SPIRITUALITY IN MEDICINE AND HEALTH CARE

INTRODUCTION
Studies have shown a very strong correlation between religious beliefs or spirituality and both
mental and physical health, particularly in terminally ill patients and the end of life. This
connection is due first to the fact that many patients turn to religion for comfort. On the other
hand as a person grown older, he becomes more religious but also more prone to disease.
In fact religious involvement is a widespread practice that predicts successful coping with
physical illness. Practices and beliefs are associated with a greater well-being, hope, optimism
and more purposeful and meaningful life. Faithful patients have more hope that they will be
taken care of by God. Clinically, this translates into a psychological coping mechanism patients
may rely on to proceed with their lives.
Moreover, spirituality influences medical decision making. In a survey published in the Journal
of Clinical Oncology, cancer patients ranked faith in God as the second most important factor
that may influence chemotherapy treatment decisions. The oncologist’s recommendation
ranked first. On the other hand, religious individuals are also more likely to present for disease
detection, and to comply with medical treatment (Koenig, 2004).
Surveys of the US public in the Gallup Report consistently show a high prevalence of
belief in God (95%) while 84% claim that religion is important to their lives. Approximately
40% of Americans attend religious services at least once a week. One survey in Vermont
involving family physicians showed that 91% of the patients reported belief in God as
compared with 64% of the physicians. A 1975 survey of psychiatrists showed that 43%
professed a belief in God. These surveys remind us that there is a high incidence of belief in
God in the US public. It also appears from surveys that physicians as a group are somewhat
less inclined to believe in God. Whereas up to 77 percent of patients would like to have their
spiritual issues discussed as a part of their medical care, less than 20 percent of physicians
currently discuss such issues with patients.
In May 1984, the Thirty-seventh World Health Assembly took the historic decision to adopt
resolution WHO, which made the "spiritual dimension" part and parcel of WHO Member
States' strategies for health. Had this important resolution been expressed as part of the
preamble to the Constitution or as a declaration, the vital parts, in the very words of the Health
Assembly, might have read somewhat as follows:
• The spiritual dimension is understood to imply a phenomenon that is not material in nature,
but belongs to the realm of ideas, beliefs, values and ethics that have arisen in the minds
and conscience of human beings, particularly ennobling ideas.
• lf the material component of the strategy can be provided to people, the non-material or
spiritual one is something that has to arise within people and communities in keeping with
their social and cultural patterns.
• The spiritual dimension plays a great role in motivating people's achievement in all aspects
of life.
The clinician ability to explore a patients spiritual values, personal meanings and vital
connections, and to respect and enhance these spiritual dimensions in the care of the patient,
may vastly increase therapeutic benefit. Specifically, the clinical conditions correlated with
spiritual concepts include terminal disease.
In this article will be explained briefly the close relationship between disease and past karma,
and role of spiritual/religious activity in health care setting.

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BASIC CONCEPT OF SPIRITUALITY IN MEDICINE
Spirituality is that aspect of life that encompasses our relationship to that which is larger than
ourselves, whether it be our ultimate purpose, community, or the Divine. Religion is a system
of organized beliefs and practices that supports service to and worship of God or the
supernatural. All of belief system (Christianity, Islam, Hinduism, Budha etc.) are religions,
prayer is a spiritual practice shared by many religions. Thus, spirituality concerning about soul
as living entity, Supreme Godhead as source of all in the universe, finaly spirituality bring us to
understanding of life and relationship with Supreme Godhead.
Spirituality, transcedence aspect of life come from the Supreme Lord as the real
knowledge or spiritual knowledge. The word upanishhad means secret and sacred knowledge.
This word occurs in the Upanishads themselves in more than a dozen places in this sense. The
Upanishads have been perennial sources of spiritual knowledge. The word upanishhad means
secret and sacred knowledge. This word occurs in the Upanishads themselves in more than a
dozen places in this sense. In Mundaka upanisad one of a hundred upanisada have been
described about a kind of knowledge, as essence of Brahma Jnana. It is assigned to the Fourth
Veda, the Atharva: ”tasmai sa hovaca : dve vidye vediavye iti ha sma yad brahmavido vadanti,
para vaivapara ca” – There is two kind of knowledges called paravidya (supreme wisdom),
and the other when aparavidya, relative knowledge acquired by the intellect and through the
performance of ritual worship and duties, contradistinction to paravidya (supreme wisdom), the
transcendental knowledge of Brahman attainable by him who has achieved moksha (liberation)
during life. Aparavidya, the knowledge of the immanent, not the transcendent aspect. The
Upanishads deal specifically with paravidya. But the interesting thing is: the Aparavidya leads
on to the Para, the knowledge of Brahmam, which is the goal. In other hand, paravidya mean
spiritual knowledge (transcedental) or real knowledge and aparavidya is a material or relative
knowledge. For example, biology is knowledge about life science, they studies about many
species of life, anatomy, fisiology, but did not invovved the soul or jiva who make species
called living think. So, studies about life without concerning the soul is not completely.
In brief there are many way to acquiring knowledge, in the other holy scripture said
that sources of knowledge come from three ways (pramanas): a. pratyaksa (direct perception),
The knowledge we get through the five senses. Pratyaksa is direct perception, what is
perceived by the eyes and the ears, b. anumana (logical argument as induction and deduction)
and c. sabda (authoritative testimony, oraly direct from the source of knowledge). Of these,
sabda is imperative, while pratyaksa and anumana are supportive. Sabda descent from real
source of knowledge (Supreme Lord) to disciple sucsession by spiritual master (guru), so
called parampara.
Spirituality and medicine is two difference knowledge, one as transcedental konwledge
and the other material knowledge. All of them has vise versa connection. Disease is suffering
of human body caused by experience of soul by mercies of Supreme Godhead. Human being
with many suffering need spiritual commitment to understand the meaning of life. Some
people think that diseases due to punished from God. Then, spirituality and medicine is very
close conection. To mastering the connection between spirituality and health or medicine some
main concepts should be learn more such as: concept of God, soul (life), transmigration of
soul, law of natural (cosmic justice) and others.

