Religion at the bedside: Do doctors have a calling?
Religion at the bedside: Do doctors have a calling?
Beliefs can have an impact on recovery, studies find
A 1999 study published in the Archives of Inter-nal Medicine finds a significant benefit of "remote, intercessory prayer" in the treatment of patients admitted to a coronary care unit and recommends such prayer as an "useful adjunct" to standard medical care.1
But a similar study conducted by different researchers and published two years later in the journal Mayo Clinic Proceedings, reaches the opposite conclusion: "As delivered in this study," the authors wrote, "intercessory prayer had no significant effect on medical outcomes after hospitalization in a coronary care unit."2
That’s just the tip of the iceberg. According to the Handbook of Religion and Health (Oxford University Press, 2001) more than 1,500 published studies and review articles in the medical literature focus on the complex relationship between religion and health. Yet as with the studies mentioned above, researchers have reached vastly different conclusions about what role religion should play in patient care.
Some question link between religion, health
Now some experts are questioning whether emphasizing a link between religion and health is appropriate — and whether studies attempting to discern "evidence-based" support for specific religious activities may, in fact, do more harm than good.
"There is little empirical support for claims of health benefits deriving from religious involvement," wrote Richard P. Sloan, PhD, and Emilia Bagiella, PhD, in the February 2002 issue of Annals of Behavioral Medicine.3 "To suggest otherwise is inconsistent with the literature."
Sloan and Bagiella, colleagues at Columbia University in New York City, conducted an analysis of 266 journal articles published in the year 2000 dealing with the subject of religion. Most of the studies did not actually study the impact of religious beliefs, but the health impact of different practices associated with certain religions instead.
In addition, the authors claim, the studies that did attempt to examine the impact of spiritual beliefs had significant methodological flaws.
"There is just no solid evidence of a relationship between religious activity and health outcomes," Sloan, director of Columbia’s behavioral medicine program, tells Medical Ethics Advisor. "Religion shouldn’t be a part of medicine, except insofar as physicians need to understand all elements of the whole person. Religion is important to some patients, and physicians do need to know that."
Clinical studies have indeed shown that religious beliefs have an impact on health outcomes — both positively and negatively — and this impact is an appropriate area of study, counters Harold G. Koenig, MD, associate professor of psychiatry and associate professor of internal medicine at Duke University Medical Center in Durham, NC, and a co-author of the Handbook on Religion and Health.
Koenig’s research has linked religious activities in elderly patients to lower blood pressure rates, improve immune function, and speed recovery from depression. However, other studies have indicated that certain religious beliefs can have negative consequences for patients, he says.
"We published a paper in last year’s Archives of Internal Medicine4 showing that certain religious beliefs — feeling punished by God or feeling deserted, not loved by God or deserted by one’s religious community — actually increases mortality over a two-year period," he says. "Those beliefs predicted mortality independent of mental health or physical health."
Koenig makes a careful distinction between his studies and those that attempt to prove "that God exists," he says.
"Prayer is being studied in two very differ-7ent manners," he explains. "One kind of study involves intercessory prayer studies that are double-blinded — people don’t know who they are praying for, and the people who are being prayed for don’t know who is praying for them. That is not based on any scientific model, nor is it based on any theological model. That way of trying to specifically prove the supernatural, is not very helpful in my estimation."
Religion a very, very powerful force’
But studies that examine the psychological and social aspects of how praying influences a person’s well-being and recovery are important, Koenig says. "Religion is a very, very powerful force in people’s lives."
What he and other researchers are trying to understand, he explains, is how prayer and other religious activities affect people’s lives and how this might affect their medical condition and healing.
"We want to understand if people pray for others, and those others know about it, does this make a difference in the lives of those who are doing the praying and those who are being prayed for?" Koenig asks. "I think that kind of research is valid, both in terms of science and theology."
Religion and spirituality do play a major role in the lives of many people, agrees Sloan. And physicians do have a responsibility to learn about their patients’ religious beliefs and take those beliefs into account when advising them on treatment decisions, he adds. But physicians should draw the line at attempting to make specific recommendations to their patients about spiritual practices, he says.
"There are some significant ethical problems associated with bringing religion into medicine," he says. "One of which is coercion. If religion is associated with better health, how do you account for the fact that lots of people are sick? Well then, it must mean that they are insufficiently devout or faithful. That is an awful thing to say to a patient, You just haven’t prayed enough or gone to church enough, or you wouldn’t be sick.’"
That’s the message that can be conveyed when a caregiver tries to impose certain religious beliefs or practices on patients who may not be religious or who may practice a different religion, he says.
"Then, there is an issue of privacy because, for many people, religion is a personal and private matter, not grist for the physician’s mill," he adds.
Physicians should know how to ask questions about a patient’s beliefs and values and use that information to help them make decisions that are consistent with those beliefs, notes Koenig.
"The effort has to be patient-centered," he says. "The main intervention is just taking a spiritual history and learning a little bit about the religious beliefs of the patient and how they might influence the situation. How those beliefs help that person to cope and whether that is a resource or whether it is a liability — because it can be a liability for some patients."
If patients are struggling with questions of faith and how it relates to their medical condition, the care providers need to help them address those issues, he says.
"People struggle with this, they ask, Why me?’" Koenig says. "What did I do wrong? Am I being punished for my sins?’ People need to resolve that. But sometimes they don’t. They get angry and have this spiritual turmoil that no one addresses, and it probably interferes with immune function and healing."
Physicians do have some responsibility to see that these issues are addressed, says Sloan, but should be wary of assuming this duty themselves.
If a patient were to ask Sloan a question related to his or her religious faith, he would feel most comfortable referring them to a member of their clergy or a healthcare chaplain, he says.
"Physicians should not feel that they must always have the answers to everything," he states. "Certainly, physicians make referrals in other areas of medicine when they lack expertise. I think it shows a lot of respect for a person’s beliefs, by not introducing your own belief system and interposing your own beliefs on that person."
References
1. Harris WS, Gowda M, Kolb JW, et al. A randomized, controlled trial of the effects of remote, intercessory prayer on outcomes in patients admitted to the coronary care unit. Arch Intern Med 1999; 159:2,273-2,278.
2. Aviles JM, Whelan SE, Hernke DA, et al. Intercessory prayer and cardiovascular disease progression in a coronary care unit population: A randomized controlled trial. Mayo Clin Proc 2001; 76:1,192-1,198.
3. Sloan RP, Bagiella E. Claims about religious involvement and health outcomes. Ann Behav Med 2002; 24:22-24.
4. Pargament KI, Koenig HG, Tarakeshwar N, et al. Religious struggle as a predictor of mortality among medically ill elderly patients: A two-year longitudinal study. Arch Intern Med 2001; 161:1,881-1,885.
Suggested reading
• Koenig HG, McCullough ME, Larson DB. Handbook of Religion and Health. New York City: Oxford University Press; 2001.
• Koenig HG. Spirituality in Patient Care: Why, How, When and What. Chicago: Templeton Foundation Press; 2002.
• Sloan RP, Bagiella E. Spirituality and medical practice: A look at the evidence. Am Fam Phys 2001; 63:33-34.
• Sloan RP, Bagiella E, Powell T. Religion, spirituality, and medicine. Lancet 1999; 353:664-667.
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