Praying for patients? God help us.
1 Jul, 09 | by Iain Brassington
Via the Press Association, the BBC has been reporting the motion to be discussed by the BMA conference that would explicitly seek to allow doctors to offer to pray for their patients. The full text of the motion is available via the Christian Medical Fellowship’s website.
Right. Go and make a cup of tea. We could be here a while.
Back? Good.
Here we go. Let’s deal with the BBC’s reportage first, before we get to the substantive issues - and let’s start at the end, with a part of the quotation from Joyce Robins, the co-director of patient concern:
Offering to say a prayer is a warm and kind thought. Most patients will accept it as such. It is no more offensive than being offered a sleeping pill. You can say thanks but that sort of thing isn’t my cup of tea.
I want to raise this now because its good to get the offence point out of their way. In normal circumstances, having someone offer prayer is not something that right-minded peiople would consider offensive. To take offence at this would be idiotic. And, in fact, I doubt that anyone ever has been offended by such a move: we might think it daft, or empty, or whatever - but the sentiment behind it is clearly praiseworthy. (There’s an echo here of the “Political Correctness Gone Mad” scare stories about Christmas being banned in various town centres for fear of offending Muslims. Not only has this never happened, but anyone who was seriously upset by a banal good wish for the Solstice Saturnalia Christmas clearly doesn’t have the first idea about minimally decent human interaction.)
We shouldn’t be harping on about the offence canard, because its not even a remotely plausible objection to offers of prayer. And there are many, many more much better objections to be had.
One objection has to do with the incongruity of medics taking god on the ward round with them. I know that there are many medics who, if not religious in a tubthumping way, are believers. Having been raised both CofE and sickeningly middle-class, I’ve met a fair few of them. But I’ve never really been able to square a supposedly naturalistic and evidence-led discipline like medicine with the evidence-free la-la land of god. A doctor’s profession involves medium-sized solid objects like people and parasites, and the training presumably takes account of the undesirability of introducing to explanations of the world stuff you don’t need and of continuing to believe in things for which there’s no evidence (and, no, a face on a piece of toast, or the fortuitous arrangement of aubergine seeds to look like the word “Allah”, if you squint a bit and use your imagination, do not count as evidence). Belief in deities simply does not fit with the methodological approach upon which the practice of medicine seems to rely. Faith without evidence is a vice.
Admittedly, though, this doesn’t address the issue at hand, because there’s a difference between having a supernaturalistic belief, and offering to pray for patients. The former is odd; the latter is pernicious.
For one thing, a medic who offers to pray for patients seems to be admitting that he doesn’t trust his training to do the job of curing, but that if he has a quiet word with his invisible best mate - a best mate who, incidentally, presently seems to favour whatever germ it is that’s making you excrete blood right now - things could be different. Well, nuts to that. I want my doctor to know his way around the medicine cabinet. I want him to go to the evidence - and if the evidence is that I’m going to lose this fight, I want him to be honest with me. Either the medicine’ll work, or it won’t. Praying simply is not a catalyst - much less is it a substitute.
Ahhh, the defence might be, but prayer isn’t about cure; it’s about a particular kind of care for the patient. That is what it’s good for.
No.
First up, this doesn’t begin to explain why doctors need the right to offer to pray. If they think that they can’t care adequately without praying, then let them pray all they want. But offering to pray is something else entirely: in essence, it’s tantamount to wandering up and down the ward wearing a white coat with the slogan “LOOK AT ME, CARING FOR YOU” embroidered in sequins across the back. If you care, that’s great. But caring is a quiet, dignified attitude. It’s not something that needs patient approval, and it’s not something that has - or ought - to be trumpeted publicly, because public trumpeting is not care at all: it’s vulgar self-congratulation.
Besides: the implication of a public offer of prayer as part of the caring relationship is that atheist doctors - or those believers who have a bit of dignity - don’t care as much for their patients, because they aren’t offering to pray. That’s clearly nonsense, and mendacious, anti-collegial and well-poisoning nonsense at that.
