Bioethics Discussion Blog: Praying With the Patient: The Ethics of One Physician’s Action

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Wednesday, July 20, 2005

Praying With the Patient: The Ethics of One Physician’s Action

Writing in “A Piece of My Mind” section of the Journal of the American Medical Association JAMA. 2001;286:1291-1292. Bruce D. Feldstein, MD told about his experience, while covering for a another doctor, with a patient Mrs. Martinez, who had metastatic lung cancer, previously treated, whom he now had to tell that a current CT scan showed metastases to the brain. She was overwhelmed by the news and described the information “a death sentence.” When it appeared that his statements of reassurance did not help, on seeing a crucifix around her neck, he considered that praying together would be best he could do for her at the time. When asked, the patient agreed. This was the first time in his career that he had considered praying with his patient. He was Jewish, she Catholic. He had concern what the words of the prayer should say. He finally led the simple prayer:


"Oh, God, You Who are the Great Healer."
"Who guides us through life,"
"In your wisdom . . . "
". . . may you guide [patient’s oncologist] and all the other doctors and nurses to provide the best care."
"Provide us all with Your comfort and guidance . . . "
"Thank you for hearing our prayer."
Amen."


and it ended with her tearful “thank you.” Later, out of concern about the ethics of what he had done, Dr. Feldstein discussed his action with an ethicist and Dr. Feldstein writes:

[The ethicist] and I looked at it in terms of core ethical principles: to do good (beneficence), to do no harm (nonmaleficence), and to respect a patient's autonomy. We examined it in terms of the duties of truth telling (veracity), loyalty and putting the patient first (fidelity), of confidentiality and privacy. We contemplated the virtues of compassion and professionalism. We reflected on the goals of a physician to relieve pain and suffering and to provide comfort, as well as the value of the Golden Rule: "Do unto others as you would have them do unto you." A prayer that is supportive and comforting for the patient, that has his or her permission, and is mutually respectful is ethical. One that is proselytizing, coercive, and unrealistic is not.

As [the ethicist] discussed, the prayer was appropriate on all counts. "Your intentions were ethical," he said, "to tell the truth and to provide comfort, what physicians pledge to do. Mrs Martinez asked you specifically for the test results. You answered truthfully. You were aware how your pronouncement could provide harm and suffering and you followed the Hippocratic principle First, do no harm. Conventional medical, psychological, or philosophical explanations were insufficient or problematic, so you considered a spiritual approach. Prayer is a tremendous source of comfort for people who are prayerful. Although new for you, in the world of spiritual care, offering a prayer is as straightforward as recommending an antibiotic.

"A physician praying with a patient may not be standard practice," he went on, "but this does not make it unethical unless you do not have the permission of the patient or if you conducted your prayer in an unethical way. You identified a cue—the cross—that it would be appropriate to offer a prayer and trusted your deep intuition and judgment. You could have called a cleric if one was available, but then there is the question of timing, to make the right intervention in the right moment. You asked her first if she was a prayerful person. She said yes. Only then did you ask her if she wanted to have a prayer together. She could have said no. You found a common language. You did not tell her what faith to have and did not pray for a miracle."

I was satisfied that that as a physician, praying with Mrs Martinez was right.


Note: The above link to the full text may be available only to subscribers or those linking via a library computer. ..Maurice.

6 Comments:

At Thursday, July 21, 2005 8:00:00 AM, Anonymous Bob Koepp said...

I agree that there is nothing unethicial about a physician praying with his/her patients, whether in the clinic, or in some more traditional "house of worship." I just hope that nobody makes the inference that, if it's OK to pray with one's patients, then prayer is a "medical" intervention. That would reflect a misunderstanding both of medicine and prayer.

 
At Thursday, July 21, 2005 10:16:00 PM, Blogger Maurice Bernstein, M.D. said...

