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Review

Religion and Medicine Interplay in Eastern Orthodoxy: A Healthcare Practice-Oriented Scoping Review

by
Andreas S. Papazoglou
1,2,
Dimitrios V. Moysidis
2,
Anna Loudovikou
2,
Christos Tsagkaris
2,
Thomas Cudjoe
3,
Rafael Mazin
4,
Dimitrios Linos
5 and
Panagis Galiatsatos
3,*
1
Cardiology Department, Athens Naval Hospital, 11521 Athens, Greece
2
European Student Think Tank, Public Health and Policy Working Group, 1058 Amsterdam, The Netherlands
3
Medicine for the Greater Good, the Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
4
Independent Consultant in Public Health, Brandywine, MD 20613, USA
5
Surgical Department of Hygeia Hospital, Erithrou Stavrou 4, 15123 Marousi, Greece
*
Author to whom correspondence should be addressed.
Religions 2024, 15(9), 1085; https://doi.org/10.3390/rel15091085
Submission received: 10 June 2024 / Revised: 8 August 2024 / Accepted: 3 September 2024 / Published: 6 September 2024
(This article belongs to the Section Religions and Health/Psychology/Social Sciences)
Browse Figures
Versions Notes

Abstract

:
A growing body of evidence has shown the influence that religion and spirituality have on individuals duelling with illness, especially at advanced stages of disease. It is often vital for such individuals to have their spiritual and religious beliefs respected and, potentially, integrated in a compassionate caregiving setting for healthcare systems. However, given the diversity in religions and spiritual practices, healthcare professionals ought to approach such cultural significance with cultural humility, i.e., approaching differences in beliefs without relying on stereotypes or assumptions. This process requires sufficient training and communication skills among healthcare providers, as well as a successful medico-pastoral partnership. The aim of this review is to provide insight into one specific religion, Eastern Orthodoxy, and discuss current evidence of the religion’s influence on healthcare and medicine. Within this review, we aim to provide a summary on religion and spirituality specific to the Eastern Orthodox identity and religious practices, along with providing clinical guidance on approaching people who identify with this faith in certain healthcare settings in a manner compatible with the principles of cultural humility. The review will discuss important key elements of religious belief and practice of Εastern Orthodoxy that may influence health and healthcare decisions by patients.

1. Introduction

Spirituality has been conceptualized on a scientific basis as “an individual dynamic characteristic, a personal quest for understanding answers to ultimate questions about life, about meaning and about relationship to the sacred or transcendent that leads to the development of values and positive inner feelings” (King and Koenig 2009; de Brito Sena et al. 2021). On the other side, religion involves an organized entity with rituals and practices focusing on a higher power or God, usually shared by a community or group. Attempts have recently been proposed for quantitative measures of spirituality to facilitate relevant research (Braghetta et al. 2021). However, investigating spirituality is still complicated; the existing measures may reflect the consequences of spirituality rather than directly assess spiritual well-being, and there is no ‘gold standard’ for assessing spiritual well-being. Despite the inability to quantify spirituality and faith in a totally scientific way, their potential influence in healthcare highlights the need for understanding by clinicians and physicians alike.
Such an understanding is warranted given the findings of how patients may cope with the imminence of death at the end of their lives due to certain diseases, such as cancer and heart failure, with spirituality and faith (Papazoglou et al. 2022a; Lo et al. 2002). This association reaffirms how spirituality is viewed as a social determinant of health (Kawachi 2020; Root Wolpe and Idler 2014), whereby in certain medical settings, such as palliative care, incorporating spiritual care interventions by well-trained experts into palliative care programs results in positive outcomes. For example, religion/spirituality may support the easing of discomfort of patients and their respective caregivers and assist them with the progression of the illness (Puchalski et al. 2009). With the growing insight into religion’s/spirituality’s impact on health and health outcomes, further exploration of its influence is necessary (Puchalski et al. 2009).
Similar to other social determinants of health, the spiritual dimension is often overlooked by many clinicians who may not meet patients’ spiritual concerns either because of a lack of education or because of feeling uncomfortable discussing these concerns (Kørup et al. 2020). Moreover, the universality of dealing with spirituality is still challenged by the existence of different religions and spiritual approaches worldwide (MacDonald et al. 2015). Given the complex volume of spirituality, reviews and summaries focused on faiths should assist clinicians and healthcare professionals in understanding, cultural humility, and awareness of incorporating such insights into clinical practice.
To that end, the aim of the current review is to provide an accessible, reasoned background for healthcare professionals concerning Eastern Orthodoxy and its potential interpretation in healthcare practice settings. Other studies have already shed light on the integration of other religions (i.e., Western Christianity and Islam) within the culture of medicine (Balboni and Peteet 2017; King et al. 2023; Zagloul et al. 2024). This review will first investigate the existing body of literature on the association of Eastern Orthodoxy with healthcare in the form of a systematic scoping review, and we will then discuss the main religious beliefs and practices observed by Eastern Orthodoxy (Papazoglou et al. 2021; 2022a). Based on this insight, we will provide guidance for physicians dealing with Orthodox patients and propose some practical, individualized tone-setting recommendations.

