Strangers or friends?
A proposal for a new spirituality-in-medicine ethic
Accepted: 21 October 2004 DOI:
Cite this article as: Curlin, F.A. & Hall, D.E. J GEN INTERN MED (2005) 20: 370. doi:10.1111/j.1525-1497.2005.04110.x Abstract
We argue that debate regarding whether and how physicians should engage religious concerns has proceeded under inadequate terms. The prevailing paradigm approaches dialogue regarding religion as a form of therapeutic technique, engaged by one stranger, the physician, upon another stranger, the patient. This stranger-technique framework focuses the debate on questions of physicians’ competence, threats to patients’ autonomy, and neutrality regarding religion, and in so doing, it too greatly circumscribes the scope of physician-patient dialogue. In contrast, we argue that dialogue regarding religion is better approached as a form of philosophical discourse about ultimate human concerns. Such moral discourse is often essential to the patient-physician relationship, and rather than shrinking from such discourse, physicians might engage patients regarding religious concerns guided by an ethic of moral friendship that seeks the patient’s good through wisdom, candor, and respect.
Key words medical philosophy physician-patient relations ethics religion and medicine spirituality
The authors have no conflicts of interest to report.
See editoral by Sheurich, p. 379
Astrow AB, Puchalski CM, Sulmasy DP
. Religion, spirituality, and health care: social, ethical, and practical considerations. Am J Med. 2001;110:283–7.
. MSJAMA: religion, spirituality, and medicine: application to clinical practice. JAMA. 2000;284:1708.
Post SG, Puchalski CM, Larson DB
. Physicians and patient spirituality: professional boundaries, competency, and ethics. Ann Intern Med. 2000;132:578–83.
Sloan RP, Bagiella E, Powell T
. Religion, spirituality and medicine. Lancet. 1999;353:664–7.
Sloan RP, Bagiella E, VandeCreek L, et al.
Should physicians prescribe religious activities? N Engl J Med. 2000;342:1913–6.
. Reconsidering spirituality and medicine. Acad Med. 2003;78:356–60.
. The witches’ brew of spirituality and medicine. Ann Behav Med. 2002;24:74–6.
. Is “quality of care” being mislabeled or mismeasured? Am J Med. 2002;112:472–8.
Childress JF, Siegler M
. Metaphors and models of doctor-patient relationships: their implications for autonomy. Theor Med. 1984;5:17–30.
Cohen CB, Wheeler SE, Scott DA
. Walking a fine line: physician inquiries into patients’ religious and spiritual beliefs. Hastings Cent Rep. 2001;31:29–39.
Lo B, Ruston D, Kates LW, et al.
Discussing religious and spiritual issues at the end of life: a practical guide for physicians. JAMA. 2002;287:749–54.
. Spirituality and medicine. In: Mengel MB, Helleman WL, Fields SA, eds. Fundamental of Clinical Practice. New York, NY: Kluwer Academic/Plenum Publishers; 2002:651–70.
Bessinger D, Kuhne T
. Medical spirituality: defining domains and boundaries. South Med J. 2002;95:1385–8.
Tarpley JL, Tarpley MJ
. Spirituality in surgical practice. J Am Coll Surg. 2002;194:642–7.
MacIntyre A. Whose Justice? Which Rationality? Notre Dame, IN: University of Notre Dame Press; 1988.
Aquinas T. Summa Theologica. Second Part of the Second Part. Section 23, Article 1. Notre Dame, IN: Ave Maria Press; 1981.
Wadell PJ. Friendship and the Moral Life. Notre Dame, IN: University of Notre Dame Press; 1989.
Cohen CB, Wheeler SE, Scott DA, Edwards BS, Lusk P
. Prayer as therapy. A challenge to both religious belief and professional ethics. The Anglican Working Group in Bioethics. Hastings Cent Rep. 2000;30:40–7.
Brett AS, Jersild P
. “Inappropriate” treatment near the end of life: conflict between religious convictions and clinical judgment. Arch Intern Med. 2003;163:1645–9.
Aristotle. Nicomachean Ethics, Ostwald M, translator. Book Six. Upper Saddle River, NJ: Prentice Hall; 1999.
MacIntyre A. After Virtue: A Study in Moral Theory. 2nd ed. Notre Dame, IN: University of Notre Dame Press; 1984.
Carrillo JE, Green AR, Betancourt JR
. Cross-cultural primary care: a patient-based approach. Ann Intern Med. 1999;130:829–34.
Laine C, Davidoff F
. Patient-centered medicine. A professional evolution. JAMA. 1996;275:152–6.
Snyderman R, Weil AT
. Integrative medicine: bringing medicine back to its roots. Arch Intern Med. 2002;162:395–7.
. Holistic medicine: advances and shortcomings. West J Med. 1982;136:546–51.
Hall DE, Koenig HG, Meador KG
. Conceptualizing “religion”: how language shapes and constrains knowledge in the study of religion and health. Perspect Biol Med. 2004;47:386–401.
Weber M, Mills CW, Gerth HH. From Max Weber: Essays in Sociology. New York, NY: Oxford University Press; 1958.
Wolterstorff N. Religion in the University. The Taylor Lectures for 2001. New Haven, CT: Yale Divinity School; 2001:[Unpublished; available on cassette from Yale University Divinity School.].
Milbank J. Theology and Social Theory: Beyond Secular Reason. Malden, MA: Blackwell Publishers; 1993.
Hall DE, Curlin F
. Can physicians’ care be neutral regarding religion? Acad Med. 2004;79:677–9.
Ehman JW, Ott BB, Short TH, Ciampa RC, Hansen-Flaschen J
. Do patients want physicians to inquire about their spiritual or religious beliefs if they become gravely ill? Arch Intern Med. 1999;159:1803–6.
King DE, Bushwick B
. Beliefs and attitudes of hospital inpatients about faith healing and prayer. J Fam Pract. 1994;39:349–52.
MacLean CD, Susi B, Phifer N, et al.
Patient preference for physician discussion and practice of spirituality. J Gen Intern Med. 2003;18:38–43.
. Beyond curriculum reform: confronting medicine’s hidden curriculum. Acad Med. 1998;73:403–7.
PubMed CrossRef Copyright information
© Society of General Internal Medicine 2005