Ethical Issues in Healthcare Prayer and Religion

Religion and health have long been linked, and continue to be so in most cultures around the world. In fact, both mental and physical health problems were once believed to have supernatural or spiritual origins, a belief which persists until this day in spite of empirical evidence showcasing the biological and chemical causes of illnesses (Koenig, 2000). Regardless of whether or not religion is a worthwhile social institution, religion, spirituality, and practices like prayer remain central to the lives of most people.

Religion can be inextricably linked with personal and cultural identity, and can greatly inform both medical decisions and health practices including lifestyle choices. There is also a notable link between religiosity and a number of health outcomes including morbidity and mortality rates, proven in empirical studies. The literature tends to support a strong connection between prayer and stress relief in particular, as prayer and religion are widely believed to mediate anxiety and stress in health-related situations.

Because religion is a major component in the lives of patients, nurses and other healthcare practitioners need to understand how to broach the subject with patients, encourage prayer and other religious practices as part of a holistic healthcare strategy, and also understand when to avoid imposing religious beliefs onto patients. Core ethical principles in nursing include autonomy, beneficence, and non-maleficence. Each of these ethical principles encourages or outright advocates the blending of religion and healthcare when the patient requests it.

As many as 96% of all Americans believe in God, and that number is even higher for African-Americans (Koenig, 2000). Therefore, it can be assumed that patients have spiritual beliefs that are important to them and their health care practices, decisions, and outcomes. Davis & Owens (2013) found that the vast majority of American patients want spirituality to be integrated into their treatment, but underscore the importance of patient autonomy.

In other words, nurses should not impose beliefs or even strongly suggest the use of prayer for patients who do not display any interest in religion. Even imposing morality on patients can be construed as malfeasance. For the majority of patients who do care about and who are interested in religion, it is critical to respect religious diversity.

Regardless of specific faith or actual set of religious beliefs, religiosity itself is linked to reductions in "all-cause mortality," including for cancer, as well as cardiovascular disease, disability in general, and usage of medical services (Davis & Owns, 2013, p. 13). There are three primary reasons why healthcare workers should encourage religiosity and prayer in patients who express their spiritual beliefs. For one, prayer and religion are linked with positive health outcomes.

Second, prayer and religiosity are connected with reductions in stress in almost all patient populations and can encourage healthy lifestyles that lead to overall health promotion. Finally, religion remains important to all Americans and nurses have an obligation to honor patient beliefs regardless of specific faith. Because religion is linked to positive health outcomes, healthcare workers should be particularly open to including religion and spiritual practices into their work with patients.

Religion and spiritual belief systems linked to less smoking, lower cholesterol levels, and generally lower risk for heart disease (Koenig, King, & Carson, 2012). In a study of children, Rew, Wong & Sternglanz (2009) found "prayer was .. positively related to the protective resources of social connectedness and sense of humor," (p. 245). In addition, Rew, Wong & Sternglanz (2009) found that "children who prayed frequently reported significantly higher levels of positive health behaviors than children who never prayed," (p. 245).

One of the main reasons why religion is linked to positive health outcomes is because of the role that religion plays in health practices, health behaviors, and lifestyle choices. Religion is linked to treatment decisions and stress relief. Almost all (96/100) participants in one study "indicated that prayer was used as a coping mechanism in dealing with the stress of cardiac surgery," (Saudia, et al., 1991, p. 60). Prayer may be especially called for when patients develop serious or life-threatening illnesses (Bearon & Koenig, 1990, p. 249).

Not all healthcare workers are in favor of using prayer and religion in healthcare, and many are actively opposed to religion. Ethical considerations include autonomy and non-malfeasance, which is why it is critical to avoid imposing specific religious beliefs on patients or to impose systems of morality of theism on atheist patients.

While some opponents of religion also claim that religion inhibits patients from seeking health care interventions or may preclude the use of medications, Bearon & Koenig (1990) found that religion does not have any proven negative impacts on health care, because "prayer and medical help-seeking are not mutually exclusive," (p. 249).

It is true that some religious patients will avoid the use of medical services or medications in favor of a purely spiritual approach, and ultimately that decision is up to the patient so long as the person is mentally capable of making those autonomous health care choices. Finally, weak methodologies (design flaws and confounding variables) cast doubt on findings" but generally studies show a positive correlation between prayer and stress reduction (McCullough, 1995, p. 15). As a healthcare worker who respects patient autonomy.