2. Materials and Methods

2.1. Systematic Scoping Review

Aiming to present an overview of the existing body of evidence investigating the connection between religiosity/spirituality and medicine/healthcare, we performed a systematic scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) extension for scoping reviews. A study protocol was agreed upon a priori and followed by all authors.

2.2. Search Strategy

Specifically, a computerized literature search in EMBASE was performed until 11 June 2023 from database inception for English language studies using the following search strings: (‘Eastern Orthodoxy’) OR (‘Eastern Orthodox*’) OR ((Armenia* OR Greece OR Greek* OR East OR Eastern OR Russia* OR Serb* OR Syria* OR Byzantine OR Orthodox*) OR (Church* OR Christian*)). References of all matched papers were hand-searched with an aim to ensure the inclusion of every relevant article in our review. Our search was restricted solely to English-language texts, which might limit the input received from studies published in languages other than English.
In regard to the selection of studies, the list of records generated by this search was reviewed by two independent investigators (A.S.P. and D.V.M.) using the Covidence web-based review platform. Studies were included if they described the relationship between Eastern Orthodoxy and medicine, regardless of their type of study or sample size. Discrepancies on study selection were resolved by consensus-based discussion.

3. Results

Of the 546 articles initially retrieved, 541 studies were screened for eligibility after deduplication. Of them, 112 were deemed eligible for inclusion in this scoping review. The detailed PRISMA flowchart of our review is illustrated in Figure 1.
Of interest, 103/112 (91.9%) included studies were published after 2000, indicating an increasing interest in the association between religiosity and medicine during the last 2 decades. Of the included studies:
  • Most of them (47; 42.0%) investigated the impact of religious fasting on various organ functions (metabolism, osteogenesis, hemopoiesis) and clinical outcomes (longevity, cardiovascular prevention, mental health);
  • Nineteen (17.0%) studied the effects of Orthodox spirituality on mental health (coping mechanisms), quality of life, and patient satisfaction or lifestyle across different clinical settings;
  • Sixteen (14.3%) were related to specific bioethical decision-making issues, such as organ donation, transplantation, and euthanasia/physician assisted suicide.
  • Fifteen (13.4%) were related to public-health outcomes (vaccination, transmittable diseases, family planning, faith-based public health initiatives) affected by religion and spirituality in Eastern Orthodox countries (e.g., Ethiopia, Greece, and Russia);
  • Eleven (9.8%) investigated the contribution of Eastern Orthodox practices in coping with cancer or within a palliative care setting, and
  • Four (3.6%) were generally concerned with the relationship of Eastern Orthodoxy with medicine.