1. Concept of God
Conceptions of God vary widely. Theologians and philosophers have studied countless
conceptions of God since the dawn of civilization. The Abrahamic conceptions of God include
the trinitarian view of Christians, the Kabbalistic definition of Jewish mysticism, and the
Islamic concept of God. The dharmic religions differ in their view of the divine, ranging from
the almost polytheistic view of God in Hinduism to the almost non-theist view of God in

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Buddhism. In modern times, some more abstract concepts have been developed, such as
process theology and open theism. Conceptions of God held by individual believers vary so
widely that there is no clear consensus on the nature of God. The contemporaneous French
philosopher Michel Henry has however proposed a phenomenological approach and definition
of God as phenomenological essence of Life (www..wikipedia)
The question of God's existence has occupied the minds of the world's greatest thinkers for
many years, the basic question; Is there a God? Is the universe just a fluke that came about by
chance and will eventually be destroyed? Are we just a compilation of molecules that just
happen to work together pretty good or are we the design of God made in his image? These
questions are the most important questions in the world.
Modern man's concepts of God are many and varied. Children tend to imagine an old
man with a white beard. Many adults regard God as an invisible force or a mentul concept or
as all humanity, the universe, or even oneself. Parasara Muni, a great sage and ancient Indian
philosopher, the father of Vyasadeva, who compiled all the Vedic literatures, gave the
following definition of God (Visnu Purana 6.5.47); aisvaryasya samagrasya viryasya yasasah
sriyah jnana-vairagyayos caiva sannam bhaga itingana - “Bhagavan, the Supreme
Personality of Godhead, is thus defined as one who is full in six opulences -- who has full
strength, fame, wealth, knowledge, beauty, and renunciation.” That mean, God is absolutly a
person with fully perfect (om purnam). In Judio-Christian era God was defined as an
omnipotent, omniscient and omnibenevolent, causes of all causes, creator of universe.
The Absolute truth (Ultimate Reality) is one, Sages call it by different names - there is one
God, (Supreme Reality) perceived differently. Supreme Reality - Brahman has two aspects,
transcendent (impersonal) and immanent (personal). In the impersonal aspect Brahman is
without attributes (nirguna Brahman). In personal aspect (saguna Brahman) the God is creator,
preserver and controller of the universe. The others holy scripture Bhagavata Purana states:
"Learned transcendentalists who know the Absolute Truth call this non-dual substance
brahman, paramatma, or bhagavan." There are three aspects of absolut truth.
Brahman (Impersonal), Brahman refers to the impersonal, all-pervasive aspect of the
Absolute Truth. The multifarious manifestations of the cosmos, moving and nonmoving --
matter, atoms, bodies, planets, space -- are not ultimate causes, nor are they eternal. They come
from the eternal Brahman, the origin of everything within the material world of duality.
Paramatma (Impersonal), Vedic philosophy distinguishes the atma from both the gross
(physical) and subtle (mental) bodies. Atma is the eternal, individual inner self, and it is not
destroyed when the body is destroyed. But this atma is distinct also from the Paramatma.
Paramatma means "the Supreme Self" or "the Supreme Soul," (atma means "self or soul," and
parama means "transcendental, absolute or supreme"). Usually, paramatma is translated as
"the Supersoul." God dwells within our hearts and accompanies us throughout our journeys
from one material body to another. He gives us good advice and fulfills our desires by
awarding us the karmic results of our actions. Therefore the Supersoul is our unknown friend,
our best friend.
Bhagavan (Personal), Bhagavan refers to the Personality of Godhead. According to
Vedic philosophy, God is not only impersonal light or all-pervasive divine consciousness but
also a person. Yet He is not a person like us, for He is free from vice and bad qualities, neither
influenced by illusion nor fettered by a material body. Nonetheless, He is a person, possessing
individual consciousness, intelligence, and personal qualities. The Personality of Godhead,
Bhagavan, is the absolute, transcendental, perfect, original, and supreme person. How could
we be persons unless our origin, God, is also a person? The word Bhagavan means "the person
who possesses all the divine attributes or six opulences," all wealth, all power, all fame, all
beauty, all knowledge, and all renunciation. Bhagavan is thus the personal God aspired to and
worshiped by the devotees of monotheistic religions like Judaism, Christianity, and Islam.

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 Scientists are attempting to calculate the length and breadth of this material world, but
they cannot begin. It will take them thousands of years simply to travel to the nearest star. And
what to speak of the spiritual world? Since we cannot know the material world, how can we
know what is beyond it? The point is that we must know from authoritative sources. The most
authoritative source is Personality of God, for He is the reservoir of all knowledge. This
material world is compared to a prison, and just as prisoners represent only a small percentage
of the total population, so the living entities within the material world constitute but a
fragmental portion of all living entities. Similarly, living entities who declare their defiance of
God are placed in the material world. Originally the living entities are all part and parcel of
God and are related to Him just as sons are related to their father. Christians also consider God
the supreme father. Christians go to church and pray, "Our Father, who art in heaven.', The
conception of God as father is also in the Bhagavadgita (14.4) said that "It should be
understood that all the species of life, O son of Kunti, are made possible by birth in this
material nature, and that I am the seed-giving father."
God is omnipotent; He can maintain all of living being in all universe. These are all attractive
features. We experience in this material world that if a man is very rich, he is attractive. Those
who were pious in a previous life receive an opportunity in this material world to take birth in
good families and good nations. The Vedic literature asserts that God has thousands holy
names, Krishna is the most popular and principal name.

*With the knowledge that thought is the beginning state of Creation, the scientific
community has an outlet from its energy and mass (dog chasing its tail) analysis of the
universe. A universe(s) created and sustained by God's thought provides the scientific basis for
understanding infinity (it is and is not), time (an illusion held together by memory and
imagination), and psychic phenomena (the One Consciousness is all-pervading). The quest of
pure science is Truth and God is Truth. The truth is that science and religion are not at odds
with each other at all; both are paths to God. The reason that the tie between science and God
had not been universally recognized was that there was no scientific bridge to link the two. It is
clear from the teachings of the Godmen that thought is the bridge to God that science has
overlooked.
Scientific Evidence Existence of God
Evolutionary theory declares that everything has a mere appearance of design. Richard
Dawkins, author of The Blind Watchmaker and a professor at Oxford University (U.K.), is
probably the leading proponent of evolutionary theory since the death of Stephen Jay Gould.
Dawkins writes: Biology is the study of complicated things that give the appearance of having
been designed for a purpose. . . . . the living results of natural selection overwhelmingly
impress us with the appearance of design as if by a master watchmaker ……….

Interestingly, in all other fields of human endeavor we find that "design necessitates a
designer." Thus, design detection methodology is a prerequisite for many disciplines, including
archaeology, anthropology, forensics, criminal jurisprudence, copyright law, patent law, reverse
engineering, crypto-analysis, random number generation, and SETI (the Search for Extra-
Terrestrial Intelligence). In general, we find "specified complexity" to be a reliable indicator of
the presence of intelligent design (God).

a. Creation of Universe
Planetary system begin from big bang phenomen, but scientist still confious about the source
of energy the event.

