As we read in an article published last week in this magazine, the world’s biggest medical and spirituality health congress, the 11^thMEDNESP, happened between June 14^th and 17^th. 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 treatment? 

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 from hospital. 

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 their power.  

How does religion and spirituality help health professionals accept their illnesses and improve treatment results? 

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 conditions.  

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 33^rd Brazilian Psychiatric Congress in November 2015, when the World Psychiatric Association (WPA) admitted the importance of the issue of spirituality and religion in health matters.  

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.