By Timothy N. Gorski
Posted: Wednesday, March 1, 2000

ARTICLES
Publication Date: March 1, 2000

Religious and spiritual concerns have traditionally been in the background in American healthcare, which has relied largely on medical science for guidance. But the medical subordination of such concerns has never given health professionals or healthcare administrators in the United States license to belittle or ignore religious beliefs and practices, which are integral to many persons' sense of well-being. More to the point, it has never meant that patients could not turn to religious practices, or to clerics, for comfort as adjuncts to medical care. Importantly, it has facilitated health professionals' maintaining detachment from patients' religious and private spiritual matters.

This is as it should be, in light of how subjective religious opinions are, how deep-rooted they can be, and their extraordinary diversity in the U.S. If religious and spiritual concerns became more influential in medicine, effective, ethical, compassionate healthcare would suffer. Incorporating religion with medicine would be inconsistent with major ideals of the medical profession:

Objectivity

A substantial increase in religion's influence on healthcare would result in a decrease in objectivity and impartiality among medical professionals.

Religious nonpartisanship

How can healthcare practitioners actively support their patients' diverse religious beliefs and practices without hypocrisy; without offending patients who do not subscribe to certain of such beliefs; and without offending atheists, agnostics, and religious nonaffiliates, who together constitute a significant proportion of the American population?

Unless American healthcare becomes balkanized on the basis of religious creeds, a substantial increase in religion's influence on medicine would lead to hypocrisy, factionalism, and partisanship within hospitals and clinics.

In no interfaith, nondenominational, or multicultural healthcare setting can a medical professional exhibit an appeal to Allah without diminishing non-Islamic mainstream religious principles. It is likewise impossible to pray conspicuously to the Virgin Mary or to Roman Catholic saints without encroaching on Protestant beliefs. Many Christians regard even spiritual practices that are neo-Christian, nondenominational, and/or eclectic—particularly those associated with the New Age movement—as harmful, if not devil-inspired. Allegiance to ecclesiastic principles has led to calls for boycotts against Disney and even the U.S. military. Un-less American healthcare becomes balkanized on the basis of religious creeds, a substantial increase in religion's influence on medicine would lead to hypocrisy, factionalism, and partisanship within hospitals and clinics.

Those who doubt that increasing religion's influence in healthcare would be divisive can easily rid themselves of such doubt, by becoming informed of recent events in which the intersection of religion and medicine has been crucial—for example, the firing of a physician based on his having submitted a letter to a local newspaper editor that conveyed views his employer described as contrary to fundamental Roman Catholic teachings; the scuttling of hospital-merger plans because of religious orders' steadfast demands concerning what medical services are ecclesiastically acceptable; and clashes over "assisted reproduction," abortion, euthanasia, and other issues on which there is no universal religious consensus. Indeed, the prospect of the spiritualizing of healthcare is appealing only to the extent that one associates such expressions as "religion" and "spirituality" with one's subjective religious and spiritual beliefs.

Even incontrovertible proof that churchgoers are healthier and more long-lived would hardly constitute a sound basis for the contention that churchgoing per se is responsible for these advantages.

Nonmaleficence and beneficence

Health professionals have a dual responsibility to their patients: to "do no harm" (nonmaleficence) and to act according to the best interests of each patient (beneficence). Both whether religion can improve health and what risks religion may entail are far from determined. Incorporating religion with medicine raises serious questions of medical ethics.

For example, although it appears that churchgoers tend to be healthier and more long-lived than nonchurchgoers, even incontrovertible proof that churchgoers are healthier and more long-lived would hardly constitute a sound basis for the contention that churchgoing per se is responsible for these advantages. The association apparently does not depend on what church is attended. Thus, social connectedness may be at least partly responsible for it. And healthier segments of the American population—e.g., the married, the occupationally satisfied, and the prominent—may tend to be more socially connected. Moreover, perhaps individuals who are healthy and socially well connected are more disposed to churchgoing than are unhealthy, poorly socially connected persons. Therefore, churchgoers may attend religious services partly because they are relatively healthy and partly because they are well connected socially. On the other hand, many of the reasons religiously nonobservant persons have for this nonobservance—for example, familial religious discord—may be such that churchgoing would be unhealthful for them.

It is very likely that an expansion of the role of religion in healthcare would not humanize medical care but rather would erode, perhaps even devastate, the physician-patient relationship . . . .

Until such questions of causality and contraindications are answered scientifically—if they can be—it is dangerous and ethically unacceptable for healthcare practitioners to counsel patients on spiritual matters. And it might well be so even if such questions were properly and exhaustively answered. For example, would scientific research establishing that believing in Allah is more therapeutic than is believing in Buddha, Yahweh, Jesus, or the Hindu pantheon constitute adequate grounds for medical professionals' promoting Islam to patients over religions associated with the other alleged divine spirits? Furthermore, would scientifically establishing that undergoing a crisis of religious doubt carries serious health risks make it appropriate to deal with such doubt as pathologic and medically remediable? And if it were appropriate, could medical professionals credibly claim an objective understanding of what is best for patients concerning religion?

