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.