Permanent link for "Religious belief and medical decision making" by Jeffrey Byrnes on February 16, 2021

If you are facing a significant health episode and believe God will perform a miracle, is it OK for you to ignore established medical science?  Is it OK for the medical team to just do what they know is best and ignore your beliefs?  The DeVos Medical Ethics Colloquy and the associated West Michigan Medical Ethics Conference will host events on Monday, Feb. 22 that will address the role of the patient’s religion in making decisions about medical care. The aim of the event is to help health care workers and community participants better understand the challenges of engaging with a patient’s religious beliefs when making decisions — even when these beliefs are shared, but in particular when they are not.

People are sometimes genuinely surprised to find out many health care decisions are not made on the basis of medical science. That claim is not intended as a general attack on contemporary health care. Rather, that claim is simply a reminder of the diversity of determinations that are made in health care.

On one hand, many determinations are, in fact, made on the basis of medical science. Determinations about whether a patient is COVID positive, at risk of a heart attack, or cancer-free — the kinds of determinations that we typically think of going into a hospital — are all made with the tools, training, and methods of medical science.

On the other hand, consider a scenario in which a patient of a certain age has had a long fight with a disease and is told by his doctor that the available treatments are no longer helping. She tells the patient that medical science has determined that the best remaining chance to prolong his life is a complicated and risky surgery. The remaining decision is this: should the patient undergo the surgery in an effort to prolong his life?

The answer to this question is not determined on the basis of medical science. Importantly, the “should I do this?” question is hardly less frequent than the kind of medical determinations that we typically think of as going on inside a hospital. For very nearly all medically advised treatments must be paired with a non-medical decision about whether to consent to that treatment.

To say that the question, “should the patient consent to the risky surgery?” is not a medical question, is simply to say that no part of the physician’s medical school training can serve as the basis for deciding whether a particular patient should undergo the procedure. Yet we do not view this as a gap in the physician’s medical education, simply because we don’t think of the consent question as the physician’s to make in the first place. The decision to consent, we feel, rests firmly on the shoulders of the patient alone. In this, determinations about what a patient should do are very different from determinations about what is medically appropriate.

One way of labeling the difference between medical decisions and decisions about what a patient should do is to say that medical decisions are based on facts, while decisions about what a patient should do are based on opinion. Understanding the kinds of decisions that are made in health care will require us to think about the kinds of decisions that we make in a different way.

Some decisions, like choosing a particular flavor of ice cream, are preferences that do not, all things considered, matter that much to us. If a friend encouraged us to try a different flavor, we might take her up on that or we might stick to our original decision, but we probably wouldn’t consider it an issue about which to argue. On the other hand, if you calculate a 20 percent tip for a dinner bill and a friend tells you that you have made a mistake, that would be a difference of fact for which there is a right answer, not just a difference of opinion. Now consider the decision to accept or refuse the wine or meat. Are those decisions more like choosing a scoop of ice cream or more like calculating the tip?

For some people, drinking alcohol, eating meat — or eating certain kinds of meat — are neither decisions based on objective fact, nor decisions one would choose differently like ordering ice cream.  For some, deciding to accept the drink or food would be informed by the decider’s religious beliefs. Religious beliefs are not the kinds of things which we presume to be shared in a pluralistic society, but they are also not the kinds of things that can be easily changed without cost.

Many of the decisions that patients face when receiving health care require them to reflect upon their bodies, their priorities, their fears, and even their own mortality. Therefore it is not a surprise that religious patients will make the relevant decisions on the basis of their religious beliefs. Often, these religiously informed decisions do not pose any particular problem for those involved. But, occasionally, strife arises in a health care setting because caregivers do not appreciate the role that religious beliefs play in a patient’s decisions.

Without that understanding a health care worker might be inclined to treat the patient’s religiously informed decision as a mere statement of preference, like choosing an ice cream flavor. Alternately, a physician might think that the treatment being offered to a patient clearly follows from a set of shared commitments, just like the solution to a math problem. In either case, the health care worker might be inclined to push back against the patient’s decision. When the treatment decision is a matter of life and death or involves a child, then the patient is even more likely to face pushback.

The task of the expert presenters of the conference and colloquy event will be to help attendees recognize, understand, and respect the character of religiously based health care decisions. This will include asking the experts to wrestle with the question of when and if it is ever appropriate to push back on a decision based on a patient’s religious beliefs. It will prove to be enlightening as we all, both the health professionals and clients, face such issues. Join us! 
 

Posted on Permanent link for "Religious belief and medical decision making" by Jeffrey Byrnes on February 16, 2021.