Center on Religion & the Professions

Improving religious literacy among professionals.

Health care and medicine

by

About the discipline

While the intention of religion and health is to nurture the individual, religion and health can sometimes become a confrontation of values.  The medical profession’s set of values and operational procedures can conflict with corresponding values found in people of faith. This disconnect can go both ways and apply to both the patient and practitioner, which can impact quality of care.

Differing beliefs: Patients may come from worldviews that hold different beliefs about what causes illness and acceptable ways to treat it. If there is a difference in values or ethics concerning the correct way to treat a specific illness, should the values of the patient or the doctor prevail? Some religions, such as Islam, have rules of conduct about nudity/modesty, touching of a person’s body, and being alone with a member of the opposite sex, even if it is a medical practitioner.

Various religions have views about the sacredness of the body and the will of God that may prevent believers from consenting to medical intervention. Christian Science, for example, holds that the ills of the flesh can be healed through prayer and faith in God. Traditionally, believers do not rely on conventional medicine, though there is no formal compulsion to eschew medical means. Some animists believe that illness is caused by evil spirits or brought on by offending deceased ancestors, rather than physical conditions. Medical practitioners can be sensitive to these beliefs when performing examinations or recommending a course of care.

Ethical choices: Practitioners also face ethical choices that might conflict with professional values. They face questions of whether they should be required to provide a type of care they find morally inconsistent with their values – such as a pharmacist whose religious values might stand in the way of filling a prescription for an emergency contraceptive or for birth-control for an unmarried woman, or a Catholic surgeon who may not believe in performing surgeries to prevent pregnancy. There is ongoing debate over “conscience clause” legislation that seeks to protect pharmacists from filling prescriptions for drugs they find morally objectionable while still protecting a patient’s right to have prescriptions filled. Some pharmacists who have lost their jobs or been disciplined are filing lawsuits.

The debate in stem-cell research extends to both the ethics of government funding and concerns over value of life. Some say that the possible ability to cure many serious diseases is worth compromising the potential life of an embryo; others say potential life is sacred and should not be compromised for any reason. Religious believers come on both sides of the debate (see Biology and Stem Cell Research). With advances in this technology there will also be debates as to whether patients will choose or have the right to choose to be treated with these cures.

These are questions that practitioners and patients wrestle with in hospitals and clinics nationwide. The Center on Religion & the Professions is devoted to helping bridge those gaps through creating curriculum and education. For example, the Center is developing a series of short courses for medical, nursing and health professionals to help them understand how clients’ religious beliefs and practices may come in conflict with traditional medical practices and ways to approach these situations.

National issues: Some medical institutions, such as Catholic hospitals, operate under the purview of privately funded religious organizations. There is some debate as to whether these institutions have the right to refuse to treat illnesses in certain ways or refuse to write or fill prescriptions for religiously objectionable drugs. The debate centers on whether the religious freedom to which such institutions are entitled trumps a patient’s right to complete care, also extending to related liability issues.

Debates over stem-cell research, therapeutic cloning, abortion, contraceptives and other medical treatments make up a large and influential part of political and public discussion. Other issues involve differences in how medical professionals and religious communities choose to confront the crisis of AIDS. For example, some people’s religious beliefs might dictate not providing some types of care to AIDS sufferers due to beliefs about how patients’ lifestyles may have affected how they were infected with the disease. Others, guided by religious beliefs, believe extending help to those with AIDS is an obligation.

Working professionals in the medical care industry confront differing sets of values and must learn to navigate these in their professional life. In addition, changes to national policy will also have an effect on the professional’s work. Understanding that culture is constantly evolving will allow the professional to adapt to a field often defined by ethical issues.

Workplace issues: Chaplains in hospital and professional settings are a growing phenomenon. They must be versed in a variety of religions because they often are speaking with people of different faith backgrounds. It is helpful for chaplains to have knowledge of the languages and cultures most likely to be encountered in their communities. Understanding the various traditions’ beliefs about the body, health and the afterlife also assists in care.

Recent studies show that doctors in the United States are more likely to be Muslim, Buddhist or Jewish than the rest of the population. Nursing shortages in the U.S. have also led to employing more nurses from overseas, while many medical students come to American medical schools from abroad and obtain positions in the U.S. This diversity offers both potential for greater understanding and improved care and possible misunderstandings or cultural clashes in a medical setting.

