As we read in an article published last week in this
magazine, the world’s biggest medical and spirituality
health congress, the 11thMEDNESP, happened
between June 14th and
17th. One of the issues that raised the
concern of most participants was how to take
spirituality into account when treating patients.
Religion and spirituality can no longer be disregarded
when treating human beings as a whole. Dr Márcia Regina
Colasante Salgado (photo),
a pulmonologist and treasurer of Brazil’s Medical-Spiritist
Association, presented a seminar on that issue during
the event and gave us the following interview:
Why should spirituality be part of a patient’s
Science is more and more realizing the importance of
spirituality for human beings. To be human is to look
for a meaning on everything around us, as we are
unfinished natural creations seeking to be come complete
beings. Many patients are spiritual or have a religion
and find in their beliefs a meaning and purpose for
their existences. That provides them support, comfort
and consolation before illness and, sometimes, the
prospect of imminent death. It is essential that these
patients be treated as people who are suffering, not
simply as faceless individuals going through physical
pain, with a mal-functioning body. Spiritual wellbeing
is one of the dimensions of our health condition, at par
with the physical, psychological and social dimensions.
To ignore that aspect amounts to ignoring the desires
and wishes of patients and failing to provide relief for
their existential anxieties and suffering.
We must add that a growing number of research shows that
religious and spiritual beliefs and practices are linked
to better mental health, life quality, better physical
health, longevity and better medical data. And religious
beliefs affect medical decisions, from patients as well
as from doctors. In some cases, patients’ beliefs clash
with medical advice. That is the case of the Jehovah
Witnesses and other Christian sects who refuse to
receive blood transfusion.
The inability to deal properly with the spiritual needs
of patients, especially those who are not religious, may
lead to an increase in the costs of healthcare,
especially at the end of one’s life. Religion may also
influence the type of support patients get in their
communities after seeing a doctor or being discharged
Finally, hospitals want healthcare professionals to be
able to respect the their patients’ spiritual beliefs.
And that requires more than simply asking patients what
their religious affiliation is. We must, therefore,
treat patients as a whole, which requires that we take
into account their spiritual and religious beliefs.
Otherwise we will be failing in their treatment.
Which professionals must be included?
All health professionals, including doctors, nurses,
social workers, psychologists, physiotherapists and
occupational therapists. In sum, all of those who deal
directly with patients.
Are there ethical boundaries that must be respected?
Absolutely. The relationship between doctor and patient
is unbalanced. Doctors hold the power and patients are
vulnerable. Doctors must, therefore, never proselytize
or ridicule their patients’ beliefs. They mustn’t either
try to awaken the spiritual side of patients, even if in
a subtle way. If a doctor shares his beliefs with a
patient, he may me inadvertently encouraging him to
accept it. And he may do so out of fear of not receiving
the best possible treatment. Doctors must not abuse
How does religion and spirituality help health
professionals accept their illnesses and improve
Religion and spirituality have been positively
associated with psychological well-being indicators,
such as happiness, satisfaction with one’s life, the
feeling of being loved, elevated self-esteem and better
physical and moral health. The higher the level of
religious involvement the lower is the level of
depression, suicidal thoughts and behavior and use and
abuse of alcohol and other drugs.
Many studies also show that religious beliefs help
coping with serious illnesses, help blood pressure
control and improve the immune system of patients with
HIV. Scientific evidence suggests that religious beliefs
help patients deal with their illnesses and can have a
positive impact on their health. Religious and spiritual
beliefs provide hope, comfort and a meaning for things
in most cases, especially when facing life-threatening
Are doctors more open now to speak about the spiritual
needs of patients or are there still barriers on
discussing that issue?
In the United States, the American Association of
Medical Colleges (AAMC) and the American Psychiatric
Association recommend the inclusion of spirituality and
religiosity in the curriculum of medical schools. A
research carried out by Harold Koening with 115
directors of medical schools accredited by AAMC (out of
122) show that 90% of them have some type of course
about health and spirituality. But only 7% of them had
effectively a compulsory subject on the issue.
In Brazil, this issue is rarely discussed. Only 10% of
medical schools have a subject on spirituality,
according to a study carried out by Lucchetti and others
in 2012. I believe there are still many barriers, as the
issue is not really discussed in academic institutions.
Things are changing, however, and we have observed
growing interest among the younger generations. A
watershed moment was at the 33rd Brazilian
Psychiatric Congress in November 2015, when the World
Psychiatric Association (WPA) admitted the importance of
the issue of spirituality and religion in health
We are going through a phase of great opening in that
area as the growing number of publications in that area
shows. But on daily medical practice we are still miles
away from setting up routine spiritual support
mechanisms for patients. The exceptions are a few
centres of excellence, such as hospices.
What else you would like to add?
Medical practice can only be of a spiritual nature if we
take into account the sacred nature of human beings and
admit that both doctors and patients are human beings
who are in need, most of all, of care.