Health Care in Religious Contexts
Ramadan and Health: A Mini Review
Safa Alakhdhair, PhD(s), Indiana State University
Introduction: Fasting, or restricted dietary intact, is an important aspect of many religious tradition including: Baha’i, Buddhist, Catholic Christian, Eastern Orthodox Christian, Hindu, Jewish, Mormon, and Muslim. With the exception of Baha’i fast and Ramadan fast, the fasting practiced by most religions usually consists of a 1 or 2 day fast that either excludes or restricts the intake of all or some solid foods, but not fluids. The fasting associated with Ramadan is unique in its length in day (28 to 30 days) and its time of day sunrise (Sahur) to sunset (Iftar), which can vary significantly depending on the participants’ latitude of residence.
Over 1.2 billion Muslims worldwide practice fasting during the month of Ramadan. Many of them are living under suboptimal nutritional conditions that have an impact on their physiological health. This can range from malnutrition to over nutrition. The impact of this unique month of altered nutritional intake will have an effect on human physiology in both healthy individuals and those with chronic diseases. Our understanding of those changes and how it impacts human health, particularly with regard to Western medical treatment protocols for individuals with chronic health conditions that are associated with some aspect of the inflammatory response, is not well known.
Methods: In preparation for an ongoing study exploring the physiological changes associated with “Ramadan fasting” in a Midwestern area of the United States with about 15 hours of daylight, we conducted a literature search using the following data bases: CINAHL, EMBASE, Global Health, Google Scholar, MedlinePlus, PyscINFO, and PubMed. We used the following search terms within the context of “Ramadan fasting”: biomarkers, chronic disease, cytokines, inflammation, inflammatory markers, heart rate variability, malnutrition, obesity, telomerase, telomere, and transcriptomes.
Results: A number of well-designed studies have explored the physiological changes that occur during the one month of intermittent fasting during the month of Ramadan. Although not universal, the studies report changes in a number of key biomarkers associated with human health and wellbeing, including significant alterations in BMI, hsCRP, and inflammatory markers. Many of the studies focused on younger college aged males and females, who are often competitive athletes. There were fewer studies exploring more sedentary older individuals. We were not able to identify any studies that specifically explored the Ramadan fasting and telomerase activity or transcriptomes.
Conclusion: The majority of the studies analyzed pooled data categories (fasting vs non-fasting or pre-fasting, fasting, post-fasting) rather than pre-, post-data from individuals. While a statistically sound practice, this process is a step removed from the individualized medical practice of the future. We conclude that existing studies form a robust additional foundation, but that additional studies are needed that will take into consideration the individualization of physiological changes that occur during this intense period of intermittent fasting. A better understanding of the individualized variations in physiological responses during Ramadan fasting is particularly necessary when considering individuals who are receiving Western medical care for chronic diseases, such as cancer, diabetes, heart disease, that are sensitive to dietary changes.
A Matter of Life and Death: Religious Bridges and Barriers to Jewish Organ Donation
Elyssa Kanet, MA, PhD(s), Bar Ilan University
This paper examines the religious considerations that affect organ donation in Jewish law, focusing on its modern applications in Jewish communities and in Israel in particular. This issue is particularly relevant because Jewish populations have among the lowest rates of organ donation worldwide, largely due to the perception that it is forbidden by Jewish law. Live organ donation and post-mortem donation will be discussed briefly; however, the organs often in highest demand and, unfortunately, the source of greatest controversy in Jewish law, are those organs procured at the time of death. It is the discrepancy between modern medical definitions and rabbinic definitions of death which most complicate the issue of organ donation for many Jewish populations. While Jewish law allows for donation (and in some cases even encourages it), donation is stunted by ignorance regarding Jewish law as well as the controversy involved in defining human death. Therefore, the issues which will be dealt with most closely are the medical and rabbinic definitions of death. With regard to this issue, we will attempt to address the following questions: 1. How does the medical community currently define death? 2. How do prominent rabbinic authorities define death? 3. What is the moral and religious significance of these definitions? 4. Which practical issues remain when both medical and rabbinic authorities agree on a definition? Finally, this paper will consider modern responses by rabbinic authorities and recent developments regarding organ donation in Israel.
