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RESPECTFUL curiosity better equips health professionals to deal with issues arising from patients’ religious beliefs than does an in-depth knowledge of the world’s religions, according to an Australian psychiatrist and expert in medical ethics.
Dr Chris Ryan, of the University of Sydney and honorary associate of the Centre for Values, Ethics and the Law in Medicine, said there were risks in presuming anything about a patient on the basis of their religion.
He was responding to an article in The Lancet on faith-based controversies in health care, which said doctors should “become better informed about the faith drivers that affect their patient’s attitudes, prejudices, behaviours, response to illness, and desire for health-care services if they are to provide professional, compassionate, and empathetic care respecting a patient’s autonomous wishes”. (1)
The article acknowledged that religious people’s views on health issues “might be substantially modified by culture, education, economics, politics, and laws”.
Dr Ryan said the more someone’s life was embedded in their religion, the more that would impact on the way any illness expressed itself, and on treatment the patient might, or might not, accept. For example, he said that some Jehovah’s Witnesses didn’t want blood products, some were concerned about different types of blood products and some weren’t fussed at all.
The best way for health professionals to handle patient beliefs was through a “respectful curiosity”, Dr Ryan said. He rejected the idea that being better informed about “faith drivers” would improve their ability to understand and respect patients’ wishes.
“There seems to be a suggestion [in the article] that if you could find out what pigeon hole the patient was in, you would know what their beliefs are. But you can’t make assumptions about people’s beliefs … People are much more complicated than that. You always have to speak to people and ask them.”
Dr Ryan has worked for 20 years in multicultural western Sydney, where “there are a lot of different religions and cultures and I can’t stay on top of them”.
“The issue really is the person”, he said.
Dr David Hunter, associate professor of medical ethics at Flinders University, agreed that understanding a patient’s religion did not equip doctors to know what patients believed. Complicating the issue was that many patients held firm non-religious beliefs, such as vegetarianism, that could be just as significant as religion in a health care setting.
“I’m a vegetarian and I prefer my medication to not involve animals, if possible. I’m less likely to say yes to a course of treatment, if my problem isn’t particularly serious, if it involves some harm to an animal. Vegans would take this more seriously still”, Dr Hunter said.
“It’s important to the therapeutic relationship to take the things that the patient considers to be serious, as serious”, he said, adding that it was the patient’s prerogative to raise those issues.
Dr Hunter said that as a sperm donor, he had experience of what can occur when health professionals took it upon themselves to learn about a religion or culture and make assumptions. He said he was one-eighth Cook Island Maori and some people from this background want all human tissue returned to them so they can have it buried appropriately.
During a compulsory counselling session on donating sperm, it became clear his counsellor understood this. She asked Dr Hunter how he wanted any unused sperm disposed of, “because your people often want the sperm to be returned’’.
Dr Hunter said he was taken aback by that “bizarre suggestion”.
“It’s not a belief that I have myself, but because she knew this bit about my cultural background she made assumptions about me that really weren’t correct. That’s part of the reason I think it’s better if cultural and religious issues are raised by the patient. They know what is important for them in a way that you won’t understand from a particular label.”
Associate Professor Richard Hutch, research consultant at the School of Historical and Philosophical Inquiry at the University of Queensland, said there was little value in getting caught up in the “argy bargy” of what stance specific religions took on controversial health issues.
He said discussions of faith commitment could get in the way of doctors “delivering, in an empathetic way, scientific diagnoses for patients”.
“Patients need to be diagnosed and treated properly in terms of modern science, without neglecting their human spirituality”, Dr Hutch said. “The canned rhetoric [patients] may appropriate from their religious tradition — for example, ‘I have cancer because I am a sinner and only if I accept Jesus Christ will I be healed’ — is beside the point and for the church, not the clinic.”
Health professionals were better focused on learning about the most powerful experiences that had occurred in a patient’s life — both highs and lows — as these were at the core of people’s identity, values and spirituality.
(Photo: 66North / iStock)
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Religious belief is self evidently one aspect of a patient’s experience which may or may not inform the clinical understanding of the physician. On the other hand the patient’s spiritual situation (not the same as religious belief) is inevitably a factor in either the causation or resolution of their illness. Unfortunately most doctors are unable or unsuited to understanding the place that spiritual wellbeing (or lack thereof) plays in the genesis of disease. This lacuna of knowledge inevitably leads to incomplete diagnosis and therapy. The current scientific basis of medicine seems to be insufficiently flexible or discerning to develop understanding in this area. The consequence is a poor outlook for holistic diagnosis and treatment.