Moreover, there’ll likely as not be times when patients are confused and scared - perhaps they’re elderly, and they know that they don’t have long to live. Doctor number one comes along and offers to pray. He’s a lovely doctor. He cares so much. But that other doctor? No. She doesn’t like me. She didn’t even offer to say a prayer for me.
Result? A much more confused and scared patient, directly because of the napalm-spirituality of the first tambourine-botherer doctor.
Let’s keep our attention on the patients. Imagine you’re in hospital and your doctor offers to pray for you. We can productively ask whether the offer is a genuine one, or a pseudo-offer; and the latter seems more likely, because it’s not the kind of “offer” that you can really refuse. You’re ill, you’re a bit vulnerable, you don’t want to upset your doctor because, right now, you’ve got better things on your mind than theology - things like the blood you’ve been excreting. Besides - what kind of person would be so cold as to refuse a kind offer like that? (Remember, that in your state you’re not going to notice the slightly masturbatory nature of the offer, and it’s not something about which you’d want to make a fuss right now anyway.) So, in effect, you’ve been corralled into a kind of relationship with your physician that you never really wanted, and which you may well not have chosen. To this extent, Robbins is wrong in the quotation above: it’d be very hard in practice to say, “Thanks but no thanks.” An offer of prayer is not - or not just - an invasion of your privacy: it’s a gleeful trampling of your integrity.
This is not, pace the proposer of the motion, Bernadette Bertwhistle, an issue of free speech (”Freedom of speech,” she says in the BBC article, “is being curtailed too much and I don’t think that is always in the benefit of patients”), since offering to pray for someone is something that doctors should not be doing, for the reasons I’ve outlined above. (Is it just me, or can anyone else smell burning martyr?) Freedom of speech is not served by stamping your foot and demanding the right to pollute the patient’s mind with whatever happens most recently to have crossed yours. Freedom of speech in the positive sense is one thing; but, just as we use the phrase “free of cancer” to mean “free from cancer”, there’s a sense in which freedom of speech has to accommodate freedom from speech.
This is a point that is touched on by the Patient Concern representative in the Beeb’s article:
[I]f Christian doctors see this as an opportunity to promote their faith to people at a time when they are particularly vulnerable, that is totally unacceptable.
Amen to that.
Just in case we forgot what all this was about, here’s the motion as reproduced on the Christian Medical Fellowship’s website. My comments are in bold.
That this Meeting:
(i) recognises that the NHS is committed to providing spiritual care for patients;
I have no idea what this means. What is “spiritual” care? And why in the name of all that some people think holy is it the NHS’ business?
(ii) notes the position on inappropriate discussion of faith matters in GMC Guidance on Personal Beliefs and Medical Practice;
Notes grudgingly, I suspect… After all, parts of this guidance are clearly against offers of prayer.
(iii) while welcoming the constructive and necessary advice in the document “Religion or belief“, is concerned that some paragraphs suggest that any discussion of spiritual matters with patients or colleagues could lead to disciplinary action;
Incidentally - I’ve had to update the links myself. The CMF links are a bit circuitous, and ensure that you have to wade through a lot of CMF pages before you get to the documents in question.
(iv) believes that offering to pray for a patient should not be grounds for suspension;
It’s pernicious, mendacious and - presumably - a waste of time, of which there’s little enough on a busy ward. That looks like very poor practice to me. I’m not sure whether suspension’s the answer, but something disciplinary seems to be in order…
(v) calls on Health Departments to allow appropriate consensual discussion of spiritual matters within the NHS, when done with respect for the views and sensitivities of individuals.
But, you see, there’s nothing consensual about it. You’d be interrupting me to talk about god. Even opening your mouth about god means its too late for me to do anything about it. You just don’t get it, do you?
If there really was a benevolent and omnipotent deity watching over us, he’d never have allowed the motion to have got to the conference.
I might have guessed that this story results from the machinations of a few evangelists rather than doctors and nurses in general.
