Ethics Case Study in Spirituality in Pediatric Oncology: Physician Prayer
Alex Lion, DO, Pediatric Hematology/Oncology Fellow, Medical Ethics Fellow, Indiana University Riley Children's Hospital
Jodi Skiles M.D., Indiana University Riley Children's Hospital - Pediatric Hematology Oncology and Pediatric Stem Cell Transplant
Alexia Torke M.D., Indiana University Health, Fairbanks Center for Ethics
J. Daniel Young DMin, Indiana University Riley Children's Hospital - Chaplain department
Mary Ott M.D., Indiana University Riley Children's Hospital - Adolescent Medicine, Fairbanks Center for Ethics
In Max Weber’s lecture entitled “Science as Vocation,” he said the world had “lost its enchantment,” through a materialistic intellectualization of every facet of life. There is a growing sense that this disenchantment has cast its shadow over the field of modern medicine. One of the ways in which physicians may rediscover vocation in their practice is by participating in the spiritual care of their patients. As physicians venture into spiritual care, ethical questions arise concerning if and how this can be done. This case study addresses the ethical considerations of a physician who prays for a pediatric oncology patient and family.
Case Report: An adolescent presents to the pediatric oncology clinic with bulky lymphadenopathy and fever concerning for lymphoma. His mother is dying at home from breast cancer. His father, a pastor, is in clear emotional and spiritual distress. The physician performs a spiritual assessment and decides to offer prayer to the family. The outcomes of physician prayer include a deeper relationship with the family, as well as reduction in emotional and spiritual distress.
Ethics Discussion: Arguments against physician prayer have drawn attention to the physician-patient power differential, the professional role/training of the physician, and concerns for protection from proselytization. Non-maleficence dictates that a physician avoid doing emotional and spiritual harm by taking a careful spiritual history. A careful evaluation of the values of the patient reduces the risks of physician prayer. In a health care setting in which trained chaplains are limited in supply, there arise occasions when other team members, such as physicians, are the only ones readily available to provide spiritual care. Two benefits of physicians praying for patients are reduction in emotional / spiritual distress and a strengthening of the physician-patient relationship.
Conclusion: When the risk of harm is reduced by careful evaluation of patient values and it is likely that the patient will benefit from physician prayer, the principles of non-maleficence, justice, and beneficence may guide the provider to do so. In this way, there exists a scenario in which it is ethical for a physician to pray for a patient. These scenarios may be more common in times of acute illness, such as after a child’s cancer diagnosis. Participating in spiritual care of patients requires a sacrifice of time and a resistance to a definition of the physician as one who treats only the body. For the physician who is able and willing to do so, a new vision emerges of a vocation that is much more than being a cog in a machine. More research is needed regarding what pediatric oncology patients currently experience as to spirituality in order to inform how physicians can collaborate with chaplains and others in defining this newly enchanted vocation.
Jodi Skiles M.D., Indiana University Riley Children's Hospital - Pediatric Hematology Oncology and Pediatric Stem Cell Transplant
Alexia Torke M.D., Indiana University Health, Fairbanks Center for Ethics
J. Daniel Young DMin, Indiana University Riley Children's Hospital - Chaplain department
Mary Ott M.D., Indiana University Riley Children's Hospital - Adolescent Medicine, Fairbanks Center for Ethics
In Max Weber’s lecture entitled “Science as Vocation,” he said the world had “lost its enchantment,” through a materialistic intellectualization of every facet of life. There is a growing sense that this disenchantment has cast its shadow over the field of modern medicine. One of the ways in which physicians may rediscover vocation in their practice is by participating in the spiritual care of their patients. As physicians venture into spiritual care, ethical questions arise concerning if and how this can be done. This case study addresses the ethical considerations of a physician who prays for a pediatric oncology patient and family.
Case Report: An adolescent presents to the pediatric oncology clinic with bulky lymphadenopathy and fever concerning for lymphoma. His mother is dying at home from breast cancer. His father, a pastor, is in clear emotional and spiritual distress. The physician performs a spiritual assessment and decides to offer prayer to the family. The outcomes of physician prayer include a deeper relationship with the family, as well as reduction in emotional and spiritual distress.
Ethics Discussion: Arguments against physician prayer have drawn attention to the physician-patient power differential, the professional role/training of the physician, and concerns for protection from proselytization. Non-maleficence dictates that a physician avoid doing emotional and spiritual harm by taking a careful spiritual history. A careful evaluation of the values of the patient reduces the risks of physician prayer. In a health care setting in which trained chaplains are limited in supply, there arise occasions when other team members, such as physicians, are the only ones readily available to provide spiritual care. Two benefits of physicians praying for patients are reduction in emotional / spiritual distress and a strengthening of the physician-patient relationship.
Conclusion: When the risk of harm is reduced by careful evaluation of patient values and it is likely that the patient will benefit from physician prayer, the principles of non-maleficence, justice, and beneficence may guide the provider to do so. In this way, there exists a scenario in which it is ethical for a physician to pray for a patient. These scenarios may be more common in times of acute illness, such as after a child’s cancer diagnosis. Participating in spiritual care of patients requires a sacrifice of time and a resistance to a definition of the physician as one who treats only the body. For the physician who is able and willing to do so, a new vision emerges of a vocation that is much more than being a cog in a machine. More research is needed regarding what pediatric oncology patients currently experience as to spirituality in order to inform how physicians can collaborate with chaplains and others in defining this newly enchanted vocation.