Marx and Stark and Finke on religion for terminally ill patients

Karl Marx viewed religion as irrational and as an exploitive tool of the status quo (Marx and Engels 1992), whereas Stark and Finke (2000) offer support for a new paradigm where religion can be viewed as being beneficial by social scientists on certain levels. The current paper discusses the potential utility of religious rituals and spirituality to ease the emotional suffering and stress of individuals who suffer from a terminal illness. Both the views of Marx and of Stark and Finke regarding religion in this context are compared and contrasted (although many of the tenants of Karl Marx must be inferred when discussing religion in this context). A general discussion/review of the research regarding the benefits of religious rituals and spiritual beliefs for terminally ill individuals is in order before discussing Marx and Stark and Finke's positions.

A terminal condition or terminal illness is defined as a condition/disease that cannot be adequately treated or cured (Glare, Virik, and Jones et al. 2003). When an individual is diagnosed with a terminal condition the probability is extremely high that the patient will die in a relatively short period of time. Thus, learning that one has a terminal condition results one of the most stressful experiences a person can endure (e.g. Holmes and Rahe 1967). Different individuals will react differently to this news; however, nearly everyone who is suddenly confronted with a terminal diagnosis goes through various stages of coping, although the specific stages and progression of the stages is still debated (Maciejewski et al. 2007). Due to the inescapable finality of being faced with death many people turn to spirituality or to religion to comfort them in this time of extreme stress (Thune-Boyle et al. 2006). Many of the stage theories describing this process of acceptance of one's fate incorporate a spiritual aspect (Maciejewski et al. 2007).

At this point it is important to make a distinction between religion and spirituality. Spirituality or being spiritual is the belief that a person is composed of physical and nonphysical (spiritual) aspects. These non-physical aspects are generally believed to tie the individual in with a higher form of meaning (Penman, Oliver, and Harrington 2009; Zinnbauer et al. 1997). Religion is defined as a belief in a God to be worshiped, usually by formalized rituals (Zinnbauer et al. 1997). Thus, it is not necessary to be religious in order to be spiritual; however, a religious person would also be considered to be a spiritual person. In this paper the term "spirituality" is used in the religious context where being spiritual is meant to imply the belief in a God and the subsequent use of religious rituals such as prayer in order to foster a relationship with this God.

Research has investigated the utility of religion and spirituality in individuals dealing with the diagnosis of a terminal illness. Penman et al. (2009) conducted a qualitative study that included in-depth interviews of four palliative care patients and ten palliative care caregivers. The interviews identified seven main themes individuals who have been diagnosed with a terminal illness display. Four of the themes related directly to God and religion, whereas three of the themes embodied spiritual engagement such as personal relationships and participating in religious practices. The researchers found that these themes led to positive practices and moved the individuals to try to understand the deeper meaning in all their activities. The researchers suggested that health care professionals working with these patients should assist them in maintaining these practices as such practices enhance coping skills.

Parvu et al. (2012) reviewed the theoretical and conceptual literature regarding coping patterns and coping with a terminal illness. Heavily influenced by the Kubler-Ross stages of grief, Parvu et al. supported the notion of using a coping pattern heavily influenced on religious rituals for dealing with a terminal condition as these rituals can be used by any individual, with any set societal or cultural values, and patients that invest in a religious coping pattern develop greater psychological well-being, better coping skills, and are less reactive than individuals not using these coping skills to deal with end-of-life issues. The authors suggest that health care teams working with terminal patients should include a counseling specialist with spiritual/religious training in order to avoid a spiritual crisis in both the patient and the patient's family.

Thun-Boyle (2006) reviewed 17 studies that examined the effects of religious/spiritual beliefs or behaviors as coping strategies for adults dealing with cancer. The general findings indicated that the strategies generally increased coping in individuals with cancer; however there were an equal number of nonsignificant results and three studies found some detrimental effects. There were several issues with methodology of the study such as how religious coping was actually operationalized, different studies had participants with different forms of cancer, and not all of the participants were terminal. The researchers suggested more focused approaches to studying the effects of religious beliefs on coping with cancer. Ekedahl and Wengstrom (2010) determined through interviews with 15 Swedish oncology nurses that their religiosity facilitated their coping skills when dealing with terminal patients. This included a sense of trust facilitated by prayer as a coping strategy. Rokack (2015) administered a questionnaire to HIV patients, cancer patients, and non-infected individuals to determine how individuals coped with the loneliness associated with a potentially terminal condition. All of the groups turned to religion and their faith as a coping measure; however, cancer patients and non-infected individuals were more similar in their coping styles. HIV patients tended to use more self-reflection.

