1

The Emerging Needs For Biopsychosocial-Spiritual Model of Health Care at the End-of-Life:
Focus on Meaning and Spirituality.

Abstract
The advanced of modern biomedical help in prologing life, but fail in delivering the quality
assessment in regards to the needs of the dying individual’s. The physical pain and suffering along
with psychological distress, stress, anxiety and depression in the course of illness gave rise to the
needs of biopsychosocial-spiritual approach of care, which is the modern humanistic and holistic
approach of the human being in medical health science. In this model illness is viewed within the
context of the complex interplay of biological, social, psychological and spiritual factors that frame
an individual’s response. The goal of patient quality of life in the faced of death and dying can be
achieved by meeting their physical needs and through attending to their social, psychological,
biological and spiritual domain of care. Spirituality is a widely accepted and recognized dimesion
of care, which helps the dying individuals to face suffering and difficulties, traumatic and stressful
events in relation to to the health-disease process, especially, in the case of patients without healing
possibilities. The purpose of this philosophical inquiry and literature review is to ponder on the
role of spirituality as coping machanism in meaning-making and a source of hope, when healing is
not possible in the last hours experiences of life for those with terminal illness.
Key Words: Biopsychosocial-spiritual, end of life, spirituality, depression, anxiety, holistic care,
suffering, terminal illness, dying individuals.
Introduction
The increasing populations of patients with terminal illness has been rise up rapidly and spread
across the Indian sub-continent, as the modern medicine sustain and proplonged life. In the faced
of advanced modern biomedical medicines, the challeges lies in the ‘process of dying’. The time
when the dying individuals were filled with physical pain and psycho-spiritual suffering, anxiety,
depression and stress. This make end-of-life an emerging needs of the dying individuals, which
focused on the humanistic and holistic view of the individual in health science. At present the
biopsychsocial-spiritual model of care is an accepted structure for understanding the needs of the
dying patients and families, more than that of traditional pathophysical and the existing
biological/disease-process approach of health care in and around the world (Richardson, 2014). In
his explaination for the biopsychosocial-spiritual model of care, Richardson stated that “within
 2

thios model, illness is viewed within the context of the complex interplay of biological, social,
psychological and spiritual factors that frame an individual’s response.” The emphasis of this
particular approach of care is to let the doctors, nurses and other caregivers to be an effective
communicatores and an ethical practitioner of the art and science of modern medicine, by equiping
themselves in the study of the psychological aspect alongside the biological determents of health
and disease, as both psychology and sociology are relevant in making health education more
effective (Dogar, 2007). However, the problem in Indian health care system is the absence of
holistic and patient-centred approach, resulted in failing to attend the needs of the patients as
whole person. The challeges ahead in Indian health care system as a whole is, how to understand
the struggles and needs of the terminally ill patients. The existing symptom control need to be
expanded to the psychological, existential and spiritual domain of care. This concept will avoid the
treatment of patients as cluster of syndromes, rather will gives room for human experience of life
in the face of terminal illness as stated by Breitman and collegues (2004).
The fact is that, though prologing life, the contemporary medicine however, failed to address the
needs of human person as a whole, as it limited its attention to the finitude of human bodies. Thus
the advance illness and chronic illness causes inequity and disharmony of mind, body and spirit
(Sulmasy, 2002; Narayanasamy, 2007). Here lies, the greatest failure of the modern medicine as it
can not achieved to produced ‘quality of life’ for patients and families, which turn out to be the
main objective principles of palliative care. The goal of end-of-life care is to focuses on healing the
whole person, rather than the mere treatment of the physical symptom and disease alone. It is to
focus on immediate ‘quality of life’ through integrting bio-physical, psychological, and spiritual
care in the therapeutic plan, rather than focusing on the length of life and its prologing process
(O’Brien, 2003; Oslen, 1997; Katrz, 1994; and Narayanasamy, 2007). However, looking at the
present existing model of health care in India, it is sad to say that, terminally ill patient needs
cannot be met thus far. People die without experiencing the meaning and quality of life as there is
no proper existing guidelines for end-of-life care in the Indian medical hospitals and colleges. The
physycians as a whole were not taught in their training process on how to create a quality of life by
meeting the needs of the dying individuals, and make them experience a meaningful death. This
violates the principles and objectives of ‘total care’ or the ‘whole person care’ of World Health
Organization definition on end-of-life care. It is also vissible that there is no proper formation of
palliative or end-of-life care team in most of the existing Indian medical colleges and hospitals.
 3