Apart from the unlikely existence of a deity (given the size and scale or our universe and our infinitesimally smallness within it), surely the point is that anyone can pray for whoever they like already without seeking permission from anyone. It can be done in private and if their is a god to petition and who takes a personal interest in anything to do with anyone, then it will work or not work just the same.
Frankly if someone offered to pray for me I’d tell them to go away and stop being so selfish and self-centred. The need to make an offer or public announcement to pray indicates to me someone lacking in self-worth and seeking approval.
pv
July 1st, 2009 at 11:55 pm
@pv: I think you’re right on the evangelists point. The CMF is trying to paint this as a grassroots movement (as if that’s morally relevant) when I’m sure that it’s not something that bothers more than the passing fixation of a couple of people. However, they’re noisy and attention-seeking people…
Iain Brassington
July 2nd, 2009 at 8:58 am
1) A Christian doctor who offers to pray for his patient does so over and above providing all the necessary medical treatment - it is not a substitute for treatment or a lack of confidence in its adequacy. A strong Biblical principle is ‘God helps those who help themselves’ so a Christian doctor must do all he can for a patient - objectively - as you so desire.
2) The Bible also teaches in Matthew that prayer is to be done in private - without showing off and so Christian doctors asking for prayer wouldn’t be walking round shoating about it but would ask a patient quietly and in a dignified manner - this is not difficult in a busy ward. Thus it’s “public” nature is confined to the prayer and the prayee essentially at that time.
3) The argument that atheists will be regarded by patients as less caring than Christian doctors and nurses is I believe symptomous of the “slippery slope argument” or perhaps “grasping at straws”. Care can involve spiritual aspects and I think the patient has a right to know they can be prayed for if they want to be.
4) For those patients who are too nice to say no…will it really create an awkward relationship? Maybe, but aren’t we awkward creatures anyway?! Saying a prayer (which will probably take one minute) does not go as far as to blur a doctor’s role in a patient’s treatment. It certainly does not trample over patient’s integrity.
You are obviously not a fan of Christianity. In hospital some people really think about God and value someone praying for them. Yes they’re vulnerable but from a Christian perspective Jesus came for the vulnerable and what we have is a well-grounded, well-practiced, well-established belief followed by millions, and so like a patient has the right to say “no”, we should have a right to ask, where it is done so in a dignified manner.
RW
July 2nd, 2009 at 11:23 pm
@RW - I’m going to paraphrase your points a bit for the sake of efficiency - but I think they can all be met.
1) A strong Biblical principle is ‘God helps those who help themselves’ so a Christian doctor must do all he can for a patient - objectively - as you so desire.
Well, I’m not sure that it’s only Christian doctors who must do all they can for the patient, and I’m mystified as to how that follows from the previous clause. I’m assuming that the last four words mean “up until the point of refusal” - there’s no need for a doctor to accede to a patient’s positive request.
2) The Bible also teaches in Matthew that prayer is to be done in private - without showing off and so Christian doctors asking for prayer wouldn’t be walking round shoating about it but would ask a patient quietly and in a dignified manner - this is not difficult in a busy ward. Thus it’s “public” nature is confined to the prayer and the prayee essentially at that time.
No. The fact that the doctor asks is what makes it public. If he’s determined to pray for his patients, then that’s his business, and - I’ll concede for the sake of the argument, might be admirable as an indication of a caring attitude. But asking if he can pray is simply self-congratulatory - there’s no need to ask, unless you want some kind of thanks from the patient. And that undermines any dignity claim that might be made, as far as I can see.
3) The argument that atheists will be regarded by patients as less caring than Christian doctors and nurses is I believe symptomous of the “slippery slope argument” or perhaps “grasping at straws”. Care can involve spiritual aspects and I think the patient has a right to know they can be prayed for if they want to be.
I’m not sure it is a slippery slope argument, since it’s about actions having undesirable consequences, rather than actions leading others to act wrongly. I have no idea what “spiritual” care is supposed to mean - we can care for a person’s wellbeing (call is psychological, if you want) without having to appeal to any sort of spooky spirit stuff; and I don’t see what prayer adds to this care. Finally, your last clause fights a straw man, since noone is saying that patients can’t be prayed for, or that thay can’t be told that someone is praying for them. However, that’s not for the doctor to do, and the target is medics asking to pray. They shouldn’t be telling patients, “By the way, I’m praying for you” - but asking if they can is beyond even that.
