PART VI.  PHILOSOPHICAL-RELIGIOUS BELIEFS & READINESS FOR DEATH

Questions 23:  What philosophical, ethical, or religious beliefs
do you hold that are relevant
to your medical care and other end-of-life decisions?

     Medical ethics seldom acknowledges its roots in religious beliefs,
but most doctors and nurses at least come from some religious tradition.
And their ways of handling difficult questions
—especially questions arising at the end of life—
are often affected by their implicit religious faiths.

     Patients might be even more deeply religious than their care-givers.
And they probably have no scientific training as doctors or nurses.

     But when you come to the end of your life,
you are correct to apply your own philosophical and religious beliefs
in making your end-of-life decisions,
even if a more scientific orientation might lead to other choices.

QUESTION 23:              RELIGIOUS BELIEFS                by JAMES PARK                  175



     Medical ethics itself is not based in science.
The fundamental values of right and wrong
come from religious tradition, cultural patterns,
or are based on rational argument—or some combination of these.
In any case, the fundamental values concerning life and death
are usually more presupposed, implicit, unstated than scientific.

     You should apply your religious and philosophical principles
in creating your medical ethics and in writing your Advance Directive.
You are not laying out patterns for others to follow.
You are deciding for yourself
how you want to be treated at the end of your life
and which path toward death seems best to you.

     It might be argued that all the religions of the world
are—at least in part—attempts to cope with death.
Many of these religions have definite beliefs about death.
And no discussion of death would be complete
without taking religious beliefs into account.

     Medical practice generally respects religious beliefs,
in part because of the personal beliefs
of the doctors, nurses, & other health-care workers themselves.
And sometimes the very institutions in which they provide health care
were established by religious organizations.
The medical personnel have learned to respect religious values,
even when they do not share the same world-views.

     Beliefs about death might be stronger than other beliefs
because of the emotional impact of facing death
—either your own death or the deaths of your loved ones.
Even if you paid little attention to religion during most of your life,
you might become intensely religious as you approach death.
And these forms of faith might be quite traditional
because you have not created your own system of beliefs.
When facing death, you might remember your childhood faith.

     Thus, medical personnel are frequently confronted by
unexamined but fervently-held religious beliefs about death.
Some families have automatic responses to ethical questions
because they grew up in a well-established religion.
Perhaps you believe that there are absolute rights and wrongs
—even if you do not know what the absolute standards are
or how to apply such standards to the situation at hand.

176    YOUR LAST YEAR: CREATING YOUR ADVANCE DIRECTIVE FOR MEDICAL CARE



     Consequently, you might turn to religious authorities
for answers to questions you have not seriously faced before.
This is the way that professional religious leaders
(ministers, priests, rabbis, mullahs, etc.)
get drawn into the discussion of medical ethics.
And sometimes the religious leaders are even called upon
to make life-and-death recommendations based on their religious tradition.

     But general medical ethics
in the United States and other Western countries
is based on a secular consensus about life and death.
This secular system of beliefs is not well defined
and it often clashes with traditional religious beliefs.
When there is a clash, the religious beliefs generally prevail
—unless they directly contradict a scientific perspective
in a way that affects treatment decisions.

     A common example of this is the Jehovah's Witnesses'
refusal of blood transfusions and blood products
because of their religious beliefs on these matters.
Based on a few Biblical passages, they believe that voluntarily accepting
blood transfusions or blood products will exclude them from heaven.
Courts have ruled that those who hold such beliefs
are allowed to refuse blood for themselves (but not for their children)
even if such refusal leads to their premature deaths.
Life-threatening choices based on more exotic religions
are usually rejected in modern hospitals.

     Because of the everyday experience of compromising
with patients and families who have strongly-held religious ethics,
general medical ethics takes on a religious tone,
even when there is no scientific basis for the belief
—such as the belief that a soul survives death.
And even modern hospitals have religious chaplains,
because religious beliefs are so important to many patients.

     Completely secular patients might be the first to notice
when hospital-ethics-in-practice have a religious tone.
The religious members of the staff take religious references for granted,
especially if the hospital was built by a religious organization.
Also many of the hospital staff have religious motivations.
Thus, it is 'natural' for a religious tone to slip into health care,
often in ways that are not noticed by religious people.

QUESTION 23:              RELIGIOUS BELIEFS                by JAMES PARK                  177



     An Advance Directive is an appropriate place for you
to state your religious or non-religious philosophy
as it applies to life-and-death decisions.
If you do not state your religious beliefs,
you will be treated as if you have generic religious beliefs,
which is the basis of the hospital chaplaincy program.
This might be nothing more than a vague spiritual tone,
without reference to any specific religious tradition.
The medical staff may assume the patients are basically religious;
so they will "do onto others as you would have others do unto you".

     And this might be appropriate for you,
especially if you have not worked out your own religious beliefs in detail.
You will be treated as a normally-religious American person.

     But if you are more religious or less religious than average,
you should state your beliefs in your Advance Directive.
If you have non-religious ethical beliefs, you should state them,
especially as they apply to life-and-death decisions.
Even a brief statement of such relevant beliefs
(whether based on religion or on some secular philosophy)
could be an occasion for a meaningful discussion with your proxies
or the members of your Medical Care Decisions Committee.

     The medical system must allow broad latitude
for all religious and non-religious beliefs.
But the medical staff should not be expected to be mind-readers.
Nor should they be expected to understand your beliefs
simply because you registered your 'religious preference or affiliation'
when you were admitted to the hospital, nursing home, or hospice.
Saying that you are a Catholic or Protestant will probably not be enough.
Your religious beliefs have probably affected
how you answered the other Questions in this book.
But here is your opportunity to state the bases of your ethical choices.

     These philosophical and spiritual matters
—and the medical decisions that will issue from them—
should be settled (at least tentatively)
years before a medical problem puts you in a health-care institution.



  The selection above is the first four pages of Question 23 from the book:
Your Last Year: Creating Your Own Advance Directive for Medical Care.
If you click this title, you will see the complete table of contents.
Two more pages on this Question explore other implications of relilgious or ethical beliefs.
If you would like to see one person's Answer to this Question,
go to James Park's Advance Directive for Medical Care.
Scroll down to Answer 23.




Go to the index page for Your Last Year:
Creating Your Own Advance Directive for Medical Care.



Go to the Portal for Advance Directives.



Go to the Right-to-Die Portal.



Go to the Medical Ethics index page.



Go to the DEATH index page.



Go to the opening page for this website:
An Existential Philosopher's Museum.






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