As medicine continues to rapidly progress, is it possible to expand human perspectives at the same pace? The constant debate between religion and science has become a relentless argument with no true solution and has created several conflicts in everyday life. Specifically, the issue of religion in health has occasionally arisen in the media as it is most often a surprise when an individual chooses God and His word over their own life. Jehovah’s Witnesses, in particular, are the most familiar to the public due to their well-known promise to refuse blood transfusions. In 2001, there was an estimate using the American Association of Blood Banks’ report that 4 million patients received blood transfusions which is equal to about 15 out of every 1000 Americans required blood each year. At the time there were 1 million Jehovah’s Witnesses in the US, which means about 15,000 needed blood at certain point. Even if their rate of death only increased by 1% due to the blood refusal, that means that 150 Jehovah’s Witnesses died in that year because of their choice to follow the blood prohibition. These personal issues have continuously emerged and certain medical innovations persistently affect decisions regarding refusal of care due to religious reasons. In these types of situations, the perspectives of doctors and patients are challenged as the values of responsibility and autonomy clash; the doctor has made an oath to heal, yet the patient has made a promise to God. Should a doctor have the ability to neglect a patient’s wishes in order to perform a life saving treatment?
For thousands of years, people have chosen to dedicate their lives to the practice of worship; anything from the Scripture of Christianity to the Tripitaka of Buddhism. There are still some that stay extremely loyal to the exact words written in these holy references which sometimes puts their beliefs in direct conflict to modern medicine. Specifically, this takes the form of generating issues between the doctor’s oath to heal and the patient’s devotion to their God, especially when the patient’s decision goes against strongly recommended medical advice.
Currently, eighty-four percent of Americans affiliate themselves with a recognized religious group and many states offer strong legal protections to patients who refuse treatments on religious grounds (The Global Religious Landscape). Autonomy is pertinent in these types of situations as the public have a right to self rule and make choices regarding their health. Therefore, it is the backbone of the American belief system as it upholds the importance of personal freedom and will always play a role in this dispute. Of course, there are many different people that hold the religious medical values in different standards than others, but in this project I am focused on a certain subset of people who obey the exact words in the religious texts. As medical innovations continuously occur, the public must be informed as new alternative treatments become available. Although these new medical advances could be helpful to many, certain people consider themselves to be restricted from these options due to their devotion to their god and perpetual loyalty to the scripture. This unceasing worship can often come into conflict with the physicians and medical professionals as well as the values of responsibility and autonomy are put in opposition.
The History of Refusal of Care on Religious Grounds
The right to refuse treatment on religious grounds is undoubtedly applicable to this issue as it gives the majority of the public the opportunity and protection to neglect their wellbeing in order to pursue their personal religious values. The history of the right to refuse treatment in the United States is traced back to the two judicial cases. The first being Union Pacific Railway Co. v Botsford, when a man sued the railroad company after becoming concussed, which had resulted due to an alleged negligence of the company. The railroad company appealed for surgical examination of the man, however, this request was denied because the Supreme Court deemed that, “No right is held more sacred, or is more carefully guarded by the common law, than the right of every individual to the possession and control of his own person, free from all restraint or interference of others, unless by clear and unquestionable authority of law” (Standler). The second case was Schloendorff v. Society of New York Hospital which promised “Every human being of adult years and sound mind has a right to determine what shall be done with his own body; and a surgeon who performs an operation without his patient’s consent commits an assault, for which he is liable in damages” (Standler).
However, in order to actually refuse care, two things are needed: competency and capacity. A patient’s competency is assumed, if the person is over 18, unless a court determines otherwise. While, capacity is the patient’s ability to understand their medical situation and make informed decisions (Leo). As long as a patient is both competent and has capacity, the physician must obtain informed consent before going forth with treatment. In order to protect a person’s autonomy, if one can consent to treatment, one can also refuse it. Nonconsensual surgery is considered battery and a doctor’s failure to disclose risk or existence of alternative treatment or treatments is considered negligence (Standler). Further, each state has now passed their own legislation to either allow or forbid religious and philosophical exemptions. Forty-seven states currently have a law maintaining religious exemption, yet only eighteen have laws upholding philosophical exemptions (States With Religious). These acts have cemented religion and its role into the American government. This is merely another piece of evidence with proves that the state and church are not separated and has been instead made to be a piece of all citizens’ lives, no matter if they are religious.
