COMMONWEALTH ASSOCATION FOR EDUCATION,
ADMINISTRATION AND MANAGEMENT
ISSN NO 2322-0147
VOLUME 2 ISSUE 7
JULY 2014
Importance of Spiritual Dimension of Health
and Responsibility of Physicians
(EDITOR-IN-CHIEF)
DR MUJIBUL HASAN SIDDIQUI
ASSISTANT PROFESSOR, DEPARTMENT OF EDUCATION,
ALIGARH MUSLIM UNIVERSITY,
ALIGARH-202002,
UTTAR PRADESH,
INDIA
website: www.ocwjournalonline.com
Excellence International Journal of Education and
Research (Multi- subject journal)
Excellence International Journal Of Education And Research VOLUME 2 ISSUE 7
ISSN 2322-0147
Importance of Spiritual Dimension of Health and
Responsibility of Physicians
By
S. M. Ahmer
P.G. Scholar
Department of Kulliyat,
Ajmal Khan Tibbiya College,
A.M.U. Aligarh.
Email: drsmahmer@yahoo.com
MohdNajmul Aqib Khan
P.G. Scholar
Department of Community medicine,
Jawaharlal Nehru Medical College,
A.M.U. Aligarh.
Email: drsmahmer@yahoo.com
Rizwan Mansoor Khan
P.G. Scholar
Department of Tahaffuzi wa Samaji Tib,
National Institute of Unani Medicine,
Kottigepalya,
Bangalore.
Email: drsmahmer@yahoo.com
Dr. Ferasat Ali
Associate Professor
Department of Kulliyat,
Ajmal Khan Tibbiya College,
A.M.U, Aligarh.
Email: drsmahmer@yahoo.com
Abstract
Hippocrates (460-377BC) said that “The physician must be ready, not only to do his duty himself, but also to
secure the co-operation of the patient, of the attendants and of externals”. Spirituality is recognized as a factor
that contributes to health in many ways. The concept of spirituality is found in all cultures and societies. It is
expressed in an individual's search for ultimate meaning through participation in religion and/or belief in God,
family, naturalism, rationalism, humanism, and the arts. All of these factors can influence how patients and
health care professionals perceive health and illness and how they interact with one another.
Physicians should be altruistic “Physicians must be compassionate and empathic in treating the patients. In all of
their interactions with patients, they must try to understand the patients' agony in the context of beliefs, family
and cultural values.
Spirituality determines the way in which a patient responds to the illness whether chronic or acute. It explains
the attitude of the patient towards the suffering. So it is the responsibility of the physicians to consider the
spirituality of the patient during the treatment and to respect his beliefs and ethical values.Doing so is part of
providing compassionate care if we truly listen to their hopes, their fears, and their beliefs and incorporate these
beliefs into their therapeutic plans, it will lead to the miraculous healing. And for this purpose it is of prime
importance to understand the spiritual values of a person.
Key words: Spirituality, health, Physician.
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Introduction
The World Health Organization formulated its definition of health following World War II,
during a period when the social health of societies was in question. Since that definition in
1946, social scientists have dutifully followed its precepts and attempted to operationalize its
concepts, including social well-being. But, American social scientists have found that
psychosocial well-being may be a more accurate formulation of mental and social well-being,
and they have questioned the reasonableness of a definition that requires complete health. It
is proposed that scholars refine the WHO definition over the next several years, while at the
same time creating bridges between a new conceptual definition and more detailed
operational definitions. An expansion of the WHO definition may be necessary to include a
spiritual dimension of health if social scientists can agree that spirituality is part of health and
not merely an influence [1].
“Health is a dynamic state of complete physical, mental, spiritual and social well-being and
not merely the absence of disease or infirmity.”
It is worth remembering these things if only to note how much the medical community had to
regain in order to reach a positive definition of health in the twentieth century. It was a
Muslim doctor, Ali ibn Al-Abbas, ten centuries ago, who defined health as"A state of the
body in which functions are runin the normal course"[2]. It was Averroes (ibn-Rushd), some
800 years ago, who defined health as "A state in which an organ performs its normal function
or undergoes its normal reaction"[3]. And it was Ibn al-Nafees, 700 years ago, who said:
"Health is a state of the body in which functions are normal per se while disease is the
opposite state" [4]. All the Muslim doctors, then, made health their starting point, while
illness was the opposite of it. The Muslim doctors deduced that "Health means that the body
is in a state of dynamic equilibrium" as Ali ibn AI-Abbas said [5]. Avicenna (ibn-Sina)
explained this dynamism of the health balance saying: "The state of equilibrium which a
human being enjoys has a certain range with an upper and lower limit" [6].