Thus, the present study is form to emphasize and promote the physical, psychological, social and
spiritual well being of the dying individuals. Some of the challenging questions like, who should
be assessed, when the assessment should take place, who should undertake the assessment, and
what action need to follows the assessment process, will also be deal in this study. The present
study is also being carried out, within the context of the available sources and document through
literature review and philosophical inquiry.
The Biopsychosocial-Spiritual Model of Health
At the initial stage of its development, the biopsychosocial-spiritual model of care was widely
understood as biopsychosocial model, in the absence of its spiritual domain of care. This model
was brought into medical realm as a part ofmedicine by George E. Engel, a professor of psychiatry
at the university of Rochester, school of medicine. Engel (1977), stated that, “the dominant model
of disease today is biomedical, with molecular biology as its basic scientific discipline. It assumes
disease to be fully accounted for by diviations from the norm of measurable biological (somatic)
variables. It leaves no room within its framework for the social, psychological, and behavoural
dimensions of illness.” So, there is a need for modern humanistic and holistic view of human being
in medical health science, new medical model of care for the dying individuals, where the ‘whole
person’ is being assess. This new medical paradigm of George E. Engel as noted by Borrell-Carrio
and colleagues (2004), focus on the three main model of care; 1. A world view that would include
the patient’s subjective experience alongside objective biomedical data; 2. A model of causation
that would be more comprehensive and naturalistic than simple linear reductionist model; and 3. A
perspective on the patient-clinician relationship that would accord more power to the patient in the
clinical process and transform the patient’s role from passive object of investigation to the subject
and protagonist of the clinical act. The biological part of the biopsychosocial model focus on
understanding how the causes of illness stems from the function of the individual’s body and the
psychological model focuis on the psychological causes for health problem, particularly on self-
control, emotional turmoil, and negative thinking, and the social domain investigates on how
different social factors like socio-economic status, culture, poverty, technology, and religion can
influence health as stated by Upadhyay and Singh (2018). In the course of its development, the
biopsychosocial model of health care realized the needs of incorporating spirituality to focus more
on the meaning and purpose in the face of death and dying.
 4

It was Daniel P. Sulmasy, an American medical ethicist, and a professor of Biomedical Ethics who
expanded the biopsychosocial model into biopsychosocial-spiritual model. Sulmasy (2002), stated
that “the healing professions should serve the needs of patients as whole persons. Persons can be
considered beings-in-relationship, and illness can be considered a disruption in biological
relationships that in turn affects all the relational aspects of a person. Spirituality concerns a
person’s relationship with transcendence. Therefore, genuinely holistic health care must address
the totality of the patient’s relational existence-physical, psychological, social, and spiritual.” The
biopsychosocial-spiritual is a patient care approach in which all dimensions of patient care
including spirituality is being taken into account. This model acknowledged spirituality as the
underlying dimension of care and enable the whole person treatment in caring the terminally ill
patient (Puchalski, 2012). Recently, this model has been widely accepted as a structure for
understanding the needs of patients and their families in developed countries like, United
Kingdom, America, Australia, Canada and ireland, however, Indian palliative or end-of-life care
has a long way to go as there are no proper infrastructure, guidelines and not even a syllabus in
most of the medical colleges and hospitals. The biopsychosocial-spiritual approach viewed illness
within the context of the complex interplay between biological, social, psychological and spiritual
factors that frame an individual’s response. It helps the patient to create a narrative for their
response to and understanding of their illness (Richardson, 2014). In the faces of physical pain of
disease and the emotional suffering of seperating from life and loved ones, the process of meaning
making becomes vitally significant. Thus, in the nexus between cognitive reasoning and personal
feelings lies the realm of meaning (Breitbart et al., 2004), and spirituality plays an important role
in meaning making when death becomes nearer in one’s life. Victor Frank (1984), wrote, “man is
not destroyed by suffering; he is destroyed by suffering without meaning.” It is to be noted that,
spirituality helps in finding meaning to people’s suffering, and provided hope in the midst of
despair. It is also true that, spiritual beliefs are related to the cultural background which assumes an
important role in the way people make meaning of suffering and illness. Spirituality and faith as a
whole, have a great impact on how people cope with the existing illness (Puchalski, 2000; Leyla &
Fatemeh, 2017).
Comparing with the existing biomedical model, which is based on purely scientific aspects of
medicine, the biopsychosocial-spiritual is a new model of care, but a broader and integrated
approaches to human behaviour and diseases. It become eminent as the medical and psychological
 5

