Assisted Suicide Bill Defeated in South Australia

South Australia's Parliament defeated a bill that would have amended an existing law to allow assisted suicide. While it's estimated that 80% of voters favor the amendment, parliament rejected it. From The Sydney Morning Herald:

But Family First MLC Dennis Hood said the bill was "dangerous" and he was relieved it was defeated.

"Parliament has spoken loud and clear. Voluntary euthanasia for SA has been soundly defeated and should be moved off the agenda," he said.

"I am grateful that members listened to my concerns and made the decision on conscience to oppose the bill."

Mr Hood said the bill would have allowed euthanasia for patients that did not have a terminal illness, left psychological referral of patients as an option only and offered a "toothless" Voluntary Euthanasia Board to oversee the practice.

In September this year, Ms Key announced she would introduce the bill into parliament's lower house while Greens upper house MP Mark Parnell will put the identical bill to the Legislative Council.

Mr Parnell had similar legislation defeated in the upper house last year.

At the time, Ms Key said it was time for the SA parliament to catch up with public opinion.

"Over 80 per cent of Australians support the right of the terminally ill and others living in intolerable pain and suffering to seek the assistance of a doctor to end their own lives at a time and in the circumstances of their choosing," she said.

Mr Parnell said the bill required a patient to be examined by two doctors, including at least one specialist and oversight by a Voluntary euthanasia Board.

But influential Port Pirie Catholic bishop Gregory O'Kelly was among vocal opponents of the plan, blaming the recent rise of minor political parties for "pushing death.

"It is a sadness that the first moves around our nation under our new political arrangement seem to be a promotion of death and abuse of marriage," he said in September.

Where Academic Advancements Come From.

From Nathan Schneider's new article at The Nation on the Templeton Foundation, "God, Science and Philanthropy":

Templeton has a history of seeding fields of study almost from scratch. After the foundation's initiative for research on forgiveness began in 1997, the number of psychology journal articles on the subject went from fewer than fifty per year to more than 100 in 2000 and nearly 250 in 2008. When Templeton first financed Larson's NIHR in the early 1990s, the number of medical schools with courses on religion could be counted on one latex glove. Now, according to Dr. Christina Puchalski of the Templeton-funded George Washington Institute for Spirituality and Health, three-quarters of US medical schools have brought spirituality into their curriculums.

The Case for Suffering.

Here are two interesting clips: one a heartbreaking story from a New Haven, Connecticut newspaper about the experience of a dying friend; the other a article on a talk given by Margaret Somerville on why aid in dying should remain illegal in Canada. What I'm contrasting in these two clips is the way suffering is discussed, the value placed on it, and the religious ideas that inform our justifications of suffering.

The so-called murder-suicide of a North Haven couple suffering from Alzheimer’s and cancer touches me, not only sympathetically, but personally. I have a longtime friend who, as I write, is facing a prolonged dying in "the American way."

She is a virtual prisoner of what, echoing President Dwight D. Eisenhower, one might call "the medical-religious complex."

Certainly, there are reasons to hold life sacred and to beware the institutionalization of death-dealing. Counterweighing these is the respect due to an individual’s autonomy in matters of ultimate value, especially the quality of one’s own life and death.

My friend has led an active, meaningful life, but now finds herself unable even to read, or to take pleasure in personal company, or to get out of her hospice bed, because of both the pain of her illness and the grogginess induced by the drugs used to combat her pain. While everyone caring for her is well-intentioned, the fact is, as she just put it to me, "I want this to be over yesterday."

AND #2:

Arguments against euthanasia are complex and far more difficult to make, she said.

"Today, the argument for euthanasia is the easiest to make," she said, noting the concern for the autonomous individual. "It's my right, my body. The individual has the right to choose death."

The arguments against euthanasia concern its effects on institutions, such as the health care system, hospitals, doctors and society as a whole, she said.

People often argue that we are merciful to dogs by euthanizing them, so why shouldn't we do the same for human beings, she said. "We're not dogs!"

Somerville said one of the biggest challenges is to argue there is something special about human beings without using religious reasons.

