Medicine: a partnership of trust and faithBMJ 2014; 348 doi: http://dx.doi.org/10.1136/bmj.g1452 (Published 17 February 2014) Cite this as: BMJ 2014;348:g1452
In my experience as a clergy person for four plus decades there has been an increase in interest regarding the relationship between spirituality and medicine. My sense is that, as medical science increases its ability to tell us how something has happened, there has been a complementary rise on the part of individuals to seek the “why.” This search for meaning and purpose in illness, as old as the Book of Job, underlies the distinct human story that is present in each and every human being that a physician treats. No two people are alike, and no two stories are alike. Each person brings their own experience, history, and family dynamic to the doctor’s office, seeking an answer to the why of their illness. Individuals stand before God in their own way and in their own belief.
We are at an age where the role of spirituality as a component in the medical treatment of illness is about to enter a new and enriched phase of development. Rather than seeing these two issues as separate and distinct, a quiet movement is occurring that sees elements in each system that, when understood and honored, can be beneficial to a person and to their healing. This latter belief is important because we all have had experience with people who have not been cured, but who have been healed; healed in a sense of facing their end in peace and with a sense of wholeness.
Increasingly, university centers have been created to study this issue, and there are a growing number of medical schools that now include some type of class, such as “The Healer’s Art,” developed by Rachel Naomi Remen, which examines the role of spirituality and medicine from both the patient’s as well as the physician’s point of view.1 Donald M Friedman is one physician who teaches this course and has commented on the value of creating a space where medical students can discuss and be open about the spiritual aspect of working with a patient. He spoke about the fact that these discussions can prepare the student to see the patient as a whole person and not just as a collection of ailments. He noted that the value of the teaching was in the fact that the students “realized how their personal experiences could help them relate to patients on an emotional and spiritual basis . . . the fact that they were willing to go to deeper places within themselves and see how it could help them relate better to patients was encouraging to me . . . I hope they will remember how being aware of their human and vulnerable sides can keep them open to the human and spiritual sides of being a patient.”2
In a speech given at the 1964 convention of the American Medical Association, the great 20th century theologian, Abraham Joshua Heschel, spoke of the need to see religion and medicine as working together for the good of the person. It is important to remember that this speech was made 50 years ago and that Heschel uses the word religion as a general term that, for us today, I believe carries with it an understanding of what we call spiritual. The thesis of the speech is the special nature of the physician and the potential for healing that can be realized when aspects of faith and medicine are joined together. His talk, entitled “The Patient as a Person,” looked at the sacred nature of this collaboration. He spoke to his audience regarding the unique role of the physician. The physician, he noted, “is a person who has chosen to go to areas of distress, to pay attention to sickness and affliction, to injury and anguish. Medicine is more than a profession . . . It is not an occupation for those to whom career is more precious than humanity or for those who value comfort and serenity above service to others. The doctor’s mission is prophetic.”3 Heschel expanded on this sacred image by saying that, “The doctor is God’s partner in the struggle between life and death. Religion is medicine in the form of prayer; medicine is prayer in the form of a deed. From the perspective of the love of God, the work of healing and the work of religion are one. The body is a sanctuary, the doctor is a priest . . . Medicine is a sacred art. Its work is holy . . . It is a grievous mistake to keep a wall of separation between medicine and religion. There is a division of labor but a unity of spirit. The act of healing is the highest form of Imitatio Dei. To minister to the sick is to minister to God. Religion is not the assistant to medicine, but the secret of one’s passion for medicine.”3
Religions, as the institutional representation of a system of beliefs, all have their own particular approaches to medicine and healing. One’s understanding of those beliefs and how one chooses to live them make up a person’s spiritual identity. Thus, each person’s spirituality might be quite different, based on their history, even though different patient’s might “affiliate” with the same religion. Taking into account that spiritual system can enhance the healing process. A growing number of spiritual assessment tools are finding their way into practice.4 Taking a spiritual inventory of a person, as well as a medical history of a person, might well enhance the treatment program that evolves. If we choose to approach the patient as a whole person, then gaining an understanding of his or her belief system, or lack thereof, may be helpful in developing a relational approach to the patient that embraces the value of the dignity and sanctity of human life and the preservation of human life in dignity and sanctity.
A study by the Pew Research Center’s Religion and Public Life Project looked at end of life medical treatment. Part of the study showed the impact of one’s religious beliefs on end of life issues.5 In a follow-up article on the study, Pew senior researcher David Masci noted that there is often a disconnect between what a person’s religion says about a particular issue, such as suicide or euthanasia, and what the individual might believe.6 This points out the need for religious communities to create and run on-going educational opportunities so as to make sure that people understand what their tradition says and explore how they, as individuals feel about those positions. Knowing this can help in the conversation between patient and physician. This is especially important as the progress of medical technology continues to increase.
As the Pew study pointed out, much of the discussion around spirituality and medicine comes into play around end of life issues. Here is where we face our greatest challenges. Medical technology has made it possible to extend “life.” We know “how” to do that. The spiritual question that is being asked more and more, is “why?” Here the issue of quality of life and of the dignity and sanctity of a human life converge into deeply human moments of meaning. These are the moments when decisions are made that encompass not just the medical point of view but also regularly the spiritual. These are the moments when patient, doctor, clergy, and family are reminded of our fragility and mortality. These are the moments that bring to mind what I suggest are the only questions that really matter in life: why was I born; why must I die; and why, for what purpose, is my life? These are deeply spiritual questions, the questions that gave birth to religions; and they are the questions that form the stuff that links medicine and faith together in one sacred enterprise.
Cite this as: BMJ 2014;348:g1452
Competing interests: I have read and understood the BMJ Group policy on declaration of interests and have no relevant interests to declare.
Provenance and peer review: Commissioned; not externally peer reviewed.