Public debates about the role of religion in decisions about health and medicine can be vociferous. Consider what emerged in the disputes about Terri Schiavo’s medical care: those who called themselves “pro-life” protested outside her hospice, and courtroom battles between Schiavo’s parents and her husband sought to adjudicate how her Catholic faith would influence her medical care. More recently, some Christians, Muslims, and Jews have argued that they have a religious obligation to flout public health guidelines in order to obey God’s command to worship in person even amid the Covid-19 pandemic.
Michael and Traci Balboni’s staggeringly rich and wide-ranging book on the role of religion in American medicine contributes to such debates. As a team, they bring a wide range of expertise, Tracy is a radiation oncologist, and her husband, Michael, is a pastor and a practical theologian. Both have previously helped coauthor important empirical studies of patients’ desires for religious support at the end of life.1
The book combines sophisticated theology with often blistering critiques of how medicine in the United States has sidelined religious practice or substituted what the Balbonis see as a falsely claimed neutral alternative “spirituality.” They argue that in order for a patient’s religious values to be respected in the context of medicine, physicians must also learn new skills and practices that will help them understand their patient’s religious convictions so they can grasp how those convictions might alter decisions about what treatments they will accept or refuse. In addition, debates about conscience provisions for physicians that have been made part of federal regulation since the completion of the Balbonis’ manuscript have at least in the eyes of some allowed physicians to reclaim their own religious values in the context of their practices.
The responses in this symposium come from varied places. Asma Mobbin-Uddin writes as a Muslim pediatrician, who asks about how religious symbols are really encountered in medicine. Justin List, a medical ethicist and primary care physician in New York City, crafted his response as he worked on the frontlines of the Covid-19 pandemic. He asks whether we frame medicine as a gift or as a social contact. I write as a chaplain, wishing to push back on what I see as the Balbonis’ theological vision. I wonder whether it is practical, possible, or even necessary for physician and patient religious preferences to align, noting the evident dangers of attempting that alignment in a clinical encounter. Lydia Dugdale, a primary care physician in a large academic medical system, asks what changes are necessary to sustain clinicians who are increasingly driven by those who see medicine as an economic and not a spiritual exercise.
This rich conversation across issues of ethics, theology, and conversation prompted by the strong claims and concrete proposals hopefully will spark more conversations and thoughts among theologians and practitioners.
See Tracy Anne Balboni et al., “Provision of Spiritual Care to Patients with Advanced Cancer: Associations with Medical Care and Quality of Life Near Death,” Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology 28, no. 3 (January 20, 2010): 445–52, https://doi.org/10.1200/JCO.2009.24.8005; Michael J. Balboni et al., “Why Is Spiritual Care Infrequent at the End of Life? Spiritual Care Perceptions Among Patients, Nurses, and Physicians and the Role of Training,” Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology 31, no. 4 (February 1, 2013): 461–67, https://doi.org/10.1200/JCO.2012.44.6443.↩