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A spiritual treatment?

As more doctors push for greater respect for patients' religious beliefs, others say science should come first.

February 28, 2005|Charles Duhigg | Times Staff Writer

The elderly Hmong woman sat beside her family as the neurologist explained that she would die without the surgery her husband refused to permit.

The doctor said a blood vessel in the nearly unconscious woman's brain had ruptured, filling her skull with blood. In a slow, loud voice he described how the pressure was pushing her brain into the hole at the base of her skull, according to Kathie Culhane-Pera, a St. Paul, Minn., physician who witnessed and took notes on the exchange. The condition, known as a brain stem herniation, would cause a fatal stroke. The only solution was drilling holes in her skull and draining the blood, the neurologist said, his impatience beginning to show.

The family members began debating in their native Southeast Asian language. Her children urged immediate surgery. But in Hmong culture male elders hold authority, and her husband said he would rather let a Hmong priest heal her with chants and prayers.

The real problem, said the husband, was that one of her souls was lost.

"If you take her home, she'll die," the exasperated neurologist shouted. The suffering woman, who requested that her name not be used but who confirmed her experiences through a relative, remained quiet as her husband argued. Then the surgeon, a devout Christian, entered the room. "It is up to this family to connect with its own spiritual needs," he told the group, according to Culhane-Pera. He turned to the father. "If your prayers don't help, I'll be here waiting for you."

Culhane-Pera was certain the woman would die without surgery. In response to the questioning looks, she remained silent. "I felt the decision had to be up to them," she said.

The family left.

Medicine, spirituality and religion have long been intertwined. The Hippocratic oath -- a code of ethics that still guides contemporary physicians -- originally pledged fidelity to Apollo, the Greek god of medicine. In the Middle Ages, priests in monasteries learned about anatomy and the pharmacology of plants. The first hospitals were attached to churches.

But tensions quickly emerged: Clerics were forbidden to perform surgery in 1215. Soon after, priests were ordered to stop accepting payment for medical services, giving rise to a professional class of doctors.

By the early 1800s, British epidemics pitted government scientists who blamed water sources against priests claiming that disease had celestial origins. The struggle came to a head in 1854, when a cholera outbreak ended after government workers dismantled a well.

Over the ensuing years, medicine increasingly became the province of science in Europe and the United States. But the spiritual origins of healthcare persist: Religiously affiliated hospitals account for 20% of U.S. inpatient care, according to a 2002 study.

As little as 10 years ago, Culhane-Pera's tolerance for spirituality in medical decisions would have been unthinkable for many. Although a 1994 study found that 77% of Americans felt physicians should address patients' spiritual needs, the same study discovered that only 11% of doctors actually participate in such discussions.

But within the last decade attitudes have changed. Today 101 medical schools incorporate patient spirituality in their curricula, up from 17 in 1995. Some hospitals, such as UCLA Medical Center, encourage physicians to include spiritual histories in patients' charts.

However, the medical community remains divided over decisions like those confronted by Culhane-Pera. Some physicians say embracing spirituality has dangerous unintended consequences. Others say doctors should prescribe prayer.

At the core of the debate is a disagreement over physicians' authority and the ethics of endorsing patient beliefs when they conflict with science.

Some, like Dr. Harold Koenig, director of the Center for the Study of Religion/Spirituality and Health at Duke University, applaud Culhane-Pera's choice.

"I recommend that physicians ask every patient if they consider themselves spiritual or religious," said Koenig. "Doctors should encourage prayer and religious participation if that is a source of comfort. Religion has a power to heal, and we have an obligation to value that alongside medicine."

But other scientists, among them Richard Sloan, professor of psychology at Columbia University, say it is dangerous to recommend treatments that push beyond scientific realms.

"If a patient has terrible pain and manages it by watching pornography, rather than prayer, should a doctor tell them to keep it up?" asks Sloan. "It's not a physician's place to make nonmedical recommendations. Spirituality is not guided by science, and doctors must be scientists before all else."

Culhane-Pera said her decision to encourage the Hmong family to make its own choice was influenced by an emphasis on cultural and spiritual sensitivity in her own medical training. Such training is becoming common.

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