Awareness and communication can benefit patients, hospitalists, and medical staff as a whole. For example, Alta Bates Summit’s intensive care unit staff in Berkely, Calif., turned to Chaplaincy Services about Muslim patients’ requests to continue their daily prayers, which include thorough washing of their hands, forearms, and other parts of their bodies (even when intravenous lines are attached). Chaplaincy Services reached out to an Islamic network group for advice and learned patients could rub a stone across their bodies to wash themselves. Chaplaincy Services now makes these stones available for staff and patients, Clark says.
Medical staff also works with Chaplaincy Services to accommodate Muslim patients’ wishes to face in the direction of Mecca during prayer, which can require maneuvering beds and other equipment, he says.
Some patients and their families may not understand how their religious tradition addresses code status, resuscitation, and when it is appropriate to withhold treatment, says Richard Rohr, MD, vice president of medical affairs at Cortland Regional Medical Center in Cortland, N.Y. While working as a hospitalist, Dr. Rohr suggested moving a terminal patient to palliative care and seeking a do not resuscitate (DNR) order. The patient’s family refused, and told Dr. Rohr they were Catholic and a DNR would violate their religious beliefs.
According to Dr. Rohr, DNR status and palliative care are described in the code of ethics adopted by the Catholic Health Association, and this type of care is generally provided at Catholic hospitals.
“I gently told them that this was within their religion, but they said no to palliative care and the DNR,” Dr. Rohr says. “The patient eventually died but it was much more difficult for them. They were subjected to active treatment that they couldn’t really benefit from.”
Families often seek the advice of spiritual advisors when making difficult decisions about code status and DNR orders. Barbara Egan, MD, a hospitalist at Memorial Sloan-Kettering Cancer Center in New York City, recalls treating an Orthodox Jewish patient who was suffering from end-stage disease. Death was imminent, and hospitalists recommended palliative care. The patient’s family members balked at the recommendation and insisted hospitalists “do everything possible” to treat their loved one. Soon after, the family’s rabbi arrived to counsel the family. After visiting the patient and speaking to medical staff about the prognosis, the rabbi urged the family not to pursue further treatment or artificial resuscitation. The patient was moved to a palliative care unit and passed away within a few days.
“The family’s rabbi told them exactly what I had: that there were no useful medical interventions for the patient,” Dr. Egan says. “But they really needed to hear it from him before they could come to an agreement on a DNR.”
Physicians’ reactions to religion at the bedside have evolved the past 25 years, says Kenneth Patrick, MD, ICU director at Chestnut Hill Hospital in Philadelphia. Physicians were more paternalistic then, and believed they knew what was best for their patients—and their families—regardless of their patient’s religious beliefs.
While serving as a fellow at Memorial Sloan-Kettering Cancer Center, Dr. Patrick worked with a terminally ill Buddhist patient in the intensive care unit. When death was imminent, the ICU director allowed Buddhist monks to light candles and pray in the room during the hours leading up to the patient’s death. At the time, this was not something that was normally done in a hospital, Dr. Patrick says. While the ritual may have kept medical staff from checking vital signs as often as they would have normally, he says this did not affect the patient’s treatment.