Expanding Paradigms of Persons and Healing
The Role of Muslim Ontology in Defining a Schema of Causes and Means of Healing
Ahsan Arozullah, MD, MPH, Darul Qasim
M. Volkan Stodolsky, PhD, Darul Qasim
Aasim I. Padela, MD, MSc, University of Chicago
Shaykh M. Amin Kholwadia, Darul Qasim
There are various understandings of existence (ontology) and how we gain knowledge (epistemology) about it. The purpose of this paper is to describe how Muslim and modern medical ontological understandings serve as a foundation for a schema of causes and means of healing. Comparing ontological frameworks facilitates a clearer understanding of the agent and means of bringing about healing. While modern medicine often attributes healing powers to medical or surgical therapeutics and to the healthcare provider, an Islamic theological perspective defines Allah (God) as the One who heals (Surah Al-Shu’ara, 26/80: ‘And when I become sick, then He (Allah) heals me’).
From an Islamic perspective in which Allah (God) is the healer, ‘how’ one attracts divine attention to one’s illness is of primary concern. Therefore, a Muslim seeking Allah’s (God’s) help through du’a (supplication) is viewed as taking an active stance by pursuing cure directly from the source of healing. Modern medicine may predominantly attribute healing powers to the healthcare provider and prescribed treatments and therefore, a patient seeking medical care may be viewed as taking an active stance in seeking cure. A Muslim understanding, similar to a broadening medical understanding, is that healing may come through a variety of means including physical (e.g. medicine, surgery), psychological (e.g. counseling, meditation), and/or spiritual (e.g. prayers, incantations, amulets).
This paper presentation will utilize case examples such as fever of ‘unknown’ origin to illustrate how Muslim and medical ontological frameworks influence and provide complementary views on healing. Medically-based treatment paradigms applied for fever of ‘unknown’ origin are often focused on empirical treatment targeted at likely biological sources of fever in the absence of a proven, tangible biological etiology. Muslim ontology may facilitate expanding the treatment options for fever of ‘unknown’ origin to include seeking healing from Allah directly regardless of the certainty of the biological origin. A Muslim approach would include making du’a (supplication) while seeking physical cure based on a medical understanding. If the condition is not explained on the physical/biological level, a Muslim may consider other potential means of healing, such as psychological or spiritual. Differing ontological understandings inform how one understands ‘who’ heals and ‘what’ the means for healing are. Healthcare providers may view patients relying on non-physical means as passive or fatalistic. However, understanding alternate ontologies may broaden this view and facilitate enhanced communications.
Fragments and Boxes: The Brewing War Between Whole-Person Care and Managed Care
Edgar Paul Herrington IV, MDiv, Louisville Presbyterian Theological Seminary
The “whole-person” health movement is gaining ground in medical circles as public pushback against traditional modes of intervention and desire for holistic care increase. This philosophy of medicine strives to treat each patient as the nexus of complex interactions between cultural, religious, and familial dimensions of identity and experience. Medical practitioners who value a holistic model of health and personhood practice the art of giving care with attention to needs that are not just physical, but emotional and spiritual. Through interdisciplinary cooperation, “whole-person” healthcare teams combine the efforts of doctors, chaplains, and counselors in an effort to treat the integrated sum of a person instead of fragmented parts of people.
Unfortunately, the reigning “managed care” system in hospitals requires preferential use of evidenced-based approaches to medicine, such that “search and destroy” methods of injury and disease intervention remain dominant. My research explores the timely and salient question of whether these two models—whole-person care and managed care—are fundamentally at odds. As a clinical chaplain and family systems therapist by training, I have worked at two large urban tertiary hospitals, one of which was a major teaching and research hospital. During my tenure both locations underwent Joint Commission Accreditation reviews. In preparation for these reviews, both hospitals also transferred all patient records to advanced electronic medical record software, eliminating paper charts almost entirely. These upgrades cost significant financial and personnel resources. The hope was to improve patient care and reduce human error by unifying all records into a single electronic file. Yet in the struggle to provide meaningful spiritual care, it was less clear whether caregivers gained ground or lost it.
