When — if ever — is prayer with patients unethical?
When — if ever — is prayer with patients unethical?
Is it ethical for a physician to pray with a patient? The question that should be asked instead is, "On what grounds would praying with a patient be ethically problematic?" according to Farr A. Curlin, MD, co-director of the Program on Medicine and Religion and associate professor of medicine at The University of Chicago's MacLean Center for Clinical Medical Ethics.
Shared prayer between a physician and patient is not a medical technique or a clinical intervention, he explains. "Properly understood, it is a response of a patient and at times, a physician, to the difficult situation the patient is in," says Curlin. "It is a very human interaction, one we would not imagine forbidding in almost any other human relationship."
Insofar as the interaction is voluntary and respectful, and not manipulative, then it is permissible, argues Curlin, adding that doctors have probably been praying with patients as long as doctors have been seeing patients.
"It is only recently that people started talking about prayer as an ethical issue," he says. "Questions have been raised as to whether prayer is incompatible with, or in tension with, physicians' professional roles."
Curlin adds it would be unethical for a physician to suggest that the prayer promises a benefit that the physician cannot guarantee, or to pray with someone without their permission.
Patients appreciative
In 2006, The University of Chicago's general internal medicine service surveyed inpatients about their religious and spiritual needs and found that less than 10% had religious or spiritual discussions with their physician, and only half of patients who wanted to have this type of discussion experienced it.1
"It is not as if there is an epidemic of too many doctors praying with patients. There is no evidence that prayer is happening very often," says Curlin. "It seems odd to put our focus on reducing the incidence of these already rare interactions to which few patients object."
Although few physicians pray with patients unless the patient brings it up, Curlin says, he doesn't see any reason why doctors cannot offer to pray with patients if they do so in a respectful way. The University of Chicago survey revealed that high patient satisfaction was linked to discussing religious and spiritual issues, even when the discussions had not been requested by the patient.
Ethical concerns about physicians praying with patients stem from medicine being thought of as a merely technical practice, where physicians are skilled providers of health care services with strict boundaries around the kind of interactions they have with patients, says Curlin.
"Some people think that a physician should limit their interactions with patients to dialogue about what technical options are available for patients and which one the patient wants," he says.
There is absolutely nothing illegal in any jurisdiction about a physician praying with a patient, adds Curlin, and no ethical norm that says this should be prohibited. Both patients and physicians, in the context of a patient's illness, reasonably recognize that the amount of control they have is quite limited, he says.
"It's a natural human response to turn to prayer in that situation," he says. To put an undue constraint on physicians just to prevent the possibility of offense to a small minority of patients doesn't make sense, he says, particularly when this risk can be mitigated with an appropriate approach.
"If people are putting pressure on health care workers to not pray with patients, they are focusing their efforts in the wrong places," Curlin says. "The last thing we need at this point in American health care is for physicians to have less human interaction with patients."
References
- Williams JA, Meltzer D, Arora V, et al. Attention to inpatients' religious and spiritual concerns: Predictors and association with patient satisfaction. J Gen Int Med 2011;26:1265-1271.
Sources
- Ralph C. Ciampa, STM, Director, Department of Pastoral Care and Education, University of Pennsylvania, Philadelphia. Phone: (215) 662-2591. Email: [email protected].
- Farr A. Curlin, MD, Associate Professor of Medicine, MacLean Center for Clinical Medical Ethics, The University of Chicago. Phone: (773) 834-9178. Email: [email protected].
- Dan Finkelstein, MD, Core Faculty, Johns Hopkins Berman Institute of Bioethics and professor, Wilmer Eye Institute. Phone: (410) 955-3429. Email: [email protected].
Spiritual discussions: Patient values are key Sensitive care has a spiritual quality that should be nurtured by all helping professionals, but more explicit interactions like prayer should be approached very carefully, cautions Ralph C. Ciampa, STM, director of the Department of Pastoral Care and Education at the University of Pennsylvania in Philadelphia. This is mainly due to the inherent power imbalance in helping relationships, and the danger of subtle coercion, he explains. "However, I have seen situations where the relationship had developed to a point of mutual understanding and trust that more explicit sharing of a spiritual component could be appropriate," says Ciampa. Physicians should pay more attention to the possibility of praying with patients, argues Dan Finkelstein, MD, core faculty at the Johns Hopkins Berman Institute of Bioethics and professor at the Wilmer Eye Institute at Johns Hopkins, both in Baltimore, MD. "A physician's calling is to cure a disease first. If one cannot cure the disease, one wants to heal whatever suffering might be there," he says. Of 124 ophthalmology patients surveyed at Johns Hopkins, 82.3% reported that prayer was important to their sense of well-being, and 45.2% reported weekly attendance at religious services.1 Finkelstein says this reflects the percentages he sees in his own practice, and underscores the importance of physicians asking the question, "Are you a spiritual person?" "If I find out that a patient goes to church or synagogue, and I know that they are suffering, I might say, 'Shall we pray together? Or, if you would like to pray, let me listen to your prayer,'" he says. Physicians don't ask the question because they aren't trained to do this, it's not something that is reimbursable, and it takes some time, says Finkelstein. "Physicians who are unsure in their own spirituality would have difficulty with the conversation," he says. "But we know a lot of patients would want it."1 Part of taking care of the patient is to know the patient, and spirituality is part of knowing the patient, Finkelstein says. "A physician may know a great deal about the patient and their family, but doesn't happen to know about their spirituality," he says. "It is an important area that is often overlooked." Reference
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Is it ethical for a physician to pray with a patient? The question that should be asked instead is, "On what grounds would praying with a patient be ethically problematic?"
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