Traditional religion used to serve as a way of putting talk of death into a context of eternity, she said. "It is very difficult to justify suffering without some form of religious argument."

Recover from Brain Death?

At Science and Religion Today I found this great study on faith and organ donation. It's an issue I've written about in the past, here and here. But the astounding fact that I pulled out of the study is this one:

When the researchers spoke with those who are unwilling or reluctant to donate their organs, they found that the majority of them—52 percent—think doctors might not try as hard to save the lives of organ donors, and 61 percent erroneously think it’s possible for a brain dead person to recover.

What's 61% of 49%? That's how many Americans who say they wouldn't be willing to donate organs actually believe that a patient can recover from brain death. What percent of Americans, whether signed up for organ donation (38%) or not, believe in miracles?

A Busy Holy Week.

Hello All,

I've been quiet for the past few days, off my usual religion/end of life/patients' rights beat. Two back-to-back conferences and a new endeavor are stretching my mind and taking up usual time resources.

On Thursday and Friday I attended the Digital Religion conference at New York University's Center for Religion and Media; two days packed with scholars, journalists, activists and lots of discussion about religion online.

Yesterday, I was downtown at a conference sponsored by Women, Action and Media, NYC, honing my media and reporting skills in the company of some amazing women.

And this coming holy week I'm busy preparing for the relaunch of The Revealer, founded by journalist Jeff Sharlet back in 2003 and published by NYU's Center for Religion and Media. You'll find the new site much the same as the old site - but reinvigorated and easier to read, with all the analysis of religion in the media you can handle. We plan to relaunch on April 1.

Busy is good! I'll keep you apprised of my doings as the week goes on.

Faith Doesn't Necessarily Determine Political Affiliation.

From Politics Daily, an article about what people believe and how they vote, by Jeffrey Weiss. Check out a couple of interesting points regarding abortion, self-identification, and a new study published at SSRC.

Here's a clip but I recommend you read the whole thing:

Wouldn't you figure that a rainmaker who believes in his power would want to create rain when it's dry? But what people believe, what they say they believe, and how they act are often only loosely linked. As Chaves points out:

"Among respondents to the General Social Survey, conservative Protestants are no less likely than other Protestants to have been divorced, to have seen an X-rated movie in the last year, or to be sexually active even if they aren't married."

When it comes to religion and politics, he offers an example that is too often forgotten: Blacks and whites in America who espouse similar theological positions tend to take very different political positions. So how does their faith explain their behaviors?

Tiptoe carefully into any such speculation, Chaves says. The ways that people behave don't make nearly as much sense as we'd like to think they do. He says:

"Almost every claim of the form, 'People act in a certain way because they are in a particular religion or because they attend religious services or because they hold this or that religious belief,' commits the religious congruence fallacy."

Careful scholar that he is, Chaves offers a counterbalance:

"I want to be clear about something I am not saying. I am not saying that religious congruence is impossible. I am saying that it is rare, and much conventional practice does not appreciate how rare it is."

And yet, scholars and pundits chew up lots of electrons using the tenets and dogmas of religion to explain how people behave. People who go to church a lot tend to vote GOP. Theology driven? Terrorists in the name of Islam attack a town. The Quran tells them so? Pastors fail to live up to the moral code that they preach. Shocking hypocrisy?

Experts and regular folks seem to expect that people will tend to act consistently with the religion they belong to or claim to believe in. Not so much, Chaves told me this week.

"This is the single most important misunderstanding of religion out there in the popular culture," he said. "Religion is fundamentally situational rather than characterological."

Translation: Where you are and who you're with generally has a lot more to do with how you act than where you pray or what you pray. And correlation is not causation.

So sure, there's a statistical link between church attendance and GOP voting. But what's the cause of that link? Don't assume, Chaves said.

"Always and everywhere, religious congruence is rare rather than common," he said.

There are examples where people act consistently with their religious teachings, Chaves said. But they are generally found in a culture where it's difficult to separate the secular from the sacred. Orthodox Jewish communities, or Amish communities, for instance. But even in those situations, plenty of members act in contradiction to their highly reinforced religious moral codes.