discourses on end-of-life care has steadily shifted over the year from focussing primarily on
symptom control and pain management to incorporated more person-centered approaches to
patient care. Such approaches emphasize on the significance of spirituality in meaning-making as
important resources for coping with emotional and existential suffering at the end-of-life. The
concern of this model of care is to focus on the person’s relationship with transcendence, and
sought for genuine holistic health care that address the whole person’s of the patient’s relational
existence, such as, physical, psychological, social, and spiritual aspect (Dogar, 2007 & Breitbart et
al., 2004). It is to be noted that, this model does not take dualistic approach to mind and body, but
rather proposes that the biological, the psychological, social and spiritual cannot be disaggregated
from the whole. Each factor interacts with and affects other aspects of the person (Moss &
Dobson, 2006). However, looking at the present context of Indian health care settings, it is true to
say that the contemporary medicine still stands justly accused of having failed to address itself to
the needs of whole persons and of preferring to limit its attention to the finitude of human bodies
(Ramsey, 1970; Sulmasy, 2002). This being the reason why, a person-centered therapy of treating
the whole person for total healing is far beyond reach, though spirituality, faith and religion palys
an important roles in every cultures across the Indian sub-continents. End-of-life care become a
challenge for many health care providers as it seeks for peaceful and meaningful death. As
Puchalski (2002) say, there are no easy ways to delivere a meaningful and peaceful death, but it is
clear that spirituality is a very important domain for the solution.
Spirituality: Meaning and Concept
Generally, most people assume that religion and spirituality as interchangeable terms, but when it
comes to end-of-life care setting, it is important to understand the difference in its concept,
principle and meaning, as spirituality is much broader than that of religion which is an outward
expression of a belief syatem. Spirituality is a term that cover several meanings with religious or
non-religious focus, so it can sometime be confused with religion. Religion is a specific set of
beliefs and practices related to faith and an approach that facilitate access to the sacred, the divine,
God and absolute truth. It is mostly based on a set of scriptures and theological teachings and
generally offers a moral code of conduct (Tanchel, 2003 & Evangelista et al., 2016). Whereas,
spirituality gives the individual autonomy over his/her own interpretation of the soul or spirit. It is
an inner, personal experience, universal and without boundaries and is about the search for
transcendent meaning. Thus, everyone who searches for ultimate or transcendent meaning can be
 6

said to have spirituality, although not everyone has a religion. Whereas, religion is communal,
particular and define by boundaries, that is characterized generally on the basis of believing in
deity (Tiffany, 2017; Testerman, 1997; and Sulmasy, 2002). The World Health Organization
(1995), has declared that spirituality is an important dimension for quality of life in the end-of-life
care, and it is considered as a tenet of palliative care. Spirituality is a broader term in relation to
one’s thought and feelings about ones being and purpose. It is based more on individual’s
philosophies, rather than the established faith and religion. It is the way one find meaning, hope,
comfort, and inner peace in life (Leyla & fatemeh, 2017 & MarieCurie, 2018). Spirituality implies
that there is a deeper dimension to human life, and inner world of the soul. It incorporated five
domains such as, meaning in life, interrelatedness, wholeness, morality, and awareness of God
(Bhandari et al., 2018 & Jones, 1985). Spirituality is often described in a language rich in
metaphors and linguistic patterns charecteristic of the influences of culture, philosophy, religion
and history. In health related literature, spirituality and its importance in health and illness has been
highlighted and is seen as a profound and central aspect aspect of the existing of many people
(Narayanasamy, 2007).
Spirituality is a topic of growing interest in health and palliative care. Several studies has
highlighted the importance of this dimension of care by clinical professionals. However, the
emerging question is, how does spirituality help people cope with dying? There is no easy answer,
however, one mechanism is through hope. It helps people find hope in the misdt of medical
hopelessness and despair that occurs in the course of serious illness and dying process. The
spiritual dimension has been recognized as an integral resource, which helps individuals to face
adversity, traumatic and stress events mainly related to the health-disease process, mainly in the
case of patients without healing possibilities. So it can be said that, spirituality is a powerful
resource for coping with health-related problems, including chronic illness and advance disease.
Thus, the principles of spirituality can be applied in all stages and contexts to patients under
palliative care, inspite of culture, religious tradition and spiritual differences (Puchalski, 2002;
Evangelista et al., 2016; and Narayanasamy, 2007). It has also been proven that, spiritual care
attends to the heart needs of the patients, as in the state of distress the intervention is needed at the
heart level, and physicians using therapeutic approaches or intervention at the spirit level have the
potential to heal and be healed through their clinical interactions. Spirituality have the potential to
mediate quality of life by enhancing patient subjective well-being in four ways; 1. Promoting a
 7

