Dr Ed Hussman was beside himself
with torment. A pregnant teenaged girl had come to his
office in downtown Toronto; she was anemic and bleeding
heavily, but when she found out she'd need a transfusion,
she refused treatment. "Her hemoglobin was 55; she was
as white as a wax candle," he recalls. "I was in shock."
She was a minor, so he called in
her parents. As it turned out, they were Jehovah's Witnesses,
whose religion explicitly forbade the use of blood products.
"I knew I couldn't force treatment," says Dr Hussman.
"But I told them that if she didn't get a transfusion,
I was afraid that she was going to bleed to death."
That didn't sway them. "They insisted that if that's
how it's going to be, that's how it's going to be."
To everyone's relief, the girl survived. There is currently
a movement among church members, led by groups like
Associated Jehovah's Witnesses for Reform on Blood,
to repeal the blood transfusion ban.
As the world gets smaller and medicine
gets more complex, conflicts between medical advice
and religious faith are becoming more and more common.
A University of Chicago study, published in the January
10 issue of Archives of Internal Medicine, looks
at how doctors cope with the struggle. For the study,
21 physicians were given extensive one-on-one interviews.
These doctors themselves had different faith backgrounds
(Protestant, Jewish, Catholic, Hindu, Buddhist, and
non-religious), and they saw a wide variety of religious
patients.
Dr Farr A Curlin, an instructor
of general internal medicine in the MacLean Centre for
Clinical Medical Ethics in the University of Chicago
and coauthor of the study, says that emergency cases
like Dr Hussman's dilemma aren't the most common sort
of clashes between medical science and religion. And
some of the doctors in the study thought the Jehovah's
Witnesses refusal to accept blood products was easy
to deal with because there was no ambiguity. One of
the anonymous interviewees said "...you know, the thing
with blood transfusions and all that comes up all the
time. I feel like as long as somebody understands the
situation, then that's his or her choice. I think that's
OK."
DIVINE
PREVENTION
In fact, most doctors in the study found that medico-religious
conflicts occurred mainly when treatment outcomes were
uncertain, or directed towards the prevention of potential
future problems. "Patients weren't saying, 'Don't treat
this crushing chest pain I have because I'm just going
to trust God,'" says Dr Curlin.
So, what can doctors do when they
feel that patients are endangering themselves by relying
on faith? "As much as doctors would like to remain neutral
about patients' ideas," Dr Curlin says, "they can't
do so when those ideas are at the root of conflict between
the patient and the physician."
The struggle between the desire
to respect patients' beliefs and concern for their well-being
often leads doctors to apply somewhat devious tactics.
"It's very common for doctors to do what we call 'negotiating
within the patient's paradigm'. They try to persuade
the patient that God intended for them to come and see
the doctor, and that the doctor is an instrument of
God's healing."
RESPECTFULLY
DISAGREE
But Dr Curlin regards that approach as ethically dodgy.
It's better to be candid, he suggests. "Rather than
portraying themselves as having religious values that
they don't in fact have, I'd hope doctors would acknowledge
where they disagree with patients, clarify how they
are committed to the patient's good as they understand
it, and try to work out some accommodation."
"That being said," he concludes,
"they don't need to open up a conversation by saying,
'You know what? I think you're deluded in your religious
ideas.' That wouldn't be a wise approach."
|