Health campaigns: Some ethnic groups are more susceptible to certain medical conditions. For example, Latinos are vulnerable to Type 2 diabetes, African-Americans to sickle-cell anemia, and eastern European (Ashkenazi) Jews to Tay-Sachs disease. Although these are ethnic factors, religion is often a bonding force in these communities. Health education campaigns targeting religious groups can be a way to effectively distribute messages about these issues.

The Center is affiliated with the MU School of Journalism, which is researching ways to target ethnic groups with media messages about health campaigns. One project focuses on how to use media to better inform African-American women about breast cancer examinations. Religious institutions can act as clearinghouses for information and be distributors of health campaign material. The Center’s focus on education in religious communities makes it a good conduit for such a partnership.

Faith and healing: Research has sought to find relationships between religion and healing. Research shows prayer’s value in helping people recover from illness is ambiguous, with some studies showing better recovery in those who prayed or were prayed for, whether or not they were aware of it; and others showing no relation between prayer and healing.

The practice of “faith healing,” a spiritual means of treating illness, prompts healing through the power of the Holy Spirit through laying on of hands, or relies on intercessory prayer of a saint or person with the gift of healing. Though scientific studies have not indicated success resulting from faith healing, many people do resort to faith healing, particularly in cases of incurable disease. Some people believe it should be the primary or sole remedy, which poses particular ethical concerns for medical professionals when parents decline or refuse medical care for their children, based on their religious rights to choose to rely on alternative healing.

Practitioners could also be aware of practices such as Ayruvedic medicine, a Hindu approach to healthy living that considers physical, mental, social and spiritual harmony. While considered an “alternative” form of treatment in the U.S., it is embraced in several other countries, and is growing in popularity and acceptance in the U.S.

The Center’s research: According to the Center’s research, people of faith don’t always have a better medical outcome, but seem to feel better about the outcome and have better sense of well-being than non-spiritual patients, even if ill or terminal. The Center’s Spirituality and Health project’s team of diverse faculty and professionals has expertise in religious studies, cultural anthropology, social work, medical sociology, neuropsychology, health psychology, rehabilitation medicine and oncology. Its current research project is investigating the relationships that exist among spirituality, religion, physical health and mental health in individuals with chronic illnesses and disabilities such as traumatic brain injury, spinal cord injury, stroke, cancer, ventilator-dependent pulmonary disorders and other physical conditions.

Follow-up studies will look at the efficacy of mindfulness-based stress reduction on persons with chronic disabilities; transcendence and right hemisphere functioning; and spirituality as a personality construct. The Center is pursuing funding to study spirituality and health-risk behaviors in adolescents and the relationship between neuroscience and religion.

Issues today: Having staff that are religiously and culturally literate helps bridge gaps in patient care. Medical staff that speak languages of patients so information can be communicated without the need of a translator – often a young relative, in recent immigrant families – is also helpful. Medical practices can be conscious of having staff that reflect the cultural makeup of the community they serve and engage in teaching about religious practices and beliefs.

Researchers can study conscience challenges in the workplace, such as how often conscience plays a role in providing or choosing not to provide a particular medication, surgery or treatment. Do people of the same faith practice these principles differently in a medical context? What roles do laws play in affecting or changing attitudes about religious and medical practice? Researchers could study whether chaplains aid in healing or are helpful in a hospice setting. They could also study the impacts of diversity among medical practitioners and patients, or work with the Center on further research into religion/spirituality, health, healing and well-being.

