RESUMEN
The relationship between spirituality and medicine is present from the very origins of Medicine. Its relevance has been rediscovered during the past decades. Numerous publications report positive health results when spiritual needs of patients are addressed. Authors like Edmund Pellegrino and Christina Puchalski have gained an acknowledged leadership in this field. The purpose of the article is to study Christina Puchalkis' contributions to the field, specifically through the identification and analysis of the ethical reasons that - according to Puchalski - justify the medical duty to provide spiritual care. As a result of our investigations, we propose to systematize the ethical reasons identified in Puchalski's writings in seven categories, that presuppose a broad definition of spirituality and a conception of "whole patient care". Our analysis shows that Puchalski's arguments are ultimately grounded on an ethics of virtue and a realist anthropology, more than in mere positive effects or in patient's wishes. Indeed, Puchaslki's anthropological conception recognized human dignity as an intrinsic value that must be always acknowledged, especially in the context of disease, where questions about the meaning of life, suffering, connection and transcendence inevitable arise. We conclude that Puchalski's ethical arguments are solid and suggest the challenge of including the spiritual dimension in the formation of health care professionals.