Practice recommendations
- For the faithful, a secularist approach to “generic religion” is of little value; the value of religious belief lies precisely in its particularity (C).
- For the devout, no dimension of life is unaffected by religious beliefs (C).
- Even when physician and patient speak from religiously discordant perspectives, the physician can compassionately and sensitively engage the patient on the patient’s terms, rather than forcing the patient to address difficult questions within a foreign moral framework (C).
- An enriched dialectic will enable sensitive and appropriate care for religiously devout patients, ensuring that their concerns are addressed more than superficially (C).
As I walked toward the elevators at the end of a her bed, staring blankly into the hall. Like many on the oncology floor, she had lost her hair. I waved at her. She nodded. I took a few steps into her room. long call night, I saw a patient sitting on the edge of
I introduced myself; she told me her name—Julie. I asked Julie how she was feeling. “I’m trying to make a decision,” she said, choking back emotion. She explained she was trying to decide whether to allow placement of a permanent chest tube to drain her recurrent pleural effusion.
“I don’t know if I can take it any more,” Julie said. “I’ve been through too much.” She knew she was dying and was reluctant to endure another painful procedure.
As a medical student, I could not offer her advice. But I hoped my presence would be a comfort. We talked about her life, her work, her interests, and her family (she was alone in the city). As we talked, she reminisced, joked, and cried about the experiences that had enriched her life. On my way out, I told her that I would be praying for her—and she broke into tears. “Can you pray with me?” she asked.
A changing landscape
For years, the medical profession has witnessed a growing interest in all things spiritual. A recent increase in scholarly attention to spirituality in medicine reflects the larger trend in the culture. (“Principles to make a spiritual assessment work in your practice,”) Yet this renewed interest in faith is not without caveats.
Scientific misunderstanding of faith
Empirical studies of the salutary effects of faith on everything from the immune system to recovery from surgery has, not surprisingly, elevated religion’s effects over its claims, contributing to widespread support of what theologians Shuman and Meador call a “generic religion." (“Allowing spirituality into the healing process,”)
Spirituality ignored diminishes medical encounter
Suffering has a way of pointing patients toward the transcendent, and the discussions that accompany this inner process require a vocabulary beyond that of physiology and pathology. The artificial neutrality of enforced secularism inevitably leads to a discussion that is conceptually impoverished, lacking the language to address the existential questions of suffering in ways that are meaningful to the patient. By honestly sharing their own experiences and perspectives, and sensitively inquiring about the patient’s worldview, physicians can raise the level of discussion and create a powerful experience of shared humanity.
This enriched dialectic will enable sensitive and appropriate care for religiously devout patients, ensuring that their concerns are addressed more than superficially. In this way, the clinical encounter will be defined neither by the bland commendation of a generic religion for its salutary effects, nor by the enforced secularism of modernity, but by the contextualization of a patient’s illness against the particularities of her life commitments. When a Muslim with diabetes inquires about fasting during Ramadan, when a Catholic grandfather speaks of divine healing of his cancer, and when a Buddhist teenager explains the role that ulcerative colitis has played in her spiritual development, the relationship between physician and patient will deepen, transforming the medical encounter into an “interhuman event.”23
Ackowledgments
We are indebted to Daniel Hall for his careful review of this manuscript and to Bobbie Sweitzer for her thoughtful critique of these ideas.
Corresponding author
Peter P. Moschovis, 1700 E. 56th St., #3010, Chicago, IL 60637. E-mail:peterm@uchicago.edu