The new EMR software, designed for medical interventions, became a substantial influence on my own chaplaincy practice and the practices of my colleagues. Unfortunately, I experienced these upgrades as counterproductive to my interactions with patients. Open-ended, patient-driven conversations turned into prescribed phrasing correlated with a suite of checked or unchecked boxes. I began spending as much time in front of the computer in my office as I did with patients, perhaps even more.
I believe there is hope for salvaging spiritual and psychological care in hospitals from the negative effects of attempting to integrate whole-person approaches with managed care. The growing demand for reform in traditional treatment options from patients, clients and therapists, chaplains, social workers, psychologists and even some physicians seems to suggest an imperative for attempting, at least, to do so. While the evidence I will present in this talk is purely anecdotal, I hope my personal experience can open conversation on the how the ongoing monopolization of hospital experience by the managed care approach might not be the panacea that politicians, device manufactures, software programmers, health care companies and some clinicians believe it to be.
Person-centered Care Across the Continuum: Attending to the Spirit in Non-Acute Medicine
Emily Trancik, PhD(c), Ascension Health
As health systems strive to provide person-centered, high-quality, and cost-effective care, the structure of health care delivery is changing rapidly. A focus on keeping patients healthy and out of the hospital leads to increases in outpatient preventative visits, ambulatory surgeries and procedures, as well as home care. In light of these changes, Catholic health systems must find new ways to ensure their mission and identity is alive across the continuum of care. Despite the awareness of the need to develop best practices for mission integration in non-acute care, the best ways to ensure holistic care for patients’ bodies, minds and spirits in non-acute care settings are still being developed. Though for non-Catholic health systems, person-centered care might mean ability access health information or make appointments conveniently on a cell phone, for Catholic systems, it is a call and an opportunity to revisit these structures and ensure that the ministry realizes its richer vision for person-centered care, the importance of care for a person's spirit in addition to her body.
This paper will describe the opportunities and challenges the changes in delivery structure present to the mission of Catholic health care, particularly as it relates to providing care outside hospital walls in home and outpatient settings. In the home, where a patient is being cared for in the context of his life, family, and past, caregivers experience an enriched vision for the patient as person. In caring for the body, the caregiver necessarily acknowledges a patient’s spirit. The dynamic of control between caregiver and patient present in the hospital is flipped, changing the relationship in meaningful ways, and with ramifications for ethics and pastoral care to which mission services must attend. Outpatient caregivers have a unique set of opportunities and challenges as well. Though they provide care in a medical setting, patients have control over their care and relationships with providers in ways they do not have within hospital walls. This change in power structure has repercussions and challenges for ethics and pastoral care in particular, for example, ensuring privacy, confidentiality, autonomy and spiritual care. In addition, the shift to non-acute care has implications for the person of the caregiver, including professional boundaries and physical safety issues.
Finally, this paper points toward the implications developments in mission structures in non-acute medicine can have for inpatient health care. Ideally, seamless care delivery structures would facilitate care for the spirit across the continuum of care. This paper will examine these issues and will suggest how coordinated patient centered care in new delivery systems could affect the ways in which we attend to patients' spirits in the hospital.
Practicing Patients: Revisiting the Patient as Person
Tobias Winright, PhD, Saint Louis University
One of the questions raised in connection with the conference theme is, "How should particular spiritual and religious needs of patients be addressed and by whom?" When the practice of medicine is referred to, usually the focus is on health care professionals such as physicians and nurses. But what about patients? They have moral agency, too. Over four decades ago one of the first major books in medical ethics was "The Patient as Person" by Paul Ramsey. Similarly, Stanley Hauerwas and Charles Pinches have written "Practicing Patience: How Christians Should Be Sick." Building on what these theologians have written, and drawing on my own experience as a patient, this presentation will explore practices, such as those related to the virtue of patience, that patients might perform not only as health care recipients but participants in addressing particular spiritual and religious needs they have in connection with illness and healing.