Articles

Books

  • Handbook of Religion and Health: Second Edition. Harold G. Koenig, Michael E. McCullough and David B. Larson. Oxford University Press, USA, 2012.
  • Spiritual Healing: Scientific and Religious Perspectives edited by Fraser Watts (New York: Cambridge University Press, 2011).
  • Faith and Health: Religion, Science and Public Policy by Paul D. Simmons. Mercer University Press, 2009.
  • Transcultural Concepts in Nursing Care by Margaret M. Andrews and Joyceen S. Boyle (Philadelphia, Pennsylvania: Lippincott Williams & Wilkin, 2003).
  • The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures by Anne Fadiman (New York, New York: Farrar, Straus and Giroux, 1997).
  • Making Healthcare Whole: Integrating Spirituality into Patient Care by Christina Puchalski and Betty Ferrell. Templeton Press, 2010.
  • Worlds Apart: A Facilitator’s Guide, A Four-Part Series on Cross-Cultural Healthcare (accompanies film “Worlds Apart”) by Alexander Green, MD, Joseph Betancourt, MD, MPH, and J. Emilio Carrillo, MD, MPH (California: Stanford University Center for Biomedical Ethics, 2005).
  • Achieving Cultural Competency: A Case-based Approach to Training Health Professionals. Wiley-Blackwell. 2009.
  • Handbook of Religion and Health. Harold G. Koenig, Michael E. McCullough and David B. Larson. Oxford University Press, USA, 2001.
  • Medicine, Religion, and Health: Where Science and Spirituality Meet. Harold G. Koenig Templeton Press, 2008.
  • Prayers and Rituals at a Time of Illness and Dying: The Practices of Five World Religions. Patricia Fosarelli. Templeton Press, 2008.
  • Spirituality in Patient Care: Why, How, When, and What. Harold G Koenig. Templeton Press, 2007.
  • What Do I Say?: Talking with Patients about Spirituality (Book & DVD). Elizabeth Johnston-Taylor. Templeton Press, 2007.
  • Spiritual Assessment: Handbook for Helping Professionals. North American Association of Christians in Social Work, 2005.
  • Caring Well: Religion, Narrative, and Health Care Ethics. David H. Smith. Westminster John Knox Press, 2000.
  • Health Care Ethics: A Catholic Theological Analysis. Benedict M. Ashley, Jean De Blois and Kevin D. O’Rourke. Georgetown University Press, 2007.
  • After We Die: The Life and Times of the Human Cadaver. Norman L. Cantor. Georgetown University Press, 2010.
  • Practical Decision Making in Health Care (Third Edition). Raymond J. Devettere. Georgetown University Press, 2010.
  • Methods in Medical Ethics (Second Edition). Jeremy Sugarcane, MD, and Daniel P. Sulmasy, OFM, MD, Editors.  Georgetown University Press, 2010.
  • Medical Governance: Values, Expertise, and Interests in Organ Transplantation. David L. Weimer. Georgetown University Press, 2010.

Case studies

Codes of ethics

Journals

More links

Professional associations and faith groups

Recent research

  • Scheitle, Christopher P. and Amy Adamczyk. “High-cost Religion, Religious Switching, and Health.” Journal of Health and Social Behavior. 51, no. 3 (2010): 325-342.
  • Inhorn, M.C. and G.I. Serour. “Islam, medicine, and Arab-Muslim refugee health in America after 9/11.” Lancet. Vol. 378, No. 9794 (Sept. 3 2011): 935-43.
  • F.D. Yates, Jr. “Ethics for the pediatrician: religion and spirituality in pediatrics.”Pediatrics in Review. Vol. 32, No. 9 (Sept 2011): 91-4.

Syllabi

Videos

  • “World’s Apart: A Series on Cross-Cultural Healthcare,” 2005
  • “Hold Your Breath,” Mohammad Kochi, a devout Muslim immigrant, faces possible death from stomach cancer; his story a powerful argument for the necessity of cultural competence and diversity training, 2005
  • “The Culture of Emotions,” designed to introduce cultural competence and diversity skills to mental/behavioral health professionals and students who deal with multi-cultural client populations, 2002
  • “Stanley,” this case study raises complex issues about medical prognosis and religious belief in end-of-life decision-making, 2002
  • “That Spirit, That Thing Inside,” Hispanic/Latino and American Indian nurses describe how they came to their careers, and have used their nursing expertise to serve their families, their tribes, and their communities, 2002
  • “Community Voices,” a multi-cultural array of patients, clinicians and other healthcare workers explore the many ways that differences in culture, race and ethnicity affect health and the delivery of healthcare services, 2001
  • “Bodies and Souls,” Sister Manette, a nurse practitioner, and a white Catholic nun, runs the only health clinic in Jonestown, a largely African-American town in the heart of the Mississippi delta, where many people haven’t seen a doctor more than once or twice in their lives, 2005