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b. Origin of Life
How did life come from a rock? How did a bird come from a lizard? Why don't we see birds
come from lizards today? Why are there no transitional fossils in our museums today? Why
have we never observed beneficial mutations? Where did the information code in DNA come
from? Where did the language convention that interprets DNA come from? How can we
explain the random development of the human eye, reproductive system, digestive tract, brain,
heart and lungs? What about the subconscious mind? What about love, morality, ethics, and
emotions? Can these things really evolve gradually and randomly over time?
Jeepers! What was happening to me?
Literally, I was in a state of "stream-of-consciousness" skepticism. Everything I knew (and
thought I knew) about the world around me didn't make sense any more. I couldn't go back! If
I was going to be intellectually honest with myself, I couldn't retreat to my prior way of
thinking... I had to go forward and personally look at the observable evidence... But, where to
begin?

c. Fossil Record
Let's start by looking at a few more of Darwin's very honest statements:
Firstly, why, if species have descended from other species by insensibly fine gradations, do we
not everywhere see innumerable transitional forms? Why is not all nature in confusion instead
of the species being, as we see them, well defined? 1
But, as by this theory, innumerable transitional forms must have existed, why do we not find
them embedded in countless numbers in the crust of the earth? 2
Lastly, looking not to any one time, but to all time, if my theory be true, numberless
intermediate varieties, linking closely together all the species of the same group, must
assuredly have existed. 3
Why then is not every geological formation and every stratum full of such intermediate links?
Geology assuredly does not reveal any such finely graduated organic chain; and this, perhaps
is the most obvious and gravest objection which can be urged against my theory. 4

Since Darwin put forth his original theory, scientists have sought fossil evidence indicating
past organic transitions. Nearly 150 years later, there has been no evidence of evolutionary
transition found thus far in the fossil record. In Darwin's own words, if his theory of "macro-
evolution" were true, we would see a vast number of fossils at intermediate stages of biological
development. In fact, based on standard mathematical models, we would see far more
transitional forms in the fossil record than complete specimens. However, we see none -- not
one true transitional specimen has ever been found.
Our museums now contain hundreds of millions of fossil specimens (40 million alone are
contained in the Smithsonian Natural History Museum). If Darwin's theory were true, we
should see at least tens of millions of unquestionable transitional forms. We see none. Even the
late Stephen Jay Gould, Professor of Geology and Paleontology at Harvard University and the
leading spokesman for evolutionary theory prior to his recent death, confessed "the extreme
rarity of transitional forms in the fossil record persists as the trade secret of paleontology." 5

d. DNA Molecule - the Impossibility of Information

The DNA (deoxyribonucleic acid) molecule is one of the greatest scientific discoveries of all
time. First described by James Watson and Francis Crick in 19531, DNA is the famous
storehouse of genetics that establishes each organism's physical characteristics. Scientists now
understand that the DNA molecule is comprised of chemical or material bases arranged in
approximately 3 billion precise sequences. DNA is not life, have no consciousness, life is
consciousness.

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With the discovery, mapping and sequencing of the DNA molecule over the last few decades,
we now understand that organic life is based on vastly complex information code, and, like
today's most complex software codes, such information cannot be created or interpreted
without some kind of "intelligence." Truly understanding the scientific reality of the DNA
molecule single-handedly defeated my life-long presupposition that life arose from non-life
through random materialistic forces. Even with trillions of years, the development of DNA is
statistically impossible.

e. Theory of Evolution - How does it really work?

The theory of evolution as depicted through the evolutionary tree in my high school classroom
only dealt with the macro-evolutionary chain between organic creatures. Through my quick
study, I found at least five other fundamental stages of evolution that would be required prior
to any possibility of organic life.

f. Cell Structure - The Complexity of the "Simple" Cell

Each person begins as a single cell -- a cell structure formed by the joining of the mother's egg
and the father's sperm. That single cell contains the digital code to make thousands of other
kinds of cells, from fat cells to bone cells -- from brain cells to lung cells. There are muscle
cells, skin cells, vein cells, capillary cells and blood cells… Ultimately, from that one original
cell, the human body will have something like 30 trillion cells conducting an orchestra of
different functions.
In the first half of this century, scientists still assumed that the cell was a fairly simple blob of
protoplasm. Without electron microscopes and other technology, the cell was treated as a
"black box" that mysteriously performed its various functions -- an unobservable collection of
"gelatin" molecules whose inner workings were unknown.
Through the marvels of 21st century technology, scientists now understand the following:
Although the tiniest bacterial cells are incredibly small, weighing less than 10 -12 grams,
each is in effect a veritable micro-miniaturized factory containing thousands of
exquisitely designed pieces of intricate molecular machinery, made up altogether of
one hundred thousand million atoms, far more complicated than any machinery built
by man and absolutely without parallel in the non-living world.1
Each microscopic cell is as functionally complex as a small city. When magnified 50,000 times
through electron micrographs, we see that a cell is made up of multiple complex structures,
each with a different role in the cell's operation. Using the city comparison, here's a simple
chart that reveals the awesome intricacy and design of a typical cell:

g. Others natural phenomen

According ancient Indian scriptute (Visnu-purana), The Supreme Lord has unlimited energies,
but all of these energies can be divided into three main categories; 1. Antaranga-sakti: Internal
energy (the spiritual world) Antaranga-sakti includes everything in the spiritual world and is
under the direct shelter of the spiritual energy, 2. Tatastha-sakti: Marginal energy (the living

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entities or soul) Stha means position. Tata is the point at the edge of the waves that roll up on
the beach, the margin between water and land, and 3. Bahiranga-sakti: External energy (the
material world) is everything a part of Supreme Lord Krishna and connected to Him? The
material world called the external energy or Krsna's separated energy. So, by the Spureme Lord
energy controlled of all His creation, both in the universe (buana agung) and in the living being
(buana alit), Supreme Lord is a real personality.

2. Concept of Life (Jiva tattva)

What is life? Everyone is curious about life – whether a scientist, a philosopher, a poet, an
artist or a religious man or woman. We all want to know about the reality and purpose behind
our existence – “Why are we born?”, “why do we die?”, “why do we suffer with diseases and
old age?”, “what is our ultimate destination?”
This material world is here for a purpose, it didn't come out of a chance combination of
chemicals. Many would have us believe there is no God in control. They would have us believe
everything happened by chance and there is no intelligence behind nature. They see material
nature as supreme and try to explain it in terms of "natural selection" and chemical reactions.
They can't see beyond the gross material elements [earth, water, fire, air and ether]. They
believe everything can be explained within the framework of material elements, the elements
scientists can put under the microscope in their laboratory.
The most popular creation theory at the moment is the "big bang"... It doesn't explain creation.
It is a very weak theory. It can't be duplicated, not even on a small-scale, they can't make a
small creation in their laboratories by putting chemicals inside a container and agitating them,
there will be no creation. Even if they can create some chemicals it requires a person to mix
them. In the Bhagavadgita (15.7), we find: mamaivaaso jivaloke jivabhuta sanatana, meaning,
all living beings are eternal and conscious particles of the Supreme Lord. In the pure spiritual
form, the living entities are also transcendental and their bodies are also made up of the three
spiritual elements that make up the transcendental body of Isvara, God. However, the
difference between Isvara, God and jiva, the living entity is that the consciousness of the
Supreme Being, God is universal (all pervasive) whereas the consciousness of the jiva, living
being is localized.

