Religion, medicine and spirituality: what we know, what we don't know and what we do.

Religion and spirituality have been linked to medicine and to healing for centuries. However, in the early 1900's the Flexner report noted that there was no place for religion in medicine; that medicine was strictly a scientific field, not a theological or philosophical one. In the mid to the latter 1900's there were several lay movements that started emphasized the importance of religion, spirituality and medicine. Lay religious movements found spiritual practices and beliefs to be important in how people cope with suffering and find inner healing even in the midst of incurable illness. The rise of Complementary and Alternative Medicine as well as the Hospice movements also influenced attention on the spiritual aspect of medicine. The Hospice movement, founded by Dr. Cecily Saunders, described the concept of "total pain"--i.e. the biopsychosocial and spiritual aspects of pain and suffering. Since the 1960's there has been increased research done in the area of religion and health and spirituality and health. Most of the studies are association studies which demonstrate and association of religious or spiritual beliefs and practices and some healthcare outcomes. More recently, studies on meditation have demonstrated significant improvement in health care outcomes and suggest meditation as a therapeutic modality. There are also numerous surveys that demonstrate patient need for having spirituality integrated into their care. Finally, a recent study demonstrated that patients with advanced illness who have spiritual care have better quality of life, increased utilization of hospice and less aggressive care at the end of life. In spite of all these studies, we still do not have a biological evidence base for mechanisms of beliefs and practices. There is considerable controversy over whether spirituality and religion can or even should be measured as criteria for integration into clinical care. Many believe that healthcare professionals have an ethical obligation to attend to all dimensions of a person's suffering, including the psychosocial as well as the spiritual and that ethical obligation is sufficient to require integration of spirituality into clinical care. Over the last twenty years, there has been an increase in the number of required courses in spirituality and medicine in US medical schools giving rise to a new field of medicine. In February of 2009, a national consensus conference developed spiritual care guidelines for interprofessional clinical spiritual care. These guidelines as well as the educational advances, research and ethical principles have supported the newly developing field of spirituality and health.