Responding to the 'Religiously Unaffiliated' in the Clinical Encounter: The Case of Miracle Invocations  
Kelly Turner, MA, Saint Louis University, St. Louis, MO

Clinicians frequently encounter situations in which patients’ or families’ spiritual beliefs produce conflicts with the secular metaphysic of biomedicine—for example, when a patient or family invokes hope for divine intervention (i.e., a miracle) in requests to withhold or withdraw life sustaining treatment. Correspondingly, scholars of clinical ethics including theologians, clinicians, and philosophers have produced a plethora of publications that characterize those who invoke miracles and prescribe appropriate ways for clinicians to respond to these invocations. The vast majority of this literature, however, addresses only patients whose religious beliefs can be judged against a particular tradition, such as Sulmasy’s “clinical-pastoral approach” to miracle invocators and Bibler, Shinall, and Stahl’s 4-part taxonomy intended for “Christian miracle invocators.” This literature is largely silent on the question of how clinicians should engage patients and families who believe in a divine entity and invoke miracles, but nonetheless identify as having no formal religious affiliation—despite the fact that an increasing portion of the American population falls into this category. In this paper, then, I use the miracle invocation literature to demonstrate how scholarly clinical ethics harnesses a particular conception of “religion” that assumes a) allegiance to a particular religious community and b) accountability to a set of religious tenets or doctrines. The danger of this embedded conception of “religion” for the clinical setting, I argue, is that miracle invocators who are unaffiliated with a particular religious community will be categorically psychopathologized or dismissed as “inauthentic.” In the second part of the paper, I describe implications for practicing clinicians: (1) patients’ and/or families’ spiritual practices which are not embedded in particular religious traditions or communities may nonetheless form holistic, coherent metaphysical-moral worldviews deserving of clinicians’ recognition and engagement, and thus (2) the authenticity of these beliefs cannot be (solely) indexed to whether or not others share them. Though these “religiously unaffiliated” miracle invocators challenge the notion of “coherence” as “coherence with a tradition,” they encourage clinicians to respond to each patient and family’s attempt to seek coherence within their own worldview fractured by illness, guided by their unique, personal relationship to the divine.