Religion and spirituality in medicine: friend or foe?

The relevance and role of ‘Religion’ and ‘Spirituality’ in ‘Medicine’ and ‘Clinical Practice’ have been ‘Issues’ undergirding ‘Robust Conversations’ from the past and coming to the present with the potentiality of persisting into the future [1-7]! The practice of ‘Medicine’ deals with ‘Patients’ who are ‘Human Beings’ created by God. It is expected that ‘Human Beings’ are regarded as ‘Persons’ who have ‘3 Components’: ‘Body’, ‘Soul’ and ‘Spirit’! A ‘Person’ is, therefore, a ‘Triune Being’! As a ‘Composite Whole’, a ‘Person’ with developed ‘Personhood’ manifests the ‘Unity’ of the ‘Triunity’ of ‘Humanity’!! A Medical Doctor is expected to deal with the ‘Patient’ as a ‘Composite Whole’ consistent with the ‘Person’ with ‘Body’, Soul’ and ‘Spirit’! For ‘Medical Practice’, dealing with the ‘Body’ is ‘Physical’ or ‘Somatic’ while dealing with the ‘Soul’ is ‘Psychic’ and the interaction with the ‘Spirit’ is ‘Pneumatic’ or ‘Spiritual’. ‘Spirituality’ thus reflects ‘Matters’ relating to the ‘Spirit’! ‘Religiosity’, on the other hand, deals with ‘Matters’ relating to the ‘Person’ belonging to a ‘Defined Group’ with stipulated ‘Ordinances’, ‘Observances’ and ‘Rituals’ among others. The ‘Concepts’ of ‘Spirituality’ and ‘Religiosity’ are two clearly distinct and different ‘Entities’!! It is suggested that ‘Persons’ can be ‘Religious’ without being ‘Spiritual’ and others can be ‘Spiritual’ without being ‘Religious’ and yet others can be both ‘Religious’ and ‘Spiritual’. There are certainly yet other ‘Persons’ who are neither ‘Religious’ nor ‘Spiritual’!! Belonging to a ‘Faith or Denomination’ is the undergirding ‘Determinant Thrust’ in ‘Religion’ while the manifestation of ‘Love’, ‘Justice’ and ‘Peace’ form the ‘Driving Thrust’ in ‘Spirituality’! The ‘Matters’ relating to ‘Spirituality’ have a ‘Nexus’ with ‘Moral Philosophy’, ‘Ethics’ and ‘Medical Ethics’. Some believe that ‘Spirituality’ and ‘Religiosity’ are synonymous and can be used interchangeably but this remains contentious [3,4,7,8]!

The consideration of the ‘Patient’ as a ‘Composite Whole’ and as a ‘Triune Being’ undergirds the relevance of ‘Holism’ in ‘Patient Care’. For the desired ‘Holistic Patient Care’, the ‘Patient’ must be regarded as a ‘Triune Being’ and a ‘Composite Whole’ which amplifies the ‘Determinant-Importance’ of ‘Spirituality’ in relation to the ‘Spirit’ of the ‘Patient’! The ‘Religious Observances and Ordinances’ may have ‘Healthful Implications’ for ‘Holistic Health’. While ‘Spirituality’ and ‘Religiosity’ are clearly distinctly different ‘Concepts’, they both have impact of ‘Holistic Health’ of the ‘Patient’ as a ‘Triune Being’ and a ‘Composite Whole’. This is consistent with the WHO Definition of ‘Health’ which states that ‘It is not the mere absence of diseases or infirmities but the presence of Spiritual, Religious, Emotional, Economic, Financial ……Well-being’ and also ’……the Capacity for coping with the Environment’ [9,10]!