The paper concludes by analyzing the ways in which the medical and religious communities have found common ground and the ways in which they remain divided on this issue. There is no expectation on the part of this paper for the religious or medical communities to adopt each other’s definitions. Rather, it acknowledges that some differences remain and will likely continue for some time (the main example covered relates to the acceptance of the cardio-pulmonary versus the brain-stem death definition). However, in religious communities where brain-stem death has been accepted (as is the prevailing definition in medical circles) and there is a demonstrated will to engage in donation, the paper identifies the remaining practical barriers to donation in order to provide guideposts for further discussion and progress on this issue.
Seeing Jesus as a Jew: Medicine and Pluralism Beyond the Bounds of “Tolerance”
Harold Braswell, PhD, Saint Louis University
This presentation is an exploration of religious pluralism in medicine. Such pluralism has been based on the ideal of religious tolerance. In this model, “tolerance” entails not encroaching on another’s religious belief. But this conception of tolerance, though protective, is also limiting. It characterizes religious belief as inherently menacing; the resulting conception of “pluralism” is predicated on erecting barriers between individuals of diverse faiths. “Tolerance” thus fails to recognize and promote the benefits of religious interchange in medicine.
I demonstrate such benefits through an examination of Our Lady of Perpetual Help Home, a Catholic hospice facility located in Atlanta, Georgia. The facility is run by Dominican nuns, and its caretaking practices are grounded in Catholic doctrine. Nevertheless, it caters to a patient population that is composed of individuals of diverse religious and secular belief systems. I claim that, at Our Lady, these non-Catholic patients were able to creatively redefine Catholic practices in ways that benefitted them, without compromising their non-Catholic identity. Thus, rather than an imposition, pluralistic religious exchange provided these patients with a generative source of comfort and care.
I examine this process in greater detail through an autoethnographic study of my own experience as a Jewish participant in the home’s religious life. I focus on my participation in the sisters’ religious practice of “seeing Jesus” in the patients under their care. I detail my attempts to negotiate this practice while preserving my identity as a Jew. Doing so entailed seeing the dying Christ in patients in order to empathize with and better care for them. At the same time, in order to maintain my Jewish identity, such “seeing” involved rejecting Christ’s divinity and envisioning him, not as a dying God, but rather as a mortal—a dying Jew. Thus, “seeing Jesus as a Jew” is a double entendre, referring to both my own Jewishness and Jewishness of Christ.
I examine the impact of this Jewish Christology through a study of my own work as a hospice volunteer to a patient whom I will refer to as “Jonas.” I argue that seeing Jesus as a Jew helped to me to better negotiate a key barrier to my work with Jonas: my own problems with attachment, which stemmed from my childhood experience of significant maternal neglect. The work of “seeing Jesus” provided a practice that allowed me to empathize with Jonas because it gave me with both a means and an obligation to forge a similar connection with the mother who had neglected me as a child. It thus helped me to become a better caretaker by curing me, in part, of the very problems that were presenting a barrier to such care. Such mutuality of healing, though fundamental to Catholic practice, can be enjoyed by individuals of diverse creeds.
I conclude by drawing on this practice to reformulate the concept of “tolerance” in a way that can better nurture religiously pluralistic medical care.
“My Mercy Embraces All Things”: Comparative Notions of Mercy in Muslim and Catholic Bioethical Responses to HIV and AIDS in Kenya
Tim Carey, PhD(c), Boston College
While the HIV and AIDS epidemic has garnered much international attention since the fist case was diagnosed in 1981, no other geographic location has been harder hit than sub-Saharan Africa. The UNAIDS Global Report for 2013 estimates that 70% of all new infections occur in this region, with countries in Eastern Africa bearing much of this statistic. Take, for instance, Kenya. Though the secular governmental and religious response has accounted for a marked decrease in the infection rate throughout the past two decades – from a peak of 10.5% in 1996 to 6.1% among the adult population in 2014 – an estimated 1.6 million Kenyans remain infected with a preponderance of these being women and young adults.