Refusal of Care Case Study
The rules of refusal of care have been shown to be upheld as there are several case studies of patients that have refused care due to religious reasons. A prominent case, In re Milton, proved the necessary component of competency ruled by the court. In 1987, a psychiatric patient with a malignant tumor in her uterus refused to give her consent to a treatment which she believed violated her religious beliefs. The psychiatric hospital tried to obtain a court order authorizing the requested treatment on the grounds that the woman as deranged. However, the woman was competent despite the fact that was suffering from a delusion that she was the spouse of a local faith healer and believed that he would heal her. The Court defended the patient’s right to adhere to the religion of her choice and to refuse medical treatment on the basis of that religion. Her right to freedom of religion must be upheld despite the fact that the treatment was arguably life-extending (Standler). This is one of the thousands of examples that judges and physicians must manage when faced with a perverse patient. It is not uncommon for a hospital to meet with a resistant patient, especially now that federal laws have made it effortless for individuals to escape necessary care due to religious reasons. Although the media may portray Christians as the sole religion that has used religious exemptions in medical situations, in reality, other religions such as Islam, Judaism, and Hinduism also have medical ‘restrictions’ that have allowed them to use exemptions.
The History of Islam
The history of Islam and its holy text, the Qur’an, is slightly complicated but the main idea to remember regarding its evolution is the split between the Shiites and Sunnis. When the Islamic Prophet Muhammad died in 632 A.D., a debate emerged about who should be his successor. Both sides agreed that Allah is the one true God and that Muhammad was his messenger, but one group (the Shiites) felt Muhammad’s successor should be someone in his bloodline, while the other (the Sunnis) felt that any individual who would follow the Prophet’s customs was acceptable (Chuck). This issue was not due to religious faith but due to political leadership, therefore, when implementing their law, usually their interpretations of the Qur’an differ. Sunni judges follow Islamic law to the letter, while Shiite judges are more lenient when interpreting the law.
However, this difference does not extend into the realm of medicine and ultimately, both sects must follow the exact same restrictions. It is commonly known that pork and alcohol are considered forbidden. In the Qur’an, it specifically states, “He hath forbidden you only carrion, and blood, and swine flesh, and that which hath been immolated to (the name of) any other than Allah.” (Qur’an 2:173). And for alcohol, “They question thee about strong drink and games of chance. Say: In both is great sin, and (some) utility for men; but the sin of them is greater than their usefulness” (Qur’an 2:219). Muslim dietary regulation can affect patients’ use of medications, especially drugs that have porcine origins, or gelatin, and contain alcohol.
Islam: Innovation Resolving Limitations
Some specific examples of forbidden medications that contain the limitations that Muslims might encounter are heparin, amoxicillin, and cough syrup; all very common for medicinal purposes. Heparin, a very familiar medicine, is of porcine origin and is used as an anticoagulant to decrease the clotting ability of the blood and help prevent harmful clots from forming in blood vessels. This medicine is similar to a blood thinner, so it is often used to treat strokes and prevent blood from clotting during surgery (Heparin). Other medicines of porcine nature may most likely include insulin and pepsin, both very necessary for treating a large section of the population. Similarly, gelatin origin is also popular, including in amoxicillin which is used in the treatment of many bacterial infections including bronchiectasis (Amoxicillin). Gelatin, itself, is even used in the treatment of strengthening bones due to osteoporosis and arthritis as well as for weight loss. Already, for the popular majority, it is not generally known that pork is forbidden for Muslims; it is even less acknowledged that gelatin is created by boiling the skin, cartilage, and bones of animals, specifically pork. This can easily foster negligence and ignorance of the doctor if they prescribe a gelatin origin medicine to a Muslim patient, even if they knew that pork was prohibited. Finally, alcohol can be found in very common medicines, including many types of cough syrups, specifically Nyquil Liquid Cough Syrup, which contains 10 percent alcohol (NyQuil). Many cough medications contain alcohol to allow ingredients to mix when they are unable to dissolve in water. Therefore, the necessary innovations for Muslims are the replacement medications for these ‘forbidden’ medicines.
