When Religion and Medicine Collide
It is complicated. Religion is a very sensitive topic that not a lot of people are willing to openly talk about. It is the beginning of many arguments not just in people from different backgrounds, but also within the family setting amongst family members who does not share the same beliefs. Religious and spiritual beliefs, or lack thereof, are very important in the lives of many patients, yet students in healthcare professions are often uncertain about whether, when, or how, to address issues concerning one’s religious beliefs and practices. Previously, students in healthcare professions were only trained to treat and diagnose a disease or an illness, and not treat the patient as a whole person. There was limited to no training in how to relate to the spiritual side of the patient, and how to go about treatment plans based on the patient’s culture and beliefs.
In this paper, I would not be discussing a specific religion. Instead, I would like to shed light to the patient-provider relationship. First, let us define what religion is. Religion is generally understood as a set of beliefs, rituals, and practices, usually a part of an institution or an organization. An individual can be spiritual and at the same time not be a part of a religious institution. Spirituality can be defined as “a belief system focusing on intangible elements that impart vitality and meaning to life’s events” (Maugans, 1996). According to adherents, an independent, non-religiously affiliated organization that monitors the number and size of the world’s religions, there are about 4,300 different religions on planet earth today (Juan, Stephen). According to Psychology Today, some experts estimate that there are about 30,000 versions of Christianity alone (Dietrich, Eric). Each of these religions follow their own set of rules of things and practices they are and they are not allowed to do. Religion and spiritual beliefs play an essential role for many patients. When diseases and illnesses threatens health, and possibly the life of an individual, he or she is likely to seek a physician with both physical symptoms and spiritual issues in mind. According to an article posted by Journey of Religion and Health, that through these two channels, religion and medicine, human beings grapple with common issues of suffering, loneliness, death, and despair, while continuously seeking for home and the meaning of life while in the crisis of illness (Vanderpool & Levin, 1990).
Many healthcare professionals have their anecdotal and intuitive impressions that the beliefs and religious practices of their patients have deep effects upon their empirical experiences with diseases and threat of mortality (Anandarajah 2001). When patients face the end of life stage or terminal illnesses, religious and spiritual factors often exhibits their coping mechanisms and influence important decisions such as advance directives, their living will, and the Durable Power of Attorney. Patients are also faced with the decision whether and when to forego life support and other desirability of CPR and other life extending support and accept death as it is (Puchalski, 2000). Patients’ spiritual beliefs and religious affiliations play an essential role in coping with serious illnesses and in making ethical decisions and their treatment options and in decisions in end-of-life care. Recent studies also conclude that patients caught between religious struggle often have a higher risk of mortality (Fortin 2004). In this case, medical providers need to inquire about their patient’s spirituality and religious beliefs and learn how these factors may help the patient cope with their current illness and conversely, when religious struggle indicates the need for referral to the chaplain. According to some healthcare professionals, it was only appropriate to discuss religion with their patients if patients brought it up.
A study of religious coping conducted in patients experiencing autologous stem cell transplants also concludes that religious struggle may affect the adverse changes in health outcomes for transplant patients (Sherman et al., 2009). In order to help patients work through these issues and ultimately improve clinical outcomes of these patients, referral to the hospital’s chaplain or clergy is necessary (Pargament et al., 2001). Today, the Joint Commission requires healthcare institutions to ensure that patients’ spiritual beliefs and practices are assessed, addressed, and accommodated (Joint Commission on the Accreditation of Healthcare Organizations, 2003).
Medical students are usually introduced to the concept of spiritual inquiry as a part of their school’s curriculum. These students get to learn the various components of provider-patient interview and assessment, usually opening with things such as the chief complaint, a specified history of the current illness, a psycho-social history which answers the questions about the patient’s religion and spirituality. Religion is an uncomfortable conversation to have with patients that is why plenty of medical students are hesitant to bring up the topic because religious and spiritual beliefs fall into that “personal” category that most people would like to avoid, these include sexual practices, alcohol consumption, use of tobacco, guns, and non-prescription medications (Handzo 2004). Patients facing serious illnesses or the end-of-life stage are often experiencing a crisis of meaning. Plenty of patients find comfort in their spiritual beliefs. This is why it is imperative for patients that their spiritual, cultural, religious beliefs, or lack thereof, be recognized, validated, and integrated in the development of their treatment plans and decisions that made that concerns end-of-life care. Respect for patient values and their religious beliefs requires competent and open communication skills in healthcare professionals.