4) Aren’t we awkward creatures anyway?! Saying a prayer (which will probably take one minute) does not go as far as to blur a doctor’s role in a patient’s treatment. It certainly does not trample over patient’s integrity.
An appeal to awkwardness isn’t the point here. If there is that awkwardness, we ought to be acting to minimise it, not just accepting of it. Still, as a matter of fact, I think prayer does transgress the role of the doctor - but I won’t labour that point. Nor is it the case that prayer tramples integrity - I never said it did. It’s telling or asking the patient that does that, because it’s uninvited scattergun piety.
You are obviously not a fan of Christianity.
Hmmm… You could say that
I’m certainly an atheist, and I’d prefer that people didn’t have false beliefs. But I’m more concerned here about demonstrative devotion; my attitude to certain people (who may be Christians) has nothing to do with my attitude to their Christianity.
In hospital some people really think about God and value someone praying for them.
Doubtless. That’s not the issue.
[W]hat we have is a well-grounded, well-practiced, well-established belief followed by millions, and so like a patient has the right to say “no”, we should have a right to ask, where it is done so in a dignified manner.
The popularity of the religion is irrelevant here. However, you’re mischaracterising the rights aspect. Medics do not have a right to ask, any more than they have a right to treat. It’s a matter of obligation. Medics have an obligation to treat their patient, and, qua medic, that’s it. They don’t have an obligation to pray, and - as I think I’ve made clear - I don’t think that there’s even the homeopathic whiff of a right to do so.
Iain Brassington
July 3rd, 2009 at 2:08 pm
Thank you Iain. When I first read the original CMF piece it made me angry. So angry that I couldn’t formulate any sort of reasoned response.
The sorts of things I was able to splutter amidst my anger were:
“it’s offensive to ask me if you can pray for me”,
“if you really want to pray for me, then I don’t need to know about it, it’s for your benefit not mine”,
“when I’m in hospital and vulnerable, this is not an offer I can refuse”,
“you’re imposing your religious views on me when I’m in a vulnerable position”,
I think one of the important things is that it’s the asking that does the harm. It’s not the praying itself. If you want to pray for me, then do it, but don’t seek my approval. RW has clearly missed that point.
What i’d be very interested to know is whether anyone with faith objects to this as well?
Ruth Wilkinson
July 4th, 2009 at 9:10 pm
Agreed - that was a point I clearly missed. My concern is that there are Christian doctors who truly believe it would be a comfort or a benefit to a particular patient to know someone was praying for or with them - and how they should be allowed to act in this situation, if at all.
RW
July 7th, 2009 at 1:40 am
@Ruth
My tutors have moulded me to be a pedant, so a pedant I shall be.
I’m not sure if you endorse any of your angry splutterings, however to say someone offering to pray for you is “offensive” is, in my mind, wrong. You may be offended by it but the offering itself is not qualitatively offensive insofar as presumably no malice or offence was (recklessly or otherwise) intended.
The fact you are offended by something does not make the act which offended you (morally) wrong or harmful. Many things have offended people over the years yet, while this may incidentally reflect on the rightness/wrongness of the act which offended, it is not determinative of its rightness/wrongness.
Further, I am not convinced that a ‘harm’ has occured, at least not a morally relevant harm. If I am right so far, the only potentially identifiable harm which may have occured as a result of the offer is ‘having been offended’. Being offended is not, generally speaking, being put in a harmed condition and even if it is, we must then prove that the harm is morally culpable. Remember that harms can produce an overall benefit, such as Blighty Wounds.
Feinberg stated that “One person wrongs another when his indefensible…conduct violates the other’s right, and in all but certain and very special cases such conduct will also invade the other’s interest and thus be harmful.”