The HIV and AIDS pandemic, then, remains a reality for millions of people living throughout Kenya. As a direct result, religious leaders are increasingly being asked to attend to the spiritual as well as physiological nature of their congregations. Specifically in the capital city of Nairobi, priests and imams in African Catholic and Sunni Muslim communities are responding to questions of treatment and transmission of HIV and AIDS by using the sophisticated language of biomedicine.
This development, the paper argues, is in itself a form of faith seeking understanding through theological bioethics, as both religious leaders and medical professionals attempt to derive a common vernacular with which to communicate with each other. Accordingly, one central element of this approach to bioethics focuses on the place of mercy, and how God’s divine mercy operates throughout the entire community irrespective of religious affiliation.
In Kenya, HIV and AIDS remain a challenge and an opportunity. On the one hand, the pandemic represents a challenge for religious leaders to reach past self-identifying religious boundaries to engage in inter-religious dialogue in order to attend to those suffering from the socially and physically debilitating illnesses of HIV and AIDS. On the other hand, it represent a shared opportunity for Muslims and Catholics in Kenya to come together to engage in acts of mercy towards their fellow Kenyans who are living with or personally affected by HIV and AIDS.
When understood in this way, mercy can only be humanly embodied through participation in the common good, from which those living with HIV and AIDS must never be excluded. By comparing scriptural accounts of divine mercy from both faith traditions – the hadith traditions of Islam, and the Gospel of Matthew within Catholicism – the paper then considers the lived Catholic and Muslim bioethical response to HIV and AIDS in Nairobi as a case study for how notions of mercy operate in the medical and pastoral care directed towards those living with the disease.
Safa Alakhdhair, PhD(s), Indiana State University
Introduction: Fasting, or restricted dietary intact, is an important aspect of many religious tradition including: Baha’i, Buddhist, Catholic Christian, Eastern Orthodox Christian, Hindu, Jewish, Mormon, and Muslim. With the exception of Baha’i fast and Ramadan fast, the fasting practiced by most religions usually consists of a 1 or 2 day fast that either excludes or restricts the intake of all or some solid foods, but not fluids. The fasting associated with Ramadan is unique in its length in day (28 to 30 days) and its time of day sunrise (Sahur) to sunset (Iftar), which can vary significantly depending on the participants’ latitude of residence.
Over 1.2 billion Muslims worldwide practice fasting during the month of Ramadan. Many of them are living under suboptimal nutritional conditions that have an impact on their physiological health. This can range from malnutrition to over nutrition. The impact of this unique month of altered nutritional intake will have an effect on human physiology in both healthy individuals and those with chronic diseases. Our understanding of those changes and how it impacts human health, particularly with regard to Western medical treatment protocols for individuals with chronic health conditions that are associated with some aspect of the inflammatory response, is not well known.
Methods: In preparation for an ongoing study exploring the physiological changes associated with “Ramadan fasting” in a Midwestern area of the United States with about 15 hours of daylight, we conducted a literature search using the following data bases: CINAHL, EMBASE, Global Health, Google Scholar, MedlinePlus, PyscINFO, and PubMed. We used the following search terms within the context of “Ramadan fasting”: biomarkers, chronic disease, cytokines, inflammation, inflammatory markers, heart rate variability, malnutrition, obesity, telomerase, telomere, and transcriptomes.