Life is Spiritual Particle or Spiriton

A spiritual particle present within any living entity whose presence causes the entire body to be
pervaded by consciousness, the symptom of the soul. The soul is eternal, it has no birth and it
never dies. The soul is the "person within the body", or "the ghost in the machine". At the time
of death the soul leaves the body and is transferred to the womb of it's next mother's womb
according to it's accumulated "karma".
Any material body inhabited by a soul will undergo changes. It will be created, it will grow, it
will produce by-products [offspring], it will dwindle and ultimately it will die. The soul is
defined as a non-material, eternal spiritual entity present within any living being. The symptom
of the presence of the soul within a body is consciousness. The soul continues to exist after the
destruction of the body and it existed prior to the creation of the body. The material body
develops, changes and produces by-products [offspring] because of the presence of the soul
within. The material body deteriorates in due cause of time and when it is no longer a suitable
residence for the soul it is forced to leave the body. This we call death.
According to Vedanta, all living beings are animated by the presence of a non-chemical or non-
molecular fundamental spiritual particle – “spiriton” Vedanta mentions that ‘spiriton’ or the
spiritual particle has the following properties.
a. It is the spiritual energy as opposed to the material energy of God.

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b. It is a transcendental particle and is ontologically different from matter.
c. It is only due to the interaction between the spiriton and material elements that the
material body appears to be active and lively.
d. Its fundamental qualities are: Consciousness, Free will, Intention and Purpose.
e. It is beyond ordinary sense perception but it can be inferred. Consciousness is the
most visible symptom of life, spiriton. Matter, however complex it may be, can never
be conscious.
f. It is the source of all our knowledge.
g. It has a will to know about itself.
h. It has a will to have pleasure.
i. It has attractive powers not only with individual beings but also with matter. The attractive
power or force between a mother and her baby is due to the interaction of spiritons.
However, when the baby is dead, the attractive power will be lost because the spiriton is not
there with the body of the child.
j. It exists eternally and it cannot be created or destroyed.
The living entities in this conditioned world are My eternal fragmental parts. Due to onditioned
life, they are struggling very hard with the six senses, which include the mind. The very first
step in self-realization is realizing one's identity as separate from the body. "I am not this body
but am spirit soul" is an essential realization for anyone who wants to transcend death and
enter into the spiritual world beyond. It is not simply a matter of saying "I am not this body,"
but of actually realizing it. This is not as simple as it may seem at first. Although we are not
these bodies but are pure consciousness, somehow or other we have become encased within the
bodily dress. If we actually want the happiness and independence that transcend death, we
have to establish ourselves and remain in our constitutional position as pure consciousness.
So, we are not these material bodies, we are the spiritual force, the spiritual spark, the soul
within. These bodies are simply an outward dress only. As I change my clothes yet still remain
the same person so I also change my bodies but I am still the same person. I am not an
Australian, an Indian, a man, a woman, a human being or an animal, I am eternally a part and
parcel of the Supreme Person.

Spiritual Evolution
The ability to inquire about the ultimate truth of life makes the human being uniquely different
from all other forms of life. Newton asked why the apple did fall. As an answer to this
question, he discovered the law of gravitation. Thus Vedanta emphasizes that the primary
subject matter of the human form of life is to inquire about the science of Absolute Truth, God.
Albert Einstein once remarked, “The important thing is not to stop questioning. Curiosity has
its own reason for existing. One cannot help but in awe when he contemplates the mysteries of
eternity, of life, of the marvelous structure of reality. It is enough if one tries merely to
comprehend a little of this mystery everyday.”
Life is eternal, individual soul but matter is not-eternal, the symptom of life is consciousness
(cetana). In the human form of life, the consciousness (cetana) , intelligence (buddhi), mind
(manas), senses (indriyas) are fully developed. Thus, human being is totally equipped to make
the deepest jijïäsa (inquiry), the spiritual inquiry. A similar message echoes in the statement of
By this inquiry, sambandha, the relationship between the self and God will be established and
the pure spiritual knowledge of the self will be understood. Isa Upanisad further declares,
isasarsyamidam sarvaa, everything belongs to the Supreme Lord.
The biological forms impose a limitation in the development of consciousness. Therefore,
different degrees of consciousness are expressed through these different bodies. Vedanta
divides the degrees of consciousness into five broad categories: acchadita (covered), sankucita
(shrunken), mukulita (budding), vikasita (blooming) and purnavikasita (fully bloomed). Trees

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and plants, for example, are almost inert. They fall into the category of ‘covered
consciousness’. However, when we observe them carefully, we see that they have a limited
consciousness. Other living entities, such as worms, insects, and other animals are in ‘shrunken
consciousness’. They are not as covered as plants, but their consciousness is not fully
developed either. Human beings have ‘budding consciousness’. A bud appears shrunken, but it
has the potential to bloom into a flower. Human consciousness has similar potential. So, human
beings have the innate ability to develop their consciousness to an almost unlimited extent, up
to the point of knowing the Absolute Truth. Other species do not have this special ability. That
is why Vedanta declares that the human form of life is the most elevated and inquiry into the
Brahman, the Absolute Truth, God is especially meant for the human form of life.

3. Transmigration of Soul (Law of Nature)

Reincarnation, punarbava or samsara mean rebirth again and again. This is main doctrine of
vedic knowledge. In Bhagavangita 15.8. stated; sarram yad avapnoti yac capy uthramat
isvarah grhitvaitani samyati vayur gadhan ivasayat - The living entity in the material world
carries his different conceptions of life from one body to another as the air carries aromas.
The Bhagavadgita explains that the mind, at death, carries with it subtle conceptions, just as
the air carries aromas. And these subtle thoughts are what shape the next body. They determine
what sort of eyes one will have, what nose, ears, and tongue, what sort of hands and legs and
other bodily features. These all assemble around the mind. The Vedic writings tell us, also, that
our karma - what we deserve for our past acts - proceeds not only from what we have done in
the present life but from past lives as well. My present birth, then, is an outcome of what I have
thought and what I have done in the past.
Karma means literally "actions". It is described by the physical law that each action has
an equal and opposite reaction. This universal law is not limited to physical actions, it works
for any action. The karma is stored in our hearts and it will mature and fructify in due course.
If at the time of death there are still karmic reactions stored within the heart which we have not
yet experienced then we have to take birth again in the material world in a body suitable to
enjoy and suffer the stored karma.
As mentioned earlier, consciousness and biological form are interrelated, due to the influence
of the modes of nature. Thus a child's body and its conscious development are different from
those of its youthful stage, and so on. in principle, then, as the body changes from boyhood to
old age, the living being, or atma, actually passes through many bodies of various ages and
varieties of conscious development. Thus the body changes, but the eterna! living being within
the body, the self remains the same. The movement of the living entity through numerous
bodies within one lifetime, something we can all verify by a little introspection, can be termed
internal (or continuous) reincarnation.
But what about the living being's passage to a new body at the time of death? In the
Bhagavadgita Lord Krshna very clearly explains reincarnation to His friend and devotee
Arjuna. The Lord says, “Just as a person puts on new garments, giving up old ones, similarly
the individual living entity accepts new material bodies, giving up the old and useless ones."
(Bg. 2.22) "Just as the embodied living entity passes, in one body, from boyhood to youth to
old age, so the living entity similarly passes into another body at death. Whatever state of being
one remembers when he quits his body, that state he will attain without fail in his next life. So,
the living entity in a man's body could go into the body of an animal, a bird, an insect, a plant,
another human, and so on. This journey of the self, or living entity, into different bodies can be
referred to as external (or discontinuous) reincarnation.
There are many scientific proofs of reincarnation having been uncovered by the
Western scientists such as Dr. Ian Stevenson with his Past Life Research Center in some
books such as Children Past Lives, Twenty Cases suggestive of Reincarnation, Where
Reincarnation and Biology Intersect, from the University of Viginia, USA. which has

