The Soul of Medicine: Spiritual Perspectives and Clinical Practice

2. Approaching Spirituality in Clinical Practice

CHAPTER TWO Approaching Spirituality in Clinical Practice John R. Peteet, M.D.; Michael J. Balboni, M.Div., Th.M., Ph.D.; and Michael N. D’Ambra, M.D. A Philosophical Framework: Is the Integration of Faith and Medicine Unethical? Richard Sloan, an outspoken critic of the “religion, spirituality, and medicine” movement, has argued that the integration of faith and medicine is based on poor science, contributes to the unethical medical practice, and is corrosive of religion (2006). Sloan raises important objections requiring thoughtful dialogue among the medical and religious communities and in society at large. This book is an attempt to continue dialogue about these complex and at times contentious issues. In our view, many of Sloan’s criticisms are valid. For example, many researchers concur with him that the quality of research in spirituality and healing has been lacking. While his criticisms do not apply to all of the research in this field, questions about scientific quality must be taken seriously. Sloan also claims that integrating religion and health care carries the danger of instrumentalizing religion. Using religion for its health benefits obscures the value and importance that it may have in its own right. Others, such as Shuman and 24 Historical and Clinical Context Meador (2003), have demonstrated that turning religious faith into one of the many tools of medicine is theologically naïve. Using religion in this way is inconsistent with many religious claims, resulting in an inappropriate subverting of the ends of religion into bodily health. Respecting others’ religious claims, regardless of whether one actually holds to those claims, requires that one not alter the meaning of the claims in order to fit one’s own paradigm. Instrumentalizing religion has all too often been the unstated paradigm underlying much research among the psychological disciplines on spirituality and health. Nevertheless , while this is an important caution, the integration of spirituality and health care does not by definition presuppose a functional use of religion. We agree with Sloan that there are important ethical questions to be considered when incorporating religion or spirituality into health care. However, as we note later in this chapter, we see issues such as religious coercion as important cautions rather than insurmountable ethical barriers. A fundamental issue that is consistently bypassed by many colleagues in discussing these matters is the nature of medicine. How do we understand medicine, health, and disease? What does it mean to provide cure and care? What is a physician? On what authority does one ground one’s views? It becomes clear upon reflection that such fundamental questions are difficult to answer. However, it is also clear that medical practice exists within a culture and each culture has a religious or philosophical component. In theological parlance, these components can be expressed as religious or philosophical “norms.” Examples of such normative aspects of a culture include (1) basic beliefs or first principles concerning the existence and nature of God or “the other” and (2) basic beliefs concerning the nature and ends of humanity. Norms function authoritatively in that they both guide the community and serve to judge questions confronting the tradition. They are warranted on their own terms within a tradition and are subsequently not empirically verifiable. Many assume answers to questions about the nature of medicine on the basis of prevailing social constructions, without critical examination. Within given societies, such viewpoints on the meaning of health, disease, care, and cure operate on a normative level but remain untested. Indeed, the more cohesive the society, the less likely that its basic presuppositions will be critically examined . We believe that sweeping criticisms of the spirituality and health movement such as those offered by Sloan suffer (at least in their publication) from inadequate reflection on the nature of medicine and a cluster of related questions. But what this book attempts to answer is not really the question of whether Approaching Spirituality in Clinical Practice 25 medicine, religion, and spirituality should be related but, rather, how that relationship is construed. We assume that one cannot engage basic questions regarding the nature of what medicine itself should be like without heavily resting one’s argument on philosophical or theological foundations, which are grounded in traditions. There is a need, as the philosopher Alasdair MacIntyre (1984) has argued, to personally admit, “I find myself part of a history and that is generally to say, whether I like it or not, whether I recognize it...