Religion and spirituality in medicine: friend or foe?

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In December 2019 I attended a symposium in the Vatican on religion and medical ethics, hosted by the World Innovation Summit for Health and the Pontifical Academy for Life. Among the speakers was an archbishop, the chief rabbi of Rome, and a Qatari scholar on Islamic ethics. The speakers presented their faith’s perspective on ethics and palliative care.

A panel session discussed whether there was any common ground among the Islamic, Christian, and Jewish approaches to palliative care. The answers noted dignity, compassion and humility, a God-centric world view, and the need to adopt a holistic approach to care that was sensitive to the patient’s spiritual needs. Such was the warmth created by the answers that it seemed quite inappropriate to ask the obvious follow-up question: “What are the differences or conflicts between your approaches?”

The reality is that differences exist even within each of the religions. Some Catholics have no objection to accepting painkillers at the end of life, and others see suffering as “redemptive,” granting a privileged union with God, whose only son, Jesus Christ, suffered on the cross for the sins of humanity. During a coffee break one delegate, a hospital chaplain, recounted how she was once asked to visit a Catholic sister who had refused analgesics on the ward. The sister explained that she was “offering it [the suffering] up” to God.

Variation also exists in the Islamic approach to the withdrawal of life sustaining treatments such as artificial nutrition and hydration, with some scholars deeming withdrawal of treatment forbidden in patients who are not brain dead, and others saying it is permissible if patients are dying. The variability of beliefs and practices within a single religion, let alone between faiths, is such that Christina Puchalski, a physician and expert in spirituality and health, recommended approaching each patient “as a culture of one.”

Tension can arise between a faith’s position on the morality of an intervention and the secular principle of non-maleficence, the duty not to cause net harm. What to do if a patient insists on life sustaining treatment for religious reasons when the doctors deem this harmful? If the doctors refuse to respect the patient’s request, how best to do so with minimum offence or damage to the relationship of trust between doctor and patient?

Further discussions gave concrete examples of spiritual issues affecting medical care. Over dinner, an Indian chaplain who regularly visited palliative care patients in the community recounted how some patients believed that their illness was a punishment by God and refused treatment. On the difficult subject of paediatric palliative care, Franca Benini, an intensive care physician, described how some children would ask, “Why has this happened to me? What have I done wrong?” She did not proffer an answer to these questions but noted the need for training on how to handle them.

Doctors have a non-absolute duty to respect patients’ religious views. They should listen to those views with an open mind and treat them with the utmost seriousness. As the physician and author William Osler wrote, you cannot treat patients as you do coal or corn.

Though in most cases the patient’s religious views should be respected, it is naive to think that religion and medicine can always coexist in harmony. A doctor should not provide treatment that confers no benefit or harms the patient, even if the request for treatment is based on religion. Religion may be profoundly important to some patients, but it is not a trump card that can force doctors to violate their own fundamental ethical values. In times of disagreement, a “spiritual care professional” such as a chaplain or imam with greater knowledge of a patient’s faith can help resolve tensions and reduce spiritual distress.