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 WHO).

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.