Spirituality in Medicine Wa/9/24/2008 9

collected the proofs the reincarnation really happened. Dr. Raymond A. Moody with his
observation “Near Death Experience” concludes that there is past life and life after death. The
scientific evidence about the relationship of current bodies or birth defect related to life in the
past has been discussed by Dr. Ian Stevenson In the case researched significantly showed birth
defect and some diseases related to the past life. Reincarnation was discussed in one of his
books titled “Life after Life”. The book tells about the experience of someone before his death
(near-death experience), it showed there is life after life. There are still many scientists who
reported their research about reincarnation related to the karma in the past.
This is a scientific process, we are travelling from one body to another, not only on this
planet but on innumerable others as well. This earth planet is situated in the middle of the
universe and above this planet there are seven levels of heavenly planets each progressively
better than the previous one, similarly, below this planet there are seven levels of hellish
planets and we, the spirit souls, are travelling throughout all these planets. Bhagavad-gita 14.
18 stated; those situated in the mode of goodness gradually go upward to the higher planets;
those in the mode of passion live on the earthly planets; and those in the mode of ignorance go
down to the hellish worlds."

4. Biodiversity of Life
The living entity in the material world carries his different conceptions of life from one body to
another as the air carries aromas. Thus he takes one kind of body and again quits it to take
another(Gita 15.8). So according to our actions in this life our next body is determined. We
have some control over our future. If we act sinfully we will be degraded in the next life to
animal bodies or to the hellish planets to suffer, if we act in the mode of goodness we will be
elevated with a birth in a wealthy family or a pious family or we may be transferred to the
heavenly planets for a higher standard of life there. We are responsible for our actions in the
human form of life, this is the difference between a human being and an animal.on he has to
eat flesh, he is forced to do so by nature. Therefore for the tiger or any other animal there is no
question of sin because the animals don't have any choice, they are simply working according
to their nature to fulfil their base desires.
There is a spiritual evolution of consciousness. We get a particular type of body out of the
8,400,000 different species of life according to our karma. Every living entity is a spirit soul
and that spirit soul takes shelter within a material body in this world according to its karma.
The living entity who has taken shelter in the dog's body is no different to the living entity in
the human body.
According to Vedic scientific views, there are 8 400 000 varieties of life (microorganisms,
plants, aquatics, birds, reptiles, animals, humanoids and human beings) counted on the basis of
different states or degrees of consciousness. According to the conscious evolutionary cosmic
time scale, one gets the human form of life after passing through millions of varieties of life.
According to modern biology, biodiversity is due to genetic variation caused by occasional
process of chance mutation. However, according to Vedanta, biodiversity is a process to
accommodate the conscious level of each individual and there is a gradual evolution of
consciousness passing from a form of less conscious state to a form of a higher conscious state
according to the subtle laws of karma (cause and effect). The law of karma and the material
modes of nature – sattva (goodness), rajas (passion) and tamas (ignorance) – are responsible
for biodiversity as well as for diversity in terms of levels of intelligence, degree of
development of mind and consciousness of the embodied being within the same species.
Padma purana stated; There are 8,400,000 forms of life. There are 900,000 forms of life
in the water, and 2,000,000 forms of trees and other plants. Then, there are 1,100,000 species
of small living beings, insects and reptiles, and 1,000,000 species of birds. Finally, there are
3,000,000 varieties of beasts and 400,000 human species.

Spirituality in Medicine Wa/9/24/2008 10

Vedanta further explains that many life forms manifest simultaneously. In other words, genetic
variation is already within a cosmic plan. Werner Arber’s observation that genetic mutation is
not due to error or mistake corroborates. He says, “Evolution does not occur on the basis of
errors, accidents or the action of selfish genetic elements. Rather, the evolution genes must
have been fine-tuned for their functions to provide and to replenish a wide diversity of life
forms. The conscious self (spiriton or soul) will continue to transmigrate from one form to the
next until the conscious self or the spiritual particle or ‘spiriton’ reaches the human form where
consciousness is fully developed.
Human life is different, human being have a certain amount of freedom to chose our
activities and we have developed consciousness to ponder on the more subtle questions which
should interest any sane person. Questions like: Who am I? Why am I suffering? What is the
purpose of life? It is the primary purpose of human life to find the answers to these questions,
the animal demands of eating, sleeping, mating and defending have to be met also, of course,
but these demands are secondary. The real purpose of human life is to make a solution to the
problem of repeated birth and death in the 8,400,000 species of life and to become liberated
and enter into the spiritual world to re-establish our original lost relationship with Personality
of God.

5. Past Karma as Real Cause of Suffering

Every civilized society has a system assuring its smooth work and protecting it from various
negative influences. This system is known as law-giving (parliament), executive (police and
courts) and penitentiary (jails) departments. We can see this system at work, and therefore we
know that society is maintained and controlled by someone. Its maintenance and running are
very demanding and it is not possible that it would appear and work by itself. Not everyone
however knows that similar system works also on the cosmic scale. In comparison with our
limited systems it is much more complex and errorless. Its three phases are called in Sanskrit
dharma, karma and samsara. This is a cosmic justice, the natural law under the Supreme Lord
controlled. All of living being in all universe under One Super Controlled, Personality of God.
There are four primary causes of suffering in material life: birth, old age, disease and death.
These sufferings are inevitable for all of us. We don't like to be sick, we don't want to get old,
and we certainly don't want to die. These suffering conditions are unnatural to us because the
nature of the soul is to be sat-cit-ananda, to be eternally youthful, to be full of knowledge, and
to experience full pleasure. This is our natural position, but here, in the material world, we are
forced to identify with a body which is mortal, full of ignorance and full of suffering... It is not
our home, we can never be comfortable here.
Medical science development is very fast. same disease unknown its cause, nowadays
have been found even from the level of molecular until chromosome or DNA which considered
to be the source of life process happened. Each disease happened by the disorder of protein
forming such as enzymes, antibody, hormone, and other mediators in the body, so that will be
physical anomaly or disease. Disturbance production of the proteins has been known by
disturbance of complex machine in the cellular level exactly at stranded of chromosomes or
Deoxyribonucleic acid (DNA). The disturbance happened due to of mutation of gen in DNA
such as: deletion, insertion, and translocation etc. as causes of any diseases. So, the body is
symbol of disease. The disease may differ from one variety to another due to the damage of the
molecular level. The Future expectation in the field of medication will also will lead to the
damage gene repair by gene therapy.
Again, the basic questions arise: why did a mutation happen to the gene of someone, who did
the mutation, do? Why does somebody with normal body, anomaly body, birth defect, invalid
body, body with psychologic disturbances and other many sufferings of bodies?. No experts
are able to reply these questions completely. Only The Omniscience, Supreme God is surely
able to reply them completely.