One example in modern political culture that Chaves said could show cause and effect: How moral or religious opposition to abortion seems to drive some voting patterns. The long, hard process of internalization has taken place so that people can draw upon that view even in the voting booth, he said.

By coincidence, another paper in this month's SSSR journal examined a phenomenon of the sort that Chaves is talking about. The paper is titled "Belonging Without Belonging: Utilizing Evangelical Self-Identification to Analyze Political Attitudes and Preferences, " by Andrew Lewis of American University and Dana Huyser de Bernardo of the University of Massachusetts.

The paper looks at polling data where Christians were asked what denomination they belonged to, whether they considered themselves to be evangelical, and where they stood on several points of theology. And then they were asked for their positions on abortion policy, same-sex marriage laws, and party identification.

The quick bottom line: "Religious tradition is a good predictor of political attitudes while self-identification is a good predictor of party identification."

Translation: People who belong to denominations that scholars consider evangelical tend to take conservative political positions more than people who self-identify as evangelical but don't belong to those denominations. But people who self-identify as evangelical but don't belong to evangelical denominations are more likely to be Republicans than people who say they belong to evangelical denominations but don't self-identify as evangelical.

Which is a modestly interesting result. The paper is filled with the sorts of symbols that only a statistician can love. When I asked Chaves about it, he said that the basic analysis and results looked pretty good to him.

But he raised an eyebrow at some of the explanations that the researchers used to explain their results. Here's one paragraph Chaves noted:

"Our models also show the importance of including evangelical self-identification into analyses seeking to explain the impact of religious affiliation on political preferences. In particular, the results show that different types of evangelical belonging influence political outcomes in different ways."

Which is to say that religion and religious identification create political outcomes and preferences. That, Chaves told me, is farther than he'd be willing to go.

Racial Disparity in Hospice Enrollment.

From HFA's Hospice and Caregiving Blog, a look at the racial disparities in hospice enrollment. The fact is that minorities including blacks and hispanics enroll in hospice much less often than whites, even though they suffer some illnesses at a higher rate.

Most of the reports I've seen coming out about this simply note the facts and statistics but make little speculation as to why. It is the why that is most important if we wish to ensure that all Americans have a chance to die the way they want to.

I can guess at a two primary reasons: fear of the medical community after decades of what these groups may rightly call discrimination against the value of minority lives; and a higher prevalence of devout faith which studies have shown compels individuals to agree to aggressive care until the end of life.

Layer these two factors over the impression in larger society that enrolling in hospice is "giving up," and the chaos of last summer that, whether we like to admit it or not, has changed the way the media and society view hospice, advance directives, end of life planning. For minorities who already have less resources for caring for the dying in their homes and a lower rate of participation in their own caregiving (because they tend to use clinics where a relationship with a doctor is not fostered) and you have a perfect storm of challenge for dying minorities and their families.

As in ever other sector of society, the poor and minorities suffer the worst outcomes because of marginalization, lack of access and information and poverty. Health care is no exception. In fact, it is one of the primary failures of our society.

The March 8 issue of the Archives of Internal Medicine reports that among patients with advanced heart failure, blacks and Hispanics are less likely to enroll in hospice care. Researchers from the Institute for Aging Research of Hebrew SeniorLife and Boston University School of Medicine adjusted for sociodemographic, clinical, and geographic factors and found that blacks were 41% less likely to use hospice care than whites, and Hispanics were 51% less likely.

Researchers looked at 98,258 beneficiaries who were not enrolled in 2000, and whether or not they entered hospice in 2001.

From the Ivanhoe Newswire:

Concerning experts is the fact that blacks develop heart failure at a significantly higher rate than Hispanics and whites, mostly because of their increased rates of diabetes and high blood pressure. A recent study revealed young and middle-aged blacks suffer heart failure 20 times more than white individuals in the same age group.

"Our findings document significant racial differences in hospice use and show that overall increases in the availability of hospice services in the 1990s have not erased racial differences in hospice utilization," Jane L. Givens, M.D., M.S.C.E., lead author and a scientist at the Institute for Aging Research in Boston, was quoted as saying.

