"I'm not religious, but I am spiritual" is a remark that I—probably just like you—hear with increasing frequency. I'm never sure exactly what the speaker means by the word "spirituality" and I sometimes wonder about those who want to import spirituality into healthcare. What would health care look like if spirituality were more explicitly a part of it? Would we all be better off?

Fortunately, the Park Ridge Center was able to explore these and related questions when, in 1998, we collaborated with the Fetzer Institute on the project "Spiritual Resources in the Healthcare Setting." This issue of the Bulletin emerges from that initiative, an attempt to understand how spirituality is characterized and map its implications—medical, social, and ethical—in the fabric of health care.

Aside from puzzling over what the term spirituality has meant, what it means now, and what motivates the expanding interest in it, project participants warned that the recent rush to integrate spirituality into health care risks reducing spirituality to one more instrumental good supporting improved health outcomes. For instance, some studies suggest that religious activity can lower blood pressure and fortify the immune system. The danger of such studies is that they may oversimplify the value of spirituality by treating it strictly in terms of its usefulness to health. In contrast, project participants pointed out that spirituality promotes outcomes such as inner resiliency, detachment, and theological creativity, but not necessarily cure from physical disease.

The project, and this Bulletin, sketches out some of the moral questions that are embedded in attempts to integrate spirituality into health care. It is a useful thought experiment to imagine this integration through the perspective of the different moral actors who inhabit modern health care. Imagine yourself as a healthcare professional. If you have little interest in spirituality but are faced with patients who seek spiritual help, should you fake a prayer or ritual even though you don't believe? Is your integrity diminished if you merely go through the motions? On the other hand, if you are a healthcare provider with spiritual interest, should you engage a patient in some spiritual practice if you don't have sufficient time or ability to deal with it? How far should the healthcare provider go if the spiritual practice does not contribute to positive health outcomes, or if the patients have different spiritual practices? Whether you engage in a spiritual practice or not, what are your professional obligations to offer it and be trained in the various spiritualities?

Alternatively, imagine yourself as a healthcare leader, such as an executive or trustee. What should motivate your organization to spend resources on spirituality—because the organization must be sensitive to the market, improve employee and patient satisfaction, or fulfill its mission? Are you off the hook if yours is a secular, non-religious organization? Should professionals other than pastoral care staff attend to spirituality? How adept should each group be with spirituality and how should the organization go about teaching spirituality to these groups—if it can be done at all? Finally, what institutional safeguards are necessary to avoid coercive practices?

Even if you cannot imagine yourself working within healthcare, as a citizen you might want to imagine what the posture of society ought to be towards spirituality through publicly funded organizations, government regulations, and incentives. Suppose, as our project group conjectured, that spirituality is a basic human good because it helps individuals and societies flourish. What is society's obligation to promote the good of spirituality, what some philosophers term the "good of religion"? If spirituality is a basic human good like health and education, who ought to promote it?

While these are only first steps into this murky area, the initial lesson is clear. In the rush to integrate spirituality into the healthcare setting, the moral questions imbedded in the practice require us to think first so we can honor the value of primum non nocere—Above all, do no harm.