Results: A number of well-designed studies have explored the physiological changes that occur during the one month of intermittent fasting during the month of Ramadan. Although not universal, the studies report changes in a number of key biomarkers associated with human health and wellbeing, including significant alterations in BMI, hsCRP, and inflammatory markers. Many of the studies focused on younger college aged males and females, who are often competitive athletes. There were fewer studies exploring more sedentary older individuals. We were not able to identify any studies that specifically explored the Ramadan fasting and telomerase activity or transcriptomes.
Conclusion: The majority of the studies analyzed pooled data categories (fasting vs non-fasting or pre-fasting, fasting, post-fasting) rather than pre-, post-data from individuals. While a statistically sound practice, this process is a step removed from the individualized medical practice of the future. We conclude that existing studies form a robust additional foundation, but that additional studies are needed that will take into consideration the individualization of physiological changes that occur during this intense period of intermittent fasting. A better understanding of the individualized variations in physiological responses during Ramadan fasting is particularly necessary when considering individuals who are receiving Western medical care for chronic diseases, such as cancer, diabetes, heart disease, that are sensitive to dietary changes.
A Matter of Life and Death: Religious Bridges and Barriers to Jewish Organ Donation
Elyssa Kanet, MA, PhD(s), Bar Ilan University
This paper examines the religious considerations that affect organ donation in Jewish law, focusing on its modern applications in Jewish communities and in Israel in particular. This issue is particularly relevant because Jewish populations have among the lowest rates of organ donation worldwide, largely due to the perception that it is forbidden by Jewish law. Live organ donation and post-mortem donation will be discussed briefly; however, the organs often in highest demand and, unfortunately, the source of greatest controversy in Jewish law, are those organs procured at the time of death. It is the discrepancy between modern medical definitions and rabbinic definitions of death which most complicate the issue of organ donation for many Jewish populations. While Jewish law allows for donation (and in some cases even encourages it), donation is stunted by ignorance regarding Jewish law as well as the controversy involved in defining human death. Therefore, the issues which will be dealt with most closely are the medical and rabbinic definitions of death. With regard to this issue, we will attempt to address the following questions: 1. How does the medical community currently define death? 2. How do prominent rabbinic authorities define death? 3. What is the moral and religious significance of these definitions? 4. Which practical issues remain when both medical and rabbinic authorities agree on a definition? Finally, this paper will consider modern responses by rabbinic authorities and recent developments regarding organ donation in Israel.
The paper concludes by analyzing the ways in which the medical and religious communities have found common ground and the ways in which they remain divided on this issue. There is no expectation on the part of this paper for the religious or medical communities to adopt each other’s definitions. Rather, it acknowledges that some differences remain and will likely continue for some time (the main example covered relates to the acceptance of the cardio-pulmonary versus the brain-stem death definition). However, in religious communities where brain-stem death has been accepted (as is the prevailing definition in medical circles) and there is a demonstrated will to engage in donation, the paper identifies the remaining practical barriers to donation in order to provide guideposts for further discussion and progress on this issue.
Seeing Jesus as a Jew: Medicine and Pluralism Beyond the Bounds of “Tolerance”
Harold Braswell, PhD, Saint Louis University
This presentation is an exploration of religious pluralism in medicine. Such pluralism has been based on the ideal of religious tolerance. In this model, “tolerance” entails not encroaching on another’s religious belief. But this conception of tolerance, though protective, is also limiting. It characterizes religious belief as inherently menacing; the resulting conception of “pluralism” is predicated on erecting barriers between individuals of diverse faiths. “Tolerance” thus fails to recognize and promote the benefits of religious interchange in medicine.
I demonstrate such benefits through an examination of Our Lady of Perpetual Help Home, a Catholic hospice facility located in Atlanta, Georgia. The facility is run by Dominican nuns, and its caretaking practices are grounded in Catholic doctrine. Nevertheless, it caters to a patient population that is composed of individuals of diverse religious and secular belief systems. I claim that, at Our Lady, these non-Catholic patients were able to creatively redefine Catholic practices in ways that benefitted them, without compromising their non-Catholic identity. Thus, rather than an imposition, pluralistic religious exchange provided these patients with a generative source of comfort and care.