Earlier studies show cultural belief and values play an important role in hospice use, but Dr. Givens says hospice care must be culturally sensitive to work.

Read the Cardiology Today and MedPage Today reports of this study.

HFA's 2009 initiative focused on Diversity and End-of-Life Care, and also included this special report on African Americans and End-of-Life Care. The report offers explanations as to why hospice, historically, has not been a choice for many African Americans, looks at grief and the African American community, and suggests ways to reach out to African Americans who are making end-of-life decisions.

How Do We Productively Talk About Death?

From Patrice Villars at GeriPal, a discussion of how palliative care practitioners - and the medical profession - talk about death. She starts with a reference to a talk she attended at the recent HPNA/AAHPM conference by Diane Meier, MD titled “Update on National Palliative Care News: How the Big Picture Affects You.”

My first reaction to the post is to disagree. Much like religion, death tends to be discussed in society in a bifurcated way where all nuance and practicality - and actuality - are lost. It's either a screaming, scary nasty thing to avoid at all costs or a saccharine-tinged "passing" into a "better place. (With religion, the portrayals are of nutso crazy bible-thumpers or benign do-gooders with the best of intentions.) But with both death and religion, neither portrayal or language-set is wholly accurate/true.

My other - new - hat is editor of TheRevealer.org (relaunching in the next few weeks). The site looks at how religion is portrayed in the media. And I think the same work toward nuance and understanding there regarding religion reporting is applicable to death "reporting." And so, if avoiding the exaggerations of death and getting at the practicality, complications, nuance and inevitability requires readdressing how we discuss death, then yes, examining the terms used is important and beneficial. But if we're devoted to creating a lexicon about death that further removes us from its actuality, then I say we're on the wrong path.

Here's a great clip, though I recommend you go to the site and read the rest of it, and the comments too:

The new (to me) hot word in the political arena is “optics”. It’s all about how you see things - perception. Perception is in the eye of the audience. (Kind of like pain or shortness of breath is what the patient says it is.) We want and NEED to have a relationship with our patients and families who are part of the general public. We need them to perceive us as helpful and valuable both to serve them and to promote our vision of a holistic health care environment that matches patients’ preferences with appropriate care. So why do our patients/families, through the media and through our work, often NOT see us as helpful and valuable, but, as my son once proclaimed me, as “The Mistress of Death”? What, we must ask if we want to sustain a future in this relationship, is our part?

Dr. Meier observed that we use language that associates palliative care with dying. Consistently. Language is important. Language creates perceptions and (may) define our relationships with the people we care about most. Consider that the tiny line in the proposed health care bill allowing physicians to be reimbursed for having a conversation every 5 years with their patients about advance directives DIED because of optics. It was perceived (used, twisted, misconstrued) by a few clever politicians that physicians were going to talk about dying and (logically, of course) talk people into dying. They quickly conveyed this idea to the general population, OUR audience – our audience who votes. Language. Optics.

Our audience – patients and families – often don’t want to hear about dying. Death and dying is scary. Scary equals reactionary sound bites (i.e. death panels) that can dash any hope we have of reasonable reform and ongoing open relationships. (Ex. Advance directives talks with your physician = dying = fear = death panel = killing Granny and babies with Down’s syndrome). And guess what other words also equal death to our audience? Terminal. Advance directives. End-of-life. Hospice. Yes, and even bereavement. As long as the majority of our patients/families (to say nothing of our health care colleagues) associate palliative care with dying, they will not have access to our services.

Whoa, this is a lot to take in. You mean don’t use the words we have been using for decades to demystify the fear and denial of death in our culture? Isn’t this who we are? What about the movement we have come to birth, nurture and protect? Really, stop using those words?

On the other hand, if these words cause others to retreat from our services, how does it serve either of us? Does rubbing someone’s nose in something we feel is important make them want to be our friends? Probably not.

Do Judges Decide With Their Souls?

The Washington Post today writes about religion and the Supreme Court. John Paul Stevens, the lone Protestant on the bench, turns 90 next month.

