By Richard P. Sloan
Should the medical care you receive from your doctor depend upon the quality of the available treatments? Or should it depend upon the doctor’s religious beliefs or political ideology? These are questions we should ask in light of Surgeon General nominee Dr. James Holsinger’s recent appearance before the Senate and because, as a country, we have become infatuated with the idea that religious devotion is good for our health. The conflicting loyalties of personal faith and professional responsibility portend danger for patients.
Most of us believe that childhood vaccination programs not only are good for individual children but promote the wellbeing of the entire country. What should we do about doctors who won’t administer the vaccines for chickenpox, hepatitis, measles, polio, and rabies because they believe that they derive from aborted fetal tissue? Recently, the Wisconsin legislature considered a bill allowing a doctor to refuse not only to administer the chickenpox vaccine to a child but also to refuse to inform the child’s parents about it by claiming religious opposition. Such objection holds the wellbeing of the larger society hostage to the moral views of a small minority by risking the resurgence of epidemic diseases we conquered decades ago.
This conflict between religious belief and medical science, it appears, is not uncommon, making it all the more dangerous. Recently, the New England Journal of Medicine reported that 14% of U.S. physicians, representing different regions of the country and different medical specialties, believe that their personal religious views rather than the needs of their patients should determine which perfectly legal medical treatments they offer and, more distressing still, that they are under no particular obligation to disclose this bias to their patients or to refer them to other physicians who will offer the treatment. Ethicists have noted that because doctors have state licenses giving them exclusive rights to practice medicine, they have an obligation to deliver medical care to all those who seek it, not just to those who share their religious convictions. That means understanding the best scientific evidence about which factors contribute to health and which ones don’t and practicing medicine accordingly. It means not permitting personal values, religious or otherwise, to supersede the best interests of patients.
In addition to influencing the availability of medical procedures, religious intrusion into medical practice threatens to violate the norm of patient autonomy by manipulative or even coercive means. Already, the Christian Medical and Dental Association, a professional society with more than 17,000 members, publishes a handbook that instructs physicians on how to use their practices to evangelize. According to a recent article in the Des Moines Register, the Iowa City VA Hospital repeatedly attempted to convert a Jewish veteran to Christianity during hospitalizations over the past two year. In 2004, CBS News reported on a Colorado orthopedic surgeon who “requests” that patients pray with him while they are gowned and supine on the gurney, ready to be wheeled into surgery. Because medical patients very often are in pain and fearful, they are especially vulnerable to manipulation by physicians who, even in these days of medical consumerism, retain positions of authority in the physician-patient relationship. When doctors capitalize on this authority to pursue a religious rather than a medical agenda, they violate ethical standards of patient care.
No one disputes that for a great many people, religion provides comfort in times of difficulty, whether illness related or otherwise. But being a medical professional means assuming certain responsibilities and foremost among them is acting in the interests of your patients rather than allowing your personal religious beliefs to interfere. As epidemiologist Petr Skrabanek put it years ago, to allow doctors’ religious values to interfere with the care patients receive is “a social movement dressed up in scientific language.” For doctors who can’t do this, there is a clear alternative: find another profession.
Richard P. Sloan is Professor of Behavioral Medical at Columbia University Medical Center and the New York State Psychiatric Institute and author of “Blind Faith: The Unholy Alliance of Religion and Medicine.”