Spirituality in Medicine Wa/9/24/2008 11

 In the advance of medical science, many diseases are still mysterious, like tuberculosis,
leprosy, cancer, degenerative disease, etc. The modern medical science which counts on limited
observation of the ability of senses of human, we know that ability and capacity of our sense is
very limited and fully imperfectly. The parameter of disease and its pathogenesis are only
based on the empirical facts in the laboratory so that such approach is only abnormality of
certain organ in the body. Our knowledge about the soul and karma are very limited. We do not
understand the transcendental knowledge as the purpose of God willness. Based the Vedic
concept of suffering or disease, there are three main causes of suffering: adhidaivika-klesa, that
is, the suffering caused by the Demigods such as earthquake, dry season, dryness, and other
natural disasters, adhibautika-klesa, that is, the suffering caused by the other living things such
as virus, parasite, microbe, insects, enemies, an many others, and adhiyatmika-klesa, that, is
the sufferings caused by own body and mind such as mental and physical disorder, all of them
caused by the transcendental energy (Bhagavata 5.14.25). The real cause of disease to
somebody cannot be released from the influence of the cosmic justice: karma and
reincarnation. All we have in the material world is birth, old age, disease and death. These four
miseries are there and we can’t avoid them, then this material world is a place of suffering.
We are destined to suffer from a certain amount of disease; its karma, the result of some
of our past sinful actions in this life and previous ones. When we perform sinful activities we
have to suffer in the future. So that suffering is predestined, its fixed up; its a result of the
sinful activities we have performed in the past. If I perform a sinful activity and I am destined
to suffer from certain disease as a result of this, because it is already predestined. Of course,
they may cure one disease – but I still have to suffer the results of my karma, so there will be
another disease to take its place.
The relationship between Karma and the disease or suffering of human bodies has been
explained so much in many Vedic literature such as in purana. For example, in Garuda Purana
5.3 mentioned “brahmaka ksayarogi syad go-ghah syat-kubjako jadah kanya-ghati bahvet
kustho trayas candala yonisu”- “The killer of Brahmana will suffer from pulmonary disease,
who kills cows will be a man with protruding back and stupid, who kills girls will get leprosy,
the three types of man will be born as “candala”.
All these reactions are stored up within our heart. At the time of death we haven't yet
experienced all of these pleasurable reactions (good karma) or all these suffering reactions,
(bad karma) they are still there, within our heart. If our heart is still full of all these stored
karmic reactions we have to take another material body, we have to come back into this
material world to enjoy the fruits of our pious activities and to suffer the fruits of our sinful
activities. The others verses in Garuda Purana we can found of karma as real cause of disease:
The murderer of a brahmin becomes consumptive, the killer of a cow becomes hump-backed
and imbecile, the murderer of a virgin becomes leprous—all three born as outcastes.
The slayer of a woman and the destroyer of embryos becomes a savage full of diseases;
Who commits illicit intercourse, a eunuch; who goes with his teacher's wife, disease-skinned.
The eater of flesh becomes very red; the drinker of intoxicants, one with discolored teeth. Who
steals food becomes a rat. Who steals grain becomes a locust... perfumes, a muskrat; honey, a
gadfly; flesh, a vulture; and salt, an ant. Who commits unnatural vice becomes a village pig;
who consorts with a Sudra woman becomes a bull. And many others.

SPIRITUALITY IN HEALTH CARE SETTING

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1. Role of Spirituality in Medicine
Many patients not only have strong spiritual beliefs, but also want their physicians to talk to
them about spiritual issues. In one study, 64% of the patients surveyed wanted their doctor to
join them in prayer. In another study, 63% thought that doctors should talk to their patients
about spirituality although only 10% reported that this actually happened. The majority of
patients surveyed perceived their spirituality as an integral part of who they are, and wanted
recognition of their spirituality to be integrated into their medical care.
Religious beliefs and practices are important in the lives of many patients seeking
medical care, yet many physicians are uncertain about whether, or how, to address spiritual or
religious issues. Often physicians are trained to diagnose and treat disease and have little or no
training in how to relate to the spiritual side of the patient. In addition, the physician's ethic
requires that the physician not impinge her beliefs on patients who can be particularly
vulnerable when supplicants for health care. Complicating it further, in our culture of religious
pluralism, there is a wide range of belief systems ranging from atheism, agnosticism, to a
myriad assortment of religions. No physician could be expected to understand the beliefs and
practices of so many differing faith communities.
At first glance, the most simple solution suggests that physicians avoid religious or spiritual
content in the doctor-patient interaction. As with many issues, however, the simple solution
may not be the best. This topic page inquires into the possibility that within the boundaries of
medical ethics and empowered with sensitive listening skills, the physician may find ways to
engage the spiritual beliefs of patients in the healing process, and come to a clearer
understanding of ways in which the physician's own belief system can be accounted for in
transactions with patients. Appropriate referral to the hospital chaplain will be explored as well
as ways in which the physician and clergy may best work together for the good of the patient.
According to the World Health Organization (WHO), the state of health is defined as
state of complete physical, mental and social well-being and not merely an absence of disease
or infirmity. WHO also suggest a fourth dimension; ‘spiritual well-being’. As said previously
that component of living species including human are gross body and subtle body as a material
energy, and divine body “soul or atman” as spiritual energy of God. Patients want to seen and
treated as whole person, not as disease. A whole person is someone whose being has physical,
psychological and spiritual dimensions. Based on the component of living being (physical,
psychological and spiritual), there are three kind of pain: physical pain as a disease,
psychological pain as stress, depression etc, and spiritual pain.
By understanding more about the concept of human which consists of physical, psychological
and spiritual component, the holistic approach has started to be developed. Someone’s
suffering is not only physical and psychological pain, but he also suffers from spiritual pain.
According to the paradigm of health concept, World Health Organization definite that health is
not only from 3 dimensions, physically health (organobiologic), mentally health (psychologic),
and socially health, but since 1984, the definition has been developed with spiritual aspects,
which is known for biopsychosocial-spiritual model.
Patients want to be seen and treated as whole persons, not as diseases. A whole person
is someone whose being has physical, emotional, and spiritual dimensions. Ignoring any of
these aspects of humanity leaves the patient feeling incomplete and may even interfere with
healing. For many patients, spirituality is an important part of wholeness, and when addressing
psychosocial aspects in medicine, that part of their personhood cannot be ignored. In this
article, I use spirituality and religion interchangeably, since the vast majority of Americans do
not make distinctions between these concepts.

