Beyond that simple piece of information, a discussion of the physician’s faith is inappropriate in the clinical setting and is a boundary violation.

Moreover, if there is a negative clinical outcome, such as unsuccessful surgery, patients – especially if they are seriously depressed – may conclude that their prayer hasn’t been answered and the clinician, by virtue of having joined them in prayer, is implicated in that failure.

That said, if a distressed patient wants the physician to pray with him or her, the physician should at least be aware that they are getting uncomfortably close to a boundary and it is a “slippery slope” to actually cross the boundary. Boundaries are not always absolutely unmovable, but if a clinician is going to breach or approach breaching them, they have to be able to justify crossing or coming close to the line. This is why I set a firm boundary of no prayer and no religious activity. In a rare circumstance in which a patient broaches the subject, I need to be prepared to justify the decision.

One scenario for a clinician whose patient requests joint prayer is to agree to be present silently while the patient prays. Another is to suggest that a chaplain be involved instead.

How would you react if a patient’s religious beliefs dictated actions you felt were detrimental to him or her?

Decisions about whether a patient is impaired by illness  – especially mental illness – or whether the person is acting from an authentic religious belief are difficult to approach, with very little straightforward solution. It helps to discuss these matters with colleagues or supervisors.

One memorable incident stands out. A young woman decided to live as a homeless person, saying that God wanted her to live a humble lifestyle without money or shelter. The homeless people brought her to us because they thought she was too vulnerable to be out on the street. We found no evidence of mental illness, although I thought it was strange and felt that it was unlikely that this was merely a religious matter. I asked a colleague with an evangelical Baptist background to assess her and he felt this was spiritual crisis, not a mental illness, so we kept an eye on her while living on the street. A few days later she became psychotic and we had to admit her to the hospital. My colleague wasn’t necessarily wrong because it can be very difficult to distinguish between authentic religious belief and mental illness.

The principle is that you have to take people as you find them and they may make unwise decisions based on religious faith. Under most circumstances, those decisions should still be respected, irrespective of our personal beliefs.

References

1.    MacLean CD, Susi B, Phifer N, et al. Patient preference for physician discussion and practice of spirituality: results from a multicenter patient survey. J Gen Intern Med. 2003;18:38-43.

2.    Balboni MJ, Babar A, Dillinger J, et al. “It depends”: viewpoints of patients, physicians, and nurses on patient practitioner prayer in the setting of advanced cancer. J Pain Symptom Manage. 2011;41:836-847.

3.    Puchalski CM. The role of spirituality in health care. Proc (Bayl Univ Med Cent). 2001;14(4):352-357.

4.    Zaidi D. Influences of religion and spirituality in medicine. AMA J Ethics. 2018;20(7)E607-674.

5.    Frush BW, Eberly JB Jr, Curlin FA. What Should Physicians and Chaplains Do When a Patient Believes God Wants Him to Suffer? AMA J Ethics. 2018;20(7):E613-620.

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This article originally appeared on MPR