4. Discussion

4.1. Eastern Orthodox Identity

The word “Orthodox” comes from the Greek words “orthos” (right) and “doxa” (belief), meaning “believing in a right way”. It signifies the true religion that adheres to the beliefs, doctrines, and practices of the early Christian church established by the Apostles and defined by the first seven Ecumenical Councils (Nicolaidis et al. 2016).
The development of the Eastern Orthodox Church in its present locality and sociality, i.e., primarily in Eastern Europe, the Middle East, North Africa, and Russia, is associated with the East–West Schism, also known as the Great Schism of the Undivided Church, which occurred in 1054 CE due to disputes over papal supremacy and faith elements over the nature of the Holy Spirit inserted into the Creed by the Western Church (The Editors of Encyclopaedia Britannica 2023). This doctrine was seen as introducing a teaching that denies the unity of the Trinity on an equitable basis (Jillions 2017). At the time, theological differences backed by political affairs promoted division and created space for practices that further isolated Western and Eastern Christianity. In this sense, the Eastern tradition resented the Western enforcement of practices such as clerical celibacy and the use of unleavened bread in the Eucharist, and beliefs pertaining to the Immaculate Conception of the Virgin Mary, in the existence of the Purgatory, and the right of confirmation being bestowed solely to bishops (The Editors of Encyclopaedia Britannica 2023).
Another fundamental difference between the two traditions lies in the different reckoning of Feast and Fast days. Specifically, the Eastern Orthodox Church observes the (older) Julian calendar; hence, its followers celebrate religious festivals on different dates compared to Catholics and Protestants, who use the more recent Gregorian calendar. In time, not only has the timing changed, but so has the intensity and interpretation of fasting. While Western Christianity prioritized the penance character of fasting over committed sins, Eastern Orthodox Christianity adopted a rather existential and pedagogical stance, in which abstaining from material goods trains the faithful to resist spiritual temptations.
Nevertheless, both Eastern and Western Christian Churches believe in God’s revelation through Jesus Christ, His Son, who had both divine and human natures, was born from the Virgin Mary (Theotokos), and was crucified and resurrected for the salvation of all humanity. Eastern Orthodoxy differs from other religions in its way of life, worship, and certain aspects of theology. For example, as compared to Protestantism, Eastern Orthodoxy does not adhere to the “Sola scriptura” doctrine and emphasizes the authority of Sacred Apostolic Tradition alongside the Scriptures (Calis 2023).
The fundamental teachings and beliefs of the Eastern Orthodox Church are based on the Holy Spirit-inspired divine Sources, which are the Scriptures (Old and New Testaments) and Sacred Apostolic and post-Apostolic Tradition, which is viewed as the application of the Testaments in real-life settings across centuries. Orthodox Christians view God as a loving Father and Creator, an Omniscient, Omnipotent, and Omnibenevolent Spirit beyond place, time, and variation. They believe that the ultimate truth can be reached only through faith, as it transcends human comprehension (Shtulman and Rattner 2018).
The Eastern Orthodox Church holds the doctrine of the consubstantial and undivided Holy Trinity of the Father, the Son, and the Holy Spirit. Orthodox believers anticipate that God will come again with glory to judge everyone on Earth according to their faith and love expressed through good deeds, especially in helping others, particularly the “least of them”, namely the most disadvantaged, such as refugees, prisoners, and explicitly people with illnesses and infirmities (patients) (Orthodox Church in America 2023).
According to the late Metropolitan of Pergamos Professor John Zizioulas, from an Orthodox Christian perspective true existence is only possible in relation with other persons and God (Compton 2019). Interestingly, the resurrectional dimension of Orthodox baptism is deemed to be nothing other than incorporation into the community (Zizioulas 1985). In Eastern Orthodoxy it is the relationships among diverse people and with God (“Holy Eucharist”) that comprise humans as genuine persons and help them to enter authentic personhood. According to Zizioulas’ theory, personhood is creativity and freedom. The person is Otherness in communion and communion in Otherness (Zizioulas 1985). Since Communion is the basis for true Otherness, the Fall/Original Sin (i.e., the rupture between being in communion with God) led to idiolatry (i.e., individuals understanding themselves as the ultimate point of reference for creation) and perverted human personhood so that it exists only as individuals (Compton 2019; Zizioulas 1985).
Sickness can be defined as an (i) inherent variation of natural normality, (ii) a defensive response to a disease-causing factor, or (iii) any situation causing suffering (Chirban 1993). However, for some Orthodox Fathers, the (spiritual) sickness is often synonymous with sin and derives from the Fall [human freedom leading to the Original Sin and rejection of the Communion with God]. Jesus is the only totally healthy person due to constant unity with God. For St. Maximus the Confessor, the essence of (spiritual) sickness is self-love (the root cause of all passions) (Zizioulas 1985). The only real healing (i.e., holistic therapy beyond the restricted limits of physical healthiness/sickness) is feasible only in communication with God (Holy communion: a central part of the spiritual healing) and lies in the eradication of self-love (egoism, idolatry) and replacing it with love for God and others, including enemies (personhood) (Zizioulas 1985; Chirban 1993).