The belief in different ‘Religions and Religious Faiths’ has implication for considering ‘Spirituality’ and ‘Religion’ in ‘Holistic Patient Care’. Typically, the ‘Abrahamic Religions’ (Christian, Islamic and Jewish Religions) dispose divergent ‘Ordinances’/ ‘Observances’ with difficult implications for practising ‘Holistic Patient Care’! This also has implication for ‘Clinical Governance’ and disposing ‘Medical Ethics’ in ‘Clinical Practice’!! The differing ‘Religious Dispositions’ with implication for divergent positions on ‘Clinical Practice’ was amplified recently [7]!! For ‘Catholic Medical Doctors’ who are ‘Practising Human Catholic Christians’, they may be inclined to subscribe to ‘Catholic Medical Ethics’ (‘Catholic Medical Ethics’ is the integration of ‘Catholic Moral Theology’ with ‘Medical Ethics’!)!!! Indeed, do ‘Patients’ seeking ‘Holistic Health Care’ really care about ‘Spirituality’ and ‘Religiosity’ in this modern times? Given the ‘Situational Reality’ in the ‘Past’ and evolving to the ‘Present’, the ‘Response’ is in the ‘Affirmative’ [5,6,11-13]! The emerging discourse on ‘Diagnostics’, ‘Therapeutics’ and ‘Holistics’ is stimulating [6]!! The Consensus Panel of the American College of Physicians has adopted ‘4 Question-Approach’ that should be part of the ‘Spiritual History’ of the ‘Evaluation’ of every ‘Patient’ to assure ‘Holistic Patient Care’ [14]!! It was reported that the manner in which ‘Sin’ was considered to be aetiologically relevant to ‘Mental Disorders’ so was ‘Religion’ also considered to be determinant in achieving their ‘Cure’ [1]! Generally, ‘Religion’ and ‘Spirituality’ are thought to assist ‘Patients’ in ‘Coping’ with their ‘Medical Conditions’ and improve overall ‘Well-being’ in addition to facilitating their ‘Recovery’ [5]!!

‘Holism’ should be emphasized in the care of ‘Patients’ who must be cared for as a ‘Composite Whole’ and ‘Triune Being’ [15]! Considering the ‘Movement and Force’ of ‘Humanism’ opposing ‘Science’, some have suggested ‘Medical Humanities’ disposing the possibilities: to ‘Cure Sometimes’, ‘Relieve Often’ and ‘Comfort Always’ [5]. Again, this amplifies the need to consider several ‘Non-Medical Disciplines’ in the discharge of ‘Holistic Patient Care’! Increasingly, several ‘Psychosocial Factors’, beyond the ‘Biomedicine’ of the ‘Patient’, must be considered in the provision of ‘Holistic Patient Care’.

The huge ‘Contemporary Challenge’ in the provision of ‘Holistic Patient Care’ has been, and still is, the absence of teaching these ‘Non-Medical Disciplines’ in the ‘Basic Medical Education Curriculum’ of several Medical Schools worlwide [12]! Here again, we suggest the introduction of ‘Medical Socieconosophy (MSE)’ as an imperative for ‘Medical Education Improvement’ [16-19]! MSE is a ‘New Study Area as an Interdisciplinary Array of the medically relevant aspects of selected relevant Non-Medical Academic Disciplines (NMADs)’ as ‘Intervention’ for ‘Basic Medical Education Curriculum Improvement’!! The infusion of MSE into ‘Basic Medical Education Curriculum (BMEC)’ guarantees ‘Interdisciplinarity’ in the ‘Formation’ and ‘Production’ of Medical Doctors ‘Fit-for-Purpose’ in this era of ‘Holistic Patient Care’. The MSE is proposed as a ‘Single Multi-Subjects Package’ to be taught over several years by Experts in the NMADs! The ‘Subjects’ identified as relevant in ‘Basic Medical Education Curriculum Improvement’ can be captured by the Bacronym ‘PRICE Plus’, the ‘Framework’ for harvesting the NMADs! Several of the NMADs in MSE are similar to some of the ‘Subjects’ included in ‘Medical Humanities’ Concept!! The MSE will, therefore, also enhance the new disposition towards ‘Medical Humanities’ in achieving ‘Holism’ in ‘Patient Care’ with manifest regard of ‘Patients’ as ‘Composite Whole’ or ‘Triune Beings’! MSE certainly includes the study of ‘Religion’ and ‘Spirituality’ in the BMEC!! This implies bringing ‘Matters’ of ‘Faith’ into BMEC for the ‘Robust Formation’ of Medical Doctors. ‘Faith’ was aptly disposed by Osler [20] thus: ‘Nothing in life is more wonderful than faith, a great moving force that can neither weigh in the balance nor test in the crucible……’!

