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      Religious Values in Clinical Practice are Here to Stay

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          Abstract

          Research to date has shown that health professionals often practice according to personal values, including values based on faith, and that these values impact medicine in multiple ways. While some influence of personal values are inevitable, awareness of values is important so as to sustain beneficial practice without conflicting with the values of the patient. Detecting when own personal values, whether based on a theistic or atheistic worldview, are at work, is a daily challenge in clinical practice. Simultaneously ethical guidelines of tone-setting medical associations like American Medical Association, the British General Medical Council and Australian Medical Association have been updated to encompass physicians’ right to practice medicine in accord with deeply held beliefs. Framed by this context, we discuss the concept of value-neutrality and value-based medical practice of physicians from both a cultural and ethical perspective, and reach the conclusion that the concept of a completely value-neutral physician, free from influence of personal values and filtering out value-laden information when talking to patients, is simply an unrealistic ideal in light of existing evidence. Still we have no reason to suspect that personal values, whether religious, spiritual, atheistic or agnostic, should hinder physicians from delivering professional and patient-centered care.

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          Most cited references15

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          A biopsychosocial-spiritual model for the care of patients at the end of life.

          This article presents a model for research and practice that expands on the biopsychosocial model to include the spiritual concerns of patients. Literature review and philosophical inquiry were used. The healing professions should serve the needs of patients as whole persons. Persons can be considered beings-in-relationship, and illness can be considered a disruption in biological relationships that in turn affects all the other relational aspects of a person. Spirituality concerns a person's relationship with transcendence. Therefore, genuinely holistic health care must address the totality of the patient's relational existence-physical, psychological, social, and spiritual. The literature suggests that many patients would like health professionals to attend to their spiritual needs, but health professionals must be morally cautious and eschew proselytizing in any form. Four general domains for measuring various aspects of spirituality are distinguished: religiosity, religious coping and support, spiritual well-being, and spiritual need. A framework for understanding the interactions between these domains is presented. Available instruments are reviewed and critiqued. An agenda for research in the spiritual aspects of illness and care at the end of life is proposed. Spiritual concerns are important to many patients, particularly at the end of life. Much work remains to be done in understanding the spiritual aspects of patient care and how to address spirituality in research and practice.
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            Religion, conscience, and controversial clinical practices.

            There is a heated debate about whether health professionals may refuse to provide treatments to which they object on moral grounds. It is important to understand how physicians think about their ethical rights and obligations when such conflicts emerge in clinical practice. We conducted a cross-sectional survey of a stratified, random sample of 2000 practicing U.S. physicians from all specialties by mail. The primary criterion variables were physicians' judgments about their ethical rights and obligations when patients request a legal medical procedure to which the physician objects for religious or moral reasons. These procedures included administering terminal sedation in dying patients, providing abortion for failed contraception, and prescribing birth control to adolescents without parental approval. A total of 1144 of 1820 physicians (63%) responded to our survey. On the basis of our results, we estimate that most physicians believe that it is ethically permissible for doctors to explain their moral objections to patients (63%). Most also believe that physicians are obligated to present all options (86%) and to refer the patient to another clinician who does not object to the requested procedure (71%). Physicians who were male, those who were religious, and those who had personal objections to morally controversial clinical practices were less likely to report that doctors must disclose information about or refer patients for medical procedures to which the physician objected on moral grounds (multivariate odds ratios, 0.3 to 0.5). Many physicians do not consider themselves obligated to disclose information about or refer patients for legal but morally controversial medical procedures. Patients who want information about and access to such procedures may need to inquire proactively to determine whether their physicians would accommodate such requests. Copyright 2007 Massachusetts Medical Society.
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              The association of physicians' religious characteristics with their attitudes and self-reported behaviors regarding religion and spirituality in the clinical encounter.

              Controversy exists regarding whether and how physicians should address religion/spirituality (R/S) with patients. This study examines the relationship between physicians' religious characteristics and their attitudes and self-reported behaviors regarding R/S in the clinical encounter. A cross-sectional mailed survey of a stratified random sample of 2000 practicing U.S. physicians from all specialties. Main criterion variables were self-reported practices of R/S inquiry, dialogue regarding R/S issues, and prayer with patients. Main predictor variables were intrinsic religiosity, spirituality, and religious affiliation. Response rate was 63%. Almost all physicians (91%) say it is appropriate to discuss R/S issues if the patient brings them up, and 73% say that when R/S issues comes up they often or always encourage patients' own R/S beliefs and practices. Doctors are more divided about when it is appropriate for physicians to inquire regarding R/S (45% believe it is usually or always inappropriate), talk about their own religious beliefs or experiences (14% say never, 43% say only when the patient asks), and pray with patients (17% say never, 53% say only when the patient asks). Physicians who identify themselves as more religious and more spiritual, particularly those who are Protestants, are significantly more likely to endorse and report each of the different ways of addressing R/S in the clinical encounter. Differences in physicians' religious and spiritual characteristics are associated with differing attitudes and behaviors regarding R/S in the clinical encounter. Discussions of the appropriateness of addressing R/S matters in the clinical encounter will need to grapple with these deeply rooted differences among physicians.
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                Author and article information