There is no right to not be offended (if there is, it is limited in my opinion to the incitement of hatred and violence). Indeed it can be in our interest to be offended (such as offending those who argued against the emancipation of women, slaves and homosexuals). It is also in our interest to allow freedom of speech, expression etc. I concede that you may attach an interest to not be offended, however I would contend that the value you may attach to your interest to not be offended, even if vulnerable etc., is outweighed by the opposing general right to freedom of expression. The right trumps the interest. The offence is subjugated to the freedom of expression.
A harm has not therefore occurred. The most that can be argued is that it is an example of nonharmful wrongdoing (not a wrongful harm) for which the author is morally reprehensible. Feinberg continued that “There can be wrongs which are not harms on balance, but there are few harms that are not to some extent wrongs.”
If this is so, the question is to what extent should professionals be allowed to inadvertently commit morally culpable wrongs which are not harms? Also, how far should public policy and professional bodies promote, in this case, secularism. Should we ban health practitioners wearing crucifixes or veils? Should community nurses and on-call doctors be obliged to remove Ichthys signs from their cars? These are morally contentious points. It may run the risk of stifling a right to freedom of expression over the interest to not be offended. Ought we allow such a subjugation of a right, even in professional spheres?
I am inlcined in this instance to state that despite being offended, the best thing to do is say “No thanks” to the offer. Being offended is part of living in a society composed of individuals who are offended by different things. As an individual of a society composed of indivduals, I run the risk of being offended. I take that risk for the benefits of living in a free society.
You may have been morally wronged in this scenario, (I’m inclined to disagree and the burden lies on you to prove otherwise). Nonetheless, you have definitely not been morally harmed. Due to the last question you ask, you may find it of interest to note that I’m an atheist although I don’t think that bears relevance to the thrust of my argument.
Cheers
Graeme Hall
July 14th, 2009 at 8:11 pm
@Graeme -
Ahhh… your tutors tuted (?) you well… and I think you’re right to take Ruth to task about offensiveness. I don’t think that that’s the main show at all - and if people do claim to have been offended, they’re clearly hypersensitive and shouldn’t be taken too seriously.
However, I think that you slightly mischaracterise things elsewhere - it’s not a matter of promoting secularism: it’s a matter of simply not introducing positive beliefs (whatever they may be). For what it’s worth, I think there’s a big problem with veils for the same reason that there’s a problem with ties and long sleeves - they’re germ hotels. Ditto headscarves and turbans, though to a lesser extent - I suppose they don’t really get all that close to the patients. Crucifixes could be problematic as well, I suppose, but not as straightforwardly - and they can be kept under clothing. While we’re at it, I’d also get rid of wedding rings while on the ward, again for reasons of infectivity. But I don’t want to get into drawing lists…
It’s not a matter of manning stuff for the sake of atheistic militancy - it’s just a claim about what is and is not proper in a healthcare setting, as far as I can see.
Iain Brassington
July 14th, 2009 at 8:25 pm
@Iain
You stated that the issue at hand is there being “a difference between having a supernaturalistic belief, and offering to pray for patients. The former is odd; the latter is pernicious.”
I infer from your use of the word ‘pernicious’ some form of harm. I believe the thrusts of your and ruth’s arguments are based explicitly on a concept of harm which is why I felt it appropriate to offer my opinions outlining why I believe such a characterisation of the debate is a misnomer.
It is then for you to demonstrate that there either is harm or in the alternative a wrong.
Next. You wrote earlier “this doesn’t begin to explain why doctors need the right to offer to pray.” You introduced the concept of rights and I believe that I try to explain how an understanding and balancing of rights and interests are instrumental within this and the wider context. You cannot just say that something is or is not “proper” and expect people to accept it. One has to offer reasoned justification detailing the impropriety. Rights-talk can offer this.
Further, you write “Freedom of speech is not served by stamping your foot and demanding the right to pollute the patient’s mind with whatever happens most recently to have crossed yours.” You have once again introdcued (or at least expanded upon) the theme of rights-talk. Incidentally, this is utter rhetoric Iain! Indeed FoS is not served in this way, but your pithy characterisation is not synonymous with a doctor saying “would you like me to include you in my prayers?”