New treatments have been created that avoid these ingredients but still have the same or a similar outcome for the patient. Although these other medications were not created because of the religious implications, but nevertheless they provide new options for the devout. NyQuil already has created Alcohol-Free NyQuil Liquid and NyQuil LiquiCaps which do not contain alcohol and instead contain another solvent (NyQuil). Some companies are also trying to eliminate animal sourced products and have created replacements for many. Instead of Heparin, there is Arixtra. Instead of Amoxicillin, there is Bactrim. These are only a few specific examples of medicines which perform essentially the same functions as the former, but as scientists continue to update medication alternatives, the public will have access to a website called iodine.com which allows them to search for medicines which contain these types of ingredients as well alternate medications listing their ingredients, benefits, and uses.
This innovation allows individuals to act on autonomy and search for a way to save themselves. Instead of bluntly refusing a treatment, Muslims have a way to directly access alternatives. By working with doctors to find available treatments, Muslims and hospitals are able to establish a relationship based on respect and responsibility to achieve both of their goals: save the patient and protect their faith to God, respectively. There is a way in daily life for a Muslim to not be affected by this restriction, now there is a way for there not to be an issue in medical situations as well.
Islam: Depriving Innovation
However, an incredible, but unavailable to the Islamic devout, innovation will come when doctors are able to successfully perform an animal to human organ transplant. REVIVICOR is a regenerative medicine company dedicated to alternative tissue sourcing by using xenotransplantation, which is the process of grafting or transplanting organs and tissues between members of different species. The ethics of xenotransplantation is an entirely different debate involving the equality of a person’s live versus an animal’s; so instead, we will focus on the religious perspective. Although it may seem far fetched, so far they have done much to bring this innovation to reality by focusing on pigs as a highly compatible source for humans. REVIVICOR’s approach is to add genes to pigs to make the organ and patient more compatible and will still require the use of immunosuppressive drugs to the amount of drug therapy required for human-to-human transplants (Xenotransplantation Program). If this innovation does come into existence, the perpetual waiting list for donors could radically decrease or maybe even disappear, depending on the decision to breed the pigs. They are still in the process of testing and experimentation, but breakthroughs such as this could lead to leaps forward in medicine that will remain out of reach for Muslims.
However, it could be argued that if xenotransplantation did become mainstream, the non-Muslims could take the pig donor organs and the Muslims could take the human donor organs. Although this could maybe be a reality, the hesitancy of the public to xenotransplantation would already a very long time to resolve and decades would need to pass before the public got remotely used to the idea. Another issue could also be connected to Judaism and their need for kosher animal products. If xenotransplantation does not derive from kosher animals, this could lead to not only a competition for the human donor organs within one religion but between two, already battling, religions.
The History of Christianity
Islam isn’t the only one with these types of medical restrictions. Christianity has been split into thousands of different sects which all interpret the Bible in a particular way, therefore, making their own religious restrictions. Specifically, Jehovah’s Witnesses are a branch of Christianity that do not use the same Bible as the main sects. This branch has too many inconsistencies from the main sects, such as as their belief that God is one rather than made up of the Father, Jesus, and the Holy Spirit as evidenced in the Bible, that they do not use the same writings. Instead, the Jehovah’s Witnesses use the New World Translation of the Holy Scriptures. Although it is slightly similar to the ‘original’ Bible, there are some differences which leave a very large impact on their lives. In the their version of the Book of Leviticus, it states that “You must not eat the blood of any sort of flesh, because the soul of every sort of flesh is its blood. Anyone eating it will be cut off.” Therefore, this translation to Jehovah’s Witnesses means that they are restricted from blood transfusions.
To highlight what this means for Jehovah’s Witnesses, an estimated 15,000, for every 1 million Jehovah’s Witnesses in the US, put their lives at risk for their beliefs annually (Elder). It is clear that there needs to be a deviation from the current situation for Jehovah’s Witnesses, and this can be achieved through the new innovations being tested.
