the biomedical grid that physicians use in fortable and lead to responses that are inappro-
the diagnosis and treatment of illness. As such, it priate. Let me give two examples. Several years
is extremely useful. But when people get sick, ago, at a conference on communication skills and
they suffer in ways that go beyond disease and end-of-life care, I was scheduled on the confer-
that makes up the experience of illness. Physi- ence’s third day to give a presentation on spiri-
cians and other caregivers can always use some tuality. Of the roughly 100 participants, I found
guidance in looking how best to care for persons. myself stunned to have approximately half come
Sulmasy 6 suggests a model of the human person up at breaks or during social gatherings to tell me
that combines the biological, psychological, so- that they were atheists. Why they felt a need to
cial, and spiritual realms of the person. There is make such a confession was unclear to me. But it
ample evidence that doctors sometimes do not do made me uneasy as to how open they would be
a real good job in caring for any of these realms, to the distress of a person who expressed himself
so intent is their focus on treating a disease. in spiritual or frankly religious terms. Another ex-
Woman with early stage breast cancer frequently ample occurred at a conference at a major med-
seek alternative medicine in the setting of psy- ical school and one of the powerhouses of aca-
chological distress not attended to by their physi- demic medicine in the United States. I gave a
cians.7 Children with malignancies treated at an presentation on assisted suicide and used the pre-
academic teaching hospital were perceived by sentation to review ethical arguments for and
their parents to have suffered from a variety of against medically assisted suicide as well as to
symptoms that the doctors ignored in their pur- present a differential diagnosis of the meaning of

3. SPIRITUALITY AND MEDICINE 431
a person’s request for assistance in suicide in the deep roots in the hospice movement, has recog-
setting of a serious illness. At the end of the pre- nized the need to attend to spirituality in assess-
sentation a faculty member commended me for ing the suffering of persons with life-threatening
the reasoned, balanced nature of the talk and illness. This recognition should extend more
praised my insight into some of the reasons why broadly through health care.
individuals might request suicide. Then he ended
with a set of questions: “But you are a physician
and a Jesuit, right? How can you be reasonable REFERENCES
and thoughtful and be a Roman Catholic priest?”
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with a minimum of a master’s degree in theology care of patients at the end of life. Gerontologist 2002;42:
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internist and geriatrician can make a diagnosis of Address correspondence to:
cancer—even though I do not perform surgery, Myles N. Sheehan, S.J., M.D.
or administer chemotherapy, or provide radia- Department of Medicine/Geriatrics
tion therapy—so all physicians should be able to Loyola University Chicago
get a sense of a person’s need for spiritual help Stritch School of Medicine
and respond with respect and, if necessary, ap- 2160 South First Avenue
propriate referral. Palliative medicine, with its Maywood, IL 60153