The clinical role of spirituality was well addressed by Speck, Higginson and Addington-Hall (1). Despite recognized positive effects of spiritual experiences, significant equivocality exists about its clinical relevance. From this, arise several issues. First, the synonymous use of spiritual and religious may pose both heuristic and practical clinical difficulty. Spiritual events manifest properties of transcendence, emotionality and alteration in physical experience. Religion may be a vehicle through which existential explanatory models and noetic properties of spiritual experiences are induced, framed and assume meaning. However, secular beliefs and experiences can be equally powerful and thus “spiritual”. Explanatory models affect patients’ locus of control and well-being (2). Perhaps revised semiotics would be beneficial to both physicians and patients.
Second, spiritual experience involves distinct neural mechanisms . Engagement of these substrates may produce many of the subjective feelings of the noetic event, and are partly responsible for the activation of extra-neural events that mediate pain and recuperation (3). Subjective properties of such experiences (qualia) appear crucial for the induction of physiologic mechanisms and concomitant salutogenic effects. Therefore, clinicians might incorporate these phenomena to affect both objective health and patients’ subjective feelings of wellness.
Ethical appreciation of these domains fosters a patient-centered approach. Simple neutrality is not viable in that patients’ belief systems may be implicitly scrutinized, promoting dissonance in the therapeutic relationship and could incur nocebo effects (4). Spiritual beliefs and practices are consistent with bio-psychosocial factors constructing patients’ worlds that are influential in health (5). Direct involvement with patients’ spirituality may be beyond the scope of clinical practice. Yet, the fiduciary relationship between physician and patient instigates clinicians’ pro-active role in evaluating patients’ spirituality, recognizing its importance and providing resources to accommodate patients’ needs.