I examine this process in greater detail through an autoethnographic study of my own experience as a Jewish participant in the home’s religious life. I focus on my participation in the sisters’ religious practice of “seeing Jesus” in the patients under their care. I detail my attempts to negotiate this practice while preserving my identity as a Jew. Doing so entailed seeing the dying Christ in patients in order to empathize with and better care for them. At the same time, in order to maintain my Jewish identity, such “seeing” involved rejecting Christ’s divinity and envisioning him, not as a dying God, but rather as a mortal—a dying Jew. Thus, “seeing Jesus as a Jew” is a double entendre, referring to both my own Jewishness and Jewishness of Christ.
I examine the impact of this Jewish Christology through a study of my own work as a hospice volunteer to a patient whom I will refer to as “Jonas.” I argue that seeing Jesus as a Jew helped to me to better negotiate a key barrier to my work with Jonas: my own problems with attachment, which stemmed from my childhood experience of significant maternal neglect. The work of “seeing Jesus” provided a practice that allowed me to empathize with Jonas because it gave me with both a means and an obligation to forge a similar connection with the mother who had neglected me as a child. It thus helped me to become a better caretaker by curing me, in part, of the very problems that were presenting a barrier to such care. Such mutuality of healing, though fundamental to Catholic practice, can be enjoyed by individuals of diverse creeds.
I conclude by drawing on this practice to reformulate the concept of “tolerance” in a way that can better nurture religiously pluralistic medical care.
“My Mercy Embraces All Things”: Comparative Notions of Mercy in Muslim and Catholic Bioethical Responses to HIV and AIDS in Kenya
Tim Carey, PhD(c), Boston College
While the HIV and AIDS epidemic has garnered much international attention since the fist case was diagnosed in 1981, no other geographic location has been harder hit than sub-Saharan Africa. The UNAIDS Global Report for 2013 estimates that 70% of all new infections occur in this region, with countries in Eastern Africa bearing much of this statistic. Take, for instance, Kenya. Though the secular governmental and religious response has accounted for a marked decrease in the infection rate throughout the past two decades – from a peak of 10.5% in 1996 to 6.1% among the adult population in 2014 – an estimated 1.6 million Kenyans remain infected with a preponderance of these being women and young adults.
The HIV and AIDS pandemic, then, remains a reality for millions of people living throughout Kenya. As a direct result, religious leaders are increasingly being asked to attend to the spiritual as well as physiological nature of their congregations. Specifically in the capital city of Nairobi, priests and imams in African Catholic and Sunni Muslim communities are responding to questions of treatment and transmission of HIV and AIDS by using the sophisticated language of biomedicine.
This development, the paper argues, is in itself a form of faith seeking understanding through theological bioethics, as both religious leaders and medical professionals attempt to derive a common vernacular with which to communicate with each other. Accordingly, one central element of this approach to bioethics focuses on the place of mercy, and how God’s divine mercy operates throughout the entire community irrespective of religious affiliation.
In Kenya, HIV and AIDS remain a challenge and an opportunity. On the one hand, the pandemic represents a challenge for religious leaders to reach past self-identifying religious boundaries to engage in inter-religious dialogue in order to attend to those suffering from the socially and physically debilitating illnesses of HIV and AIDS. On the other hand, it represent a shared opportunity for Muslims and Catholics in Kenya to come together to engage in acts of mercy towards their fellow Kenyans who are living with or personally affected by HIV and AIDS.
When understood in this way, mercy can only be humanly embodied through participation in the common good, from which those living with HIV and AIDS must never be excluded. By comparing scriptural accounts of divine mercy from both faith traditions – the hadith traditions of Islam, and the Gospel of Matthew within Catholicism – the paper then considers the lived Catholic and Muslim bioethical response to HIV and AIDS in Nairobi as a case study for how notions of mercy operate in the medical and pastoral care directed towards those living with the disease.