4.2. Eastern Orthodox Practices

Worship is the center of church life in Eastern Orthodoxy. It is highly liturgical, embracing seven sacred ceremonies (sacraments/“Mysteria”) characterized by a mystical nature: four of them are to be received by all believers (Baptism, Chrismation, Holy Eucharist, Confession, or Repentance), and three sacraments are optional ones: ordination, marriage, and unction. Veneration of sacred objects (icons, crosses, relics) and meditative prayer are integrated into Orthodox rituals. The most awesome ceremony in the Orthodox Church is the Holy Eucharist (Communion with God), which is officiated at the Divine Liturgy every Sunday or at great Feasts and is deemed to be a foretaste of an eschatological hope delivering God’s Grace to the believers (Compton 2019). In that sacrament, the elements of bread and wine (“changed” into the very Body and the very Blood of Christ) are shared with the believers by the priest. Finally, faith, morality, prayer, and good deeds are of outmost importance for Orthodox Christians and seem to have high intra-correlation with one another since one of those virtues cannot truly exist without the other.

4.3. Co-Existing among and beyond Feasting and Fasting

As Democritus said, “A life without festivity is a long road without an inn”. Therefore, Feasts are a significant part of Eastern Orthodoxy, with the greatest of all Holy days being the celebration of Easter (the Resurrection of Christ), which is recognized as the “Feast of Feasts” in the Orthodox Church. Immediately below it in importance, there is a group of 11 Great Feasts: 7 of them in honor of Jesus Christ, and 4 of them dedicated to the Virgin Mary (Table 1). Moreover, Sunday as a day is devoted to the Resurrection of Christ, and, thus, the Divine Liturgy taking place every Sunday in every Eastern Orthodox Church should be attended by every believer except for reasonably incapable ones. It is common practice that the whole family goes to the Church every Sunday, and then Bible School usually takes place for the younger believers. Of course, the extent to which an Orthodox believer observes these practices varies significantly, not only geographically but also based on how seriously the individual takes their religiosity.
Besides Orthodox Feasts, religious fasting is also considered a significant part of Eastern Orthodox practices. More specifically, fasting is defined as the avoidance of certain foods (meat and dairy products) every Wednesday and Friday throughout the whole calendar, in addition to other established fasting periods (Table 1). Of note, recent evidence suggests that religious fasting (i.e., periodic veganism) might have a beneficial impact on the cardiometabolic profile of the believers, as suggested by most of the retrieved relevant studies (Papazoglou et al. 2022b).
Family values have been developed across periods of fasting and feasting. The Orthodox Christian family is oftentimes described as an embodiment of the Church in a domestic setting, where parents preach and teach their offspring through their example of attending religious congregations, observing fast, and feasting within their local Orthodox community. Unity and continuity have a prominent meaning for the Orthodox family. In the same way that Christ cannot be distanced from the Church, husbands cannot be distanced from their wives. The opposite would result not only in a catastrophe for their offspring, but also a disturbance of the social and ontological balance (Chebotareva and Volk 2020).

