For many of us, honoring our patients' belief systems and values, even when they are different from our own, is an accepted and important aspect of our practice. A recent discussion thread on TheONC raised the interesting question of just what acceptance and support might mean in a situation where belief systems between patient and professional are not only different, but where a patient is actively proselytizing.
Do we have an obligation to support a patient in her mission (whatever that mission might be)? What if the act of recruiting others to her belief system was the most meaningful thing she felt she could do, as is often the case with proselytizing members of any organized religion? Does some form of participation in her mission constitute support, or is it beyond the bounds of what we as professionals should expect of ourselves in our interactions with our patients?
I worked with a nurse, we'll call her Shannon, who became the mission of one long-term patient. Shannon was raised Christian, but hadn't been to church in years and wasn't sure what she believed. Still, she was very supportive of her patient, Jim, and open to his requests for a moment of prayer before medical interventions.
During the course of one particularly long hospitalization, Jim made it a point to try to re-convert her.
He had a poor prognosis; conventional chemotherapy had failed and he had a serious fungal infection in one lung. He was aware of the fact that, as he put it, "I might not make it out of the hospital alive."
He was an Evangelical Christian and worked hard to help everyone on the team "find Christ, the one true Lord." Most of the team rejected his overtures, and some were even hostile, so Shannon eventually became the full focus of his attention. He believed that his illness and extended hospitalization were tests of his faith and grounds for a sacred mission.
Shannon often prayed with him when he asked, thanked him politely when he recommended that she study certain passages of scripture, and quickly finished a task and moved on to another patient when he began speaking to her more directly about her personal faith. Her supervisor offered to transfer him from her caseload, but she continued working with him, explaining: "I don't mind. I know where he's coming from."
Jim needed something meaningful to do and his mission to re-convert Shannon satisfied that need. There were others on the service who dealt with him by simply refusing to acknowledge any religious statements he made, essentially ignoring most of his commentary. They struggled with the choice to not engage in something that was clearly a meaningful part of his life, yet such an intrusion on their own.
Who was doing the right thing: Shannon or her colleagues? In the end, the answer to a question like this is a deeply personal one. For some, sitting and reading a prayer or a bit of scripture, regardless of a patient's ulterior motive, would be a welcome moment of peace in the day. It might seem innocuous enough for some, border on uncomfortable for others, and for yet a third group, the act might feel offensive.
Ultimately, we must each make our own choice about how to respond to the religious aspects of our patients' communications, particularly when they speak to us directly about our faith and what they believe we should believe. Ideally, we'll maintain a sense of our own spiritual integrity even as we support the underlying feelings and motivations of a proselytizing patient: The need to feel purposeful and to imbue their life with meaning.