Should Religion Play a Role in the Practice of Medicine?

Lorell LaBoube

Should religion play a role in the practice of medicine? That's the question for this edition of the Bioethics Channel, a production of the Center for Practical Bioethics. For more information about the Center and its programs, visit practicalbioethics.org. That's practicalbioethics.org. Our guests hail from the University of Chicago, where Dr. Farr Curlin is an assistant professor of medicine. Dr. John Lantos is professor of pediatrics and bioethics. at the University of Chicago, and he is also the John B. Francis Chair in Bioethics at the Center for Practical Bioethics. Both of you have conducted research and written extensively on the issue of religion and medicine. Dr. Curlin, what prompted you to begin studying to this area?

Dr. Farr Curlin

Well, I came to medicine as a religious believer interested in, as a Christian, interested in understanding how the Christian faith and tradition and its teachings informs the practice of medicine. So I was interested in the topic in an intrinsic way from the beginning. As I went through training, it struck me that there were not many venues in which we could consider why we practiced as we do. And then among those venues, a few in which you would hear people refer to the ideas that seemed to animate what they did, which were the ideas that they learned from their religious traditions in many cases.

Lorell LaBoube

So you've done some research on this. What is the research found so far?

Dr. Farr Curlin

Well, we found that certainly doctors' religious characteristics seem to account for a substantial amount of the differences in the way they practice in particular areas of medicine. I think the... What's not surprising is that if you look at areas of overt moral controversy in the broader public, sexual and reproductive health care, end-of-life care, controversial areas, we find that the disagreements track more heavily onto differences in religious characteristics than they seem to track onto most anything else.

Lorell LaBoube

Dr. Lantos, from your research, have you found any consensus within the medical community on the issue of religion in the practice of

Dr. John Lantos

medicine? Consensus would be too strong a word, although there are certain things about which the vast majority of doctors agree. For example, most doctors think that patients should be informed about something like birth control or abortion. A small minority, mostly the highly religious older male physicians. hold to a different standard and think that some of these topics shouldn't be discussed and patients shouldn't even be informed of the availability of treatment options. So consensus, I think, might be an unreachable goal, but widespread agreement among the large majority is seen in many of these issues.

Lorell LaBoube

Well, you've touched on it. Go ahead,

Dr. Farr Curlin

Dr. Curlin. I think another area, I think John's right in what he said, is Another area of consensus, although it's a very limited one, is that there's agreement that religion seems to matter to a lot of people and seems to matter particularly in the context of illness and in the face of potentially loss of health or even loss of life. And so the profession has a sense that we ought to at least pay attention to this issue, but where the... the disagreement starts to develop is any further than that. And the question is, what does the doctor do? How does the doctor interact with, relate to, respond to patients' spiritual, religious concerns? What are the boundaries of that role? And then, of course, the deep disagreements about the extent to which a doctor's own religious commitments should inform or shape or... define the things that he or she is willing to do and not to do.

Lorell LaBoube

And that's really something in a day-to-day practice kind of a mold, right, Dr. Lantos?

Dr. John Lantos

One of the other interesting things we found in our surveys is that the population, the group of doctors in the United States, are much more religiously diverse than the patients. So there are many more Hindu doctors, there are many more Muslim doctors than there are Hindus and Muslims in the population. So one of the issues that comes up when a doctor from any religious background thinks about the role of religion in their practice of medicine is, does their patient share their religious beliefs and their religious traditions? When they do, it leads to one set of understandings about a doctor-patient relationship so that an Orthodox Jewish doctor taking care of an Orthodox Jewish patient or a Muslim doctor taking care of a Muslim patient might be able to do things because of that shared religious understanding that people could not do across religious understandings.

Lorell LaBoube

Well, I think it might be safe to say that prayer is something that cuts across all religious traditions or pretty close. So my question is, Dr. Curlin, should a physician offer to pray with a patient or if a patient asked for a doctor to pray with him or her, should they?

Dr. Farr Curlin

Great question. Prayer does cut across virtually all religious traditions, but, of course, prayer is a response to and appeal to a deity, to God, however understood and differently understood among different traditions. So it's not straightforward that one person's prayer is recognized by another as being the sort of prayer that they would join in. This has been a controversial topic. I think that it is an area in which doctors should exercise discernment, caution, respect, but it's an area in which there should be freedom. I mean, prayer is, I think of it in the Christian tradition, is at its most basic, it's a sort of a recognition of our profound need for God, our dependence on one, not ourselves. And when a physician, If a physician and a patient have enough either trust for one another or familiarity with one another that the patient seems to suggest that they want the physician to pray and the physician's comfortable doing so, I don't think we should try to draw some sort of... clear rule that says that's out of the doctor's scope of practice.

Dr. John Lantos

One of the interesting phenomenon we found, Far and I were in a workshop once at the University of Chicago, and we asked all the doctors who were gathered, how often do your patients bring up religion when you're seeing them in the office? And we went around the table, and some people said, all the time. All my patients bring it up. Some people said, never. And it turned out what it meant to bring up religion was itself something that required interpretation. How do

Lorell LaBoube

you define that?

Dr. John Lantos

So for me, if a patient comes into the room carrying a Bible, they are bringing up religion. If when they leave, they say, have a blessed day, they're bringing up religion. For other people, they're carrying a book and they're leaving with a greeting.

