Perspectives on Religion and its Engagement of Medical Systems: Synthesis, Tensions, Trajectories
Gary Ferngren, PhD, Oregon State University
Jonathan Wildt, AM, Lawndale Christian Health Center
Richard Timms, MD, Scripps Research Institute, CA
Omar Haque, MD, PhD, Harvard Medical School
Moderator: Michael Balboni, PhD, Harvard Medical School
This multidisciplinary panel explores historical and contemporary examples of how the medical system shapes and is shaped by religious values and communities. The panel examines ways that religion has found synthesis with healthcare systems, ways that there have been tensions, and explores one trajectory on how religion may engage the medical system.
1. “From Fee-to-Service to Private Charity: a Historical Example of Religion and Medical Systems
The opening presentation will provide a historical example of a major systems change in the medical treatment of the sick poor by contrasting the failure of classical societies (Greek and Roman) to develop either private or public medical philanthropy. With the development of Christian medical philanthropy there grew up in the first centuries of the Christian era a variety of private institutional approaches to care for the sick poor, who were previously excluded from by the canons of classical beneficence. While they did not replace fee-to-service, they complemented it in several ways, particularly in establishing for the first time institutional care of the dying. The two different models will be examined with a focus on religious rationales and contextual factors.
2. Between-Two Systems: A Contemporary Example of a Religious Clinic Operating on Philanthropy and Government Funds
This presentation engages the question of how does an explicitly religious clinic maintain its values, provide state-of-the-art medicine, and follow a sustainable business plan? The presentation highlights how a religious medical clinic in Chicago has bonded its spiritual mission of “showing and sharing the love of Jesus by promoting wellness and providing quality, affordable health care for Lawndale and the neighboring communities.” and the larger healthcare system. The presentation provides an example on how spiritual values have informed its own care and identifies contemporary tensions where American healthcare system shapes a religious clinic in challenging directions.
3. “The Changing Business of Medicine Since the 1970s: A Qualitative Analysis of the Influence on Medical Staff
Major progress has occurred to our health delivery system over the past forty years mostly centered around advances in technology, specialization and efficiency related controls. The advances are most obvious within in-patient facilities where medical care is complex and specialized. In-patient experiences are often delivered by “strangers” who have limited connections with the patients’ lives. ER specialists, hospitalists, an alphabet soup of sub-specialists, and teams within specialty units lead the institutional medical troops.
The third presentation describes personal responses to a changing healthcare delivery system based on 24 qualitative, one-on-one interviews of medical professionals who have worked in medicine for a minimum of 30 years. Identified themes based on participant responses highlight the impact of changes in control, efficiency, specialization, institutionalization, and connections with patients and colleagues. Systemic changes are prominent within inpatient settings where the medical caregiver spends more time on administrative tasks, complex technical aspects and specialty aspects of care. Time is more absorbed by efficiencies of delivering care and record keeping. Specialists feel less connected to colleagues and the lives of their patients. The older generations of physicians see a greater work-life balance in younger physicians who better contain the related demands. Older medical professionals emphasize the incremental and unintentional nature of the changes or influences on their lives. As one explained, “most of us don't enjoy the changes of medical practice. It certainly has become a more impersonal environment where we feel less in control. I know that these changes occurred without an intent of making our practice less personal. Perhaps our loss of control was intentional as the business aspects of medicine became more controlled by non medical staff including a mess of governing and review bodies at all sorts of levels.”
4. How Religious Traditions Can Prevent Dehumanization in Medicine
Drawing from recent work that connects medical ethics with cognitive science and moral psychology (i.e., Haque & Waytz, 2012), the first part of this presentation will describe the six common social and psychological pathways that cause dehumanization in medicine. The common factor in these pathways is that dehumanization occurs when there is denial of a distinctively human mind to another person. Specifically, dehumanization involves stripping agency or experience from our perception of other persons. Denial of experience typically manifests in treating others like cold, unfeeling, machines, whereas denial of agency typically manifests in treating others like uncivilized, irrational animals (Haslam, 2006).
The second part of this presentation will describe how religious traditions have an important role to play in preventing dehumanization in medicine. Specifically, one cause of dehumanization in medicine is mechanization, thinking of patients as mechanical systems made up of interacting parts, which can be useful for diagnostic or therapeutic clinical problem solving (Haque & Waytz, 2012). However, this methodological posture to aid clinical problem solving can become a metaphysical stance towards patients in general, in which patients are no longer understood as persons with subjective mental states, but only as material bodies. By drawing on examples from traditions within Islam, Judaism, and Christianity, I show how religious traditions contribute resources for affirming patients as having bodies, but also as being persons with subjective mental states and an inherent dignity.
This paper presentation will be broadly relevant to physicians, scholars, and students and trainees alike. The practical lesson to be drawn from this analysis is that clinicians should see their daily work as methodologically concerning interventions in the processes and mechanisms of material bodies, but should see their metaphysical worldviews (whether materialist or idealist) as relevant to the ethical question of how to prevent dehumanization in medicine.