The Importance of Lament; A Medical Lesson from the Book of Job
Elizabeth Marshall, MD, MAT, The Everett Clinic and Providence Regional Medical Center
Grief and lament are intimately woven into the human condition and history, its sacred scriptures, rituals, narratives and societal conscience. Historically, the world’s religions have addressed the great question of suffering; the Book of Job may be the first, and oldest, book written in the Hebrew Bible. It is not insignificant that this text raises the key human question; why is there suffering? Why am I (Job) suffering? And who is GOD if this can happen to me?
The openness to human and heartfelt lament in the book of Job evidences a communal acceptance of the importance of active grieving. A Priest once said that grief is a commodity, something to be exchanged with fellow human beings, through mutual support and aid. Grief is an opportunity to exchange meaning –to communicate caring, offering and receiving aid and support; to affirm the dignity and worth of the individual in the midst of and in spite of his or her suffering; and to practice the expression of gratitude. (Jobs friends failed in this, instead, blaming the sufferer and claiming his sufferings as punishment from God.) Above all, Job teaches us that suffering and grief can give rise to a new understanding of God Himself; an acceptance of God and His supremacy not because we understand Him, nor because He will predictably fit into our human notions of His motives, intentions or actions, but because He is, simply, GOD. It is Job’s suffering that allows him to “see” God, stripped of Job’s own ideas and ideologies.
Culturally, as we in the west move away from our Judeo Christian roots and into the postmodern era, an increasing distance from both the reality of suffering and grief (as a normative part of the human experience rather than unjust), their potential meaning as part of human existence, and their individual and communal expression through lament has occurred. As a primary care physician and theologian, I have often assisted my patients by allowing them to give voice to their grieving – opening the conversation to make room for their lament, educating them about the grieving process, and sitting silently with them in the context of their suffering. (It is not insignificant that Job’s initial lament occurred after he sat silently for five days, accompanied in his silent suffering by his friends.) The average physician tolerates 7 seconds of silence during a patient encounter; on average, it takes 22 seconds for a person to absorb bad news. Silence is generative; from shared silence deep lamentation arises and the cry of the human soul is expressed - with all the anguish of Job - in my office. These moments are often healing for patients, providing (as Job’s lament did) almost immediate insight into their suffering, and shedding light on next steps in key ways.
Patient narratives/cases will be presented in light of this discussion.
Ahsan Arozullah, MD, MPH, Darul Qasim
M. Volkan Stodolsky, PhD, Darul Qasim
Aasim I. Padela, MD, MSc, University of Chicago
Shaykh M. Amin Kholwadia, Darul Qasim
There are various understandings of existence (ontology) and how we gain knowledge (epistemology) about it. The purpose of this paper is to describe how Muslim and modern medical ontological understandings serve as a foundation for a schema of causes and means of healing. Comparing ontological frameworks facilitates a clearer understanding of the agent and means of bringing about healing. While modern medicine often attributes healing powers to medical or surgical therapeutics and to the healthcare provider, an Islamic theological perspective defines Allah (God) as the One who heals (Surah Al-Shu’ara, 26/80: ‘And when I become sick, then He (Allah) heals me’).
From an Islamic perspective in which Allah (God) is the healer, ‘how’ one attracts divine attention to one’s illness is of primary concern. Therefore, a Muslim seeking Allah’s (God’s) help through du’a (supplication) is viewed as taking an active stance by pursuing cure directly from the source of healing. Modern medicine may predominantly attribute healing powers to the healthcare provider and prescribed treatments and therefore, a patient seeking medical care may be viewed as taking an active stance in seeking cure. A Muslim understanding, similar to a broadening medical understanding, is that healing may come through a variety of means including physical (e.g. medicine, surgery), psychological (e.g. counseling, meditation), and/or spiritual (e.g. prayers, incantations, amulets).
This paper presentation will utilize case examples such as fever of ‘unknown’ origin to illustrate how Muslim and medical ontological frameworks influence and provide complementary views on healing. Medically-based treatment paradigms applied for fever of ‘unknown’ origin are often focused on empirical treatment targeted at likely biological sources of fever in the absence of a proven, tangible biological etiology. Muslim ontology may facilitate expanding the treatment options for fever of ‘unknown’ origin to include seeking healing from Allah directly regardless of the certainty of the biological origin. A Muslim approach would include making du’a (supplication) while seeking physical cure based on a medical understanding. If the condition is not explained on the physical/biological level, a Muslim may consider other potential means of healing, such as psychological or spiritual. Differing ontological understandings inform how one understands ‘who’ heals and ‘what’ the means for healing are. Healthcare providers may view patients relying on non-physical means as passive or fatalistic. However, understanding alternate ontologies may broaden this view and facilitate enhanced communications.
