PART VI. PHILOSOPHICAL-RELIGIOUS BELIEFS & READINESS FOR DEATH
Questions 23: What philosophical, ethical, or religious beliefs
do you hold that are relevant
to your medical care and other end-of-life decisions?
Medical ethics seldom acknowledges its roots
in religious beliefs,
but most doctors and nurses at least come from some religious tradition.
And their ways of handling difficult questions
—especially questions arising at the end of life—
are often affected by their implicit religious faiths.
Patients might be even more deeply religious
than their care-givers.
And they probably have no scientific training as doctors or nurses.
But when you come to the end of your life,
you are correct to apply your own philosophical and religious beliefs
in making your end-of-life decisions,
even if a more scientific orientation might lead to other choices.
QUESTION
23:
RELIGIOUS
BELIEFS
by JAMES
PARK
175
Medical ethics itself is not based in science.
The
fundamental values of right and wrong
come
from religious tradition, cultural patterns,
or
are based on rational argument—or some combination of these.
In
any case, the fundamental values concerning life and death
are
usually more presupposed, implicit, unstated than scientific.
You should apply your religious and
philosophical principles
in
creating your medical ethics and in writing your Advance Directive.
You
are not laying out patterns for others to follow.
You
are deciding for yourself
how
you want to be treated at the end of your life
and
which path toward death seems best to you.
It might be argued that all the religions of
the world
are—at
least in part—attempts to cope with death.
Many
of these religions have definite beliefs about death.
And
no discussion of death would be complete
without
taking religious beliefs into account.
Medical practice generally respects religious
beliefs,
in
part because of the personal beliefs
of
the doctors, nurses, & other health-care workers themselves.
And
sometimes the very institutions in which they provide health care
were
established by religious organizations.
The
medical personnel have learned to respect religious values,
even
when they do not share the same world-views.
Beliefs about death might be stronger than
other beliefs
because
of the emotional impact of facing death
—either
your own death or the deaths of your loved ones.
Even
if you paid little attention to religion during most of your life,
you
might become intensely religious as you approach death.
And
these forms of faith might be quite traditional
because
you have not created your own system of beliefs.
When
facing death, you might remember your childhood faith.
Thus, medical personnel are frequently
confronted by
unexamined
but fervently-held religious beliefs about death.
Some
families have automatic responses to ethical questions
because
they grew up in a well-established religion.
Perhaps
you believe that there are absolute rights and wrongs
—even
if you do not know what the absolute standards are
or
how to apply such standards to the situation at hand.
176
YOUR LAST YEAR: CREATING YOUR ADVANCE DIRECTIVE
FOR MEDICAL CARE
Consequently, you might turn to religious
authorities
for
answers to questions you have not seriously faced before.
This
is the way that professional religious leaders
(ministers,
priests, rabbis, mullahs, etc.)
get
drawn into the discussion of medical ethics.
And
sometimes the religious leaders are even called upon
to
make life-and-death recommendations based on their religious
tradition.
But general medical ethics
in
the United States and other Western countries
is
based on a secular consensus about life and death.
This
secular system of beliefs is not well defined
and
it often clashes with traditional religious beliefs.
When
there is a clash, the religious beliefs generally prevail
—unless
they directly contradict a scientific perspective
in
a way that affects treatment decisions.
A common example of this is the Jehovah's
Witnesses'
refusal
of blood transfusions and blood products
because
of their religious beliefs on these matters.
Based
on a few Biblical passages, they believe that voluntarily
accepting
blood
transfusions or blood products will exclude them from heaven.
Courts
have ruled that those who hold such beliefs
are
allowed to refuse blood for themselves (but not for their children)
even
if such refusal leads to their premature deaths.
Life-threatening
choices based on more exotic religions
are
usually rejected in modern hospitals.
Because of the everyday experience of
compromising
with
patients and families who have strongly-held religious ethics,
general
medical ethics takes on a religious tone,
even
when there is no scientific basis for the belief
—such
as the belief that a soul survives death.
And
even modern hospitals have religious chaplains,
because
religious beliefs are so important to many patients.
Completely secular patients might be the first
to notice
when
hospital-ethics-in-practice have a religious tone.
The
religious members of the staff take religious references for
granted,
especially
if the hospital was built by a religious organization.
Also
many of the hospital staff have religious motivations.
Thus,
it is 'natural' for a religious tone to slip into health care,
often
in ways that are not noticed by religious people.
QUESTION
23:
RELIGIOUS
BELIEFS
by JAMES
PARK
177
An Advance Directive is an appropriate place
for you
to
state your religious or non-religious philosophy
as
it applies to life-and-death decisions.
If
you do not state your religious beliefs,
you
will be treated as if you have generic religious beliefs,
which
is the basis of the hospital chaplaincy program.
This
might be nothing more than a vague spiritual tone,
without
reference to any specific religious tradition.
The
medical staff may assume the patients are basically religious;
so
they will "do onto others as you would have others do unto you".
And this might be appropriate for you,
especially
if you have not worked out your own religious beliefs in
detail.
You
will be treated as a normally-religious American person.
But if you are more religious or less
religious than average,
you
should state your beliefs in your Advance Directive.
If
you have non-religious ethical beliefs, you should state them,
especially
as they apply to life-and-death decisions.
Even
a brief statement of such relevant beliefs
(whether
based on religion or on some secular philosophy)
could
be an occasion for a meaningful discussion with your proxies
or
the members of your Medical Care Decisions Committee.
The medical system must allow broad latitude
for
all religious and non-religious beliefs.
But
the medical staff should not be expected to be mind-readers.
Nor
should they be expected to understand your beliefs
simply
because you registered your 'religious preference or affiliation'
when
you were admitted to the hospital, nursing home, or hospice.
Saying
that you are a Catholic or Protestant will probably not be
enough.
Your
religious beliefs have probably affected
how
you answered the other Questions in this book.
But
here is your opportunity to state the bases of your ethical choices.
These philosophical and spiritual matters
—and
the medical decisions that will issue from them—
should
be settled (at least tentatively)
years
before a medical problem puts you in a health-care institution.
The
selection above is the first four pages of Question 23 from the book:
Your
Last
Year: Creating Your Own Advance Directive for Medical Care.
If you click
this title, you will see
the complete table of contents.
Two more pages on this Question explore other implications of
relilgious or ethical beliefs.
If you
would like to see one person's Answer to this Question,
go to James
Park's Advance Directive for Medical Care.
Scroll down to Answer 23.