Sunday, April 17, 2016

Bringing the Best of Religion into Medicine

Yesterday I went to the funeral of my older daughter-in-law's mother. She was a much-loved person who was very active in her church. The beautiful Episcopal ceremony evoked her spirit with love and humor. The minister conducted the service in a spirit of inclusiveness and solidarity. The words from John 14:2 - "In my Father's house are many mansions" - were interpreted as reflecting love of all humanity, not as a promise to believers alone.

For me the service brought out what is best in religion. Three years ago I wrote that all liberal (i.e., inclusive) religions are comparably true and good and all fundamentalist (i.e., exclusive) religions are comparably false and bad. I continue to hold that view.

Even though I'm thoroughly in the secular humanist fold, over the years of medical practice I often found that religious language felt truer to the aims of clinical care than purely secular modes of expression. Here are four examples:

"Omniscient being." In all areas of medicine we often bump up against uncertainty. At times that my patient and I wished we knew what to do or what to expect, I might say something like "if we had access to an omniscient being, we wouldn't have to wonder about XYZ..." The concept of a god evoked our wish for the assistance that a benevolent god would give us, and at the same time, acknowledged our limitations.

"Blessing." Historically, to be "blessed" meant having god's favor. Our perfunctory"God Bless You" when someone sneezes goes back to pre-antibiotic days when sneezing might presage pneumonia and pneumonia could mean a rapid death. Even though I don't believe in a god who might intervene, comments like "let's hope that you will be blessed with better health" felt like a stronger expression of hope and possibility than they would with purely secular phraseology.

"Prayer." Many years ago, a patient of mine who conducted himself courageously despite significant impairment from chronic schizophrenia, ended an appointment by asking me to remember him in my prayers. Without thought or hesitation, I said I would. I took my patient to be requesting that I care about him deeply and feel for him  what I've written about as "the right kind of love between doctors and patients." Since I did feel that way about him I felt I was speaking truth in committing myself to remembering him in my prayers.

"Calling." In its original meaning, a "calling" came from god in the literal form of god's voice. The clinicians I respect most among physicians, nurses, social workers, and other health professionals ("profession" is another term that comes from a religious context) all think of health care as a "calling." Many religious clinicians understand the calling to health care as a call from god - literally, to do "god's work." But when I've used the concept of "calling" with first year medical students in the ethics class, it gets a mixed reception. For some it rings true. They feel "called" to a sacred profession, whether they're believers or not. But others have chided me for being too moralistic. For them, medicine is a "job." I don't try to talk them out of this view, but I do suggest that when they're with patients at the bedside, the "job" may be transformed into a "calling."

When my mother experienced the cerebral hemorrhage from which she died a few days later, the ambulance took her to a Catholic hospital. I was impressed and comforted by the spiritual wisdom of the care she and her small family (me and my father) received, especially from the nurses. And when I visited the Swami Vivekananda Hospital in Saragur, India, in 2009, I learned that twice a week they conducted a non-denominational prayer service for patients and staff. Religious language and "liberal" religious practice make superb partners for the enterprise of health care!


Anonymous said...

Another important function of religion in medicine is providing a moral compass. The rejection of this source of guidance may explain some of the pharmaceutical ethics problems about which you've recently written. Yesterday's NY Times story on the appearance of Valeant Pharmaceuticals' CEO Michael Pearson before a Senate committee quoted him as saying, “Let me state plainly that it was a mistake to pursue, and in hindsight I regret pursuing, transactions where a central premise was a planned increase in the prices of the medicines.” A quick read might miss the subtlety that is quickly apparent from a Judaeo-Christian perspective: Pearson seems to be expressing regret/remorse rather than repentance. The former simply means, "I'm sorry I got caught," whereas the latter implies that he recognizes that he did wrong and wants to change his behavior henceforth.

The Times goes on to report that "Senator Claire McCaskill of Missouri, the ranking Democrat on the committee, said the company’s policy was 'using patients as hostages. It’s immoral. It hurts real people and it makes Americans very, very angry.'" That statement implies that the Senator has a normative standard against which she is judging Mr. Pearson's conduct. I doubt that she would be satisfied if he could go back and do it over, with more subtle price increases that would not have drawn as much public attention.

Without a moral compass we are no better off than a ship in fog without any navigational guidance. Any mariner can tell you what is likely to happen to that vessel! Secular folks usually say that you should follow your conscience, but conscience can be programmed, as witness the Hitler Youth movement. To say that they were wrong implies an external standard that can't be adjusted to suit one's ideological bias or self-interest. As a senior who will soon enough find himself in the hands of physicians, I do hope they hold themselves responsible to an external standard of conduct.

Anonymous said...

After posting the previous comment, I saw another NYT article from mid-March titled "Pressure on Valeant Puts William Ackman’s Image as Moneymaker at Risk." Ackman's Pershing Square Capital was the largest investor in Valeant. Sadly, even after public display of the company's bad behavior, some of the investment professionals including Mr. Ackman seemed to think this would all blow over, and they were putting more money into Valeant to prop up plummeting stock prices! They apparently had NO sense of moral wrongdoing whatsoever!

Jim Sabin said...

Dear Anonymous

Thank you for your very thoughtful comments. I'll probably write a post later today or tomorrow that keys off of the Senate hearing. I agree with you that there's a lot to learn from it.

I agree that religion at its best can provide an admirable moral compass. Sadly, sometimes it's a source of zealotry, up to the point of being guided by the "pseudo-compass" of killing those who do not share one's dogma. I also agree with you that secular conscience can be misguided. I have personally experienced my career in health care as being part of a moral community that shares a calling. For some members of that community the "calling" or "compass" comes from their religious outlook. For others it's based on what I've been calling "secular humanism."

Using your term, I believe that a valid and admirable "external standard of conduct" can be derived from both religious and secular foundations. The organizations and cultures that we are part of can reinforce or undermine the "external standard." That's why I've made organizational ethics such a central focus for this blog.

Again, thank you for your thoughtful comments. And - good luck in your future interactions with physicians!