Just what is health? According to the definition of
the World Health Organization (WHO), "Health is a state of complete
physical, mental and social well-being and not merely the absence of
disease or infirmity" (from the Preamble to the Constitution of the
It would seem, however, that most people generally think of health
as being the absence of disease or infirmity. The sense I get from
contact with most of the patients in our hospital, the Kosei General
Hospital in Tokyo, is that many people who are ailing physically are
also troubled in their hearts and minds. Surely anyone who has ever
been ill can remember feeling this way.
Or if we turn this around, a person who is physically frail but is
blessed with good human relationships and lives cheerfully without
cares may be healthier than someone who is physically fit but lives
each day under stress.
I often think it might be better to change the concept of health to
wholesomeness. True good health is a state of physical, mental, and
social wholesomeness. This conforms to the WHO definition.
With that premise in mind, what then should be the role and mission
of hospitals? It would seem that hospitals naturally should not simply
be facilities for treating diseases of the body only; they must be
places for dealing with ailments of both mind and body.
When Rev. Nikkyo Niwano, the founder of Rissho Kosei-kai, established Kosei General Hospital, he employed the Buddhist term shinkan
(true regard) as the founding spirit of the hospital. Shinkan is a term
found in chapter 25 of the Lotus Sutra, "The All-Sidedness of the
Bodhisattva Regarder of the Cries of the World," which means knowing
fully and in detail the aspects and forms of the suffering faced by
people in this world, and at the same time seeing through to the
essence of that suffering (the wisdom of a bodhisattva).
It is on the basis of this doctrine that we are endeavoring, at the
point of providing a wide range of health care services, to offer
patient-centered care that aims through treating each illness to
harmonize the mind and the body. In other words, we are not merely
treating disease, but providing holistic care by carefully observing
the patient, listening to the patient's concerns, and remaining in
close contact with the patient.
Kosei General Hospital has a terminal care ward called the Kosei
Vihara, the first such hospice facility to be established by a
religious organization in Japan. It is an inpatient facility for
patients seeking to ease the physical and emotional pain of terminal
cancer. Here, steps can be taken to alleviate the patient's physical
suffering through the administration of painkillers such as morphine.
But no matter how much one alleviates physical pain, if the patient has
family or household problems the treatment cannot reach the mental and
emotional pain the patient may be suffering. On the contrary, it is not
uncommon for the easing of physical pain to cause a patient to recall
troubles that may have been forgotten, or to experience an increase in
emotional distress. For that very reason, the doctors, nurses, and
spiritual care workers make every effort to stay close to the patient,
with a determination to listen carefully to them.
If one asks, however, if the medical care in the hospice is perfect,
the answer is that that is far from the case. This is because a wide
range of mental and spiritual concerns can afflict each patient, so
although doctors can write a prescription to treat a disease, they
cannot so easily prescribe for the mind.
In European and American hospices a deeper religious approach is
usually possible because the same religious faith is often shared by
both the medical care staff and the patient. In a Japanese hospice,
however, there is no common religious base on the staff side and the
patient side, so it is difficult to engage in a religious approach.
Just because Kosei General Hospital is affiliated with Rissho
Kosei-kai, a Buddhist organization, does not mean that it provides
direct, Buddhist-based care to patients. There are not a few patients
who do not wish for such care.
Consequently, any discussion of the mental and spiritual issues of
patients comes back to what the central government, which administers
the national health insurance system, and those concerned with hospital
administration think about a spiritual approach to patients. We hear
the term "healing" a lot, and perhaps the root problem in Japanese
medical care is that it is not clear just who should attempt to provide
spiritual healing for the patient.
I personally believe that spiritual and religious medical
practitioners with different assigned roles from those of doctors and
nurses are essential, but more importantly I believe that the time has
come for all those associated with Japanese religions to seriously
think about the situation of those who are close to death, and how to
help them, starting with how to care for them on a daily basis, as
their lives approach their natural end.