Abstract

The central question of this work is how should physicians respond to patients' religious beliefs when those beliefs cause patients to act in a manner that is at odds with what most of the community regard as reasonable? I use the example of a Jehovah's Witness who refuses a life-sustaining blood transfusion as a paradigm case of a religiously grounded disagreement about medical care. In chapter 1, I explain the reasons for Jehovah's Witnesses' refusal of blood and lay out three responses to the question of how physicians should respond. The options of coercing a transfusion, respecting patients' right to self-determination, and respectfully but critically tolerating patients' medical decisions are considered throughout this work. In chapter 2, I contrast four readings of the Kantian demand for respect and argue that respect for persons as engagement can best guide physicians' interactions with patients where there is intractable disagreement. In chapter 3, I develop the idea of respectful toleration as the preferred response to patients whose religious beliefs are the foundation of a medical decision that is at odds with our initial standards of reasonableness. This response to patients is characterized by tempered beneficence that leads to engagement and persuasion, but stops short of coercion. In chapter 4, I suggest that the reluctance to engage patients in a critical discussion of their religious reasons is based on a misguided understanding of a physician's role and the process of change within religion. In chapter 5, I consider the question how a physician should respond to patients who, despite attempts at engagement, affirm their religious commitment to refuse life-sustaining treatment. I argue that physicians should respond to dying patients with whom they disagree with empathy and sympathy. ;My thesis is that religious reasons in medical decision-making should not be accorded a privileged status. They should be subject to critical scrutiny while we try to understand religious tradition's attempt to establish deeper meaning in human life. There should not be a wall between physicians and patients that prevents physicians from talking, reasoning about, and engaging patients in a discussion of their religious beliefs and reasons.