A 40-year-old woman with no significant family history of cancer came to me for a second opinion about her widely metastatic infiltrating gastric cancer. She had been diagnosed less than one month prior and had seen a local oncologist and had been started on chemotherapy treatments. Her affect was not as I suspected it would be: she smiled frequently and seemed very upbeat for someone with such a terrible diagnosis. When it came time to discuss many of the emotionally upsetting aspects of her case, such as her prognosis, she shifted constantly to talk about God, her religion, her religious ways of coping, and her conviction that God could perform miracles. Finally, she asked me if I was religious. As a nonreligious person, this made me very uncomfortable; nonetheless, I told her I wasn’t religious. She then began to talk in a way that I perceived to be proselytizing, trying to convince me of the validity of her views. Finally, she asked if she and her family could pray for me right there in the examination room. I allowed them to do this and patiently waited as they prayed for several minutes. I am not sure I handled this right. What were my ethical obligations to participate?
Dr. Helft Responds
Farr Curlin’s 2006 paper in Medical Care using data from a national survey of physicians found that almost all responding physicians (91%) agreed that it was appropriate to discuss religious issues if a patient raised them, and 73% agreed that when religious issues arise, they often or always encourage patients’ own religious or spiritual beliefs and practices. Physicians who identified themselves as religious or spiritual were more likely to address such issues directly. From a professional perspective, your encounter was a little different, since the focus of the religious discussion became you. I suspect your discomfort was either because you did not want your own nonreligion to affect the way the patient experienced her doctor-patient interaction, or perhaps due to a rational concern that she might then consider you in a negative light—or both. Such concern for the patient’s experience should always be paramount, so I tend to agree that listening to what she had to say, perhaps without offering a response other than to let her know verbally or nonverbally that you were listening, was an appropriate reaction.
I do not think that anything in professional ethics obligates a physician to pray with a patient; I also think that tolerating the act as you did demonstrated respect for her deeply held beliefs and feelings.
On a related note, patients whose spiritual needs are met appear to benefit from several positive outcomes (eg, more values-congruent care and treatment at the end of life), suggesting that patients who use religious styles of coping may benefit from referral to professional chaplaincy resources. Finally, Curlin and other scholars of religion in medicine have noted that lack of congruency between physicians and patients may highlight important differences in values and values frameworks, pointing out that making such values frameworks explicit may lead to better decision making.
Financial Disclosure: The author has no significant financial interest or other relationship with the manufacturers of any products or providers of any service mentioned in this article.
Disclaimer: The advice offered in this ethical consultation feature is based solely on the information supplied by readers, and is offered without benefit of a detailed patient history or physical or laboratory findings. The information is offered as a discussion of ethical issues and is not intended to be medical or legal advice and, therefore, should not be considered complete or used in place of a formal ethics consultation or in place of seeking advice from your ethics committee, legal counsel, or other available resources. One should never disregard or change medical advice or delay in providing it because of something that is printed here. The opinions expressed here are only those of the author and do not reflect the viewpoint of ONCOLOGY.
1. Curlin FA, Chin MH, Sellergren SA, et al. The association of physicians’ religious characteristics with their attitudes and self-reported behaviors regarding religion and spirituality in the clinical encounter. Med Care. 2006;44:446-53.