This reflected their understanding of what is stated in the Holy Quran:
"…Your gracious Lord ... has created and formed perfectly and shaped your nature in just
proportions (82:6-7).
"Consider the human self, and how it is formed in most normal form” (9,1.- 7)
"We have created man in the most perfect conformation” (95.-4)
From the following verses of the Quran:
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"And He enforced the balance.That you exceed not the bounds, but observe the balance
strictly; And fall not short thereof ' (55. - 7-9).
Spirituality in different eras:
Spirituality in Ancient Medicine
Early Greek medicine focuses on the god of healing. Worshippers believe that Asclepius,
with the help of his daughters Hygeia and Panacea, heals the faithful if they build temples in
his name, make sacrifices, and sleep in the temples. People, who stayed there, engraved in to
slabs of stone their story of how they got better. They all believe it was the work of
Asclepius.
Spirituality in Medieval Medicine
Medieval concepts of mental illness stressed that individuals were responsible for their
actions-mental illness came from sin and resulting punishment from God. As sin was central
to mental illness, religious activity was believed to be central to cure. (Medical journal of
Australia, 2007)
Spirituality in Modern Medicine
In spite of the growth of scientific knowledge in medicine, concept of spirituality has
survived and continues to flourish.
According to World Health Organization –
“Health is a state of complete Physical, mental, spiritual, and social well being not merely
absence of disease or infirmity.”
According to Association of American Medical Colleges:
“Spirituality is recognized as a factor that contributes to health in many persons. The concept
of spirituality is found in all cultures and societies. It is expressed in an individual's search for
ultimate meaning through participation in religion and/or belief in God, family, naturalism,
rationalism, humanism, and the arts. All of these factors can influence how patients and
health care professionals perceive health and illness and how they interact with one another.”
The Joint Commission on Accreditation of Health Care Organization has a policy that state“For many patients, spiritual services are an integral part of health care and daily life. The
hospital is able to provide for spiritual services for patients who request them.”
What is spirituality?
Spirituality has been defined in numerous ways. These include: a belief in a power operating
in the universe that is greater than oneself, a sense of interconnectedness with all living
creatures, and an awareness of the purpose and meaning of life and the development of
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personal, absolute values. It's the way you find meaning, hope, comfort, and inner peace in
your life. Although spirituality is often associated with religious life, many believe that
personal spirituality can be developed outside of religion. Acts of compassion and
selflessness, altruism and gratification, and the experience of inner peace are all
characteristics of spirituality. This may be because of dissatisfaction with the impersonal
nature of our current medical system, and the realization that medical science does not have
answers to every question about health and wellness.
Spirituality is recognized as a factor that contributes to health in many ways. The concept of
spirituality is found in all cultures and societies. It is expressed in an individual's search for
ultimate meaning through participation in religion and/or belief in God, family, naturalism,
rationalism, humanism, and the arts. All of these factors can influence how patients and
health care professionals perceive health and illness and how they interact with one another
[7].
The word "spiritual", said Dr Mahler, was defined in a variety of ways, all of which have one
common denominator. "They imply a phenomenon that is not material in nature but belongs
to the realm of ideas that have arisen in the minds of human beings, particularly ennobling
ideas. As far as can be gathered from the history of humankind, human beings were moved to
action through ideas that arose in their minds. Often, people developed their ideas in order to
improve the material world in which they lived, and their lot within that world. This is where
Homo sapiens differ from all other known species."
A spiritual philosophy is our basic belief system about the nature of our existence, about its
purpose and goal.
Dimensions of Health
Man is a trinity that is comprised of the Body (Physical), the Mind (Mental), and the Spirit
(Spiritual). The Body, Mind and Spirit work in harmony to make the best that can be in this
life. If one of these three elements is “sick” or out of balance with the other two, then, your
entire being will be sick.
Unfortunately, most of traditional medicine focuses on the Body. Traditional medicine tends
to overlook the importance of the Mind and the Spirit and its role in healing the Body.
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Spiritual and religious health allows focusing on our inner faith and the belief that we must
respect and protect what we put into our Body to maintain a healthy balance with the Mind
and Spirit [8].