4.4. Orthodox Medical Paradigms Reaffirmed by Physicians–Saints

Former physicians declared as Saints after their deaths (Figure 2) constitute great paradigms of how Christians over the centuries recognized the importance of providing compassionate and holistic care to their patients and addressing both their physical and spiritual needs (Fitzgerald 1948). Their paradigms serve as a historical perspective on how the combination of faith and medicine has been practiced in the past. They also highlight the importance of compassion, selflessness, and dedication to the well-being of others, which are values rooted in Christian teachings.
Saint Vasilios’ House of Healing (“Basilias”) in Cappadocia (modern Turkey) has been considered the most profound paradigm of Christian love for poor patients (Holman 2001; Caner 2018). It exemplifies the Christian ideal of caring for those in need (the “least” neighbors) and demonstrates God’s love through acts of compassion and service. Saint Vasilios (329 to 379 AD) was known for his works of charity and compassion towards the poor and needy. He believed that the Christian faith required active service to those in need, and he established a number of philanthropic institutions to provide support and care to the sick, the poor, and the destitute. The most known of them was the House of Healing, a center providing free medical care and housing for the sick and needy, regardless of their social or religious background. Saint Vasilios deemed healing as a holistic process that involved addressing both the physical and spiritual needs of the patients (Holman 2001; Caner 2018).
Another great example is Saint Pantaleon or Panteleimon (< “pantas” + “eleimon”; eleemosynary or benevolent to everyone), who was a physician and martyr (275–305 AD) living in Nicomedia (modern Turkey) (Sullivan et al. 2011; Gerstel 2012). He is regarded as the patron saint of physicians, and his life continues to inspire doctors and healthcare workers around the world. According to tradition, Saint Panteleimon was educated in medicine and became a skilled physician, known for his ability to heal both physical and spiritual illnesses in a miraculous way. He was also known for his kindness and compassion towards his patients, and for his willingness to provide free medical care to the poor and needy.
Additionally, in the 3rd century, Cosmas and Damian were twin Arab brothers who were known for their medical skills and their willingness to provide free medical care to the poor (Montagut and Julien 1993; Friedlaender and Friedlaender 2016; Soh 2020). They were martyred for their Christian faith, and their story became a symbol of the selfless love and service that Christian physicians can provide to their patients. Moreover, Leontius, Anthimus, and Eutropius were three Christian physicians who lived in the 4th century and were known for their medical skills and their commitment to serving others. They saw medicine as a way to express their faith and their love for their fellow human beings, and they worked tirelessly to provide care to those in need. Today, the example of those Saints, who assisted the suffering and needy without accepting payment (“An-argyros”, i.e., not accepting payment), serves as a reminder of the importance of treating patients with compassion and respect, regardless of their ability to offer some payment (Montagut and Julien 1993; Soh 2020; Friedlaender and Friedlaender 2016).
Very close to us in the 20th century, Saint Luke of Crimea emerged as a surgeon who performed complex surgeries and developed new surgical techniques despite working in difficult conditions, including shortages of equipment and medication (Fitzgerald 1948). He credited his success to his deep faith in God and his belief that surgery was a form of service to others. Today, Saint Luke serves as an inspiration for physicians striving to provide high-quality medical care, even in challenging circumstances.

4.5. Potential Implications for Physicians

Based on this narrative summary of the Orthodox faith, approaching patients practicing this faith warrants cultural humility to assure this social factor can strengthen a clinician–patient relationship. First, they remind us of the importance of treating patients with compassion and respect, addressing both the physical and spiritual dimensions of disease and healing. Second, they emphasize the importance of serving those in need, regardless of their ability to pay, and of making medical care accessible to all, in line with the principles of universal health coverage and equitable healthcare. Third, medicine can be considered a form of spiritual service, and physicians have the potential to make a profound impact on the lives of their patients and their communities. Orthodox Christianity encourages a sense of humility, faith in future body resurrection, and reverence for life, and, hence, physicians should recognize the sacredness of human life, particularly when dealing with Orthodox patients. They may also pay attention to the resilience shown by patients considering disease as a source of absolution or preparation for the repose in Heaven and comprehend patients’ reactions to bad news as well as patients’ (un)willingness to undergo a treatment course under this prism.