There are several ways to approach this issue with respect. All we have to do is ask. Asking open ended questions may help healthcare professionals and patients to have a more open communication. For example, asking patients how important things like religion are in their ability to help them cope with their illness. If you are not comfortable approaching this orally, you can also try written forms. Include religion on one of your patients intake forms that new patients fill out when they visit their clinics. This is similar to taking patients’ sexual and health history because it helps the medical provider to come up with a treatment plan based on the patient’s lifestyle. Dr. Puchalski, a physician, developed the FICA Spiritual History Tool that serves as a guide for conversations in a clinical setting. Dr. Puchalski and other physicians have developed a series of questions specifically designed to lead a comfortable conversation with the patients about their spirituality and beliefs. FICA means: F – Faith and Belief – This question goes like this, “Do you consider yourself spiritual or religious?” If the patient responds with “No”, you can follow up by asking, “What gives your life meaning?”. This could expand the conversation which may help with your treatment plan. I -Importance – This determines how much of a consideration spirituality and religion is when it comes to healthcare with the question, “What importance does your faith or belief have in your life? What role do your beliefs play in regaining your health/strength?”. C – Community – This is where you find out if your patient has some support from the community or family. Does the patient have emotional support? – “Are you part of a spiritual or religious community?”. A – Address in Care – How does your religion affect your patient here and now. You can ask questions like, “How would you like me, your healthcare provider, to address religion in your healthcare and treatment plan?” (Puchalski 2001). By asking these questions, the patient will feel more comfortable and appreciated by their healthcare provider. It would mitigate any fear and anxiety they may have and they will feel listened to. Although, some patients are very comfortable expressing their religious beliefs and spirituality with most people they have an interaction with. The best thing to do is to listen. Develop a sensitive way to acknowledge, validate, and understand the patient’s perspective. Some patients may also request that you pray with them. Some medical providers do not mind doing this, but it can definitely make some uncomfortable. If you are uncomfortable doing this, it is best to be a silent participant or observer and refrain from leading the prayer. Basically, your patients just want to be heard especially if they have strong religious beliefs, they want to know that their medical provider has some sense of spirituality because it is comforting to them. It is imperative to be present—the patient wants to feel like there is another human being inside the examination room with them who understands their emotional side of the circumstances they are facing.
Today, as the world starts getting more diverse and open, students in the healthcare professions are often taught how to approach religion while providing care for their future patients. In D’Youville College alone, as a physician assistant student, we are required to take three semesters of religion and ethics classes, such as Challenges of Death, Religious Studies, and Bioethics, to better prepare us for the real world. In my Challenges of Death class, we covered the major religions in the world and discussed its different practices when it comes to end-of-life care and death stages, and try to integrate it to the medical setting to help us understand and respect our future patients. Even though I respect a people’s religious beliefs, I am completely against it when it becomes neglect. For example, the members of The Followers of Christ Church, a faith-healing sect with approximately 1,000 members, are known for this occurrence. Earlier this year, a religious Oregon couple pleaded guilty to criminal negligent homicide and criminal mistreatment, after their new born passed away from something preventable just because they did not believe in medical care and refused to seek help (Swenson, The Washington Post 2018). Preventable deaths like this one are constantly happening and I am happy that irresponsible parents can now be charged and get in trouble for allowing their child to die just because it contradicts their “beliefs”. I consider myself a religious person but I also believe in science. I believe God has blessed us with intelligence and skills so we can develop weapons like medicine, vaccines, and cure for things that threatens our mortality. Yes, if it is our time to perish, it is our time, but if we have the opportunity to extend it at least for a little bit, we should do so. There are plenty of preventable diseases that are spreading throughout the entire world right now because parents and some individuals refuse to take the necessary action to protect themselves, which endangers not only their own health but also the health of the people around them, especially those who are immunocompromised.
Healthcare professionals tend to neglect their own personal psychological and spiritual beliefs in order to provide what is best for their patients without biases and judgements. They refuse to have their personal opinions and views on certain things hinder their ability to heal and serve their patients. Healthcare professionals work in an intense and immensely stressful environment, and more often than not, exposed to the suffering and pain of other people and witness mortality in their own hands. We are told to not get emotional and avoid developing attachments to our patients so we can always decide what is best for them. Our own feelings do not matter anymore. When I started volunteering at a hospital, I was told by my supervisor to not get emotionally involved with any of my patients, which I think was difficult given that my main responsibility was to provide emotional support to my patients. I had patients who were going through the pain of chemotherapy as they battle cancer, and not have any support system around them. I stayed with one patient the entire time she was hospitalized and it was tough hindering my own emotions to participate. I also had patients with different religious beliefs than my own and I was able to do my job by being sensitive and respectful. When they are praying, I join silently to show solidarity and respect. My hospital never taught us how to deal with different religions so I had to learn everything as I go. Many hospitals expect their workers to not value their own emotions. However, I believe that being in this profession and what really makes a great medical provider, are those who are in touch with their own feelings and emotions and that which provides meaning and value within our own lives, while working and sacrificing ourselves in a profession dedicated to the care of others.