healthy personal lifestyle that is congruent with religious or personal faith tradions; 2. Providing
systems of meaning and existential coherence; 3. Establishing personal relationships with divine
others; and 4. Ensuring social support and integration within the community (Anadarajah, 2008;
Narayanasamy, 2007; and Daaleman & VandeCreek, 2010). So, the end-of-life care practitioners
may seize the opportunity to encourage patients to find meaning in the suffering as they face the
end of life. By understanding the meanings associated with suffering, dying patient may begin to
actively transform their feelings into signals that draws out an actively engaged response to living
and dying (Breitbart et al., 2004). Even the existing Indian Traditional and Natural Ayurvedic
Science recognizes the positive affects of spirituality enhancing the mental and physical conditions
of the individuals. Spirituality is also found as an important agent which promote health-related
behavior and life styles that enhance health and decrease disease risk which in turn reduces stress
and improves coping (Awasthi, 2011). In its broader sense, spirituality speaks to the idea of a
process or jopurney of self-discovery and of learning not only who you are, but also who you want
to be. Spirituality is a dynamic involving process, the one that impacts and is impacted by an
individual life experience (Richardson, 2014). Spirituality is also recognized as a source of
strenght, comfort and helps patients in the end of life to cope with their situation. However, due to
the insufficient knowledge on the subject of spirituality and its attributes in coping with terminal
illness, many health care providers in India are lacking in the implementation of its policy, privacy
and confidence.
Spirituality and Life Limitting Medical Illness
In their study of “health and psychology” Marks and colleagues (2015), found out that, health is
not only the absence of illness, it includes physical, cultural, psychological and economics needs of
the person and most importantly, the spiritual need. It is evidence that, both medical professionals
and terminally ill patients have identified spiritual domain of supportive care as priorities and an
essential element for quality end of life care. The domains of quality care includes, receiving
adequate treatment for pain and symptom control, avoiding inappropriate prolongation of dying,
achieving a sense of spiritual peace, relieving burden, and strengthening relationships with loved
ones as stated by Breitbart and colleagues (2004). According to Manitoba’s Spiritual Health Care
Partners (2017) of Canada, spirituality has the following impacts on people with chronic disease
and terminal illness.
 8

 The way people understand illness, recovery and loss. Eg. Punishment by a higher power
Vs normal though regrettable suffering.
 Patient/client decision-making about medical treatment. Eg. Compliance with
recommended treatments.
 The patient/client relationship with health care providers. Eg. Trust by the patient is
enhanced when spirituality is affirmed.
For many terminally ill patients, spiritual issues are central in life, particularly in death and dying.
Mostly, people use their spiritual beliefs in coping with chronic illness, loss and transformation.
Spirituality is recognized as a factor that contributes to health in many persons. Recently, medical
practitioners also recognized the inadequacy of spirituality in health care system in terms of care
for the dying. Thus, palliative care researchers have increasingly recognized the importance of
examining the spiritual dimension in end-of-life experience and acknowledged spirituality as part
of total existence for the dying individuals (Puchalski, 2002 & Chochinov, 2006). In dealing with
the “essence of spirituality in terminally ill patients” Chao and colleagues (2002), stated the
essence of spirituality as, communion with self (sel-identity, wholeness, inner peace), communion
with others (love and reconciliation), communion with nature (inspiration and creativity), and
communion with a higher being (faithfulness, hope and gratitude). Many research indicated the
great impact of spirituality, faith and religious beliefs in health outcomes and their positive role in
patient’s coping with illness like cancer and HIV. Individuals with higher level of spirituality and
their involment in existing religious practices resulted in reducing risk for depression. Spirituality
help patients construct meaning in regards to suffering associated with illness, which may facilitate
coping and acceptance (Solan et al., 1999; McCullough et al., 1998; Baider et al., 1999; Koenig et
al., 1992, 1998; & Breitbart et al., 2004).