Well, we teach our first year med students in their introduction to clinical medicine that there are 3 basic components to a patient's illness: biologic, psychologic and social (spiritual may be put under psychologic) and physicians should be aware of each regarding how they are affecting the patient and the disease. We tell them that the therapy includes attempting to treat each factor. Though I can't say that praying with the patient has a direct biologic effect but I am sure in many cases there is a direct psychologic effect. Therefore, since part of our professional duties is to support the emotions of our patients, I would look to the prayer as a "therapeutic intervention." Perhaps the term "medical intervention" should be limited strictly to those treatments solely applied to the biologic. ..Maurice.

 
At Thursday, August 11, 2005 9:06:00 PM, Anonymous Bonny Lee said...

While reading the piece on "Praying with the Patient: The Ethics of One Physician's Action," I wondered why the physician didn't ask the patient whether or not she wanted to see a cleric first, rather than jumping straight to offering to pray with the patient. Reading further, the bioethicist's analysis of the event stated that calling in a cleric would have thrown off the "timing" of making the "right intervention at the right moment."

Both the physician and the ethicist speak of his prayer with the patient as a kind of remedy. So then I wondered whether this 'remedy' would also have been available to, say, a Buddhist patient. How many doctors out there would know how to pray with a practicing Buddhist? Does this mean that a similarly overwhelmed, tearful, Buddhist patient would not receive this so called "right intervention at the right moment," and would have to wait for a religious leader to be brought in? If the Buddhist patient would be expected to wait, then what makes this scenario with a Catholic patient such an emergency? A physician's discomfort and feeling of helplessness does not necessarily qualify a moment as "the right moment" to dispense a prayer.

In this case, it's obvious that the doctor was not qualified to be a spiritual resource for his patient (he admitted this much as well). He was lucky this time that he knew enough about his patient's religion to not accidentally say anything offensive. But in general, I don't think doctors should initiate prayer with their patients. Even in a devastating situation such as this one, it would have been enough for the physician to grieve with his patient simply as an empathetic human being.

 
At Thursday, August 11, 2005 10:00:00 PM, Blogger Maurice Bernstein, M.D. said...

Perhaps if the physician in such as situation as described could have expressed words and behavior which would represent the physician's empathy to the patient's plight, that would have been an even better therapy which could be administered at that time. It is reasonable to consider that not all initiation and praying with the patient represents true empathy on the part of the physician. For a religious Catholic patient, the simple prayer offered in this story, obviously was comforting but Bonny is correct in being concerned about that patients of another religion or culture being benefitted by prayer offered by a doctor. In conclusion, hand holding and expressions by the physician of his or her true understanding empathy may be the best that a physician can do. ..Maurice.

 
At Wednesday, November 22, 2006 9:55:00 PM, Anonymous Luke Elliott, MD said...

I think that the physician's prayer was well done, and needed at the moment it was given. I disagree with the comments made by Bony. Has Bony ever been with a patient when they are at a time of need and need to pray? Has Bony ever helped someone see their need for God's love? Has Bony ever told anyone news like the physician did? Well, I can answer yes to each question that I raised. And in over 15 years of practice, I feel that I have been used of God to reach those in need with His love, via the medical field. Luke Elliott, MD

 
At Tuesday, June 24, 2008 9:28:00 PM, Blogger Maurice Bernstein, M.D. said...

Kelly wrote the following comment today:

Thanks for the information on patient/doctor ethics. I suppose that it really depends on the person you're talking to whether praying with a patient is wrong or right. On one hand you might have someone saying that if the patient and the doctor are both okay with it, then it's alright. Then however, you have people saying that if a patient is having an affair with a doctor and it's alright with them both, does it matter? It's a very interesting debate.


I think the difference is that an "affair" is an ongoing romantic relationship which can interfere with a therapeutic doctor-patient relationship. It is not directed and the intent is not related to the patient's illness. Praying is usually an isolated behavior and if accepted by both parties, may be supportive to the relationship. The intent for the prayer to help heal the illness. Whether it does or not is still being investigated. ..Maurice.

p.s.- there is more to the posting but it is totally related to a different subject than this thread and I plan to post it elsewhere.

 

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