The question of faith and the court has come up often lately and I too have pointed out that a majority of the justices are Catholic. Yet the justices seem to make decisions that are less predicated on their faith than on their political ideology.

Of course the most conservative justices on the court tend to think of themselves as "post-religious."

Clearly, the court thinks of itself as post-religious. Last fall, Alito said he was frustrated that discussions about the court's Catholic majority became "one of those questions that does not die." He complained of "respectable people who have seriously raised the questions in serious publications about whether these individuals could be trusted to do their jobs."

Scalia has said he would be "hard-pressed to tell you of a single opinion of mine that would have come out differently if I were not Catholic." Ginsburg has said that whereas her predecessors on the court have been known collectively as the "Jewish justices," she and Breyer are "justices who happen to be Jews."

The article also quotes the fantastic Marci Hamilton. Here's a clip:

Such diversity makse religious labels at best incomplete. "Just because there is a disproportionate number of Catholics on the court doesn't mean that you will know how the decisions will come down," said Marci A. Hamilton, a law professor at the Cardozo Law School in New York, who has written extensively about religion and the court.

Other scholars agree that even on questions of the separation of church and state, a justice's generally liberal or conservative philosophy is a far better indicator than religion. Sotomayor, for instance, seems likely to side more with colleagues appointed by Democratic presidents than with the court's conservative Catholics, appointed by Republicans.

But perceptions matter, too. Religion becomes a diversity consideration just like ethnicity and gender, especially with 51 percent of Americans identifying with one of the Protestant religions.

Clearly, Obama did not consider Sotomayor's Catholic upbringing to be disqualifying, despite the court's majority. "And the president has every right to ask [a potential nominee], 'What is your position on how you would separate your faith from the rule of law?' " Hamilton said.

Perceptions also matter, she said. As religions become more politically active, it is natural for the public to wonder about the influence on the court.

Former Justice Sandra Day O'Connor surprised some last fall at a conference when asked about the need for geographic diversity on the court. "I don't think they should all be of one faith, and I don't think they should all be from one state," she said.

Changing Mystical Practice.

NYTimes columnist Ross Douthat had an article yesterday on the way Americans have changed mysticism. He writes:

Yet by some measures, mysticism’s place in contemporary religious life looks more secure than ever. Our opinion polls suggest that we’re encountering the divine all over the place. In 1962, after a decade-long boom in church attendance and public religiosity, Gallup found that just 22 percent of Americans reported having what they termed “a religious or mystical experience.” Flash forward to 2009, in a supposedly more secular United States, and that number had climbed to nearly 50 percent.

In a sense, Americans seem to have done with mysticism what we’ve done with every other kind of human experience: We’ve democratized it, diversified it, and taken it mass market. No previous society has offered seekers so many different ways to chase after nirvana, so many different paths to unity with God or Gaia or Whomever. A would-be mystic can attend a Pentecostal healing service one day and a class on Buddhism the next, dabble in Kabbalah in February and experiment with crystals in March, practice yoga every morning and spend weekends at an Eastern Orthodox retreat center. Sufi prayer techniques, Eucharistic adoration, peyote, tantric sex — name your preferred path to spiritual epiphany, and it’s probably on the table.

This democratization has been in many ways a blessing. Our horizons have been broadened, our religious resources have expanded, and we’ve even recovered spiritual practices that seemed to have died out long ago. The unexpected revival of glossolalia(speaking in tongues, that is), the oldest and strangest form of Christian worship, remains one of the more remarkable stories of 20th-century religion.

And yet Johnson may be right that something important is being lost as well. By making mysticism more democratic, we’ve also made it more bourgeois, more comfortable, and more dilettantish. It’s become something we pursue as a complement to an upwardly mobile existence, rather than a radical alternative to the ladder of success. Going to yoga classes isn’t the same thing as becoming a yogi; spending a week in a retreat center doesn’t make me Thomas Merton or Thérèse of Lisieux. Our kind of mysticism is more likely to be a pleasant hobby than a transformative vocation.

Nature, Science and Religion Are Coming Together.

