Medical education is changing and so too is clinical practice. A movement of physicians and others is underway to shift medical values and practices toward healing the whole person, not simply curing disease, toward recognizing that patients often suffer spiritually as well as physically and psychologically, and toward developing clinical practices that understand and incorporate spirituality and religion into health care. Pediatricians in particular will need to adapt their clinical practices in order to take seriously the spiritualities and religions of children's and adolescents' health, illness, and death.
One way spirituality is being integrated into clinical practice is by means of the spiritual history. Physicians routinely ask patients a series of medical and social questions in order to learn the patient's history. Questions about spirituality are now more commonly included either as part of the social history or as a separate questionnaire.
Spiritual histories typically ask whether spirituality or religion is meaningful in a patient's life, where patients draw meaning and hope from, and whether they belong to a religious community. If the patient responds positively to these initial questions, further questions are appropriate regarding what spiritual beliefs they hold regarding their health, disease, or disability and how these beliefs might affect particular health care decisions they are facing. Other relevant questions ask about the patient's spiritual practices as a means to healing, for example, do they pray, meditate, do tai chi, read scripture, or attend religious services for health, and do they have spiritual resources, such as a spiritual leader, that the physician might support the patient in contacting, or would they like a referral to a chaplain.
Spiritual histories are particularly relevant in caring for severely and chronically ill or dying patients whose spiritual dilemmas are often most acute. The end of life frequently raises questions about the purpose and meaning of life, the need for hope, and feelings of despair. While physicians are not expected to be spiritual healers (nor are they trained to do so), they are in a unique position to support patients in a healing process that affirms not only the physical, but also the spiritual, social, and psychological aspects of their lives.
While many spiritual histories were first developed for adults, similar questions are important for children and adolescents. To the extent that parental spirituality influences the care of their children, it is appropriate for health care practitioners to learn also something of parental spiritual histories so as to come to an understanding of a family spiritual history. Given that parents routinely make critical health care decisions on behalf of their children, this understanding is particularly important for pediatricians and other practitioners working with children and adolescents.
HEALING CULTURES AND CULTURAL DIVERSITY
The parental responsibility for health care decision making is typically noncontroversial for parents within dominant Western religious traditions that largely accept and affirm conventional Western medical practices. However, controversy often arises when the beliefs, values, or practices of religious communities and those of biomedicine are at odds. Christian Science parents, for example, sometimes find themselves at the center of heated legal and moral debates about their children's health and healing. Biomedicine and Christian Science represent distinct healing cultures that are unlikely to be integrated into a single approach to care.
Religious healing, known also as faith healing or spiritual healing, is understood to be healing that occurs by non-scientifically observable means. While certain spiritual dimensions of human health are gaining acceptance in medical practice and research, medicine is a long way from recognizing the spiritual healing beliefs and practices central to dominant and nondominant cultures and religious communities in the United States. For example, many Christians believe that prayer can heal not only the soul but also the body and that prayer can heal not only one's own body but can also heal the bodies of family and friends for whom they have prayed.
Studies of "distant healing," that is, the healing of others through prayer, are exceedingly difficult to design and execute, but such studies are underway. Interestingly, this research is somewhat controversial within religious as well as medical communities. Some religious practitioners reject the understandings of prayer and healing implied by researchers' attempts to measure the healing effectiveness of prayer. Prayer for these believers is primarily a means of communication with God, not a therapeutic intervention or a medical prescription. Furthermore, they believe that such studies misunderstand the nature of healing, which they understand to be ultimately a gift from God, not a predictable response to human prayer. Nonetheless, studies of prayer and other spiritual practices presumed to enhance health are proceeding and may offer important findings.
Medicine is challenged to recognize the diversity and depth of religious and spiritual contributions to human health and healing. Additional research on religion and health and improved medical education are important steps toward a fuller understanding of the constellation of connections between religion, spirituality, health, and medicine.