2. The Main Isues of Spirituality in Medicine

Spirituality in Medicine Wa/9/24/2008 13

The effect of spirituality on health is an area of active research right now. Besides being
studied by physicians, it is studied by psychologists and other professionals. The studies tend
to fall into 3 major areas: mortality, coping, and recovery.

a. Mortality
Some observational studies suggest that people who have regular spiritual practices tend to
live longer (9). Another study points to a possible mechanism: interleukin (IL)-6. Increased
levels of IL-6 are associated with an increased incidence of disease. A research study involving
1700 older adults showed that those who attended church were half as likely to have elevated
levels of IL-6 (10). The authors hypothesized that religious commitment may improve stress
control by offering better coping mechanisms, richer social support, and the strength of
personal values and worldview.
b. Coping
Patients who are spiritual may utilize their beliefs in coping with illness, pain, and life
stresses. Some studies indicate that those who are spiritual tend to have a more positive
outlook and a better quality of life. For example, patients with advanced cancer who found
comfort from their religious and spiritual beliefs were more satisfied with their lives, were
happier, and had less pain. Spirituality is an essential part of the “existential domain” measured
in quality-of-life scores. Positive reports on those measures—a meaningful personal existence,
fulfillment of life goals, and a feeling that life to that point had been worthwhile - correlated
with a good quality of life for patients with advanced disease.
Some studies have also looked at the role of spirituality regarding pain. One study showed that
spiritual well-being was related to the ability to enjoy life even in the midst of symptoms,
including pain. This suggests that spirituality may be an important clinical target. Results of a
pain questionnaire distributed by the American Pain Society to hospitalized patients showed
that personal prayer was the most commonly used nondrug method of controlling pain: 76% of
the patients made use of it. In this study, prayer as a method of pain management was used
more frequently than intravenous pain medication (66%), pain injections (62%), relaxation
(33%), touch (19%), and massage (9%). Pain medication is very important and should be used,
but it is worthwhile to consider other ways to deal with pain as well.
Spiritual beliefs can help patients cope with disease and face death. When asked what helped
them cope with their gynecologic cancer, 93% of 108 women cited spiritual beliefs. The most
common spiritual reassurances cited were beliefs that they would be in the loving presence of
God or a higher power, that death was not the end but a passage, and that they would live on
through their children and descendants.
Bereavement is one of life’s greatest stresses. A study of 145 parents whose children had died
of cancer found that 80% received comfort from their religious beliefs 1 year after their child’s
death.
c. Recovery
Spiritual commitment tends to enhance recovery from illness and surgery. For example, a
study of heart transplant patients showed that those who participated in religious activities and
said their beliefs were important complied better with follow-up treatment, had improved
physical functioning at the 12-month follow-up visit, had higher levels of self-esteem, and had
less anxiety and fewer health worries. In general, people who don’t worry as much tend to have
better health outcomes. Maybe spirituality enables people to worry less, to let go and live in
the present moment. Related to spirituality is the power of hope and positive thinking. In 1955,
Beecher showed that between 16% and 60% of patients - an average of 35%—benefited from
receiving a placebo for pain, cough, drug-induced mood change, headaches, seasickness, or the
common cold when told that the placebo was a drug for their condition.

Spirituality in Medicine Wa/9/24/2008 14

From a physician’s standpoint, understanding patients’ spirituality is quite valuable as well:
• Spirituality may be a dynamic in the patient’s understanding of the disease.
• Religious convictions may affect health care decision making.
• Spirituality may be a patient need and may be important in patient coping.
An understanding of the patient’s spirituality is integral to whole patient care.

3. End of Life Care and Peaceful Dying

For physicians and health care providers, dealing with a terminal diagnosis can be difficult,
because many still view a patient’s death as a failure, instead of part of the life cycle. I realized
early in my career that physicians are not invincible, or infallible. There comes a time when a
patient has a terminal diagnosis, when as a physician you know there is nothing more you can
do to stop the disease process. These are the times when a test, a study, or an x-ray can no
longer make a difference. Even with all of the modern medicine and technical skills, we can
only strive to make a person more comfortable. Dying is more than a physiologic process—
the cessation of life. Dying is spiritual event, becouse end stage of life soul will leaving the
body. It can be a time of great personal discovery and connections for both the dying and those
caring for them. People who are in the dying process continue to need intimate, natural and
honest relation-ships. This time can be one for rekindling or enriching friendships. It can also
serve as a new method for exchanging and expressing love, a means of aiding in reconciliation
and transforming experience for those involved. Most significantly, dying teaches us to focus
on the moment and to cherish the simplest things.
In being with a dying person, it is helpful to trust your innate compassion and intuition to lead
the way to care for the patient. Bring both your strengths and vulnerability to the bedside. It's
all right to cry.
Eventually, when escorting the the departure of the soul (passing away), the patient
always remembers The High Personality, God and says the holy name of Supreme Godhead, as
in Bhagavadgita Sri Krishna said: janma karma ca me divyam evam yo yeti tattvatah tyakta
devam punar janma naiti mam eti so ‘rjuna.” – One who knows the transcendental nature of
My appearance and activities does not, upon leaving the body, take his birth again in this
material world, but attains My eternal abode, O Arjuna. (Bg 4.9). That is the main purpose of
life, the last terminal of the adventure of the soul is to release from the cycle of birth and death,
and come back to the original source as the eternal attendant of The Grand Creator. Although,
he will pass away, but the patient will experience it with the full of sradha and bhakti in his
heart ambience. That is called good death, death with dignity, peaceful dying and welldying or
other term.
The Principles of a good death as follows: (Richard Smith editor, BMJ 2000;320:129–30)
• know when death is coming, and to understand what can be expected
• be afforded dignity and privacy
• control over pain relief and other symptom control
• To have choice and control over where death occurs (at home or elsewhere)
• To have access to any spiritual or emotional support required
• To have access to hospice care in any location, not only in hospital
• To be able to issue advance directives which ensure wishes are respected
• To have time to say goodbye, and control over other aspects of timing and say holy
scripture or holy name of God.

