By Jake Greenblum and Ryan Hubbard

We recently offered a reply to criticisms of our view that physicians should refrain from deliberating with their patients on religious grounds when helping them make medical decisions.  Part of what prompted our research into this topic is recent work discussing appropriate ways of communicating with religious patients who cite the possibility of a miracle to inform medical decisions.  Some argue that miracle invocation should not factor into the decision-making process, while others argue that it should.  What’s common to both sides is the assumption that it’s permissible for physicians to deliberate with their patients on religious grounds.  We dispute this assumption.

A crucial part of our argument is that physicians are relevantly akin to public officials such that they should be constrained by public reasons when making medical decisions.  Public reasons are considerations that any reasonable person would consider reasons.  Thus, religious considerations would not count as public reasons.  As one critic correctly notes, this view draws from the liberal political philosophy of John Rawls.  Indeed, one of our aims has been to emphasize the public dimension of medical practice, thereby moving the normative framework to the level of political philosophy.

Many of the criticisms push back against our view that physicians are relevantly akin to public officials and should only deliberate on public reason’s terms.  Some critics objected to the use of public reason as overly exclusionary and oppressive.  Part of the worry here is that public reasons and reasonableness are inevitably determined by those in privileged, powerful positions.  And this results in oppressing marginalized, less-privileged groups.

There are at least three problems with this objection.  The first is that that an intellectual division of labor is hardly evidence of oppression.  Second, citing public reason can avoid oppressing marginalized groups by bringing such groups into the conversation with the appropriate interlocuters.  This is something we believe should be done. For instance, in our original article we describe how chaplains can “translate” religious discourse into terms consistent with public reason. The third problem with this objection is that it presupposes a relativistic view of reasonableness, one that simply expresses the interests of the powerful. But this conception of reasonableness is not the one we endorse. Indeed, we think reasonableness is a valuable tool to wield against the powerful.

Paper title: Physicians’ Duty to Refrain from Religious Discourse: A Response to Critics

Authors: Ryan Hubbard and Jake Greenblum

Affiliations: Ryan Hubbard, Gulf Coast State College, Social Sciences Division. Jake Greenblum, University Health System, San Antonio, TX

Competing interests: n/a

Social media accounts of post author(s): @RyanKHubbard