The spiritual dimension is described and is interpreted as the need for: meaning, purpose and
fulfillment in life; hope/will to live; belief and faith. As the spiritual dimension is important
for the attainment of an overall sense of health, well-being and quality of life (referred to as
the health potential) and as illness and hospitalization can precipitate spiritual distress,
patients' spiritual needs should be addressed. The spiritual dimension is understood to imply a
phenomenon that is not material in nature, but belongs to the realm of ideas, beliefs, values
and ethics that have arisen in the minds and conscience of human beings, particularly
ennobling ideas. Ennobling ideas have given rise to health ideals which have led to a practical
strategy for Health for All that aims at attaining a goal that has both a material and
nonmaterial component. If the material component of the strategy can be provided to people,
the non-material or spiritual one is something that has to arise within people and communities
in keeping with their social and cultural patterns. The spiritual dimension plays a great role in
motivating people's achievement in all aspects of life.
Role of the Physician
The relationship between spirituality and medicine has been the focus of considerable interest
in recent years. Studies suggest that many patients believe spirituality plays an important role
in their lives, that there is a positive correlation between a patient's spirituality or religious
commitment and health outcomes, and that patients would like physicians to consider these
factors in their medical care. A spiritual assessment as part of a medical encounter is a
practical first step in incorporating consideration of a patient's spirituality into medical
practice.Spiritual practices tend to improve coping skills and social support, foster feelings of
optimism and hope, promote healthy behavior, reduce feelings of depression and anxiety, and
encourage a sense of relaxation. By alleviating stressful feelings and promoting healing ones,
spirituality can positively influence immune, cardiovascular (heart and blood vessels),
hormonal, and nervous systems. Again, the health benefits of religion and spirituality do not
stem solely from healthy lifestyles. It is believe that certain beliefs, attitudes, and practices
associated with being a spiritual person influence health.
Physicians should be altruistic “Physicians must be compassionate and empathic in treating
the patients. In all of their interactions with patients, they must try to understand the patients'
agony in the context of beliefs, family and cultural values. Spirituality determines the way in
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which a patient responds to the illness whether chronic or acute. It explains the attitude of the
patient towards the suffering. So it is the responsibility of the physicians to consider the
spirituality of the patient during the treatment and to respect his beliefs and ethical
values.Doing so is part of providing compassionate care. If we truly listen to their hopes, their
fears, and their beliefs and incorporate these beliefs into their therapeutic plans, it will lead to
the miraculous healing. And for this purpose it is of prime importance to understand the
spiritual values of a person.
Family physicians are concerned with any factors that affect their patients' health. It is
important that physicians maintain a balanced, open-minded approach to medical care
without sacrificing scientific integrity. Physicians can begin to incorporate spirituality into
medical practice in three ways:
1. By scientific study of the subject;
2. By assessment of the patient's spirituality and diagnosis of spiritual distress; and
3. By therapeutic interventions.
Scientific study involves evaluating the current evidence for a link between spirituality and
health and planning further study to clarify these effects. It is important to keep an open mind
regarding new methods of study and to be aware that there are some things that may never be
fully understood.
For assessment and diagnosis, the physician should evaluate whether spirituality is important
to a particular patient and whether spiritual factors are helping or hindering the healing
process.
Therapeutic interventions include consideration of a patient's spirituality in recommendations
regarding prevention, medical treatment and adjuvant care. In addition, elements of general
spiritual care should be incorporated into the routine medical encounter. Although not easily
measurable, a physician's ability to offer connection, compassion and presence can be a
powerful therapeutic intervention.
Aspects of Spiritual Care
What is involved in serving patients and providing compassionate care? Physicians can begin
with the following: Practicing compassionate presence- i.e., being fully present and attentive
to their patients and being supportive to them in all of their suffering: physical, emotional,
and spiritual.
1. Listening to patients' fears, hopes, pain and dreams.
2. Obtaining a spiritual history.
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3. Being attentive to all dimensions of patients and their families: body, mind, and spirit.
4.Incorporating spiritual practices as appropriate.
5. Involving chaplains as members of the interdisciplinary health care team.
Spiritual History
A Spiritual history helps physicians and opens the door to conversation about values and
beliefs, uncovers coping mechanisms and support systems, reveals positive and negative
spiritual coping, and provides an opportunity for health care.
What doctors and clinicians should consider?
