Spiritual care is increasingly promoted as a holistic and integrative component of healthcare, supported by growing research on religion, health, and wellbeing. Yet the institutional conditions under which spiritual care is implemented often remain insufficiently examined. This paper argues that understanding the distribution of authority between professional and religious actors is essential for evaluating the possibilities and limits of effective spiritual care. Drawing on a meta-study of Turkish scholarship on spiritual care (2004-2026), complemented by bibliometric and thematic mapping, the paper analyses how spiritual care has developed within a dual institutional framework. Academic discourse is overwhelmingly shaped by nursing scholarship, structured around globally circulating definitions and competency scales that position spirituality as a professionalized domain of clinical expertise. At the same time, spiritual support services in public hospitals are administered primarily through the Directorate of Religious Affairs, which deploys state-employed religious personnel within healthcare settings. This configuration reveals that spiritual care is not only a matter of integrating medicine and theology, but also a question of who is authorized to define, administer, and legitimize the sacred within public institutions. The Turkish case shows how parallel regimes of professional and religious governance can coexist without full conceptual or institutional alignment, generating tensions that shape practice on the ground. Rather than assuming that dialogue alone ensures effective integration, this paper suggests that attention to institutional authority structures is a necessary precondition for developing sustainable and context-sensitive models of spiritual care. By foregrounding these structural dynamics, the paper contributes a sociological perspective to ongoing conversations about how medicine and theology might engage more responsibly and realistically.