TRS3311 College of St Scholastica Religious Perspectives on Healthcare Ethics Essay Instructions
Write a 500-600 word essay describing your personal moral worldview. What factors (family, community, friends, religion, and so on) have been the most influential in forming your conscience? Also, note the ways that your culturae affects your understanding of morals and ethics. Include (at least) two references to the readings for Unit 1 as part of your paper.
Guidelines
Length: 500-600 words
Source: Course Material
Format:
Follow correct APA Style and include all required components:
APA 6th ed CHECKLIST.pdf Religion, Bioethics and
Nursing Practice
Marsha D Fowler
Key words: faith; Native American; religion; religious ethics; sacred
This article calls nursing to engage in the study of religions and identifies six considerations
that arise in religious studies and the ways in which religious faith is expressed. It argues
that whole-person care cannot be realized, neither can there be a complete understanding
of bioethics theory and decision making, without a rigorous understanding of religiousethical systems. Because religious traditions differ in their cosmology, ontology, epistemology, aesthetic, and ethical methods, and because religious subtraditions interact with
specific cultures, each religion and subtradition has something distinctive to offer to ethical
discourse. A brief example is drawn from Native American religions, specifically their view
of ‘speech’ and ‘words’. Although the example is particular to an American context, it is
intended to demonstrate a more general principle that an understanding of religion per se
can yield new insights for bioethics.
Introduction
Religion has been a potent and pervasive influence trans-historically, culturally and
internationally. Indeed, it is hard to conceive of a nurse who has never had a religious
patient. Even so, nursing has resolutely avoided the academic study of religion. While
nursing has looked at religion as a variable in empirical research, and has explored
non-religious spirituality, neither of these constitutes the study of religion itself. This
omission ultimately obviates any claim that the profession might make to whole-person
or holistic care. For the purposes of nursing ethics, the nursing profession must come to a
better and more knowledgeable understanding of: the ways in which religion and
ethics interact, particularly in reference to bioethics; the differing ways in which specific religions inform, critique and enlarge moral discourse within health care; and the
effects of particular religious traditions on bioethical decisions.
Writing about religion is fraught with pitfalls due to the very nature of religion
and the ways in which adherents express their religious faith. Thus it is important to
preface the discussion by identifying a few considerations basic to any discussion of
religion.
Address for correspondence: Professor Marsha D Fowler, Azusa Pacific University, 901 E Alosta
Ave, Azusa, CA 91702, USA. Tel: +1 626 815 5402; E-mail: mfowler@apu.edu
Nursing Ethics 2009 16 (4) © The Author(s), 2009.
Reprints and permissions: http://www.sagepub.co.uk/journalsPermissions.nav
10.1177/0969733009104604
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MD Fowler
• Religious traditions are not univocal; even within one historic religious tradition
there will be different streams of expression: For instance, Christianity has Eastern
Orthodox, Roman Catholic, Protestant, and Radical Reformation streams and multiple subtraditions within each of these streams. Judaism finds expression among
Orthodox, Conservative, Reform, Reconstructionist and Haredi branches with subgroups such as Hasidism. Buddhism has major streams such as Theravada and
Mahayana; Mahayana Buddhism includes Tibetan, Zen, Pure Land, and Son forms.
Although subtraditions may retain a common core with the parent tradition, that
core may be interpreted, expressed and lived differently.
• Religion and culture are mutually interpenetrating, reciprocating, and often inseparable: Sikhism in Vancouver, Canada, does not look identical to Sikhism in the Punjab,
India.1 Portuguese Catholicism looks different from Italian Catholicism, which looks
different from Mexican Catholicism. For example, a little Catholic church in Southern
California, with members largely of Italian coastal descent, has an altar in the shape
of a boat and the entire place of worship expresses a nautical theme found in many
Catholic churches whose congregations descended from fishing communities. More
widely, religion and culture interpenetrate so that culture may shape the symbols
of religious tradition, as in the fishing churches mentioned above. Conversely,
some cultures are suffused with religious influence where adherence may not be
widespread. For instance, there may be a specific underlying religious metaphysics
that originally informed the shape of civil law or a constitution in a nation that no
longer widely embraces that particular religion. The prevailing ethos and culture of a
nation may also be reflective of aspects of a specific historic religious tradition where
that religion is not or perhaps is no longer widely embraced. For instance, the communal emphasis of communism is not inharmonious with a basic communal
emphasis of the Russian Orthodox Christianity that predated it. That is to say,
Russia was Orthodox even when it was an atheist state.