Patients' autonomy

Increasing religion's influence in healthcare would diminish the autonomy of patients. It is incumbent on physicians to know the health advantages and health risks to individual patients of each of numerous validated interventions, and to be prepared to convey such information intelligibly to pa-tients so that the patients can make informed decisions. In matters of religion, however, a hands-off policy should continue to prevail among health professionals, except when the potential health consequences of particular religious behaviors are clear-cut and adverse to the patient—for example, a patient's refusal of a blood transfusion without which he or she would die, or parents' rejection of critical medical care for their underage children.

When the prospective health consequences of particular religious behaviors are not clear-cut, and when they are not adverse to the patient, the religious views and spiritual suggestions of medical professionals are extraneous. Indeed, expressions of such opinions may be unwelcome and, even if they are welcome initially, may introduce coercion into the physician-patient relationship. It is out of a respect for patients' autonomy that the rule of nonjudgmental noninterference has been established for such eventualities as certain nonreligious cultural practices, unusual sex acts, childbearing in various hazardous circumstances (e.g., of the patient's making), and even, to some degree, "recreational drug use." It is ironic that in such cases medical professionals respect individuals' lifestyle choices, for good or ill, as an ethical obligation, while it is seriously and widely proposed that such professionals should urge their patients to pray, attend religious services, and embrace various supernatural beliefs. Aren't religion and spirituality at least as intimate as sexuality, the instinct to reproduce, and nonreligious cultural aspects of personality?

Humanism

Biomedicine is rooted both in science and in humanism—a philosophy that promotes, for example, not only consideration for the sick and understanding and tolerance of religious beliefs and practices in general, but also ac-ceptance of the rights of conscience of nonreligious persons. Consistency with this long-standing aspect of modern medicine requires that healthcare professionals distance themselves from any purely religious issues that may arise in the context of their duties; it certainly demands that such professionals forbear from promoting and/or challenging religious beliefs, whatever their patients may want in the way of medico-spiritual counseling.

It is very likely that an expansion of the role of religion in healthcare would not humanize medical care but rather would erode, perhaps even devastate, the physician-patient relationship, which has always been the cornerstone of compassionate medical care. A 1999 edition of the Texan paper The Arlington Morning News quoted a hometown girl who had recently graduated high school: "I want to be a pediatric surgeon because I really love little kids, and if you work on little kids and they die, then you at least know they will go to heaven since they haven't had time to do anything wrong in their life." The sentiments behind this statement were undoubtedly innocent—but would such an expression comfort parents with a desperately ill child being prepped for surgery? And suppose the parents' afterlife-related beliefs differ markedly from those that the surgeon's statements suggest.

There are many other risks—subtler than those of diminishing patients' autonomy and privacy—inherent in the encroachment of religion on medicine. For example, how would the role of clergy change? How would relationships change in interfaith households and among friends of different theologies? The effects would be unpredictable and, especially in cases of grave illness, could be perilous. If healthcare professionals—who themselves have disparate religious, antireligious, and secular philosophies—were constrained to incorporate religion and spirituality in their practices, certainly they would do so differently, and with scarce scientific grounds for such disparities. Healthcare practitioners simply have no right to influence directly and deliberately the spiritual aspects of patients' lives.

In healthcare there are numerous occasions for misunderstandings that can undermine the often fragile physician-patient relationship. A physician's mispronouncing a patient's name, addressing a patient by the wrong name, or momentarily forgetting what a patient has just said, for example, can alone put a dent in their relationship. Physicians' spiritually pontificating, sermonizing, or even just neutrally broaching specific religious concepts can only make matters worse. For instance, how might a patient—particularly a religious non-Christian patient—react if a physician asked him or her: "Have you accepted Jesus Christ as your personal savior?"

Traditionally, recourse to religion or to spiritual practices has figured in biomedical settings in developed countries only in cases of grave, in-tractable, or incurable illness. But many formerly grave, intractable, or incurable diseases are very treatable; and it is because those ostensible explanations and remedies that were religious did not satisfy medical professionals that there has been progress against formerly untreatable diseases.

By distancing itself somewhat from religion and spiritual concerns, American healthcare avoids stepping on spiritual and other toes. Incorporating religion with medicine would ultimately please no one. Unions of religious and governmental bodies have long tended to be calamitous. There is no good reason to believe that expanding American healthcare's religious or spiritual features would have different results.

Gynecologist Timothy N. Gorski, M.D., is President of the Dallas/Fort Worth Council Against Health Fraud.

Source Notes:  
Priorities Volume 12 Number 1 2000