Dr. Farr Curlin

And to sort of... build on what John's describing in our data that we collected, we found that religious doctors, if you control for where they practice, the sorts of patients they practice with, their specialty, their age, their gender, every other characteristic we could control for, religious doctors are more likely to report that their patients frequently bring these issues up. So I think part of what's going on is that you are, if you're religiously formed in your antenna is up in a way for these cues. And you probably see things that other people would miss or maybe see things that aren't even there potentially. But that's something we found from our research.

Lorell LaBoube

So if a doctor or a patient is in a particular part of the country or they grew up in a particular part of the country, they're more likely to bring religion into the interaction?

Dr. Farr Curlin

Absolutely. We found that, not surprisingly, the southeast was the area in which Doctors were most likely to report that patients bring up religious and spiritual concerns. But wherever the doctors are, if the doctors are more religious, on average, they're more likely to say their patients bring these things up, which also raises the question of whether, in ways that are not fully explicit, doctors and patients are associating themselves together, at least to some extent, based on what they know of the doctor's religious beliefs.

Dr. John Lantos

Sure. I think there are some patients who really want their doctor to pray with them.

Dr. Farr Curlin

Mm-hmm.

Dr. John Lantos

they may be shopping for doctors by dropping little cues that say, in subtle ways, I'm a religious person. And if the doctor doesn't respond, they may go find another doctor.

Lorell LaBoube

Now let's get to the question of if a patient requests a procedure or a medication that you as a physician believes is morally wrong, what should you do? Is that when we get into the issue of conscience-based medicine?

Dr. Farr Curlin

Yes, yes. So there's a... an important set of questions that go under the umbrella of conscience and conscientious refusals is probably the most accurate term to use, which is the situation in which a patient requests something that's legal. I don't think it's controversial for doctors to refuse things that are illegal, but it's a legal procedure or practice, and the doctor believes that to participate in providing that would be to do something that's unethical. And

Dr. Farr Curlin

what I think is that what we have to define there is what are those practices that are really intrinsic to being a good physician in a particular area. And obviously that's going to be an area of dispute. But where there's agreement that this practice is so intrinsic to being a good physician in this area, then doctors really have to be willing to provide that or they need to find another area of practice. But in the areas of controversy, sexual and reproductive health care, end-of-life care, those are areas in which the dispute is about what medicine includes.

Lorell LaBoube

Now, here are a couple of questions that Dr. Lantos and I, as we were discussing this podcast, that were planted by Dr. Lantos. Okay, are you ready for this, Dr.

Dr. Farr Curlin

Curley? Sure, sure.

Lorell LaBoube

Okay. Are doctors better if they were religious?

Dr. Farr Curlin

It depends on the outcome, I guess, and I don't know. I don't know. I think a doctor who is conscientious in general is a better doctor. So that much I think I can say. Conscientiousness probably does not track with a high degree of correlation with religiousness. I know a lot of conscientious physicians who are agnostics. I know a lot of conscientious physicians who are religious. But conscientiousness I do think – makes a doctor a better doctor in general.

Lorell LaBoube

The other plant by Dr. Lantos, is medicine a moral enterprise?

Dr. Farr Curlin

Absolutely. That's an easy one. When you apply science, you apply it toward goals with an understanding of an ordering of values and aspirations that science itself cannot provide. And so if you think about medicine, it is fundamentally, I think, animated by our deep sense that we are obligated to attend to those who are sick, that their sickness actually increases our obligation. That's nothing science tells us. I mean, that's something that goes deep down and, frankly, for most people is animated by and cultured by their religious communities and religious traditions. Not for all, not to say that, but, you know, when you read the stories about healing in the Hebrew Scriptures or in the Christian Scriptures or, frankly, in the Islamic Scriptures, Those stories have a lot of power for people, and they train them from a young age that caring for the sick is a high calling.

Lorell LaBoube

Now, Dr. Lantos, do you agree with what Dr. Curlin just said?

Dr. John Lantos

Oh, absolutely. I mean, it's hard to make the opposite argument. The opposite argument would be doctors are mere technicians

Dr. John Lantos

who – get guidance about what professionalism is all about by either responding to any request from any patient, no matter how bizarre it may seem or how harmful it may be to the patient, or else respond only to the dictates of professional societies or the state. I mean, there has to be a domain in between for individual moral decision-making.

Lorell LaBoube

But bottom line, a patient should let his or her doctor know about their religious beliefs and vice versa. Would you agree with that?

Dr. Farr Curlin

I think certainly if a patient's conscious of or aware of the fact that their beliefs are going to impact their clinical decision-making, it would be wise to let their physicians know and vice versa. The physicians, I think, have an obligation. If they know that they have a particular type of practice or they refuse a particular type of practice that a reasonable person would expect, they should let people know up front.

Dr. John Lantos

On the other hand, I don't think... Doctors should tell patients about their religious beliefs. Patients, I think, are free to tell doctors or not as they want, but doctors' first obligation is to be competent professionals and healers. If patients ask about their religious beliefs, they should tell. If doctors have certain restrictions, as Farr said, they should inform the patients about that. But telling patients about... other religious beliefs, I think, is out of bounds for a doctor-patient relationship. Well, would

Lorell LaBoube

I be controversial, Dr. Lantos and Dr. Furlan, if I said, shall I close the program by saying we were blessed with your presence today?

Dr. John Lantos

Very controversial.

Lorell LaBoube

Ah, there you go. Okay. Dr. Farr Curlin and Dr. John Lantos, thanks for being with us. You've been listening to the Bioethics Channel, a production of the Center for Practical Bioethics. For more information about the Center and its programs, visit practicalbioethics.org. That's practicalbioethics.org. I'm your host, Laurel LeBue. Thanks for listening to the Bioethics Channel.