Physicians are confronted with new information from the popular media, peer-reviewed journals, and their patients regarding the association of religious and spiritual factors with health outcomes. Although religion and spirituality have become more visible within health care, there are considerable ethical issues raised when physicians incorporate these dimensions into their care. Spiritualities are responsive to patient needs by offering beliefs, stories, and practices that facilitate the creation of a personally meaningful world, a constructed "reality" in the face of illness, disability, or death. It is largely through narrative that physicians incorporate into the health care encounter the spiritualities that are central to their patients' lived experience of illness and health.