At CNN, Todd Leopold talks to Margaret Atwood about her new novel, "The Year of the Flood," which is meant as a sequel to "Oryx and Crake," a book I've had on my "to read" pile for a few years now. The interview made me pull out the book from the bottom of the stack primarily because of the following bit:

"Flood" is, in some ways, a continuation of "Oryx and Crake," which introduced much of its world. The characters Oryx and Crake, the latter a genetic engineer, have small but pivotal roles. Atwood says she decided to continue the story because "so many people said, 'What happens?' ... I didn't know the answer, and therefore had to think about that."

A number of the issues raised in "Oryx and Crake," she continues, piqued her interest, particularly since they parallel what's going on in real life. "One of those is the way that nature, science and religion are coming together," she says, noting the popularity of the film "Avatar." "The interesting thing to me is [the] various trends, and my religion in the book is kind of what it would be if people just got a little bit more organized, though they might not go for those [shapeless] outfits."

Faith and Racism.

Wendy Wood of USC conducted an analytical study of existing research into the link between religion and racism. Here findings are both expected and shocking.

One can only ask what the implications are for other discriminatory opinions in the US such as anti-reproductive rights and anti-social services. And, at risk of running out these implications too far, what this study says about the Tea Party-furcated Republican party, committed to “no”-ing our nation’s way to a complete stalemate under our current black-led administration.

From Science and Religion Today, where I found the study. Here's a clip:

The researchers found barely any difference between the amount of racism among religious fundamentalists and more moderate Christians. “Only religious agnostics were racially tolerant,” they write in their paper.
We shouldn’t be shocked, Wood explains:

Religious groups distinguish between believers and nonbelievers and moral people and immoral ones. So perhaps it’s no surprise that the strongly religious people in our research, who were mostly white Christians, discriminated against others who were different from them—blacks and minorities.

She also points out that people who are religious because they value tradition and social convention were especially likely to be racist, noting:

The effect stays significant even in recent years. For people who are religious for conservative reasons, they have become less racist in recent years as racism has become less socially acceptable. But even they are still significantly racist, just that the effect has reduced in magnitude.

Faith and Groundhog Day.

Punxsutawny Phil gave us 6 more weeks of winter this morning but there's a bright spot on the radio.

Don't miss Angela Zito, religion professor extraordinaire from NYU's Center for Religion and Media, talking about Groundhog Day, the movie and the event, on The Take Away this morning.

"We are all here until we manage to get it right."

Nine Texas Church Arsons This Year.

Church Mutual Insurance today issued a press release warning churches in Texas of ways that they can take precautions against arson. Since the first of the year, 9 churches in Texas have been burned.

It's an odd release, on the one hand making church pastors and congregations fearful of arson and welcoming insurance policies against such an instance, and on the other, providing practical measures for these religious entities. Via Religion Press Release Services the release reads:

Arson protection tips for Texas churches

MERRILL, Wis.—The occurrence of nine suspicious fires at worship centers in eastern Texas since the first of the year emphasizes the need for vigilance in protecting ministries.

As the No. 1 insurer of religious organizations in the United States, including more than 8,000 customers in Texas, Church Mutual Insurance Company is at the forefront of providing risk management solutions for religious organizations on a variety of topics, including fire safety.

"Worship centers can be easy targets as they are unoccupied at night, and if they are in a rural area, they have few, if any, neighbors nearby for the criminals to worry about," said Rick Schaber, Risk Control Manager of Church Mutual. "The reasons for arson range from religious disagreements to covering up other crimes, such as burglary to acts of vandalism. Arson is on our radar screen each and every year."

There are many steps religious organizations can take immediately to reduce the risk of arson including:

• Maintain adequate exterior lighting to eliminate hiding places.
• Use motion detection lights to alert neighbors of activity.
• Put interior lighting on sequential timers to give the impression of occupancy and activity.
• Trim or remove shrubbery that blocks the view of possible entries to your building.
• Trim tree branches that might allow second-story access.
• Ladders offer easy access to your roof. Store them properly.
• Install deadbolt locks with a minimum one-inch throw on all outside doors (if your building codes permit).
• Keep all doors (including interior offices and closets) locked when unattended.
• Install locks on all basement, ground floor and second-story windows.
• Remove and secure gasoline and other fuel sources from inside and around your building.
• Request patrols by local police.
• Establish a neighborhood watch program. Notify law enforcement authorities of suspicious activity—do not confront suspects yourself.