Christianity: Innovation Resolving Limitations
Jehovah’s Witnesses have eternally been deprived of blood transfusions, yet a plausible solution would be synthetic blood. Some reform has been made in the society of Jehovah’s Witnesses. Previously, the Society had permitted Jehovah’s Witnesses to accept only fractions of blood plasma, however, it appears that now they may accept fractions of all “primary” components. The Society defines primary components as red cells, white cells, platelets, and plasma. This means that while Jehovah’s Witnesses are unable to accept red blood cells, hemoglobin is approved (Doyle). Although this reform could help certain situations, such as a Jehovah’s Witness with an abnormal hemoglobin count, which leads to either anemia or polycythemia vera, it does not prevent as many deaths as full blood would (Mayo Clinic Staff). This slight reform is still not enough to save a person that is in need of a blood transfusion.
Fortunately, progress has been made regarding this issue and at the beginning of 2017, synthetic blood was entering the human trial phase of approval. Artificial blood generally uses stem cells, but this technique is very inefficient due to the short life span of the stem cells. What scientists are looking for is the way to create immortal stem cells in order to provide a sustainable source for blood and make it easier to match rare blood types (Gammon). Additionally, this innovation could also directly help Jehovah’s Witnesses obtain life saving treatments without compromising their beliefs. This compromise of Jehovah’s Witnesses to use stem cells rather than blood itself could potentially save the patient as well as preserve their autonomy. Although some Jehovah’s Witnesses may still be against the idea of stem cells, especially those that derive from embryos, even small steps can move this issue forward. The need for compromise is evident in this situation and the Society has already proved themselves capable of necessary reform. This proves that advances in medicine can work together with reforms made in religion to uphold both of their values of loyalty; loyalty to God as well as loyalty to the patient. Unfortunately, until Jehovah’s Witnesses are willing to make more compromises, the promise to refuse of blood transfusions is steadily passed from generation to generation.
Christianity: Depriving Innovation
Still, these medical refusal issues do not only impact adult Jehovah’s Witnesses, but also their children. This creates another layer of ethical dilemmas where the parent is more devout than their child, who generally would not be considered competent by the courts. Again we are faced with the requirement for consent, but in this case it isn’t from the patient themselves. Medical professionals have to follow the legal requirements, which have been simplified to create easy access to refuse medical care on religious beliefs. This can generate quite an emotional response from the physicians and public where the legal respect for autonomy and the desire to save a child intersect. This issue can be applied to other religions as well, however, the Society of Jehovah’s Witnesses have been known to worship the deaths of children that have upheld the refusal rule and regarded them as some sort of martyr. There was a 1994 magazine published by Awake!, dedicated to the 26 children’s lives lost but was glorifyingly titled “Youths Who Put God First”.
This is just a specific example of how some Jehovah’s Witnesses reacted to the losses of children; to them, the choice of God is more important than saving the children’s lives. The front cover is filled with their smiling faces as if they were happy to give up their short life in order to fulfill God’s wishes. The federal government has played a major role in this situation as the laws put into place for adults refusing treatment now extend into the lives of their children. The complex issue of parental control over kids is continually witnessed due to the law restricting minor autonomy until the age of 18. This, consequently, allows parents to make choices based on their own religion without consulting the patient themself.
The History of Judaism
Judaism has three main branches: orthodox, conservative, and reform. Although the reform branch is much larger, the orthodox branch is more into the original texts. Therefore, in its branch, the preservation of human life is valued above almost all else. In their law, nearly every other consideration is put second to saving a life. For example, fasting is postponed if the practice might endanger the individual’s health. Euthanasia, therefore, is prohibited because it is the active choice of death. In the Talmud, it states that, “He who closes the eyes of a dying person while the soul is departing is a murderer” and “Let Him who gave me [my soul] take it away” (Shabbat 151b). Taking a life, or your own, is against the law of God and is regarded as a criminal act. This extremely clear statement that disobeying God’s word will leave you in His bad graces does not leave much room for exceptions. There is a sense of loyalty needed to God and a seemingly small promise that you shall die the way God intends, however the promise grows vastly once you are dying at the age of 30.
Judaism: Innovation Resolving Limitations
In support of these faithful individuals, the digital age provides a few innovations to help guide both the patients and the doctors to help Orthodox Jews during the challenging times when life is close to an end. Although there can be no separation from the word of God, the patient can make certain to inform the hospital and physicians of their situation. This clear instruction of what the patient wants upholds their autonomy as well as the respect for the doctor as now the hospital is forewarned of the patient’s condition and wishes. Digital advances also allow remote access to religious leaders which provides the patients with comfort and with guidance on what medical treatments are allowed. This guidance can be great assistance to the family and the patient alike, especially when the patient is unsure of how to proceed further.