• Religious traditions often fall along a continuum of expression: This continuum may
be characterized in a number of ways, including: conservative (or ultraconservative)
to liberal; traditional to progressive; fundamentalist to mainstream, and so on. This
continuum may give rise to separatist groups or other forms of clustering of like
minded adherents. The continuum is not limited to religious beliefs and practices,
but also interacts with views of culture or politics. Either end of the spectrum may
be associated with specific sociopolitical views. For instance, conservative (evangelical and fundamentalist) American Christians have often been associated
with conservative Republican Party politics, extending to politically conservative
positions on issues of justice (e.g. how health care should be organized nationally).2
• The formal tenets of a religion may not be quite the same as those expressed by
an individual adherent: Individuals may differ in their beliefs from those formally
expressed by the religious tradition to which they belong. That is to say that lay
persons may not be aware of, may misunderstand, may modify or reject, or may culturally attenuate many of the beliefs, standards and practices of a religious tradition,
including perspectives on health, bioethical issues and decisions.
• Religion may find expression in ways that are sublime, and it can also find expression
in ways that are toxic: The current religious wars make it necessary for the mass
media to attend to the socially toxic aspects of religion, but, admittedly, religion has
had a hand in colonialism, the suppression of cultures, the oppression of peoples, and
the death of innocent persons.3–5 Religion can also be toxic at the individual level as
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Religion, bioethics and nursing practice 395
in the ‘lethal triad’, the consequence of which is often death (e.g. Solar Temple, Jim
Jones in Guyana, Heaven’s Gate).6 Any examination of religion, particularly with
an interest in health care, must acknowledge but move beyond a focus on the toxic
to a better understanding of what various traditions bring positively to an understanding of health and illness, and the resources they provide for patients, including
guidance in bioethical decision making.
• Religion may co-mingle with civil religion: Sociologically, civil religion is the ‘folk
religion’ of a nation and its political culture. It often draws upon specific religious
language and specific religious symbols and images to unify a people, while at the
same time being devoid of actual religious content. Political civil religion may include
rituals and expressions specifically linked to patriotism: presidential exclamations
such as ‘God bless America’, and the phrase ‘one nation under God’, evoke not
so much religious faith as nationalistic fervor.7 However, some religious traditions
may so co-mingle with culture that the actual religious content may, in an accommodationist syncretism, become a variant form of nationalism.8
An academic study of religions seeks to explore the theology, philosophy, sociology
and other aspects of particular religions. Religious studies are intended for a broad
learned audience and are neither sectarian nor evangelistic in nature. This article calls
nursing to the academic study of religion and the ways in which religious faith may
affect persons, whether nurse or patient, concerning their views of health, illness, caring
for another who is ill, suffering, bioethical analysis, and more. Knowledge of religions
and their theology will influence clinical practice. Beyond a theoretical understanding,
nursing must examine the ways in which knowledge of a patient’s religion is pivotal
to understanding the patient as a person. Clinical care may well need to be modified.
Knowledge of a patient’s religion may also bring ethical issues into our awareness that
we had previously been unable to see.
