Ethics Paper, Nicole Zanin

February 18, 2007

Checking Belief Systems at the Door:  An Argument for Secular Medicine
I chose a small, but distinguished public liberal arts college on the western prairie of Minnesota for my undergraduate education. I grew up in rural Minnesota where the prairies meet the lakes, and babies are born in blizzards from October to March. The town looked much like the rural town I grew up in with grain bins marking the city’s entrance and Lutheran church steeples predominating.  My freshman year of college I took an introductory creative writing course that led me to the place I am today—pursuing medical school and a career in medicine. Creative writing seems to be the antithesis of medicine, but a liberal arts education teaches that all parts of knowledge are connected.  Medicine is about invention, analysis, and synthesis of information. Writing encompasses those same concepts. My professor sent us into the local nursing home to record the words of the elderly.  The students took their words and shaped them into poetry and compiled books that we read and gave to the residents and their families.

This service-learning project proved to be defining part of my college experience.  Among other lessons, the course helped me explore the intersection of religion, spirituality and medicine. I learned an important lesson: patients teach us about the intersection of faith and medicine.  Patients show us how secularism is advantageous in the dynamic America in which we will practice.

Helen was one participant in the project that gave me a valuable perspective on spiritual belief in the face of hardship. At the age of 94, her son committed suicide on one of those dreadful cold, snowy Minnesota days in March.  I had known Helen for over a year when this happened, and I witnessed the transformation of a women, perhaps the most profound of her life, happen in the final years of her earthly being.  She lived in the nursing home I worked in, and unlike many of my other elderly friends, she did not have Alzheimer’s disease.  Her mind was intact, and the news of her son’s death made her question every tenet of her faith.  I listened a lot.  I came three times a week to read to Helen modern books on grief, the Bible, whatever she needed.  I am not Christian.  I left the Lutheran faith many years ago, and my belief in Christian theology faded as my abstract thinking skills sharpened. People of the Lutheran faith surrounded me, both at home and at college, and I had strong feelings about the fallacies in their faith.  The Lutheran faith is an integral part of Minnesota culture—Catholics may even feel ostracized, not to mention those of non-Christian faiths.  Helen did not know what I believed.  She asked, but I found graceful ways to divert the question to her own beliefs. She might say, for example, “What church do you attend?”. I would respond, “Now, tell me in what ways your church has helped you grieve.” What was paramount in this situation was not what I believed, but what Helen needed to get through her son’s death.  My job was to be neutral.  The society we live in honors my individual choice as well as hers: to practice or not practice religious and spiritual traditions.  My neutrality served Helen.  Had I imparted my own belief system on Helen, she may have felt awkward sharing with me.  I would have failed to acknowledge her best interest in favor of my own need of expression.  Helen taught me that a caregiver who gives compassion and allows one to grieve her illness in the fashion she feels most comfortable is the one patients need.  Sharing our own beliefs with patients can be alienating to them.  Ignoring their beliefs is also damaging.  Knowing what they believe, allowing them space to express their beliefs, and avoiding any judgment by imparting our own beliefs is the most important aspect of patient spiritual care.  
 Although Hall and Curlin maintain that secular physicians are not beneficial to their patients, I contend that being a neutral caregiver gives our patients permission to display their religious beliefs without fear of judgment. The authors of the assigned piece, “Can Physicians’ Care Be Neutral Regarding Religion?” argue that a mutual respect for patient and physician differences in religion requires wisdom and character by both parties.  This assertion is an important one, but the authors’ follow-up comment fails to identify the complexity of religious beliefs in our society and the benefits individualism imparts:

“It is increasingly unclear how such wisdom and character are formed in a culture with crumbling civic and religious institutions (including medicine), and where rampant individualism challenges any claim of the community (civic or religious) over the rights of the individual.” 

This statement makes a false assumption.  Individualism is not at the root of our society’s inability to negotiate the intersection of faith and medicine, but rather it is a facet of the relationship that enables us to accept one another.   When we recognize, both as physicians and patients, that religious belief and spiritual practice are an individual’s choice, the stress of negotiation is subdued.