Patients benefit from attending to spirituality in health care, says Georgetown University bioethics expert

Media Contact:
Maria Maisto, mcm87@georgetown.edu

(WASHINGTON, D.C., March 21, 2024)  In a Perspective piece titled “Physicians, Spirituality, and Compassionate Patient Care” in the March 21, 2024 issue of the New England Journal of Medicine, Daniel P. Sulmasy, MD, PhD, André Hellegers Professor of Biomedical Ethics, director of the Kennedy Institute of Ethics at Georgetown University, and faculty member at the Pellegrino Center for Clinical Bioethics, argues for the clinical and ethical importance of attending to spiritual well-being in the healing process.

Noting that it can be challenging to tackle the interconnections of spirituality, religion, and health care in an increasingly pluralistic world, Sulmasy offers practical suggestions and clear ethical guidelines to facilitate the integration of the “spiritual” into a “biopsychosocial approach to 21st-century health care.”

There are biomedical reasons to attend to spirituality in the patient encounter, Sulmasy observes.  He highlights a case where a patient’s insomnia was alleviated without immediate recourse to medication or psychiatric referral, but rather by addressing her spiritual concerns. Research shows that the benefits of such an approach are tangible, aiding patients in decision-making, improving satisfaction with care, and enhancing quality of life.

In addition, Sulmasy points out, many medical ethicists believe that the bioethical principles of beneficence and respect for patients as whole persons obligate clinicians to be open to “the spiritual aspects of their patients’ lives and identities.” Failure to do so, he suggests, is disrespectful to the patient and “divorces medical practice from a fundamental mode of patient experience and coping.”

Sulmasy writes that to address the spiritual needs of patients responsibly, it is important to adhere to the “ancient ethical obligation for physicians to refer to specialized practitioners when they are not qualified to provide a particular form of care.” Chaplains are the appropriate professionals for the medical team to consult or bring in for patients’ spiritual care, but Sulmasy also notes that sometimes the physician is the very first person to whom patients disclose or reveal any spiritual need.

He suggests that medical schools need to incorporate into the curriculum appropriate instruction on addressing spirituality. Many medical schools now provide guidance on how to be attentive to religious and spiritual concerns as part of cultural competency training, and Sulmasy points to the FICA Spiritual History Tool, which trains medical professionals on how to assess patients’ spiritual needs, as an important supplement.

Sulmasy, who teaches in the departments of Philosophy and Medicine at Georgetown University and continues to practice medicine part-time as a member of the University faculty practice, also suggests guidelines for how medical professionals can ethically express —or protect the privacy of — their own personal religious or spiritual beliefs or practices (or lack thereof) in the context of the patient encounter. Praying with patients, for example, can be appropriate in some circumstances, but it is important to remember that “respect for persons runs in both directions,” and that medical professionals are under no obligation to participate in any kind of religious or spiritual expression, even if requested by the patient.  

Instead, Sulmasy offers sample language for medical professionals to use to gently avoid, or appropriately participate in, spiritual or religious expression with patients. He also unequivocally affirms that it is inappropriate for medical professionals to impose their religious or spiritual beliefs or practices on patients, since doing so would “violate patients’ dignity and freedom, which are the bedrock justifications for attending to spiritual needs in the first place.”

Attention to the relationship of spirituality to patient care is “salutary for patients and health care professionals alike,” Sulmasy concludes, and can be carried out effectively with education, sensitivity, and proper ethical guidance.

“Physicians, Spirituality, and Compassionate Patient Care” was published in the New England Journal of Medicine online on March 16, 2024 and in print on March 21, 2024 and is a pivotal contribution to the ongoing dialogue on the integration of spirituality into medical practice. A podcast interview with Dr. Sulmasy is available at nejm.org.

Daniel P. Sulmasy, MD, PhD is the director of the Kennedy Institute of Ethics and holds a joint appointment at the Pellegrino Center for Clinical Bioethics at Georgetown University in Washington, D.C. He is the inaugural André Hellegers Professor of Biomedical Ethics, with co-appointments in the Departments of Philosophy and Medicine. He practices medicine part-time as a member of the Georgetown University faculty practice.

Previously, he was at the University of Chicago as the Kilbride-Clinton Professor of Medicine and Ethics in the Department of Medicine and Divinity School, Associate Director of the MacLean Center for Clinical Medical Ethics, and Director of the Program on Medicine and Religion. Additionally, he has held faculty positions at Georgetown University and New York Medical College. He received his AB and MD degrees from Cornell University, completed his residency, chief residency, and post-doctoral fellowship in General Internal Medicine at the Johns Hopkins Hospital, and holds a PhD in philosophy from Georgetown. He has served on numerous governmental advisory committees, and was appointed to the Presidential Commission for the Study of Bioethical Issues by President Obama in 2010.

His research interests encompass both theoretical and empirical investigations of the ethics of end-of-life decision-making, ethics education, and spirituality in medicine. He is the author or editor of seven books: The Healer’s Calling (1997), Methods in Medical Ethics (2001; 2nd ed. 2010), The Rebirth of the Clinic (2006), A Balm for Gilead (2006), Safe Passage: A Global Spiritual Sourcebook for Care at the End of Life (2013), Francis the Leper: Faith, Medicine, Theology, and Science (2014), and Physician-Assisted Suicide: Before, During, and After the Holocaust (2020). He also serves as editor-in-chief of the journal Theoretical Medicine and Bioethics.

The Kennedy Institute of Ethics is one of the world’s premier bioethics institutes. Founded at
Georgetown University in 1971, its faculty have included founders of the field as well as next-
generation leaders. With a top-ranked graduate program, the world’s most comprehensive bioethics library, a highly praised intensive summer course for health care practitioners, and faculty expertise on issues such as death and dying, clinical research ethics, reproductive ethics, disability ethics, and environmental ethics, the Institute is a renowned resource for the University, the policy world, and the global bioethics community.