Physician response to conflicts between faith and medicine
January 11, 2005
How do doctors interpret and respond to conflicts between their best medical advice and a patient's religious concerns?
A study in the January 10 issue of Archives of Internal Medicine suggests that such conflicts are not uncommon, that most physicians strive to accommodate the demands of a patient's faith, but that certain types of conflict tend to push doctors over a threshold toward negotiation, persuasion, and appeal to other authorities.
"There is often a tension between respecting the patient's religious beliefs and pursuing the patient's best interests," said study director Farr Curlin, MD, assistant professor of medicine at the University of Chicago. "We explored the ways doctors negotiate that tension, how they balance respect for a patient's beliefs against their own commitment to promote and protect a patient's health."
Curlin and colleagues conducted 21 one-on-one, in-depth interviews, centered on "open-ended grand tour" questions, with physicians representing diverse religious backgrounds. They kept doing interviews, he said, until they reached the point of "thematic saturation."
All 21 physicians had encountered cases where religion and medicine came into conflict. These conflicts fell into three categories. Physicians were least frustrated by cases of stark disagreement, in which the lines between medical and religious reasoning were clear, such as a Jehovah's Witness who needed but refused blood transfusions. "As long as somebody understands the situation," noted one physician, "then that's his or her choice."
Physicians were more disturbed by cases where the conflict was not between science and religion but rather between "different worldviews," for example patients or families who insisted that "life in any form was better than death," and demanded aggressive treatment even when the doctors considered it medically futile.
Doctors were most aggravated by patients who had no moral objection to a particular therapy but simply chose faith over medicine. Several physicians mentioned patients who had a disease for which there is effective treatment, yet decided to rely purely on prayer.
"That's really tragic," said one physician, citing the case of a woman with a small breast cancer who chose prayer over treatment. "Oh gosh," the doctor recalled. "We can do something for you now but six months from now it will be a lot harder."
Cases like that challenge a physician's desire to remain open-minded and flexible, or at least to accommodate patients' religious ideas. Curlin's team noted that doctors described three strategies they use to persuade patients to go along with their recommendations.
First, physicians may encourage patients to think of prayer as an adjunct to medicine, not as a substitute. If that fails, they often try to convince the patient that medical care can be part of a religious worldview, that therapy is "something provided by God," or that "God is bringing you here for us to try to help you." If that fails, the doctor may appeal to the patient's religious community, such as family members or clergy.
Although most physicians try to remain neutral regarding the religious beliefs and values of their patients, the authors suggest that this is not always possible. "Science tells patients what they can do," the authors note, "but physicians tell patients what they should do, and the latter is always a moral exercise."
"Rather than striving for illusory neutrality," they conclude, "physicians should practice an ethic of candid, respectful dialogue in which they negotiate accommodations that allow them to respectfully work together with patients, despite their different ways of understanding the world."
This study was funded by grant support for "The Integration of Religion and Spirituality in Patient Care Among U.S. Physicians: A Three-Part Study" from the Greenwall Foundation, New York, N.Y., and from The Robert Wood Johnson Clinical Scholars Program, Princeton, N.J. Additional authors include Marshall Chin, John Lantos, Rita Gorawara-Bhat, and Chad Roach of the University of Chicago.
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