4.6. Practical Recommendations Regarding the Patient–Physician Relationship

Considering the identity and principles of Eastern Orthodoxy as well as the aforementioned examples of physicians–Saints having Orthodox faith and love both to their God-Father and their patients, we could propose the following practical suggestions for physicians dealing with patients of the Eastern Orthodox Church:
  • To obtain a sufficient and efficient social history, encompassing spiritual beliefs (religious history), which seems to be an initial and prerequisite step for aligning health management to the patient’s spiritual needs. This process is suggested for other religions too and is often a powerful intervention per se (Ebertsch 2018). Orthodox patients, whose beliefs often form the core of their way of thinking, almost always appreciate a physician sensitive to these issues. Taking into account the spiritual dimension of the patient, the physician sends a message that he/she is concerned with the whole person. As part of compassionate caregiving, it is necessary to understand if patients have religious or spiritual means of coping with or finding meaning in their suffering. The ability to elicit a comprehensive spiritual history (a possible modified HOPE tool (Anandarajah and Hight 2001) presented in Figure 3) and to understand the spiritual dimension of patients’ lives is critical for building and maintaining patients’ trust. It is also important to understand the following: (i) to what extent patients’ spiritual or religious beliefs can affect the therapeutic decision making and their coping skills (Puchalski 2001); (ii) whether patients feel alienated from institutional religion and see themselves more as spiritual than as religious (Koenig 2007); and (iii) whether patients’ religious struggle might lead to negative coping (e.g., excessive guilt, viewing a disease as a punishment from God, or absolute belief in a cure and non-resolved anger when the cure does not occur) (Pargament et al. 1998; Puchalski 2001). When the patient appears reluctant to talk with a priest and prefers to discuss his/her spiritual concerns with a trusted physician, being supportive is usually all that is required. The physician could also ask whether there is a group of familiars or relatives important to the patient that should be contacted and may offer some help.
  • To encourage partnerships with local Orthodox religious communities and clergy: To support patients with spiritual beliefs, physicians should respect and acknowledge their religious convictions, assist in reconciling these beliefs with medical reality, and consider involving their spiritual supporters, such as clergy, in decision making. This partnership between medicine and religion is crucial, especially when patients have concerns about treatment recommendations that may conflict with Orthodox community norms (e.g., an autopsy, pregnancy termination or in vitro fertilization, organ donation/transplantation, death determination, and removal of life supports such as ventilators). Such collaboration can positively influence disease management and help patients reframe their own thinking (Yeary et al. 2011; Galiatsatos et al. 2016). These collaborations can be further scaled up towards health promotion and efforts to tackle disinformation. Religious community engagements during the COVID-19 pandemic have demonstrated potential to amplify evidence-based information and debunk popular myths (Galiatsatos et al. 2020).
  • To encourage spirituality and prayer in patients coping with their illness, be it due to the suffering of the disease and/or the undesired prognosis that may result in death. A systematic review has highlighted the growing number of randomized trials exploring the impact of spiritual interventions on patients facing death (Dos Santos et al. 2022). These interventions range from psychotherapy and life reflection to meditation and mindfulness. Some studies specifically investigate spiritual or religious practices such as Islamic prayer or Buddhist chanting (Mitchinson et al. 2023; Hindmarch et al. 2022). In the Orthodox faith, prayer is a means of seeking strength and grace to overcome difficulties and spiritual emptiness. Christ himself prayed to accept death as the gateway to eternal life. Spiritual beliefs and practices (namely prayer, blessed oil and holy water, use of relics of saints, holy icons, offering names for pleas, and pilgrimage) also play a significant role for the families of patients, helping them cope with suffering and the impending loss (Fouka et al. 2012; Plakas et al. 2011). Interestingly, even patients who do not identify as religious or spiritual still express spiritual needs in the face of serious illness and life-threatening situations (Delgado-Guay et al. 2011). It is noteworthy that personal prayer is frequently utilized by hospitalized patients as a non-drug method to manage pain (76% of patients reported using it) (McNeill et al. 1998; Yates et al. 1981). Further research is needed to explore the potential benefits of encouraging prayer and spirituality, such as Byzantine chanting, in improving outcomes and mental health for Orthodox patients in various clinical settings, including end-of-life care, palliative care, and surgical preparation.
  • To provide patients with access to attending Orthodox sacraments. Some patients may wish to participate in Orthodox sacraments during their hospital stay. A priest is a helpful resource in arranging for sacraments that are important to patients under particular circumstances, namely those at the beginning or close to the end of life. The former pertains to Baptism and Christening, while the latter pertains to Confession, Unction, and Holy Communion. Veneration of sacred objects (icons, crosses, relics) and religious fasting are also important for some patients; hence, a physician should not discourage those practices unless they are contraindicated based on their health status.
Some observational studies suggest that regular spiritual practices might be associated with longevity (Strawbridge et al. 1997). Another study pinpoints interleukin IL-6 level reduction as a possible underlying mechanism (Koenig et al. 1997). The authors hypothesized that religious commitment and spiritual activation can modify pro-inflammatory cytokines, improve stress control, and suppress the progression of chronic diseases (Kurita et al. 2011). Most US physicians believe that spirituality has a substantial and generally positive impact on patients’ health (even on hard clinical outcomes) and that on occasion the influence is due to divine intervention (Curlin et al. 2007).
5.
To encourage post-recovery spiritual commitment. Some studies have shown that spiritual commitment and participation in religious activities tend to bolster recovery from illness and surgery and follow-up treatment adherence (Harris et al. 1995; Groleau et al. 2010). This might be attributed to positive feelings (gratitude), less anxiety, and fewer health worries.
6.
To emphasize the training of young medical residents concerning the clinical value of spirituality. In the medical curriculum, future clinicians should be advised “to listen respectfully, cure sometimes, relieve often, and comfort always”, showing commitment to a humanistic relationship-centered medicine (Rasinski et al. 2011; Lo et al. 2002b). This is similar to the cultural humility provided to other social determinants of health, be it race, ethnicity, employment, and so forth. Clinicians should not feel unskilled and uncomfortable discussing spiritual concerns, and should understand the importance of providing support for religious beliefs and practices that do not disagree with appropriate medical care. Current evidence suggests that physicians’ own religious characteristics shape/affect the ways they relate to their patients (Curlin et al. 2007). The incorporation of spiritual care training for physicians and nurses would make even non-religious healthcare providers more likely to provide spiritual care to seriously ill patients (MacLean et al. 2003). Moreover, similar training of the clergy could facilitate the priests in recognizing their role as partners in the healthcare team in providing care for the patient. Even a minimum level of physicians’ training on spirituality, mental health, and life philosophy could improve the existing standards in clinical care.