Therefore, I don’t think i have mischaracterised the debate. Harms, wrongs, rights and interests are all explicitly or implicitly relied upon in discussion. I think I have offered a reasonably justifiable explanation to state that on these bases, the argument to not offer prayer has not been made out. I note your silence on the suggestion to merely say “no thanks” and the minimal inconvenience it would cause. Of course, no doctor should say anything to his patient which will confuse vulnerable people, but I tentatviely suggest that this goes for (anything, not just the offer of prayer (this alludes to your initial rant).
As a side issue with regards your point of infection. It would appear that following your argument to its logical conclusion, health practitioners should be naked (preferably shaven?) or at least walk around in minimally appropriate underwear but no otiose clothing which will increase the risk of infection? Let’s not draw lists, let’s just strip. Interesting… Maybe infection is not the only concern?
Anyway, I agree the issue in play is whether health practitioners ought to be at liberty to offer prayer, not infection-risk. Infection is a side issue at the very most.
Re. promotion of positive beliefs. It could be said that the offer of a prayer, while offending some, will give some a psychological boost. Even those who are atheist may take it in the manner it is offered - (hopefully) a kind gesture. They may feel comforted by this, or at least feel as if someone is thinking about them, boosting self-esteem (particualarly for the scared or lonely) and thus the doctor is arguably offering a holistic medical approach rather than a merely anatomical medical approach.
The above argument may be viewed as tenuous, but so is your assertion that to offer prayer in a way highlighted above is to “introduce positive beliefs” and that (i infer) to do so is wrong. Why is it wrong if the patient may benefit or at least ought to be rationally indifferent to the offer? It is this ‘wrongness’ which is the crucial issue, and I highlighted that in my intial response. Respectfully, I did not mischaracterise the debate.
Justification needs to be offered to state why offering to pray for someone is so wrong that it should be prohibited, restricting enshrined rights such as FoS and FoExpression. I’m not saying there is no such justification, rather that none has hitherto been compellingly stated.
Graeme Hall
July 14th, 2009 at 9:47 pm
@Graeme - If I meant “harmful” where I wrote “pernicious”, I’d've written “harmful”. To call something pernicious is different - and wider.
Nor is it me that introduced the rights-talk: it’s the CMF motion that seeks to defend an alleged right to offer to pray. I simply denied that there was any such right - and denied, too, that there ought to be, on the grounds that it’d be pernicious. I could have offered a more detailed argument, I suppose - but this is a blog. An argument’d be longer, more nuanced and - damnit - I’d put it in a proper journal and at least get some academic credit for the thing. (I might yet…) That speaks to the rhetoric point, too. It’s OK to take rhetorical shortcuts on a blog post. Welcome to the internet.
The mischaracterisiation point refers to your claim about promoting secularism; the OP was never about that. I think that’d be improper on a ward, too, simply because there’s no need, and no place, for theology in medicine.
It’s easy to get carried away with the infectivity point - but there are certain claims about reasonability to be made. It’s reasonable to expect HCPs not to wear loose clothing and jewellery.
Note, too, that I think you’re treating the phrase “positive beliefs” as “beneficial beliefs”. There’re two problems with this: first, “positive” does not mean “beneficial” - it can mean harmful (just as stabbing you would be a positive action, albeit harmful and probably undesirable); second, I don’t much care whether it’s beneficial or not. That’s not the issue.
Iain Brassington
July 15th, 2009 at 10:40 am
Further to RVs comments, what is gained by telling the patient that you will pray for them. If prayers work, they will work whether the patient knows or not - unless one is looking for a placebo affect. If the patient needs to know, then there is no point in praying for someone who is unconscious!
Phil Brassington
July 16th, 2009 at 1:34 pm
You could at least have used a witty pseudonym, you know…
Oy veh.
*considers editing*
Iain Brassington
July 16th, 2009 at 4:13 pm