Fragments and Boxes: The Brewing War Between Whole-Person Care and Managed Care
Edgar Paul Herrington IV, MDiv, Louisville Presbyterian Theological Seminary
The “whole-person” health movement is gaining ground in medical circles as public pushback against traditional modes of intervention and desire for holistic care increase. This philosophy of medicine strives to treat each patient as the nexus of complex interactions between cultural, religious, and familial dimensions of identity and experience. Medical practitioners who value a holistic model of health and personhood practice the art of giving care with attention to needs that are not just physical, but emotional and spiritual. Through interdisciplinary cooperation, “whole-person” healthcare teams combine the efforts of doctors, chaplains, and counselors in an effort to treat the integrated sum of a person instead of fragmented parts of people.
Unfortunately, the reigning “managed care” system in hospitals requires preferential use of evidenced-based approaches to medicine, such that “search and destroy” methods of injury and disease intervention remain dominant. My research explores the timely and salient question of whether these two models—whole-person care and managed care—are fundamentally at odds. As a clinical chaplain and family systems therapist by training, I have worked at two large urban tertiary hospitals, one of which was a major teaching and research hospital. During my tenure both locations underwent Joint Commission Accreditation reviews. In preparation for these reviews, both hospitals also transferred all patient records to advanced electronic medical record software, eliminating paper charts almost entirely. These upgrades cost significant financial and personnel resources. The hope was to improve patient care and reduce human error by unifying all records into a single electronic file. Yet in the struggle to provide meaningful spiritual care, it was less clear whether caregivers gained ground or lost it.
The new EMR software, designed for medical interventions, became a substantial influence on my own chaplaincy practice and the practices of my colleagues. Unfortunately, I experienced these upgrades as counterproductive to my interactions with patients. Open-ended, patient-driven conversations turned into prescribed phrasing correlated with a suite of checked or unchecked boxes. I began spending as much time in front of the computer in my office as I did with patients, perhaps even more.
I believe there is hope for salvaging spiritual and psychological care in hospitals from the negative effects of attempting to integrate whole-person approaches with managed care. The growing demand for reform in traditional treatment options from patients, clients and therapists, chaplains, social workers, psychologists and even some physicians seems to suggest an imperative for attempting, at least, to do so. While the evidence I will present in this talk is purely anecdotal, I hope my personal experience can open conversation on the how the ongoing monopolization of hospital experience by the managed care approach might not be the panacea that politicians, device manufactures, software programmers, health care companies and some clinicians believe it to be.
Person-centered Care Across the Continuum: Attending to the Spirit in Non-Acute Medicine
Emily Trancik, PhD(c), Ascension Health
As health systems strive to provide person-centered, high-quality, and cost-effective care, the structure of health care delivery is changing rapidly. A focus on keeping patients healthy and out of the hospital leads to increases in outpatient preventative visits, ambulatory surgeries and procedures, as well as home care. In light of these changes, Catholic health systems must find new ways to ensure their mission and identity is alive across the continuum of care. Despite the awareness of the need to develop best practices for mission integration in non-acute care, the best ways to ensure holistic care for patients’ bodies, minds and spirits in non-acute care settings are still being developed. Though for non-Catholic health systems, person-centered care might mean ability access health information or make appointments conveniently on a cell phone, for Catholic systems, it is a call and an opportunity to revisit these structures and ensure that the ministry realizes its richer vision for person-centered care, the importance of care for a person's spirit in addition to her body.