Access to online records to these leaders can make the process much easier, specifically when the patient is bedridden and is unable to leave the hospital. When an irreligious patient is indecisive, they most likely listen to their doctors; however, now a devout patient, must combine the information they receive from both their physician and their religious leader. This emotional struggle can severely damage the patient’s morale, which might even result in radical decisions. However, at least by obtaining the information from both the doctor and the religious leader, the patient is completely informed.
Further, digital record keeping now allows for a patient’s wishes to be known by doctors and hospitals to follow their belief systems even when admitted in a non responsive state. This ensures that no treatments contrary to the patient’s convictions are provided. Not only does this support the patient’s wishes, but also helps the stakeholders in the hospital to prevent a lawsuit based on ignorance. If there was clear instruction to not give care to an unwilling patient, the doctors would have a foolproof way to abide by the patient as well as protect their hospital from an unnecessary prosecution. By having digital evidence for the physician of the patient, there is clear confirmation of patient refusal based on religious grounds. Although this innovation does uphold the concept of non-maleficence, there have been many advances in end of life care which are, in fact, he complete opposite.
Judaism: Depriving Innovation
For decades, the world has been creating new and accessible end of life methods, which are not available to these devout Jews, such as pill forms or vaccines that provide tremendous comfort to some patients who are suffering during a long fight with a disease. Not only is active euthanasia an option, but passive euthanasia, such as withholding food and water or a DNR, is also a very uncomplicated for many. However, a man named Dr. Philip Nitschke is a euthanasia activist who has taken these type of innovations and attempted to escalate them even further. Nitschke has created accessible forms of euthanasia for self deliverance through his company Exit International; this company’s mission is to educate and provide tools for patients to self facilitate the end of their suffering. Innovations such as the CO Genie, a gas mask, or the peaceful pill, a barbiturate-based painless method, have been created specifically with this dedication in mind (Exit).
(Dr Philip Nitschke)
While these novelty changes could be incredibly helpful for many patients and their families, these methods are not aligned with religion and certainly not aligned with Orthodox Judaism. Again, this Jewish promise to allow God to take control over their life, specifically how it ends, must be maintained despite the straightforward additions to the practice of euthanasia. Trustworthiness is particularly necessary in this religion as there is a need to stay true to God’s wishes before your own.
Religious Impact in Hospitals
Doctors and hospitals alike have accommodated to many of the spiritual patients’ needs. There has been a trend among hospitals shifting to locate rooms for people form a wide variety of faiths, as well as for those who have no faith and are spiritual but not religious. In stressful situations, hospital chapels, meditation rooms, or prayer rooms offer employees, patients, and families alike to find comfort in a safe space. This provides a feeling of the patients that their wishes are understood and continuously will be upheld. By having these rooms of protection, the religious individuals are able to stay in touch with their devotion and God, especially in their times of need. These times of need are especially more common in places such as hospitals and by having this direct and nearby area to pray, it creates a feeling of safety.
In addition, usually healthcare professionals also receive training to understand and protect the religious and spiritual values of patients. It is important to cover topics such as the importance of relations between personal religiousness and health and disease and the implications of these relations over the treatment processes; as well as providing useful attitudes that the doctors should perform as well as attitudes that should be avoided. This training is essential to the doctor’s performance as some physicians might not fully be aware or even capable of understanding the depths of what religion can extend to. Without it, there can be a feeling of impatiences and misunderstanding if the doctor is not as devout as the patient. By creating this mutual level of insight, the doctors will be able to empathize more with their patient and be more willing to search for alternative treatments. Further, hospitals, in many cases, even allow the patient’s own spiritual leader (such as a priest, rabbi, etc.) to come to the hospital. Although digital records of spiritual leaders can help to an extent, by having physical contact with an individual with the same feeling of faith can allow for the patient to have a much more meaningful response.
Balancing Autonomy and Responsibility
The values most pertinent to the discussion of the intersection of religion and medicine come down to the responsibility of the doctor and the autonomy of the patient. The balance that doctors and hospitals need to find lies between the requirement to treat the patient’s illness and respect the patient’s belief system.