Additional arson prevention tips are found in Church Mutual's Fire Safety At Your Worship Centerbooklet and DVD.

"We have distributed millions of our fire safety booklets and videos to religious organizations and various fire safety agencies over the years," Schaber said.

Founded in 1897, Church Mutual does business in all 50 states and currently insures more than 100,000 houses of worship, schools, camps, colleges and senior care facilities.

Church Mutual offers all of its safety material to any religious organization at no charge. To order the booklet or video—Fire Safety At Your Worship Center—call Church Mutual at (800) 554-2642, select Option 4 and enter Extension 4205. Or go to www.churchmutual.com, select Safety Resources and click on Order Safety Material.

Faith and Medicine: What is the Doctor's Responsibility?

If Wendy Cadge is saying with this article that because 3/4 of Americans believe God can cure those with no chance of survival, doctors should entertain that belief and stop being so technology-oriented, this article at the Christian Science Monitor is not only irresponsible but silly. She writes:

Modern medicine, with its profound dependence on technology, often seems nothing short of miraculous. But even the best medicine sometimes falls short of offering a successful treatment or cure. It is in these situations that recent national surveys show many Americans think God can help.

Indeed, three-quarters of Americans believe God can cure people who have been given no chance of survival by medical science. More than half of Americans regularly pray for their own health or the health of their family. Yet many physicians are unwilling, or ill-equipped, to support patients and families on this level.

Many doctors see religion and spirituality as a barrier to medical care or, at most, a useful crutch when medicine has no more answers. But healing involves more than just medical diagnosis and treatment. Often patients and families see spirituality as a source of support when they are ill, or appear to be dying.

A holistic approach to medicine requires physicians to understand the complex role of spirituality and religion in compassionate patient care. The best prescription: Integrate these topics throughout medical education.

Appear to be dying?" Doctors ill-equipped to encourage families for a holy miracle? Godly healing is the new frontier in medicine? Medicine "sometimes falls short of a cure"? Um, statistically, we all die. So 100% of the time, medicine is eventually going to fall short of a cure. While faith is an enduring and credible support in grief, it cannot heal a patient. (Millions of federal dollars have been spent the past decades to prove that prayer aids healing. They all proved it doesn't.)

Cadge talks to a number of physicians - about 30 - and finds that few really know what to do when patients want to discuss their faith or pray with them. She concludes that this is a problem, caused by poor "faith" and "spirituality" training in medical school:

This may be changing, however, as a growing number of medical schools – many with the support of the George Washington Institute of Spirituality and Health (GWish) – started offering courses about spirituality and religion during the past 20 years. These courses try to prepare students to engage in a broad range of conversations about spirituality and religion. Individual courses vary significantly, however, leading GWish to collaborate with medical schools to develop six core competencies in spiritual and health education and to design a uniform way to measure and evaluate them.

While such top-down efforts are a good beginning, it’s clear that most practicing physicians have at least some level of discomfort regarding spirituality in their work, and some consider it a real source of conflict. Our bottom-up research approach – based on talking to physicians in the field – convinces us that a more nuanced, flexible approach to helping doctors and medical students navigate the spiritual shoals is needed.

That bottom-up approach was talking to 30 doctors informally about religion and spirituality. And she then recommends how lack of spiritual understanding in doctors it can be remedied:

First, physician educators must pay attention to the way they and their colleagues act around spirituality and religion in their work. Too many debates about spirituality in medicine are focused on what physicians should do rather than what they are actually doing now.

snip

Second, doctors should pay more attention both to people’s religious traditions and to their broader senses of spirituality and meaning.

snip

Third, it makes sense to systematically include hospital chaplains and nurses in educational initiatives. Two-thirds of American hospitals have chaplains, and nurses have a much longer tradition of talking with patients about spirituality and religion at the bedside than do physicians. Nurses also often spend more time with patients than do physicians

.