A consensus panel of the American College of Physicians has suggested four simple
questions that physicians could ask patients:
The FICA Method of taking Spiritual History:
F - (Faith and belief): Are there spiritual beliefs that help you cope with stress or difficult
times?
I - (Importance): Is spirituality important in your life?
C - (Community): Do you have someone to talk to about religious matters?
A - (Address/action): Would you like to explore religious, spiritual matters with someone?
(Baylor University Medical center Proceedings, 2001)
Considering these issues and approaching questions of spirituality and religiosity of patients
will not only improve patient care, but also doctor patient relationships and patient wellbeing.
Throughout these activities, it is important to understand professional boundaries. It is
important to recognize that patients come to physicians to seek care for their medical
condition. In delivering this care, physicians can be respectful and understand the spiritual
dimension in patients' lives but to go beyond that e.g. to lead prayer or provide in-depth
spiritual counseling isinappropriate. Physicians are in a position of power with patients. Most
patients come to us in vulnerable times. If the physician suggests a certain religion/spiritual
belief or ridicules a patient's belief, the patient might adopt that physician's belief or lack of
belief out of fear of disagreeing with a perceived authority. Therefore, it is critical that when
discussing spiritual issues with patients, the physician listens and supports and does not
guide.
Spirituality may be a dynamic in the patients understanding of the disease. Religious
convictions may affect health care decision making.Spirituality may be a patient need and
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may be important in patient coping. An understanding of the patient's spirituality is integral to
whole patient care. [9].
The following highlight findings for those persons who were more spiritually or religiously
involved:
-
Higher rates of overall well being and life satisfaction.
-
Lower rates of depressive symptoms and suicide.
-
Lower rates of divorce and higher rates of marital satisfaction.
-
Lower rates of alcohol and other drug abuse, including cigarette smoking and
recreational drug use.
CONCLUSION
Patients want to be seen as WHOLE Persons, not as disease. A whole person is someone
whose being has and spiritual dimensions. Ignoring any of these aspects of humanity leaves
the patient feeling incomplete and may interfere with healing.
Various studies reveals that spiritual practices have been considered as an important activities
in the maintenance of well being , as coping response at the time of stress and as a source of
comfort.
Scientists in this field feel that research should begin to focus on assessing the validity of this
connection, a better understanding of why there is this connection, and how it works. There is
also interesting research emerging that evaluates the impact of religion and spirituality.
References
1. World Health Organization (1984) Global Strategy for Health for All by the Year
2000: the
spiritual dimension [Report of the Director-General to facilitate discussion of the
Executive Board], EB73/1984/REC/l, Annex 1, p.23
2.
Ibn AI-Abbas, A., Kamel as-sina'ah (in Arabic) vol.2 p.3 , from M.H. Khayat,
“Spirituality in the Definition of Health” The World Health Organization's Point of
View.
3. Ibn Rushd (Averroes)-. Al-collimate (in Arabic) from M.H. Khayat, “Spirituality in
the Definition of Health” The World Health Organization's Point of View.
4. Ibn AI-Nafees: Al-moojaz fit-tibb (in Arabic) from M.H. Khayat, “Spirituality in the
Definition of Health” The World Health Organization's Point of View.
5. Ibn AI-Abbas, A., Kamel as-sina'h (in Arabic) vol.2 p.3 from M.H. Khayat,
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“Spirituality in the Definition of Health” The World Health Organization's Point of
View.
6. Ibn Sina (Avicenna): AI-qanoon (in Arabic) from M.H. Khayat, “Spirituality in the
Definition of Health” The World Health Organization's Point of View.
7. Association of American Medical Colleges Report III: Contemporary Issues in
Medicine: Communication in Medicine, Medical School Objectives Project.
Washington, DC: Association of American Medical Colleges; 1999. pp. 25–26.
Available at http://www.aamc.org/meded/msop/report3.htm#task.
8. National Center for Complementary and Alternative Medicine. Mind-Body Medicine:
An Overview. National Center for Complementary and Alternative Medicine Web
site. Accessed at nccam.nih.gov/health/backgrounds/mindbody.htm on December 2,
2004.
9. Pargament KI, Smith BW, Koenig HG, Perez L. Patterns of positive and negative
religious coping with major life stressors. Journal for the Scientific Study of Religion.
1998;37:710–724.
10. Miller, T.Q. (1997). Statistical methods for describing temporal order in longitudinal
a. research. Journal of Clinical Epidemiology, 50, 1115-1168
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