Physicians as public servants: why physicians have no business discussing religion with patients

By Jake Greenblum & Ryan Hubbard.

It is generally agreed that healthy liberal democracies have a robust separation between church and state. However, controversy arises when interpreting the appropriate place of religion in the public sphere, including the proper role of religion in medicine. Just consider the current political debate in the US on medical issues such as conscientious objection as well as the fact that there is a new office in HHS devoted to expanding medical professionals’ so-called rights to religious liberty. A related issue that has gained traction in the bioethics literature is whether it is appropriate for medical professionals to cite religious considerations when responding to religious patients’ religious language.

The kind of case commonly discussed in the literature involves invoking miracles. Imagine a case in which Jane’s father is in a coma and on life support.  Physicians have declared his case futile, but Jane insists that he remain on life support because a divine action – a miracle – may bring him out of his coma.

The dominant view in the literature assumes that it is appropriate to discuss miracle invocation with the patient on religious terms by discussing with the patient interpretations of the Bible, what God’s wishes are, the meaning of miracles, et cetera. In our paper, ‘Responding to Religious Patients: Why Physicians have no business doing theology’, we contest this assumption.

We make two main arguments for why physicians should not engage with their patients on religious grounds. The first is that most physicians are akin to public officials and operate within a public space. This is because they receive public funding and many of their decisions impact the public by their role in distributing public medical resources. Therefore, we maintain that the decisions physicians make should be constrained by public reasons, i.e., non-sectarian considerations that any reasonable person would consider a reason regardless of their religion or creed. Because religious considerations such as waiting for a miracle are not public reasons, physicians ought to avoid citing them.

The second argument appeals to the fiduciary nature of the physician-patient relationship. The crucial idea here is that physicians have an obligation to avoid citing certain considerations when making medical decisions because to cite them would undermine the trust characteristic of the physician-patient relationship. Such considerations include religious ones. Citing these considerations undermines trust because physicians are expected to make medical decisions consistent with medical science and religious considerations are inconsistent with this clinical expectation.

We realize that our thesis may not sit well with many, since it might seem to undermine the physicians’ liberty or to disrespect religious patients. However, a few points help to assuage these worries. First, we do not claim that religious patients or surrogate decision-makers should be censored. They are and should be free to make decisions as they see fit. We just think that if religious patients think religious considerations have epistemological or normative merit, chaplains, not physicians or other clinical professionals, are the relevant interlocutors. Second, the decision-making process aims to respect and accommodate patients by translating religious considerations into non-sectarian considerations.  For example, ‘the God given sanctity of life’ can translate into the ‘intrinsic value of life’ without losing its force as a reason. Third, our thesis does not prevent physicians from practicing their own religion in their private life and leaves room for their religious convictions to motivate their practice.

Our view is motivated by a commitment to liberalism: it assumes that public roles should operate within a public reason framework. An upshot of our paper is to show that the apparent conflict that some writers see between liberalism and religion is misguided. Liberalism and religion are not opposing forces. They simply speak past each other since their goals are fundamentally different: liberalism aims to create a public sphere that accommodates all reasonable views of the good life, while religion strives to give answers to how one should live by drawing on the divine.

 

Paper title: Responding to Religious Patients: why physicians have no business doing theology

Authors: Jake Greenblum* & Ryan Hubbard^

Affiliations: * University Health System, San Antonio TX, ^ Gulf Coast State College, Panama City FL

Competing interests: None

Social media accounts of post authors: @RyanKHubbard

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