Under the value of responsibility, doctors are trained to accommodate to these types of situations, but continually face new scenarios as medical advances happen. Doctors have taken an oath, both to themselves and to the medical community, that they have a responsibility to their patients to do all they can to save them. On the other hand, they have a conflicting moral responsibility to abide by the personal wishes of the patients and sympathize with their needs. The doctor must choose between also choose between their responsibility to their patient and their responsibility to their patient’s illness. Some doctors believe that they must focus to the patient as a whole, including their religious needs, yet some would rather save the individual and disregard their rights. However, personal experience of the doctor usually plays a role and can create a bias. Some doctors understand the need for faith and also dedicate their lives to God and religion; this can allow a push from the doctors to provide alternative medicines, while other doctors might be harsher to the patient and pressure them into what they believe is the best and well known medicine.
Personal autonomy remains a pillar of the American belief system regardless of religion and will always play a role in this dialogue. There have been many laws put into place which allow individuals to reject life saving treatments in order to uphold their devotion and maintain their perceived ‘relationship’ with God. Throughout history, we have seen the laws first side with the doctors and then gradually move to the patients as they gained more and more rights in medical scenarios. Although this was a necessary step for autonomy, there became less and less room for exceptions, such as when children are in danger and the autonomy autonomically goes the parents. This can either help or aggravate the situation further as minor autonomy is uncommon. This debate of autonomy for children is an entirely other ethical debate, but clearly plays a role in the intersection of religion and medicine.
We have walked through just a few of the scenarios where devout beliefs and medical innovations intersect and while these two concepts do not always cooperate well together, there is a constant process of innovation that provides new options and alternatives. With ongoing medical advances we see both an increasing ability to accommodate these devout patient belief systems and at the same time some of these advances create new dilemmas that keep them out of reach. No matter if your personal view is that this intersection causes conflict, we know that there are resources to research options to allow the coexistence of autonomy and treatment.
Despite, or perhaps due to, the perpetual medical advances occurring throughout the world, it is difficult for a society’s belief system to keep up. The concept of religion has been ingrained so deeply, not only into our individual lives, but in the state of the government. Federal and state laws have been put into place to uphold the freedom of individuals, generally based on religious grounds, to refuse medical care. Although this is not a step backward, in some situations it does more harm than good. While religion is meant to bring spiritual hope to people in need, especially in hospitals, it is evident that in cases this comes at the price of faith based restrictions to life saving procedures that hurt the patient. Islam, Christianity, and Judaism are only a few of the many religions that present these restrictions to their true believers. At the same time, medical advances continue to provide both solutions to these restrictions and further ethical dilemmas to those of faith. Religion remains important to society and hundreds of millions of Americans are affected by its ‘rules’; therefore, there is an incredible opportunity to find solutions that avoid going counter to patient beliefs and still allow the doctor to abide by their oath.
However, while I believe there is a need for refusal of care in some situations, I do not believe refusal of care on the grounds of religion is sufficient. If anything, I think there should be a repeal of all state laws to be replaced with a federal law with strict background checks on those requesting religious refusal of care. There should be evidence and record keeping of the family or individual with the appeal in order to make sure their intent is pure and not due to a simple lack of information. This lack of education leads directly to the need for more exposure of why certain treatments are necessary. In regards to vaccines, there should be a mandatory session for individuals to attend if they decide to refuse vaccines in order to make it clear what they are standing to lose and the impact on society at large. Another concern of refusal of care involves families which reminds the public of the impact of religion on children. Already, kids have their choices made by their parents, which is socially acceptable; however, as soon as their parents make a questionable decision for their children in a medical atmosphere, there is a call for minor autonomy. This topic of child autonomy versus parent autonomy in medical situations is further provoked when the element of religion is added.
The discussion of the intersection of religion and medicine is entirely necessary as medical and personal advances continue to occur. In order to keep pace with the progress of the world, debates and decisions need to be made in order to prevent the current conflict of health versus faith. Although medical innovations can provide extreme help to these religious restrictions, it can also severely irritated the issue. Not only can medical advances cause panic in this issue, but other stakeholders such as families, children, and government are also affected. For this very reason, there is a need to balance religious respect, public good, and keeping children healthy until they can make their own competent decisions.