|
What
does it mean to be healthy? Although physical
assessment, lab tests and scans may provide
some objective measurements, there’s more to
the picture. Most nurses instinctively know
that health encompasses more than purely physical
qualities. The psychological and spiritual dimensions
also weigh heavily upon the healing process.
Yet, a recent article in The New England
Journal of Medicine questions the ethics
of spiritual care.1
In
the article Richard P. Sloan, et al, argue first
that the research on the relationship between
religion and health is inconclusive. They have
a good point. We have to ask if that research
even is appropriate. Science can only measure
objective data. We can’t even measure the subtleties
of human relationships, so how can we quantify
the effects of a relationship with God? There
are just too many variables and too many subjective
qualities. Spirituality, by its very nature,
cannot be quantified. We shouldn’t rely on research
to determine whether or not we should provide
spiritual care--a conclusion the authors share.
Second,
the authors argue that the relationship between
the health care professional and the patient
is unequal, so prescribing religious activity
is coercive and, therefore, unethical. Here
they compare recommendations for involvement
in religious activity with other areas considered
private, such as marriage and childbearing.
However, there is a big difference between prescribing
and educating. Should we really withhold information
that we know will help others simply because
it might interfere with their lifestyle? Furthermore,
the authors argue, most health care professionals
don’t share the religious background of their
patients, nor are they trained adequately in
engaging patients in conversations about religious
matters. Here the authors put in a plug for
chaplains and community clergy--not surprising
since most of the authors are chaplains. However,
many chaplains do not share the religious orientation
of the patients, either, and community clergy
may have great difficulty relating to someone
with a serious illness.
Next,
the authors go back to the research, arguing
that a minority of patients (albeit a substantial
minority: 37-40 percent) indicated that they
want their physicians to include a spiritual
component in their medical care. After critiquing
the research further, they conclude, "Patients
often ask for things that are unrealistic or
that may not be in their best interests."
On the other hand, a key to good diagnosis and
treatment is being able to listen carefully
to patients and to recognize their concerns.
Finally,
the authors conclude that using research to
validate spiritual care merely trivializes religion.
"Religion is more than a collection of
views and practices, and its value cannot be
determined instrumentally; it is a spiritual
way of being in the world." Again, I would
say, "Yes, but there is more."
Christian
faith is not just a collection of views and
practices; neither is it a "spiritual way
of being in the world." It is a dynamic,
personal relationship with God. While that relationship
may at times bring comfort, the Bible also refers
to it as refining fire (Mal 3:2-3; 1 Pet 1:7).
Faith, indeed, often makes us extremely uncomfortable.
I wonder how the prayer research would have
been interpreted if the patients studied had
included Job, the prophet Jeremiah or the apostle
Paul. God allowed Job to suffer unjustly. Job
lost everything: his health, wealth and family.
His prayers seemed to fall on deaf ears. Jeremiah’s
ministry ended in apparent failure. Paul’s physical
ailment never went away, and his life ended
in prison.
The
goal of spiritual care is not comfort, but facilitating
a person’s relationship with God. Times of crisis,
including illness, serve to get our attention
and redirect our thinking toward God. Nurses
and doctors are usually among the first to encounter
people when they begin to question, "Why
is this happening to me?" Our roles require
us to tread on deeply private aspects of our
patients’ lives. When we are already conversing
about bowel movements, urination, menstrual
periods, sexual practices and the possibility
of death, addressing spiritual concerns is certainly
in order.
Jesus,
the Great Physician, provides the model. When
he healed a paralyzed man, he first told him,
"Your sins are forgiven" (Mt 9:2-8;
Mk 2:1-12; Lk 5:17-26). He acknowledged the
importance of faith in the healing process (Mt
15:28, 17:20-21; Mk 2:5, 5:34). He healed some
physical and psychiatric symptoms by casting
out demons (Mt 8:28-34, 9:32-34, 17:14-21).
He sent some of those he healed to the clergy
(Lk 17:11-19), but he refused to be bound by
human religious restrictions when people needed
healing (Mt 12:9-14). His healing resulted in
people praising God and following him (Mt 15:31,
20:34).
Health,
from God’s perspective, is never a purely physical,
scientifically defined state. Health is always
related to salvation--that dynamic, personal
relationship to God. In turn, that relationship
with God must be nurtured and expressed in human
community. The Bible calls this God-centered
human community shalom. The concept of
shalom expands our understanding of health.
If we are working toward shalom, then
we cannot ignore spiritual needs. Neither can
we relegate spiritual care only to the professional
clergy. God has called each of us to care for
one another through the priesthood of all
believers (Eph 4:15-16; Heb 10:23-25; 1
Pet 2:9).
Is
spiritual care unethical? Let me approach it
from another perspective. Would it be unethical
to provide antibiotics for a raging bacterial
infection? Of course not! It would be unethical
to withhold them. In a similar vein, if we begin
with a biblical understanding of health, withholding
spiritual care would be unethical.
Of
course, spiritual coercion is unethical, as
is providing any medical treatment without informed
consent. Sadly, abuses of power and privilege
do occur; however, an unequal relationship does
not necessarily preclude entering a patient’s
private world. Guided by a personal relationship
with God, tempered with proper training, nurses
and other health care professionals can and
should be prepared to offer appropriate,
ethical spiritual care.--JAS
1
Richard P. Sloan, et al., "Should Physicians
Prescribe Religious Activities?" The
New England Journal of Medicine 342, no.
25 (June 22, 2000):1913-16.
|
