Medical decision-making frameworks have traditionally focused on rational, evidence-based approaches while neglecting the significant influence of spirituality, concepts of fate, and free will. This paper examines how spiritual beliefs and the notion of free will impact healthcare decisions and proposes an integrated model that acknowledges scientific, spiritual, and volitional dimensions.

This study employs a hermeneutic analysis of contemporary literature on medical decision making, alongside evidence from studies on spirituality in healthcare and philosophical work on free will. Drawing on Masic's framework of medical decision-making, Zürcher et al.'s compatibilist approach to free will, and empirical studies of spirituality's impact on healthcare choices, the paper develops an expanded model that incorporates spiritual and volitional dimensions.

Evidence demonstrates that spirituality and the exercise of free will significantly influence medical decision-making across multiple contexts. Patients with greater spiritual well-being show less decisional conflict and uncertainty. Religious convictions directly affect treatment preferences, from life-sustaining interventions to end-of-life care. The concept of free will, understood in compatibilist terms following Frankfurt's hierarchical model, provides a theoretical framework for understanding how patients can make authentic decisions aligned with their deeper values even in constrained circumstances. Despite this evidence, mainstream medical decision-making models continue to exclude spiritual and volitional factors.

An integrated hermeneutic approach to medical decision-making one that acknowledges spiritual dimensions and the importance of free will alongside clinical evidence enhances patient care by addressing both physiological needs and deeper questions of meaning and authenticity. By recognizing spirituality and free will as central rather than peripheral factors, healthcare providers can create more holistic, patient-centered approaches that honor the full spectrum of human experience in medical contexts.