                Contributors
                akorup@health.sdu.dk
                jsoendergaard@health.sdu.dk
                rechristensen@health.sdu.dk
                connie.thuroe.nielsen@rsyd.dk
                g.lucchetti@yahoo.com.br
                pramakrishnan@ses.gtu.edu
                Klaus.baumann@theol.uni-freiburg.de
                Eunmi.lee@theol.uni-freiburg.de
                Eckhard.Frick@tum.de
                Arndt.Buessing@uni-wh.de
                nalyousefi@ksu.edu.sa
                azimatul.karimah@fk.unair.ac.id
                esther.schouten@med.uni-muenchen.de
                Andreas.schulze@med.uni-muenchen.de
                inga.wermuth@med.uni-muenchen.de
                nchvidt@health.sdu.dk
                Journal
                J Relig Health
                J Relig Health
                Journal of Religion and Health
                Springer US (New York )
                0022-4197
                1573-6571
                17 October 2018
                17 October 2018
                2020
                : 59
                : 1
                : 188-194
                Affiliations
                [1 ]GRID grid.10825.3e, ISNI 0000 0001 0728 0170, Research Unit of General Practice, Institute of Public Health, , University of Southern Denmark, ; Odense, 5000 Denmark
                [2 ]GRID grid.10825.3e, ISNI 0000 0001 0728 0170, Department of Mental Health Service, , University of Southern Denmark, ; Vejle, Denmark
                [3 ]GRID grid.411198.4, ISNI 0000 0001 2170 9332, Department of Medicine, , Federal University of Juiz de Fora, ; Avenida Eugênio de Nascimento s/n-Aeroporto, Juiz de Fora, 36038330 MG Brazil
                [4 ]GRID grid.446914.a, ISNI 0000 0001 2189 7919, Graduate Theological, Union-University of California, ; 2400 Ridge Rd, Berkeley, CA 94709 USA
                [5 ]AdiBhat Foundation, New Delhi, 110048 India
                [6 ]GRID grid.5963.9, Caritas Science and Christian Social Work, Faculty of Theology, , Albert-Ludwig-University, ; 79085 Freiburg, Germany
                [7 ]GRID grid.15474.33, ISNI 0000 0004 0477 2438, Research Centre Spiritual Care, Department of Psychosomatic Medicine and Psychotherapy, , The University Hospital Klinikum rechts der Isar, ; Langerstr. 3, Munich, 81675 Germany
                [8 ]GRID grid.461666.5, ISNI 0000 0001 0261 3087, Munich School of Philosophy, ; Kaulbachstr. 31, Munich, 80539 Germany
                [9 ]GRID grid.412581.b, ISNI 0000 0000 9024 6397, Institute of Integrative Medicine, Faculty of Medicine, , Witten/Herdecke University, ; Gerhard-Kienle-Weg 4, Herdecke, 58313 Germany
                [10 ]GRID grid.56302.32, ISNI 0000 0004 1773 5396, College of Medicine, , King Saud University (KSU), ; Riyadh, 11461 Saudi Arabia
                [11 ]Department of Psychiatry, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo General Hospital, Surabaya, East Java, Indonesia
                [12 ]GRID grid.411095.8, ISNI 0000 0004 0477 2585, Department of Neonatology, , University Hospital Munich, ; Marchioninistrasse 15, 80366 Munich, Germany
                [13 ]GRID grid.411095.8, ISNI 0000 0004 0477 2585, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, , University Hospital Munich, ; Munich, Germany
                [14 ]GRID grid.7143.1, ISNI 0000 0004 0512 5013, Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, ; 5000 Odense, Denmark
                Author information
                http://orcid.org/0000-0002-1926-9435
                Article
                715
                10.1007/s10943-018-0715-y
                6976554
                30328542
                68464578-737a-4cd3-a2af-3dd3b8c9185a
                © The Author(s) 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                Funding
                Funded by: Psykiatriens Forskningsfond
                Award ID: AKK1257
                Award ID: A.K.KørupA2121 1.r.17
                Award Recipient :
                Categories
                Philosophical Exploration
                Custom metadata
                © Springer Science+Business Media, LLC, part of Springer Nature 2020

                Sociology
                religion,value-neutrality,clinical practice,physicians,medical ethics
                Sociology
                religion, value-neutrality, clinical practice, physicians, medical ethics

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