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
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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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