Religion and ethics
Bioethics in the USA has largely adopted the language and arguments of philosophy
as the language of moral discourse in health care. This is in spite of the fact that, historically, philosophy has been more interested in meta-ethics than in normative or
applied normative ethics. Indeed, one philosopher has asserted that bioethics (a form
of applied normative ethics) saved philosophy departments from extinction.9 Historically, normative ethics has always been the domain of religions, if for no other reason
than that religious persons needed ways to think about actions and relationships and
to know whether or not they had erred morally. With the rise of bioethics in the 1960s it
must be noted that many of the early bioethicists were trained in theological seminaries,
were religiously identified, and wrote from a religious perspective (e.g. Paul Ramsey,
James Gustafson, Richard McCormick, Albert Jonsen, Immanuel Jakobovits, Fred
Rosner, David Bleich). It remains the case that a large number of biomedical ethicists
writing in bioethics today continue to do so from an explicitly religious perspective
(e.g. Elliot Dorff, Margaret Batten, Keown Damien, Robert E Florida, Vandana Shiva,
Lisa Cahill, Stanley Hauerwas, Gilbert Meilander, Laurie Zoloth-Dorfman, Abul Fadl
Mohsin Ebrahim). Some who have a strong religious commitment that informs their
bioethics nonetheless write in completely areligious language.10 Increasingly, however,
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MD Fowler
the medical ethical literature is devoting more attention to religious bioethics.11 Unlike
medicine, writers in bioethics in nursing rarely do so from an explicitly religious bioethical perspective. Unlike medicine, nursing has made no concerted effort to explore
the inter-relationships of specific faith traditions, bioethics and the discipline.
Fox12 identifies three phases in the growth and development of bioethics in the USA.
The first phase is centered on voluntary consent by participation in human research
projects. Fox dates this period from the late 1960s to the mid-1970s. The succeeding period,
continuing through the mid-1980s, focuses on life, death, personhood and end-of-life
issues. The third phase focuses on access to care, cost containment, rationing, and the
allocation of medical resources. This periodization does not exclude the continuing relevance of questions from preceding phases upon the next.12 Fox makes two observations
of significant importance for the present discussion. First, she characterizes American
bioethics as rationalistic, ‘intellectually provincial and chauvinistic’, and conservative,
with a lack of attention to its ‘American-ness’ and an overweening emphasis on
autonomy at the expense of social and relational values. She writes:
The skein of relationships of which the individual is a part, the socio-moral importance
of the interdependence of persons, and of reciprocity, solidarity, and community between
them, have been overshadowed by the insistence on the autonomy of the self as the highest
moral good. Social and cultural factors have been primarily seen as external constraints
that limit individuals. They are rarely viewed as forces that exist inside, as well as outside
of individuals, shaping their personhood and enriching their humanity (p. 207).12
Fox further observes that American bioethics neglects both social problems and
religion.
… social problems are ‘de-listed’ as ethical problems in a manner that removes them
from the sphere of moral scrutiny and concern … Bioethics deals with religious variables
in a comparable fashion. When questions of a religious nature arise in bioethics, there
is a tendency either to screen them out, or to ‘reduce’ them, and fit them into the field’s
circumscribed definition of ethics and ethical (p. 207).12
This is the situation ‘despite the significant contributions of highly esteemed religious
ethicists and theologians to bioethics, the field is studiously secular in its perspective.’12
An emphasis has been placed on rational, deductive, objective/dispassionate, universalizing, secular analysis that is assumed to be ahistorical and acultural. The exclusion of
social, religious and relational values, the emphasis on autonomy of the self, and the
rationalism of the field are even more acutely important to consider when dealing with
patients from more communitarian or tribal societies.
General reasons for examining religious-ethical systems
The reasons for turning nursing’s attention to religion and religious-ethical systems are
practical. The first is that approximately 85.7% of the world population identifies as
religious (11.92% identify as non-religious; 2.35% as atheist).13 The perception in the USA
that the world is increasingly secularizing contrasts with the evidence that religious
adherence is actually increasing world-wide.14 To understand a patient and to engage
in whole-person care necessitates at least basic knowledge of the person’s religion.
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Religion, bioethics and nursing practice 397
The second reason is demographic in nature. For example, approximately 12% or
over 37.5 million residents of the USA are foreign born (2004 statistics). In addition, 34%
of the population self-identified as a racial or ethnic minority.15 Minority and foreignborn persons cluster around the periphery of the USA from Hawaii, California, the
Southwest, Florida, to New York.15 Although 60% of the US population is ‘non-Hispanic
white’, in cities such as Los Angeles this group is now a minority. The 2006 demographic estimates for Los Angeles County, California, are: population 9 948 million;
Hispanic or Latino origin 47.3%; non-Hispanic White 29.2%; Asian 13.1%; Black, 9.6%;
foreign born 36.2%; and language other than English spoken in the home 54.1%.15
Practically, then, sizable numbers of the US population who will become patients have
not been reared in the dominant, White, western Euro-American culture and it may
be found that they embrace a value complex that differs from it. At least part of this
value complex will derive from religion, either directly or indirectly.
