There is no doubt that modern clinical medicine in the West is practiced in a pluralistic and multicultural context. Yet nowadays, there is frequently a divide between the moral values of clinicians and those of their patients. Whereas many clinicians, whatever their own personal beliefs, ascribe to a basically secular morality that emphasizes such values as individual autonomy and social utility, many of their patients ascribe to cultural and religious traditions that emphasize such values as obedience to God and the responsibility of families and communities to care for their own. In addition, whereas it is usually quite easy to negotiate respect for the strictly ritual requirements of such patients in such areas as prayer and diet, it is more difficult to negotiate great differences in moral perspectives between clinicians and their patients when it comes to practical questions involved in medical treatment in general and the treatment of the patient at hand in particular. Sometimes these differences need to be more generally negotiated in the public policy discussions that take place in hospital ethics committees or even in legislative and judicial settings. Other times, these differences need to be more particularly negotiated on a case-by-case basis between clinicians and their patients and the patients’ immediate families, plus those from their traditional communities authorized by patients and their families, such as priests, rabbis, pastors, or imams, to provide them with moral guidance or even moral governance.
This section aims to acquaint clinicians with such potential differences between their moral values and the moral values of their patients and their families and communities. It does not suggest, much less propose, ways that these moral differences can be negotiated in a clinical setting. This section is, therefore, descriptive and not prescriptive. Nevertheless, such information will surely be useful in making informed moral judgements when dealing with patients who come from the religious and cultural traditions discussed in this chapter.
Here the distinctive views on basic issues in biomedical ethics from a significant number of the world’s major religions and cultures are represented. The authors of these distinct contributions to this section of the book are all experts in the ethics of their respective religious and cultural traditions, especially in the way their traditions deal with biomedical questions. Despite their intellectual expertise in both the theoretical and applied ethics of their own traditions, the contributions of all the authors in this section will be easily understood by those having little or no familiarity with these traditions. Also, accessible references in English for further reading and inquiry are provided.
In terms of the relation of religion and culture at work in all of these contributions in one way or another, one can see that if “culture” is the way of life of a particular community having historical continuity from a premodern time into the present and intending to persevere into the future, then one can see that “religion” lies at the core of all these cultures. But what is “religion”? Clearly, there is no one overriding general definition of a class called “religion” in which all the “religions” discussed here (or anywhere else) are simply its specific manifestations. Instead, one can only see certain overlappings between the various traditions themselves. That is, there are some things that some social phenomena usually called “religions” have in common with some other “religions,” and other things they have in common with some other “religions.” Nevertheless, perhaps one can say that what all of the religions dealt with in this section have in common is that moral decisions in all of them are made by reference to some transcendent reality; that is to something or someone beyond human making and human control. As such, ethics in all of them is in one way or another part of worship. Other than that, though, almost all the other commonalities are between specific cultural traditions rather than among all of them, let alone encompassing them all in some larger structure.
The force of various forms of what might be called traditional moral beliefs and sentiments varies from patient to patient. Some patients are quite articulate and coherent in expressing their moral beliefs and sentiments, or they are quite clear about whom they themselves designate to articulate these beliefs and sentiments for them. Other patients are less articulate, less coherent, and frequently less than wholehearted in affirming any traditional moral view for themselves. Then, there are patients who affirm no traditional moral view or who have rejected the traditions in which they were once participants, whether actively or only passively (as in the case of a tradition into which one was only born, yet recognized by others as being a member of it). Therefore, it is extremely important that the clinician should not only be aware of the tradition from which his or her patient comes but also should evoke from the patient just what his or her relation is to that tradition: wholehearted, halfhearted, rejecting, or non-existent. Frequently, especially in situations of long-term treatment, such information about the patient’s religious position is as important, or almost as important, as information about the patient’s physical condition. Minimally, such information should be sought when the psychological state of the patient is being examined and assessed.
The recognition that the patient’s moral perceptions require attention in the clinical setting does not, of course, imply that those perceptions are correct or valuable for the whole process of clinical treatment. There are patients who are often very much misinformed about what their own tradition teaches about a particular moral issue. In fact, there are even times when a so-called “religious” position masks psychological pathology. Therefore, this section of the book, with its brief but accurate accounts of the moral positions on basic biomedical issues of the various traditions considered, can be helpful to a clinician when trying to ascertain whether a patient is accurately representing his or her own tradition on the moral question at hand, or whether the patient is expressing his or her private confusion or pathology. (Of course, such knowledge will be of no use to a clinician who considers all religion to be pathological per se, which is also an issue that needs to be examined when treating a religious patient.) Yet, even when a patient is correct about the position of his or her tradition on the moral question at hand in his or her own treatment and no psychological pathology is evident, such religious points of view cannot be allowed to dominate the ethical aspects of clinical decision making. These traditions should have a voice but not a veto. Clinicians and other healthcare professionals are bound by their own moral convictions, professional ethics, often by mission statements of the healthcare institutions where they work, and by the law. For example, the dominant role of the family in many traditionally based moralities can run counter to modern secular notions that only the autonomy of the individual patient is to be taken into consideration. This is especially important to note when a child is the patient and who cannot be expected to make his or her own moral decisions, but also in the case of many adults who would say that they freely accept the authority of their family and their traditional community (often seen as an extension of the family) to make major decisions affecting their lives and their health.
The attention of clinicians to the religious views of their patients can also enrich their own personal process of developing a cogent moral point of view. When this happens, there is genuine dialogue between clinicians and patients and the communities in which they all live – both with each other and apart from each other. This section seeks to contribute to that ongoing dialogue.