Thus, the research generally supports the notion that religiosity, especially use of rituals such as prayer, provide some benefit to individuals with a terminal condition. However, there is another way to view this research. Karl Marx viewed religion as supporter of economic oppression (Stark and Finke 2000). Of course in his most famous statement Marx referred to religion as the opium of the people (Marx and Engels 1992; Stark and Finke 2000). Marx was of the opinion that religious beliefs are illusions that foster reasons to keep the classes in a stratified and in an unequal position (Stark and Finke 2000). This corresponds with Stark and Finke's (2000) first element of what they describe as the old paradigm of religion where religious beliefs were a central concern for social scientists due their potential for exploitation of the certain classes of people. Starke and Finke (2000) countered with a new paradigm to describe religion. In the current context Stark and Finke (2000) would point to the research that indicates that people with spiritual and religious commitments enjoy better physical and mental health and therefore religious rituals do serve constructive functions. Thus, most of the aforementioned research regarding religion and patients with terminal conditions could be used by Stark and Finke as evidence of their rebuttal to the old paradigm (the notion supported by Marx).

It may very well be that both Marx and Stark and Finke would agree that religious commitments and spirituality due help individuals accept the inevitable and keeping them from draining limited resources like medical care by not engaging in futile treatments (see Reiner 2007). However, Marx would object to the notion religious beliefs are necessary to ease stress in end-of-life situations. For Marx, religion and spiritual beliefs are delusions resulting in a failure of the individual to recognize reality. By rendering individuals submissive to their life station religion negates the dignity of these individuals. So while Marx might agree that religious beliefs and commitments might ease the stress and suffering for individuals with terminal illness, it could be argued from a Marxist point-of-view that religion is not necessary for this. Instead, accepting reality, understanding the situation fully, and accepting one's fate without religion would lead to an equally dignified condition. Thus, Stark and Finke (2000) emphasize religion as having a rational function by providing a protective effect, whereas Marx would counter that religion is irrational and delusional and is not necessary for such a protective effect if individuals accept reality. Religious rituals such as prayer are simply delusional approaches to coping from a Marxist view, whereas they are helpful coping mechanisms from Stark and Finke's rational view.

The empirical research supports this later view. For instance, Iwaszczyzszyn et al. (2013) performed a semantic analysis of the quality of life for patients in palliative care centers in Poland. They concluded that the medical establishment can improve the quality of life for patients by recognizing the issues that patients face such as continuing their relationships and recognizing their beliefs and religious views. Allowing terminal patients to utilize their spiritual and religious beliefs in the form of prayer and other rituals has been demonstrated to improve the quality of the patient's life. This would be consistent with Stark and Finke's (2000) theoretical model of a new paradigm that supports the utility of religion.

However, the major fault in this particular argument is the notion of what an "improved quality of life" constitutes. For instance, would it be ethical not to inform individuals who have a terminal condition that their illness is terminal in an effort to ease their pain and suffering regarding the inevitable? Would such a decision improve the quality of life of these individuals? Of course we cannot directly answer for Stark and Finke here, but we can project that these individuals would most likely not consider that being dishonest with terminally ill patients in order to protect them from pain and suffering is ethical. Moreover, research has indicated that a large number of individuals support honesty by clinicians with terminal patients as well such ideas as the withholding of life-sustaining treatments in cases where they are futile (e.g., Young et al. 2011). This quandary illustrates the viewpoint of religion held by Karl Marx and the old paradigm. It is not ethical to engage in fantasy or in lie to patients regarding their situation in order to save them from distress. Thus, despite the research that suggests that the use of religious rituals such as prayer ease stress and pain in patients with terminal illnesses, these findings are a sham in that they encourage the maintenance of a lie and the continuation of the exploitation of people. Thus, not only is the use of religious rituals by terminal patients not necessary, it also represents a form of the exploitation that occurs in society between different classes. It would be much more comforting, practical, and ethical for individuals with terminal illnesses to be supplied with full disclosure regarding their condition and be treated with honesty and ethical integrity. Marx could easily counter that the use of religious rituals fosters neither.

Stark and Finke (2000) argue that the assertion by Marx that religion is harmful to society is a political claim, not a scientific one. Stark and Finke (2000) note that religion is more like than amphetamine as opposed to an opiate in that it has spurred many peasant rebellions, generated uprisings against the status quo in numerous instances, and does not merely serve as a form of compensation for disenfranchised groups but as a form of inspiration. The scientific evidence indicates that the use of religious rituals and a spiritual approach are indeed empirically validated coping mechanisms that can be used by terminally ill patients in order to ease their suffering.

We can also suppose that Starke and Finke would make no claims regarding the validity of religion or spirituality (the notion that there really is a God or that there really is some type of higher power). In fact, in order to make their case it appears that any such claims as to the validity of religious beliefs are considered irrelevant by them and it is only their positive effects on society that should be considered. Thus, Stark and Finke do not concern themselves with the validity of religion in an absolute sense, but with the evidence that religion (in this case religious rituals and spiritual rituals) are beneficial. Pevy, Jones, and Yarber (2008) discuss the relevance of these issues. In their qualitative analysis of 38 hospice patients the researchers found that their religious beliefs and religious rituals were beneficial to these individuals by comforting them. The mechanism of comfort was generally reported to be a belief in the afterlife, that the individual was moving on to a better place, and the installation of hope in individuals who were terminally ill. The overall indication here is that these terminally ill individuals were able to reconcile their situation by believing in an afterlife and a form of cosmic order that was outside of their control and brought order to things.