In a secular state like India, the concept of spirituality is found in all the existing cultures and
societies. But the spiritual needs of the dying patients are not being met and is still consider as one
of the worst place to die as the wishes and voice’s of the dying patient’s are not being listen and
heard. It is to be noted that, spirituality is an expression of individual search for ultimate meaning
through participation in religion and or belief in transcendent being, family, naturalism,
rationalism, humanism and the arts (Puchalski, 2002). In the research done on palliative and
hospice patients found that 41-94% of the patients who were facing death and dying process want
 9

their physicians to address their spiritual needs. Interestingly, it is also found that 49% of non-
religious patients felt the needs of spiritual assessment by their physicians in a polite ways
(Daaleman & Nease, 1994; Ehman et al., 1999; King & Bushwisk, 1994; Moadel et al., 1999; and
Sulamasy, 2002). Spirituality probably is observed as having the healing power on an individual’s
health. A particular study done on mental health shows that, those with less spirituality
experienced more depression and appear to recover from depression more slowly. The findings
also reveals that spirituality/religious beliefs ahs its influence on medical decision in
seriously/terminally ill patients, and delay’s on one’s perception of physical disability that usually
developed later in life (Awasthi, 2011; Koenig et al., 2004; & Braam et al., 1997).

The World Health Organization (1995), stated that spirituality is an important dimension for
quality of life. As the modern treatment advance in extending the sying process, quality of life has
become increasingly important for those who are at the end of life. Recently, spiritual well-being
has been found as positively correlated with subjective well-being, hope, positive mood stress,
purpose in life, and overall with quality of life (Leyla & Fatemeh, 2017). As a whole, spiritual
aspects at the end-of-life focuses on three main themes: Spiritual Despair (alienation, loss of
oneself and dissonance); Spiritual Work (forgiveness, self-exploration, search for balance); and
Spiritual Well-Being (connection, self-actualization and consonance). Mostly, terminally ill
people, especially, those who are at the end of life experience a state of imbalance, disharmony of
mind, body and soul. Feelings of anger, sadness, guilt and anxiety are some common element
following the period of disorganization and disruption. Most importantly, despair and hopelessness
are two common thread for patients and their families, these strugles mostly resulted in patient’s
feelings of seperation from theirusual support system. It is at this point, serach for meaning in
suffering become apparent (Rego & Nunes, 2016; Mark et al., 2015; William, 2006; &
Narayanasamy, 2007). A study carried out by Awasthi (2011) pointed out that, spiritual activities
enhanced patient coping skills, decrease depression, increase social support and give better health
outcomes which promote the acceptance of spirituality in health care settings. Generally, in the
end-of-life, it is not uncommon to experience spiritual distress and usualy happened at a time when
an individual is unable to find sources of meaning, love, comfort, and at the time when conflict
occurs between beliefs and life events (Rego & Nunes, 2016; Richardson, 2014; and Anandarajah
& Hight, 2001). In the course of life limiting terminal illness, spirituality plays an important role as
 10

it provides a context in which people can make sense of their lives, explain and cope with their end
of life experiences, and most importantly, it helps in finding and maintaining a sense of hope, inner
peace and harmony in the midst of existential challenges of life (Holloway et al., 2011).

The Role of Spirituality in Meaning-Making

It would be not wrong to say that spirituality is the central to the dying individual and is
recognized by many experts. It become imminent when an individual experiences emotional stress,
physical illness and death. It is true that spirituality decreases fear of death and increase comfort by
enhancing the positive view point of death and dying in the terminally ill patient’s (Nwogu, 2014).
It is the way in which dying people find meaning, peace, purpose and how they experience their
connectedness to self, others, and the significant or sacred one, and is seen as the universal human
charecteristic. A strong sense of spirituality helps patients to adjust and cope with their illness, and
produce a sense of positive health in the midst of disease. Spirituality is found as an essential
element for terminally ill cancer patients as it gives a structure for finding meaning and view point
through a source more noteworthy than self and provide a sense of control over sentiments of
medical and physical hopelessness. It is also widely understood as a natural dimension of what it
means to be human and a framework for understanding the human experience from birth till death
(Puchalski, 2012; Leyla & Fatemeh, 2017; Manitoba’s SPHCP, 2017; Balboni & Puchalski, 2001).
As Puchalski (2002) stated, at the early stage of illness the patient may hope for a cure. But, when
cure becomes uncertain in the later stage, the patient may now hope for quality time to finish
important projects or goals, travels, make peace with loved ones or with God, and experience a
peaceful and meaningful death. This can result in a healing, which can be manifested as a
restoration of one’s relationships or a sense of self.