5. Conclusions

This scoping review aimed to provide insight into Eastern Orthodox identity and practices, and also shed light on the existing evidence of the religion’s influence on healthcare and medicine. Clinicians should align with cultural humility principles when approaching individuals who identify with this faith in various healthcare settings. Encouraging and respecting patients’ spirituality could ultimately affect beneficially both patient outcomes and healthcare decisions. Integrating this culture at the healthcare system level could set the scene for meaningful partnerships between healthcare practitioners and religious communities. Leveraging relevant knowledge and resources has a major potential to contribute to achieving long-standing healthcare goals, such as equitable access to healthcare, as well as to tackling pertinent health challenges, including infectious disease outbreaks.

Author Contributions

Conceptualization, A.S.P., D.V.M., C.T. and P.G.; methodology, A.S.P., D.V.M., C.T. and P.G.; formal analysis, A.S.P., D.V.M. and A.L.; investigation, A.S.P., D.V.M., A.L. and C.T.; writing—original draft preparation, A.S.P., D.V.M., A.L., C.T. and P.G.; writing—review and editing, A.S.P., T.C., R.M., D.L. and P.G.; visualization, A.S.P., D.V.M. and A.L.; supervision, P.G.; project administration, P.G. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

Not applicable.

Informed Consent Statement

Not applicable.

Data Availability Statement

Data are contained within the article.

Conflicts of Interest

The authors declare no conflicts of interest.