This paper will describe the opportunities and challenges the changes in delivery structure present to the mission of Catholic health care, particularly as it relates to providing care outside hospital walls in home and outpatient settings. In the home, where a patient is being cared for in the context of his life, family, and past, caregivers experience an enriched vision for the patient as person. In caring for the body, the caregiver necessarily acknowledges a patient’s spirit. The dynamic of control between caregiver and patient present in the hospital is flipped, changing the relationship in meaningful ways, and with ramifications for ethics and pastoral care to which mission services must attend. Outpatient caregivers have a unique set of opportunities and challenges as well. Though they provide care in a medical setting, patients have control over their care and relationships with providers in ways they do not have within hospital walls. This change in power structure has repercussions and challenges for ethics and pastoral care in particular, for example, ensuring privacy, confidentiality, autonomy and spiritual care. In addition, the shift to non-acute care has implications for the person of the caregiver, including professional boundaries and physical safety issues.
Finally, this paper points toward the implications developments in mission structures in non-acute medicine can have for inpatient health care. Ideally, seamless care delivery structures would facilitate care for the spirit across the continuum of care. This paper will examine these issues and will suggest how coordinated patient centered care in new delivery systems could affect the ways in which we attend to patients' spirits in the hospital.
Practicing Patients: Revisiting the Patient as Person
Tobias Winright, PhD, Saint Louis University
One of the questions raised in connection with the conference theme is, "How should particular spiritual and religious needs of patients be addressed and by whom?" When the practice of medicine is referred to, usually the focus is on health care professionals such as physicians and nurses. But what about patients? They have moral agency, too. Over four decades ago one of the first major books in medical ethics was "The Patient as Person" by Paul Ramsey. Similarly, Stanley Hauerwas and Charles Pinches have written "Practicing Patience: How Christians Should Be Sick." Building on what these theologians have written, and drawing on my own experience as a patient, this presentation will explore practices, such as those related to the virtue of patience, that patients might perform not only as health care recipients but participants in addressing particular spiritual and religious needs they have in connection with illness and healing.
The Importance of Lament; A Medical Lesson from the Book of Job
Elizabeth Marshall, MD, MAT, The Everett Clinic and Providence Regional Medical Center
Grief and lament are intimately woven into the human condition and history, its sacred scriptures, rituals, narratives and societal conscience. Historically, the world’s religions have addressed the great question of suffering; the Book of Job may be the first, and oldest, book written in the Hebrew Bible. It is not insignificant that this text raises the key human question; why is there suffering? Why am I (Job) suffering? And who is GOD if this can happen to me?
The openness to human and heartfelt lament in the book of Job evidences a communal acceptance of the importance of active grieving. A Priest once said that grief is a commodity, something to be exchanged with fellow human beings, through mutual support and aid. Grief is an opportunity to exchange meaning –to communicate caring, offering and receiving aid and support; to affirm the dignity and worth of the individual in the midst of and in spite of his or her suffering; and to practice the expression of gratitude. (Jobs friends failed in this, instead, blaming the sufferer and claiming his sufferings as punishment from God.) Above all, Job teaches us that suffering and grief can give rise to a new understanding of God Himself; an acceptance of God and His supremacy not because we understand Him, nor because He will predictably fit into our human notions of His motives, intentions or actions, but because He is, simply, GOD. It is Job’s suffering that allows him to “see” God, stripped of Job’s own ideas and ideologies.
Culturally, as we in the west move away from our Judeo Christian roots and into the postmodern era, an increasing distance from both the reality of suffering and grief (as a normative part of the human experience rather than unjust), their potential meaning as part of human existence, and their individual and communal expression through lament has occurred. As a primary care physician and theologian, I have often assisted my patients by allowing them to give voice to their grieving – opening the conversation to make room for their lament, educating them about the grieving process, and sitting silently with them in the context of their suffering. (It is not insignificant that Job’s initial lament occurred after he sat silently for five days, accompanied in his silent suffering by his friends.) The average physician tolerates 7 seconds of silence during a patient encounter; on average, it takes 22 seconds for a person to absorb bad news. Silence is generative; from shared silence deep lamentation arises and the cry of the human soul is expressed - with all the anguish of Job - in my office. These moments are often healing for patients, providing (as Job’s lament did) almost immediate insight into their suffering, and shedding light on next steps in key ways.
Patient narratives/cases will be presented in light of this discussion.