Meaning making is not just a cognitive constructs, it is a general life orientation, a personal
significance and causality, a coping mechanism, and outcomes. In terminal illness improving a
sense of meaning in life is always a primary focus, as it helps patient and their support system
finds deeper meaning and experience a sense of self-awareness while being in the terminal stage.
At this point, meaning-making process may serve as an interpretive framework for patient
suffering. Spirituality is an inner resource’s that helps patients adjust to illness, hospitalization and
even to transition after discharge. Spirituality also helped the patients with greater quality of life,
 11

even with advanced disease; gave longer life expectancy, recovery from illness and surgery; gave
the ability to deal with physical and emotional pain; it lower measured depression and anxiety; and
substantially reduced risk for problematic substance use and suicide (Park & Folkman, 1997;
Breitbart et al., 2004; Manitoba’s SCHP, 2017; Puchalski, 2012; & Koenig, 2012). In an analytical
studies on the interface between pschology and spirituality, Rego & Nunes (2016), found
spirituality and its beliefs contributed for patients and carers to find meaning, and it is being
considered as the main source of hope that is associated with less depressive symptoms, less
negative affects and have greater spirituality buffered the impact of stigma on self-esteem.
Spirituality is an essential element of person-centered care and critical factor in the way patient’s
with terminal illness cope with their illness from diagnosis through treatment, survivour,
recurrence and dying. Spiritual coping resources include powerful cognitions that give meaning to
difficult life circumstances and provide a sense of purpose, an optimistic worldview that may
involve the existence of personal transcendent force that loves and care about human and is
responsive to their needs. Spirituality is also act as a source of strenght tha helps patient to cope,
find meaning in their lives, and make sense of the positive cancer experience. Thus, clinician
inquiry into patients’ spirituality is also important in terms of building trust with the patient as well
as for ensuring the treatment plan in accordance with patients beliefs and values. (koenig, 2012;
Leyla & Fatemeh, 2017; & Puchalski, 2012).

Conclusion and Challenges

It was in 1948 Geneva conference, that the World Medical Association pledge to adopt the
humanitarian goals of medicine by including spirtual dimension of care in medical practices. The
practical changes has been taken place with the formation of WHO on 7th April 1948, as the health
care has evolved from disease-centered care to patient-centered care, and more recently to person-
centered approach. This being the reason spirituality has achieved its important role for high
standard medical training and clinical practices (Saad et al., 2017). But looking at the present
situation of Indian end-of-life care, the challenges still lies in the formation of proper text,
guidelines, principles and most importantly in the implementation of the holistic care. One reason
might be due to failing in the implementation of the two important aspects of care which Meador
(2004), described in his writing; “an understanding of the virtue of caring (in contradiction to
curing) as a practice of medicine; and an appreciation of the art of listening well in the care of
 12

patients.” Seieng the growing needs of the dying people in India, it is essential to implement the
biopsychosocial-spiritual approach of care for the well-being and quality of life in the face of death
and dying. The needs of the hours is to experience dying as natural as birth. As Christina (2002)
said, dying should be a meaningful experience, a time when patients find meaning in their
suffering and have various dimensions of their experience addressed by their care giver’s. The
researcher, therefore, support this model of care to be implemented in the Indian health care
setting, which would allow people to die in peace and dignity, to be able to engage in those
activities that brings peace and meaningful death. India need a multi-disciplinary team working
together in health care setting, rather than the physicians and nurses alone. This would bring a
better health outcomes for the patients, families and even to the care givers. Bisopsychosocial-
spiritual approach is the only propose solution for the holistic care in treating the existing terminal
illness in India, rather than the biomedicine alone. The researcher, however, also aware of the
difficulties in forming a proper hypothesis for spiritual model of care, as it leads to several
controversies in the health care settings. The propose solution lies in proper training of the
upcoming physicians and other care providers in this particular area of care.