Balancing Science and Religion

Superstition, religion, and medicine have made their long journey together, and even now are unable to let go of one another's hands. Religion is the reluctant fellow traveler of superstition, and science attempts to disown them both - in vain. The links joining the three are indissoluble. They will never be destroyed.

- Sherwin Nuland, MD (The Mysteries Within)

His mother's handwriting was strong. The envelope contained the obituary that I knew would be coming, and in those words I remembered the young man's struggle with cancer, his talents, and his potential. Over the time I had known him, I had heard about his studies, his dedication to his sports and his love of family. Then I read something that I had not known about him.

"He had wanted to be a pastor."

I was startled. Here was a huge part of his existence into which I had never penetrated; I had no clue that his faith was an important part of his life. He had clearly put his calling on hold as he completed surgery, chemotherapy and radiation.

When the cancer persisted and then had begun growing despite all efforts to control it, he must have realized that he would never enter the seminary and become a parish pastor. I can't help but think that this realization would have affected him profoundly but, throughout the time I had known him, this facet of his life had never surfaced.

A recent study confirms that we rarely address these issues. Almost 90% of patients with advanced cancer consider religion to be either "somewhat important" or "very important."

Despite this, the patients report receiving adequate spiritual support only half the time from their own religious communities and only one-quarter of the time from their medical systems. When they do get adequate support, though, they report significantly better overall quality of life. Not surprisingly, attendance at religious services drops after a cancer diagnosis, but personal religious practices increase. (Balboni TA, "Religiousness and spiritual support among advanced cancer patients and associations with end-of-life treatment preferences and quality of life," Journal of Clinical Oncology, 2007; 25:555-560.)

Physicians are not trained to assess spiritual and religious needs. One assessment tool (see GWish) uses the acronym "FICA" for Faith, Importance, Community and Address in Care. For example: "Do you consider yourself to be spiritual or religious?" "Have your beliefs influenced your life and how you handle stress?" "Are you part of a supportive religious community?" "How should we address these issues in your health care?" Most physicians avoid the topic, feeling, no doubt, that they would soon be in deep water sorting through issues they potentially know little about.

Perhaps my patient would never have wanted to address these issues with me. I know that his care was complicated enough as it was. Still, was he angry or confused when his cancer refused to be controlled? Did he view the cancer from a biological vantage point similar to my own? Or did he try to deal with his cancer from a strictly spiritual vantage point? Was he constantly trying to discern the will of God? Did he agonize that his prayers were insufficient? All of the above? How might addressing these topics openly have helped him and his family?

Bruce H. Campbell, MD, FACS
Professor of Otolaryngology and Communication Sciences
Chief, Division of Head and Neck Oncology
Interim Director, The Medical College of Wisconsin Cancer Center

"Reflections" is a collection of essays by the health professionals of the Medical College of Wisconsin.