I don't even know what the first point means.

The second, in a broad sense, has validity. All humans should be sensitive to other's religious and spiritual beliefs.

The third is a great recommendation - but one that is already addressed at the 624 Catholic hospitals in the US and all others, despite secular or denominational affiliation who employ chaplains, priests, and buddhist guides.

The doctor's job, however, is a science-based job. And while doctors are required, by definition, to focus on science, they are also members of society, a society that is infused with religion and spirituality.

What I suspect Cadge's concern is about is end of life counseling. Elsewhere in the article she asserts that, "A holistic approach to taking care of people, one that will most help those who seek healing, means that more doctors will have to begin to understand patients’ complex relationships to spirituality and religion, rather than ignoring them."

She never clearly defines what she means by a "holistic approach to taking care of people."

If she means participating in religious practices like prayer or helping patients to look to God for a cure when medicine fails, I think she is misguided in her assignation of responsibilities for doctors.

Yes, doctor's notoriously need to improve their people skills but sympathizing with a patient's faith is not the same as helping them to pray for a miracle.

I know I'll get a lot of criticism for this post, particularly from my more "discerning" readers who will find it more proof that I'm anti-Christian or anti-relgion or that I don't believe in miracles. They'll be right with the latter point. And I find encouraging terminal patients to believe in miracles only an exacerbation of an already dire problem in the medical field: inability to talk realistically about unfavorable diagnoses or impending death.

Despite what Cadge claims, the medical profession has long abandoned dying patients to their pastors and priests. Medicine and faith have been intertwined from the beginning (as she inadvertently notes with her opening sentence about miraculous medicine.) They have recognized that when their science no longer works, it is easier to allow a patient who does not want to accept death to take up entertaining miracles with their faith leader.

Cadge's diagnosis that doctors should encourage hope for miracles is letting doctors without the personal skills to speak frankly with dying patients off the hook. I'm not at all saying that all patients can accept impending death. Some choose to fight on, to pray for reprieve from God and their disease, to forego the preparations for death in lieu of eternal hope. That's fine.

Although studies have shown that issues of grief are often better handled by families whose loved one accepted death and prepared for it. A doctor's role is not to encourage nor discourage such belief but to report his findings as accurately as possible and in a manner that does not cause emotional or physical harm to the patient.

Expecting spiritual guidance from doctors is asking too much. Clear discussion of diagnoses, compassion, scientific dexterity and sticking around til the end are a doctor's duties.

UPDATE: With regard to the questionable quality and accuracy of another Christian Science Monitor article, I linked to this post and the Cadge article on a listserve I subscribe to (feminist topics). One person replied saying that I was misreading Cadge, that she was petitioning for spiritual and religious sensitivity for doctors. I replied with the below. Am I off the mark on this one? Let me know in email or comments:

I agree that doctor sensitivity to faith is absolutely necessary. But informed consent implies the doctor ethically informs of options, the patient consents according to his/her conscience. My point is that sensitivity to faith and reticence to addressimpending death should not blur those roles.

A March study shows that devout patients are 3 times more likely to receive futile care at end of life than the less devout. A NYT article from August says due to lack of training on how to talk about death doctors are bad at prognosticating because they "view it as a personal failure. Most predictions are overly optimistic...and the sicker the patient, the more likely the doctor is to overestimate the length of survival." Futile care often leads to a more painful death, and great emotional challenges for the family. Rampant patient over-treatment is preventing our medical system from addressing those most in need.

The CSM piece laments that "only a quarter of the physicians surveyed reported having received any formal training at the intersection of spirituality, religion, and medicine."

Not to be obtuse but what is that intersection for a doctor? Does it mean that the medically sound diagnosis for pancreatic cancer is any different for a Atheist or a Muslim than it is for a Christian? And why is increased spiritual or religious sensitivity necessary for, say, palliative doctors but not OB/GYNs?

How information is conveyed is a matter of sensitivity. What information is conveyed is not.