Science and Religion:Making a Good Medical Decision
Beyond the issue of physicians praying with their patients, either initiating or on request, there is the issue of the relationship between science and religion with respect to principles of patient autonomy and physician beneficence in patient care. In a survey of physicians on this matter, Farr A. Curlin, M.D. et al, writing in the Jan 10 2005 issue of the Archives of Internal Medicine come to this conclusion:
“There is no bright line that can be drawn between discussion of medicine and discussion of religion. Therefore, when conflict occurs, moral (ie, religious) counsel inheres in medical recommendations. Science tells patients what they can do, but physicians also tell patients what they should do, and the latter is always a moral exercise. If religious advocacy is a threat to patient autonomy, one must ask whether autonomy is not equally threatened by challenges to patients’ ideas of religious faithfulness, whether or not they conflict with medical evidence.
Our findings suggest that physicians always navigate a balance between respect for patient autonomy (remaining open-minded and flexible) and concern for the patient’s good (persuading the patient to adhere to recommendations). That navigation will always be guided by the physician’s sense of what "the good" is. Rather than striving for illusory neutrality, physicians should practice an ethic of candid, respectful dialogue in which they negotiate accommodations that allow them to respectfully work together with patients, despite their different ways of understanding the world.”
I would agree that the physician’s recommendations (what the patient should do) does carry a moral potential since should is not necessarily free of moral opinion. The practical issue in medical practice is unfortunately there doesn’t often appear to be enough time (or skill or motivation?) for physicians to “negotiate accommodations” and the patient is left with what seems as a paternalistic type of physician advice and the physician may be left with impression that the patient is being unrealistic and stubborn. What is the solution to the issue? Those patients who have significant decisions to make should be scheduled for more of the physician’s time. Physicians should also be aware of the potential conflict between religion or moral beliefs (physician’s and patient’s) and the science of medicine. If the physician feels insecure in the art of mediation, well.. this would be something to learn as part of continued medical education. ..Maurice.
posted by Maurice Bernstein, M.D. @ 5:29:00 AM
4 comments
4 Comments:
I wonder about your suggestion that the spiritual "may be put under psychologic" as a way of viewing it as a "therapeutic intervention." I think that if we take motive and intention seriously, then praying with a patient in order to have a psychologically therapeutic effect needs to be distinguished from praying with a patient in order to share in his/her spiritual life. And in the former case, is it really praying, or just "going through the motions" for medical rather than spiritual reasons? This starts to look very much like dispensing placebos, to which I have no objections -- but the point would still hold, that placebos are hardly sacramental.
I also think it's important not to conflate morality with religion, as Farr A. Curlin seems to do in the quotation from the Archives of Internal Medicine. And while I agree that a physicians recommendations are about "what the patient _should_ do," there's an implicit reference to the goals of treatment -- i.e., "if you want to restore your health, prevent disease or further decline, etc., then you _should_ do as I recommend." That's very different from a moral injunction I think. After all, should "non-compliance" be viewed as immoral behavior?
I suppose you are correct that if the physician
praying with the patient is used psycho-therapeutically it could easily be
interpreted as spiritually neutral. But, on the other hand, if you read the full
article you will see that the doctor wept with the patient after the prayer,
having found the experience emotionally challenging. Might there have been some
spiritual involvement by the physician and it was not all just one placebo
activity?
With regard to the expression "what the patient should do", if the
physician was actively trying to avoid any personal moral bias then obviously the recommendation would be simply based on the best treatment as determined by the
facts, the physicians estimation of risk vs benefit and medical standards of practice. But I wonder if that freedom from moral bias is always the case. ..Maurice.
I think it is rarely the case. If it were, physicians would not get so angry at patients who do not follow recommendations. Neutrality implies a lack of emotion on the physicians part, which isn't necessarily a good thing. I think that if the physician cares about the patient but recognizes him/her as a morally autonomous individual, I think the physician will feel sad rather than angry when recommendations aren't followed. Anger indicates that the physician believes, even subconsciously, that the patient has some responsibility to follow recommendations-a moral imperative, even. Noncompliance is interpreted as a personal insult to the physician rather than a decision about the patient's own health.
5in9years
I worry about the implications of "praying" with patients since there is no operational definition of praying, how to do it, what it does, what it's goal is etc. Surely there is no ethical breach to acknowledge a patient's desire to "pray" and to sit quietly as he or she engages in whatever it means to her or him to do so. But to "pray together" is confusing and has the potential to be misleading I am atheist but would sincerely accept my patient's request to share a period of silence if it were somehow therapeutic for her.
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