September 2000

Spirituality and Prayer Play Role in Integrative Care

A surge of interest in the role prayer can play in medicine is reflected by recent articles in The New England Journal of Medicine and other publications. "The reason for this interest is that our society is searching for deeper meaning in health care," said Carl Middleton,

vice president of theology and ethics for Catholic Health Initiatives. "Catholic Health Initiatives is providing a solution through our rollout of an integrative model of medicine, which we define as a comprehensive, collaborative and personal approach to meeting patients’ biophysical, psychological and spiritual needs."

Integrative medicine places equal emphasis and importance on the body, mind and spirit in bringing a patient to health and wholeness. "In integrative care, practitioners assess the spiritual needs of patients just as they assess their physical and emotional needs," said Middleton.

As for the role of prayer and spirituality in medicine, Middleton draws a clear distinction between prayer and spirituality. "I define spirituality as the way people make sense of their life situations and events, while prayer is a personal expression of an individual’s relationship with God," he said. "When people experience major health events, especially bad news such as a diagnosis of cancer, their first question is often, ‘Why is this happening to me?’ They may pray to comfort themselves, but it is their spirituality that attempts to find some meaning in the event, to make sense of it, to cope with and respond to it."

In Catholic Health Initiatives’ approach to integrative care, patients express their thoughts and feelings about their health when they tell the stories of their illnesses to their practitioners. These stories are called clinical narratives, and they help practitioners understand patients’ feelings and attitudes so that they can address patients’ spiritual, physical and emotional needs. "The Comprehensive Care Evaluation Tool that Catholic Health Initiatives has developed to help practitioners perform integrative patient assessments includes questions about patients’ views of spirituality," said Middleton. "Like the clinical narrative, the answers to these questions help practitioners assess patients’ spiritual needs so that they can care for the whole person in mind, body and spirit."

While research continues as to whether prayer can heal, Middleton believes that is the wrong question to ask. "I think the right question is, ‘Is prayer helpful in healing?’" he said. "I believe the answer is yes. Through prayer, patients can feel that God is their partner and that they are not alone in their illness or disease. This can have a calming and beneficial effect."

Even though praying for the sick has ancient roots, the question of whether it is appropriate for practitioners to pray with patients is always controversial in society. "I would say that it is appropriate for practitioners to invite a patient to enter into a dialog on spirituality," Middleton said. "Beginning such a dialog is one of the things our Comprehensive Care Evaluation Tool is designed to do. Through this dialog, practitioners can pick up cues as to how comfortable patients are with spirituality and prayer, and whether they would be comfortable with an invitation to pray together. This process does take intuition and judgement on the part of the practitioner, which come with experience. Practitioners who don’t feel comfortable with their experience in this area are encouraged to call on their market-based organization’s spiritual care leaders for assistance."

However, what practitioners should not do is impose their own value system, spirituality or prayer on a patient. "We must only pray with patients upon their consent," Middleton said. "Without consent, prayer becomes a breach of patient autonomy, which is the right of the patient to accept or reject treatment modalities, including prayer."

For patients who consent, prayer can be a powerful therapeutic tool. "Human spiritual needs are inseparably intertwined with physical and emotional needs," said Middleton. "The integrative approach to care will ensure that we address all three in equal measure."