FUNDAMENTAL ASPECT OF SPIRITUAL CARE

Spirituality in Medicine Wa/9/24/2008 15

What is involved in serving patients and providing compassionate care? Physicians can begin
with the following:
• Practicing compassionate presence—i.e., being fully present and attentive to their
patients and being supportive to them in all of their suffering: physical, emotional, and
spiritual needs.
• Listening to patients’ fears, hopes, pain, and dreams
• Obtaining a spiritual history and spiritual pain
• Being attentive to all dimensions of patients and their families: body, mind, and spirit
• Incorporating spiritual practices as appropriate
• Involving chaplains as members of the interdisciplinary health care team
• Remember to care for the person, not the patient or the illness.
• Have empathy for the person’s suffering.
• Learn how to be with emotional pain rather than trying to alleviate it.
• Allow expression of feelings—guilt, anger, sorrow, depression—without judgment.
• Share your own feelings, other experiences and emotions if it seems appropriate.
• Fascilitate and guiding for religious activity; prayer, meditation, yoga, chanting of holy
Name, etc.
• Honor the spiritual dimensions and cultural aspects of the dying process.

Throughout these activities, it is important to understand professional boundaries. In-depth

spiritual counseling should occur under the direction of chaplains and other spiritual leaders, as
they are the experts. The physician should not initiate prayer with patients, as this blurs the
boundary of physician and clergy. Leading prayer involves specific skills and training that
physicians do not have. Furthermore, a physician leading a prayer might lead a prayer from his
or her tradition, which could be offensive or inappropriate for the patient. If the patient
requests prayer, the physician can stand by in silence as the patient prays in his or her tradition
or can contact the chaplain to lead a prayer.
Finally, the spiritual history is patient centered, and proselytizing and ridiculing patients’
beliefs are not acceptable. It is important to recognize that patients come to physicians to seek
care for their medical condition. In delivering this care, physicians can be respectful and
understand the spiritual dimension dimension in patients’ lives. But to go beyond that, e.g., to
lead prayer or provide in-depth spiritual counseling, is inappropriate. Physicians are in a
position of power with patients. Most patients come to us in vulnerable times. If the physician
suggests a certain religion/spiritual belief or ridicules a patient’s belief, the patient might adopt
that physician’s belief or lack of belief out of fear of disagreeing with a perceived authority.
Therefore, it is critical that when discussing spiritual issues with patients, the physician listens
and supports and does not guide or lead.
Many physicians are not familiar with spiritual histories. I’ve developed the “FICA” questions
to guide the conversation (Table 1). I teach medical students and physicians to take a spiritual
history as part of a social history, at each annual exam, and at follow-up visits as appropriate. A
spiritual history helps physicians recognize when cases need to be referred to chaplains. It
opens the door to conversation about values and beliefs, uncovers coping mechanisms and
support systems, reveals positive and negative spiritual coping, and provides an opportunity for
compassionate care.

Spirituality in Medicine Wa/9/24/2008 16

References
1. Damodara, BS. 1996. The Scientific Basis of Krishna Consciousness. The Bhaktivedanta Book Trust,
Mumbai, India:
2. Damodara , BS. 1988. The Principle of Reincarnation in Consciousness The Missing Link. The
Bhaktivedanta Book Trust. Mumbai, India. P. 57-68
3. Prabhupada, ACBS. Bhagavad-gita as it is. Bhaktivedanta Book Trust.
4. Stevenson I. 1997. Where Reincarnation and Biology Intersect. Praeger Publisher. London
5. Stevenson I. 1974. Twenty Cases Suggestive of Reincarnation. University Press of Virginia, Charlottesville.
6. Moody RA. 1975. Life After Life. Mockingbird Book, Georgia.
7. Webster R. 2001. Past-life Memories: Twelve Proven Methods. Llewellyn Publications. St. Paul, Minnesota.
8. Bhaktivedanta Swami Prabhupada. 1995. A Second Change : The Story of a Near-Death Experience.
Bhaktivedanta Book Trust. Mumbai, India.
9. Bhaktivedanta Swami Prabhupada. 1995. Life Comes From Life. Bhaktivedanta Book Trust. Mumbai, India.
10. Bhaktivedanta Swami Prabhupada. 1984. Coming Back: The Science of Reincarnation. Bhaktivedanta Book
Trust. Mumbai, India.
11. Sumalsy DP. 2002. A Biopsychosocial-Spiritual Model for the Care of Patients at the End of Life. The
Gerontologist 42 : 24-33.
12. Hari Dhama Dasa. Spiritual Need, Pain and Care : Recognition and Response in ISKCON :
www.iskcon.com/icj/6_2/62haridhama.htm
13. Koenig HG. 2000. Religion, Spirituality, and Medicine : Application to Clinical Practice. MS JAMA;284:
1708-1709.

Prepared by
Made Wardhana

Spirituality in Medicine Wa/9/24/2008 17

Table 1. The FICA method of taking a spiritual history
F Faith and belief. Ask: Are there spiritual beliefs that help you cope with stress or difficult
times? What gives your life meaning?
I Importance and influence. Ask: Is spirituality important in your life? What influence does
it have on how you take care of yourself? Are there any particular decisions regarding your
health that might be affected by these beliefs?
C Community. Ask: Are you part of a spiritual or religious community?
A Addresslaction. Think about what you as the health care provider need to do with the
information the patient shared—e.g., refer to a chaplain, meditation or yoga classes, or
another spiritual resource. It helps to talk with the chaplain in your hospital to familiarize
yourself with available resources.

Table 2. Recommendations of the Association of American Medical Colleges for a

Curriculum on Spirituality

Outcome goals
Students will be aware that spirituality, and cultural beliefs and practices, are important
elements of the health and well-being of many patients. They will be aware of the need to
incorporate awareness of spirituality, and culture beliefs and practices, into the care of patients
in a variety of clinical contexts. They will recognize that their own spirituality, and cultural
beliefs and practices, might affect the ways they relate to, and provide care to, patients.
Students will be aware of the range of end-of-life care issues and when such issues have or
should become a focus for the patient, the patient’s family, and members of the health care
team involved in the care of the patient. They will be aware of the need to respond not only to
the physical needs that occur at the end of life, but also the emotional, sociocultural, and
spiritual needs that occur.

Learning Objectives
With regard to spirituality and cultural issues, before graduation students will have
demonstrated to the satisfaction of the faculty:
• The ability to elicit a spiritual history
• An understanding that the spiritual dimension of people’s lives is an avenue for
compassionate caregiving
• The ability to apply the understanding of a patient’s spirituality and cultural beliefs and
behaviors to appropriate clinical contexts (e.g., in prevention, case formulation,
treatment planning, challenging clinical situations)
• Knowledge of research data on the impact of spirituality on health and on health care
outcomes, and on the impact of patients’ cultural identity, beliefs, and practices on their
health, access to and interactions with health care providers, and health outcomes
• An understanding of, and respect for, the role of clergy and other spiritual leaders, and
culturally based healers and care providers, and how to communicate and/or collaborate
with them on behalf of patients’ physical and/or spiritual needs
• An understanding of their own spirituality and how it can be nurtured as part of their
professional growth, promotion of their well-being, and the basis of their calling as a
physician

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Spirituality in Medicine Wa/9/24/2008 19