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Religions 15 01085 g001
Figure 1. PRISMA flowchart of our scoping review.
Figure 1. PRISMA flowchart of our scoping review.
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Figure 2. A hand-made Orthodox icon depicting some of the most revered Unmercenary Physicians—Saints (Greek: Άγιοι Aνάργυροι, romanized: Agioi Anárgyroi). Permission to reproduce the figure was obtained for use in this article.
Figure 2. A hand-made Orthodox icon depicting some of the most revered Unmercenary Physicians—Saints (Greek: Άγιοι Aνάργυροι, romanized: Agioi Anárgyroi). Permission to reproduce the figure was obtained for use in this article.
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Figure 3. A proposed spirituality assessment tool for physicians dealing with Orthodox patients, according to the HOPE concepts (Anandarajah and Hight 2001). The HOPE concepts for discussion were proposed as follows: H—sources of hope, strength, comfort, meaning, peace, love, and connection; O—the role of organized religion for the patient; P—personal spirituality and practices; E—effects on medical care and end-of-life decisions.
Figure 3. A proposed spirituality assessment tool for physicians dealing with Orthodox patients, according to the HOPE concepts (Anandarajah and Hight 2001). The HOPE concepts for discussion were proposed as follows: H—sources of hope, strength, comfort, meaning, peace, love, and connection; O—the role of organized religion for the patient; P—personal spirituality and practices; E—effects on medical care and end-of-life decisions.
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Table 1. Great Feasts and most significant religious fasting periods observed in Eastern Orthodoxy according to the Julian calendar.
Table 1. Great Feasts and most significant religious fasting periods observed in Eastern Orthodoxy according to the Julian calendar.
Great FeastsDate of Celebration
Easter, Christ’s ResurrectionMoveable Feast
The Entry into Jerusalem (Palm Sunday)The Sunday before Easter
The Ascension of Christ40 days after Easter
Pentecost50 days after Easter
The Nativity of Christ (Christmas)25 December
The Transfiguration of Jesus6 August
The Exaltation of Cross14 September
The Baptism of Christ (Theophany)6 January
The Presentation of Jesus at the Temple (Candlemas)2 February
The Presentation of Virgin Mary21 November
The Dormition of Virgin Mary15 August
The Annunciation25 March
The Nativity of Virgin Mary8 September
Most significant fasting periods and duration
The Great Fast or the period of Lent (49 days prior to Easter)
The Christmas Fast begins on 15 November and ends with Christmas (25 December)
The Dormition Fast begins on 1st August and ends with the Dormition of Virgin Mary (15 August)
The Fast of the Apostles begins 8 days after Pentecost and ends on 28 June
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MDPI and ACS Style

Papazoglou, A.S.; Moysidis, D.V.; Loudovikou, A.; Tsagkaris, C.; Cudjoe, T.; Mazin, R.; Linos, D.; Galiatsatos, P. Religion and Medicine Interplay in Eastern Orthodoxy: A Healthcare Practice-Oriented Scoping Review. Religions 2024, 15, 1085. https://doi.org/10.3390/rel15091085

AMA Style

Papazoglou AS, Moysidis DV, Loudovikou A, Tsagkaris C, Cudjoe T, Mazin R, Linos D, Galiatsatos P. Religion and Medicine Interplay in Eastern Orthodoxy: A Healthcare Practice-Oriented Scoping Review. Religions. 2024; 15(9):1085. https://doi.org/10.3390/rel15091085

Chicago/Turabian Style

Papazoglou, Andreas S., Dimitrios V. Moysidis, Anna Loudovikou, Christos Tsagkaris, Thomas Cudjoe, Rafael Mazin, Dimitrios Linos, and Panagis Galiatsatos. 2024. "Religion and Medicine Interplay in Eastern Orthodoxy: A Healthcare Practice-Oriented Scoping Review" Religions 15, no. 9: 1085. https://doi.org/10.3390/rel15091085

APA Style

Papazoglou, A. S., Moysidis, D. V., Loudovikou, A., Tsagkaris, C., Cudjoe, T., Mazin, R., Linos, D., & Galiatsatos, P. (2024). Religion and Medicine Interplay in Eastern Orthodoxy: A Healthcare Practice-Oriented Scoping Review. Religions, 15(9), 1085. https://doi.org/10.3390/rel15091085

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