REFERENCES
1. Foucault M. Madness and civilization: a history of insanity in the age of reason. New York: Random House 1965.
2. Koenig HG, Cohen H, Blazer D et al. Religious coping and depression among elderly hospitalized medically ill men. Am J Psychiatry 1992; 149:1693-1700.
3. Dyson J, Cobb M, Forman B. The meaning of Spirituality: a Literature Review. J Adv Nurs 1997; 26:1183-1188.
4. Koenig GH. Religion, Spirituality and Medicine: application to clinical practice. JAMA 2000; 284:1708-1709.
5. Gordon J. Medical Humanities: to cure sometimes, to relieve often, to comfort always. Med J Aust 2005; 182:5-8
6. Mann H. Diagnosis: Fact or Fiction. https://www.bmj.com/content/353/bmj.i1884/rr of 26th April 2016
7. Sokol D. Religion and spirituality in medicine: friend or foe. BMJ 2020; 368:m106 of 13th January 2020.
8. Hassed CS. Depression: dispirited or spiritually deprived? Med J Aust 2000; 173:545-547
9. World Health Organization. The first ten years of the World Health Organization. Geneva. WHO 1958
10. World Health Organization. Regional Office for Europe. Health Promotion: A discussion document on the concept and principles: Summary Report of the Working Group on Concept and Principles of Health Promotion. Copenhagen, 9-13 July 1984.
11. D’Souza R. Do patients expect psychiatrists to be interested in spiritual issues? Australian Psychaitry 2002; 10:44-47.
12. D’Souza R. The importance of spirituality in medicine and its application to clinical practice. MJA 2007; 186:S57-59
13. Koenig GH, McCullough M, Larson D. Handbook of Religion and Health. New York. New York Oxford University Press 2010
14. Lo B, Quill T, Tulsky J. Discussing palliative care with patients. Am Intern Med 1999; 130:744-749
15. Russell G. Holism and Holistic. BMJ 2016; 353:I1884 of 26th April 2016
16. Eregie C.O. ‘More Talk on the ‘Health Professional Associations-Industry Funding’; Conflicts of Interest are better avoided: A Proactive Role for ‘Medical Socioeconosophy’. https://www.bmj.com/content/365/bmj.l2093/rr-3 of 22nd May 2019
17. Eregie C.O. ‘The NHS Health Workforce Crisis and the Modern Firm: Considering an Additional Role for ‘Medical Socioeconosophy’ in Basic Medical Education Curriculum Improvement’. https://www.bmj.com/content/365/bmj.l4173/rr-3 of 26th June 2019
18. Eregie C.O. ‘’Fit-for-Purpose’ Medical Doctors in Today’s Globalized World: Further Imperative for ‘Medical Socioeconosophy’ in Basic Medical Education Improvement’. https://www.bmj.com/content/366/bmj.l4997/rr-1 of 30th August 2019
19. Eregie C.O. ‘Medical Reformation: The imperative for the complementarity of the ‘twin interventions’ of generalism and medical socioeconosophy’. https://www.bmj.com/content/368/bmj.m157/rr-1 of 19th January 2020
20. Osler W. The faith that heals. BMJ 1910; 1:1470-1472

Professor Charles Osayande Eregie,
MBBS, FWACP, FMCPaed, FRCPCH (UK), Cert. ORT (Oxford), MSc (Religious Education),
Professor of Child Health and Neonatology, University of Benin, Benin City, Nigeria,
Consultant Paediatrician and Neonatologist, University of Benin Teaching Hospital, Benin City, Nigeria,
UNICEF-Trained BFHI Master Trainer,
ICDC-Trained in Code Implementation,
*Technical Expert/ Consultant on the FMOH-UNICEF-NAFDAC Code Implementation Project in Nigeria,
*No Competing Interests.