In contradistinction to national demographics, the vast majority of nurses in the
USA are non-Hispanic White. According to the American Nurses Association’s most
recent posted data (2004):
The total number of licensed RNs [registered nurses] living and working in the United
States was estimated to be 2,909,467 as of March 2004 … Of the nurses who indicated their
racial/ethnic background in 2004, 88.4 percent (an estimated 2,380,639) were white, nonHispanic; 4.6 percent or 122,495 were Black/African American, non-Hispanic; 3.3 percent
or 89,976 were Asian or Pacific Islander, non-Hispanic; 1.8 percent or 48,009 were Hispanic;
0.4 percent or 9,453 were American Indian/Alaskan Native; and 1.5 percent were from
two or more racial backgrounds. The 2004 survey estimates that 3.5 percent of the RNs
practicing in the United States (100,791) received their basic nursing education outside the
United States.16
Thus, there is a higher percentage of White nurses than in the dominant culture today
and their demographic characteristics are markedly different from those of the general
patient population. The implications are that patients may embrace a value complex that,
although differing from the general culture, may differ even more markedly from that
of their nurses. The assumption here is that a significant aspect of that difference will
reside in religious-ethical and cultural differences, again making an understanding of
religions of great importance. Although these statistical examples are from the USA and
Los Angeles County, other nations experience similar immigration patterns that affect
the cultural, racial and religious balance, which can create disparities between the
demographics of nurses and the patients to whom they render care.17–20
These are but two practical reasons for nursing to engage in the academic study of
religion. A broader practical reason is as noted above that there has been a resurgence
in religion world-wide. Thomas writes:
… the global resurgence of religion … is a far more wide ranging phenomenon than religious
terrorism, extremism, or fundamentalism. The world resurgence of religion taking place
in the developed world … is part of a larger crisis of modernity in the West. It reflects a
deeper and more widespread disillusionment with a modernity that reduces the world to
what can be perceived and controlled through reason, science, and technology, and leaves
out the sacred, religion, or spirituality (p. 11).14
With the escalation of technomedicine in clinical practice, combined with a worldwide nurse shortage and pressures of cost containment, for overworked clinicians it is
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easy to ‘… [leave] out the sacred, religion, or spirituality’ (p. 11)14 in clinical practice. The
price of this is paid by both nurses and patients. More globally, the ills of the world,
including human use of the planet, will not be cured by a technofix, and the strife in
the world that continues to lead to war and death cannot be understood without
attention to both toxic religion (for the ill that it causes) or to irenic religion (for the
good that it does).
There are other, deeper reasons to take account of religion, as I will try to demonstrate.
Since Christianity claims the greatest number of adherents world-wide as well as in
the USA,21,22 it is important to demonstrate the significance of religiously-based ethics
using a non-Christian example.
An example from Native American religion and ethics
A discussion of any tradition raises theoretical issues that are sensitive in nature, such
as the issue of ‘representation’. No one person speaks for the whole of a tradition, and
no non-member of a tradition truly represents that tradition. Thus, whenever possible,
voices from those groups must be used to represent themselves, directly or indirectly,
as in the quotes that follow.
In the early to mid-1990s an American television station aired a program called
‘Northern exposure’, set in a fictional Alaskan town (episodes can still be seen in rerun and online). Marilyn Whirlwind, a Tlingit Indian was one of the show’s major
characters. She was played by actor Elaine Miles, of Cayuse/Nez Perce Native descent,
although raised as a member of the Umatilla Tribe. Whirlwind was often noticeably
silent when others would speak, but when she spoke her comments were observant,
incisive, pithy and sage, for example: ‘He moves nice. It’s his stillness that’s not right.’
By contrast, various reviews described her as blunt, taciturn, unsettling and cynical.
Miles herself is an accomplished Native dancer with a number of dance awards to her
credit. In an interview, she also acknowledged that she has a skill-set common to Native
Americans who embrace their tradition:
I know my Native American heritage. I can speak and understand my language, the
Cayuse and the Nez Perce. I know how to bead. I can weave. I know how to process our
foods … we go root digging, and we will b…
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