Spiritual well-being in palliative care: Reflecting on Kerala’s model through the lens of Buya Hamka

Dear Editor,

We are all ready to read the article “Palliative Care Policy and Practice in Kerala, India: Implications for Sustainable Development Goal 3” with great interest. The article not only provides a comprehensive overview of Kerala’s success in building a community-based palliative care system but also offers important reflections on how this practice resonates with the global health goals of SDG 3. ¹ However, upon closer examination, We are believe there is one dimension worth highlighting, as it is central to the human experience of chronic illness and the end of life: spiritual well-being. Kerala has demonstrated how home-based palliative care, warm social relationships, and community support can create a safe space for patients to navigate the illness process more meaningfully. However, this spiritual dimension, which is indeed very strong in Asian cultures, has not been explicitly presented in the article’s analysis, especially in support of SDG 3.

In this context, the thoughts of Buya Hamka, an Indonesian Islamic scholar, provide a rich philosophical foundation for understanding the role of spirituality in inner healing. Hamka often emphasized that peace of mind is the highest form of human health, and that dhikrullah, or remembrance of God, is a form of healing that brings clarity, fortitude, and acceptance of life’s destiny. ² This thinking aligns with scientific evidence showing that spiritual well-being plays a crucial role in reducing anxiety, improving quality of life, strengthening coping, and helping patients achieve self-acceptance when facing terminal illnesses. Recent research has confirmed that spirituality is an integral component of a holistic approach to palliative care, particularly in cultures that place the meaning of life and transcendent relationships as part of everyday life.^3,4 Meanwhile, Kerala, with its communal traditions, already implicitly incorporates spiritual care practices through the presence of volunteers, empathetic communication, and support that respects the values and beliefs of each patient. ¹

Recent studies also demonstrate that integrating spirituality into palliative care significantly improves the well-being of both patients and caregivers. Spirituality has been shown to increase emotional resilience, reduce psychological distress, strengthen patient-family relationships, and provide new meaning to the experience of illness, often perceived as a period of loss and uncertainty.^5,6 In many Asian societies, including India and Indonesia, spirituality is not an additional aspect but a foundation for how people understand suffering. Therefore, integrating this perspective not only enriches the analysis of the Kerala model but also broadens the scope of the article’s contribution to other countries with highly spiritual cultures. This approach also aligns with global recommendations to expand the definition of universal health coverage to include meeting patients’ spiritual needs, particularly in the end-of-life phase.^7,8

Hamka emphasized that inner strength born of faith and peace of mind is often more decisive than any medication in helping someone cope with difficult situations. ² This idea is especially relevant when we read the experiences of palliative care patients who feel more at peace when they are at home, surrounded by family, and supported by caregivers who understand their spiritual values. Kerala has demonstrated that community-based palliative care is successful not only because of its structure but also because it allows patients to stay connected to their daily spirituality, a source of strength for many. In these warm and sincere care spaces, spirituality is present not as an abstract concept but as a breath that guides patients to rediscover dignity and hope amidst limitations. ⁹ Here, we see that the relationship between palliative care and inner strength is not merely complementary, but at the heart of a healing process that honors humanity.

Thus, the article would be even stronger if it positioned spiritual well-being as one of the fundamental pillars of the success of the Kerala model, as this dimension not only broadens the horizons of modern palliative care, which emphasizes the maintenance of meaning, inner peace, and self-acceptance, but also reflects the cultural values entrenched in Asian societies that see spirituality as the most essential source of strength in facing suffering.^5,8,10 This perspective aligns with the views of great thinkers such as Buya Hamka, who asserted that the highest mental health arises from peace of mind and remembrance of God, and that a clear inner strength can soften the burden of illness and re-establish human dignity during the most fragile phases of life. By incorporating the spiritual dimension into the analysis, Kerala’s palliative practice no longer appears merely as a model of community-based healthcare, but as a manifestation of a holistic human approach that touches the body, mind, and spirit, thus providing a deeper understanding of how palliative care can provide comfort and a more meaningful quality of life for patients and their families.

We hope this reflection can enrich the discourse on global palliative care and encourage further research that more explicitly places spiritual well-being as an integral component in SDG 3. Human health and well-being are essentially related not only to the body but also to the soul, and humane palliative care must be able to embrace both holistically.