Jonathan Wildt, AM, Lawndale Christian Health Center
Richard Timms, MD, Scripps Research Institute, CA
Omar Haque, MD, PhD, Harvard Medical School
Moderator: Michael Balboni, PhD, Harvard Medical School
This multidisciplinary panel explores historical and contemporary examples of how the medical system shapes and is shaped by religious values and communities. The panel examines ways that religion has found synthesis with healthcare systems, ways that there have been tensions, and explores one trajectory on how religion may engage the medical system.
1. “From Fee-to-Service to Private Charity: a Historical Example of Religion and Medical Systems
The opening presentation will provide a historical example of a major systems change in the medical treatment of the sick poor by contrasting the failure of classical societies (Greek and Roman) to develop either private or public medical philanthropy. With the development of Christian medical philanthropy there grew up in the first centuries of the Christian era a variety of private institutional approaches to care for the sick poor, who were previously excluded from by the canons of classical beneficence. While they did not replace fee-to-service, they complemented it in several ways, particularly in establishing for the first time institutional care of the dying. The two different models will be examined with a focus on religious rationales and contextual factors.
2. Between-Two Systems: A Contemporary Example of a Religious Clinic Operating on Philanthropy and Government Funds
This presentation engages the question of how does an explicitly religious clinic maintain its values, provide state-of-the-art medicine, and follow a sustainable business plan? The presentation highlights how a religious medical clinic in Chicago has bonded its spiritual mission of “showing and sharing the love of Jesus by promoting wellness and providing quality, affordable health care for Lawndale and the neighboring communities.” and the larger healthcare system. The presentation provides an example on how spiritual values have informed its own care and identifies contemporary tensions where American healthcare system shapes a religious clinic in challenging directions.
3. “The Changing Business of Medicine Since the 1970s: A Qualitative Analysis of the Influence on Medical Staff
Major progress has occurred to our health delivery system over the past forty years mostly centered around advances in technology, specialization and efficiency related controls. The advances are most obvious within in-patient facilities where medical care is complex and specialized. In-patient experiences are often delivered by “strangers” who have limited connections with the patients’ lives. ER specialists, hospitalists, an alphabet soup of sub-specialists, and teams within specialty units lead the institutional medical troops.
The third presentation describes personal responses to a changing healthcare delivery system based on 24 qualitative, one-on-one interviews of medical professionals who have worked in medicine for a minimum of 30 years. Identified themes based on participant responses highlight the impact of changes in control, efficiency, specialization, institutionalization, and connections with patients and colleagues. Systemic changes are prominent within inpatient settings where the medical caregiver spends more time on administrative tasks, complex technical aspects and specialty aspects of care. Time is more absorbed by efficiencies of delivering care and record keeping. Specialists feel less connected to colleagues and the lives of their patients. The older generations of physicians see a greater work-life balance in younger physicians who better contain the related demands. Older medical professionals emphasize the incremental and unintentional nature of the changes or influences on their lives. As one explained, “most of us don't enjoy the changes of medical practice. It certainly has become a more impersonal environment where we feel less in control. I know that these changes occurred without an intent of making our practice less personal. Perhaps our loss of control was intentional as the business aspects of medicine became more controlled by non medical staff including a mess of governing and review bodies at all sorts of levels.”
4. How Religious Traditions Can Prevent Dehumanization in Medicine
Drawing from recent work that connects medical ethics with cognitive science and moral psychology (i.e., Haque & Waytz, 2012), the first part of this presentation will describe the six common social and psychological pathways that cause dehumanization in medicine. The common factor in these pathways is that dehumanization occurs when there is denial of a distinctively human mind to another person. Specifically, dehumanization involves stripping agency or experience from our perception of other persons. Denial of experience typically manifests in treating others like cold, unfeeling, machines, whereas denial of agency typically manifests in treating others like uncivilized, irrational animals (Haslam, 2006).
The second part of this presentation will describe how religious traditions have an important role to play in preventing dehumanization in medicine. Specifically, one cause of dehumanization in medicine is mechanization, thinking of patients as mechanical systems made up of interacting parts, which can be useful for diagnostic or therapeutic clinical problem solving (Haque & Waytz, 2012). However, this methodological posture to aid clinical problem solving can become a metaphysical stance towards patients in general, in which patients are no longer understood as persons with subjective mental states, but only as material bodies. By drawing on examples from traditions within Islam, Judaism, and Christianity, I show how religious traditions contribute resources for affirming patients as having bodies, but also as being persons with subjective mental states and an inherent dignity.
This paper presentation will be broadly relevant to physicians, scholars, and students and trainees alike. The practical lesson to be drawn from this analysis is that clinicians should see their daily work as methodologically concerning interventions in the processes and mechanisms of material bodies, but should see their metaphysical worldviews (whether materialist or idealist) as relevant to the ethical question of how to prevent dehumanization in medicine.