The world of health care can present all sorts of important ethical dilemmas, but perhaps none are so difficult as those involving patients and religion. In this edition of FM89’s commentary series The Moral Is, CSU Bakersfield philosophy professor Christopher Meyers says that patients, courts and clergy all need to do a better job at sorting out what to do when medical advice conflicts with a patient's faith.
Among the hardest cases in clinical ethics consulting are those in which patients’ or families’ religious beliefs motivate medical choices contrary to best professional advice. A common example is when a family requests that medically ineffective life-sustaining treatments not be withdrawn while they hope for divine intervention.
These cases usually can be ethically managed with education and counseling. This allows decision makers to come to grips with the medical reality, including that continued aggressive treatment will most likely only increase the patient’s suffering.
Some cases, however, are much harder: family choices can cause patients to suffer through otherwise manageable pain, to languish for years in a permanent vegetative state, or even to die prematurely – all because their religious convictions preclude the medically appropriate response. These choices cause real harm.
Some of the more common examples include an unwillingness to consent to medically necessary surgery because it cannot be performed without a blood transfusion, refusal of a range of invasive procedures, and the rejection of pain medication. Even for experienced health care professionals, these cases can be heart-wrenching.
Now families and patients make harmful medical choices for a range of reasons, but those that are religiously motivated share a striking feature: Far more often than not, once faith is invoked, health care professionals accept that decision, even if doing so runs contrary to their best professional judgment. By contrast, when the reasons are secular – like medical ignorance, financial gain, or family dysfunction – the treating team will often aggressively engage the decision makers and strive to get them to change their position.
The reason for this difference is understandable and seemingly wise: Who are health care professionals to question someone’s faith?
But shouldn’t some faith-based reasons be subject to questioning, particularly when they are made on behalf of the incapacitated and when they cause harm? Are there no standards health care professionals may use to rationally assess religious beliefs in their efforts to act in their patients’ best interests?
The courts have provided little guidance, handing down widely variant rulings. For example, one may not ingest peyote as part of a religious ritual nor use religious belief to justify withholding medically needed blood products from a minor child, but may ritualistically sacrifice animals. And too often when they do jump in, the courts use vague, overly expansive language, as they did in this year’s Hobby Lobby ruling: the imprecision there led to a Satanist group’s claim of religious exemption to abortion information mandates.
Meanwhile, the professionals in the health care trenches do their best to navigate these turbulent waters while keeping their patients’ well-being in the forefront. Surely we – churches, courts, ethicists – can do more to provide them with helpful standards.
Christopher Meyers is a Professor of Philosophy and Executive Director of the Kegley Institute of Ethics at California State University, Bakersfield. The views expressed are his own and do not necessarily reflect those of the University or the Institute or Valley Public Radio. The Moral Is commentary series is produced by KVPR and the Bonner Center for Character Education at Fresno State. See more commentaries online at KVPR.org
