A Necessary Tension!

Like many contemporary ethical dilemmas revolving around religion, this question pitting patients’ interests against religious conviction presumes a fault line or dualism, characteristic of modernity, which has now led us into what T. S. Eliot called a wasteland. It is hard to believe that just a few hundred years ago the great philosophers, theologians and religious figures like Maimonides were also the era’s greatest doctors. And it would have been unimaginable to them that patients’ interests (to be cured) and God’s desires (to choose life) could conflict. No wonder, that well into this century, this sensibility was expressed by many like my grandparents who saw doctors as gods!

The explosive advances in medicine since the enlightenment were to a great extent dependent on the differentiation (Kant) between the knowledge spheres of science and religion, and the emergence of scientific and empirical methods to study the body. This healthy differentiation became, over the centuries, an unhealthy separation and even antagonism between medicine and religion with the unfortunate consequence of medicine seemingly always associated with pushing the limits (a good thing) and religion seemingly always being associated with holding the line (a bad thing). The fact that this question feels so pressing reflects the failure of both physicians and religious leadership to understand their respective expertise’s, roles, limits, and to ultimately see the patient as a whole human being.

One can already hear the reaction to this question in our polarized public culture. Our secular fundamentalists, certain of the primitive and backwardness of all religion, are outraged at the very thought that a physician would have religious convictions yet alone that such convictions could possibly come into conflict with a patient’s interest. On the other side, our religious fundamentalists are equally horrified having to defend “God’s objective Truth” against physicians recklessly taking life into their own hands. If our choice is between religious fundamentalists who know exactly what the God in whom they believe wants them to do and secular fundamentalists who are just as certain about their truth then the only thing for sure is that patients interests will not be maximally perceived yet alone honored.

Obviously, legally, in our country, a physician’s primary responsibility is to a patients well being as understood by contemporary medical ethical standards (e.g. AMA) and not to any particular religious conviction. This is no different than a fireman’s primary responsibility to save people from a burning building regardless of any conflict with his religious convictions. But what this question is actually getting at is a psycho-spiritual tension that is crucial to keep alive in our medical and religious communities as well as our broader culture.

The term “religious conviction”, as it is used pitted against patient’s interest, describes an inner experience that any ethically and morally sensitive doctor needs to cultivate and be ever sensitive to. There are times when a physician ought to feel a stirring, an anxiousness, an unease, a disquieting sense - a signal of transcendence if one is “religious” and immanence if one is “secular” – that medical tradition, precedent, and protocol as inherited, learned, and practiced is not in one’s patient’s interests and that some deeper, more inclusive, intuition, sensibility and awareness that comes from outside of one’s medical comfort zone needs to be brought to bear on the situation. Any doctor who is never open to this inner dissonance is one who, whether religious or not, is guilty of hubris and by definition can not have his patients interests maximally in mind and therefore is not genuinely living up to the sacred calling of doctor.

By the same token, “patients interests”, as it is used pitted against religious convictions, describes an inner experience that any ethically and morally sensitive religious person needs to cultivate and be ever sensitive to. There are times when a deeply religious person ought to feel a stirring, an anxiousness, an unease, a disquieting sense - a signal of transcendence if one is “traditionally religious” and immanence if one is “ a religious humanist” – that religious tradition, creed and precedent as inherited, learned, and practiced is not in one’s patient’s interests and that some deeper, more inclusive, intuition, sensibility and awareness that comes from outside of one’s religious comfort zone needs to be brought to bear on the situation. Any religious person who is never open to this inner dissonance is one who, whether traditional or not, is guilty of hubris, and by definition can not have God’s desires/interests maximally in mind and therefore is not genuinely living up to being a religious person.

Precisely at this moment in my life my brother-in-law, a wonderful doctor, and I, a rabbi, are each feeling this tension from our respective traditions as our father-in-law, who we both deeply love, suffers from pancreatic cancer. We have reached a point – which admittedly is different for each person – where we honestly feel the limits of our own traditions (medical and religious) to be simply offered as the way to deal with the present moment. Neither one of us can hide behind the certainty of the terms “patient interests” or “religious conviction”. For us, the question of patient’s interests versus religious conviction has dissolved in a humility that needs to be at the core of great medicine and great religion all along the way. When that happens the tension between patients interests and religious conviction is a guarantee that the person being cared for becomes a whole human being.

By Irwin Kula  |  August 13, 2007; 8:42 AM ET
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