Religious red herrings
- Correspondence to Dr Mark Sheehan, Oxford BRC Ethics Fellow, The Ethox Centre, Department of Public Health, University of Oxford, Old Road Campus, Rosemary Rue Building, Headington, Oxford OX3 7LG, UK;
- Accepted 19 March 2012
- Published Online First 13 August 2012
Brierley et al take big polarised political debates deep into the context of paediatric intensive care. They are concerned that ‘deeply held belief in religion leads to children being potentially subjected to burdensome care’. However, it can be argued that they make a mistake in categorising this as a problem derived from religion, religious belief or the depth of religious conviction. Religion here is a red herring.
- virtue theory and bioethics
- resource allocation/priority setting
- artificial reproduction
We live in a time that echoes with the shrill political voices of the religious right and the militant atheist where, ironically, the religious right demand individual freedoms but seek to impose their moral conception of the world on others and where, just as ironically, the usually left leaning liberal atheist endeavours, through a kind of ridicule, to squash world views different from their own.
Medicine has never quite been comfortably placed with respect to this schism. It aspires to the strict religion of science and its correspondingly impoverished view of rationality, but it deals with people and their values, neither of which ever quite fit the model. The lessons of medical paternalism are now written deep in the physician's codes of conduct lest they forget that the patient's values are pre-eminent. Of course, all of these generalities ride roughshod over the genuine ethical complexities that arise in the clinical context.
Brierley et al take these big polarised political debates deep into the context of paediatric intensive care. They suggest that religion is becoming an increasing problem and that the default position should be that ‘parental religion is not a determining factor in decision-making for the child’. They are concerned that ‘deeply held belief in religion leads to children being potentially subjected to burdensome care’.
In what follows I will argue that they make a mistake in categorising this as a problem derived from religion, religious belief or the depth of religious conviction. Religion here is a red herring. I do agree that society—perhaps in the form of legal precedent—does need to be clearer about the limits of parental choice in these difficult cases, but the specification of these limits will not include reference to religious belief.
Of course the importance of the authors' mistake is clear: it is this misclassification of the problem that sets up the nature of the conflict as being medicine versus religion and, in doing so, returns us to the debates between the religious right and the militant atheists. Making the practice of medicine part of this debate—or even allied to it—seems, at the very least, unproductive.
The central claim in the paper about the involvement of religion comes from the discovery that the difficult and, indeed, unresolved paediatric intensive care cases all involved an insistence by the parents that, on religious grounds, there would be a miraculous cure for their child. Of the five unresolved cases, ‘Christian fundamentalist churches with African evangelical origins featured most frequently’. These are the paradigm examples of ‘religious stonewalling’.
However, as the authors point out, part of the problem may be the way in which the parents of these children relate to their religion and the kinds of things that influence this relationship: social economic status, education, culture. They wonder whether ‘the need to have a belief in a religious structure is such a part of the fabric of certain cultures, where creed and culture are so intertwined that to separate out religious from cultural acceptance of death and understanding of futility, is not possible’. They also point to the ‘unorthodox interpretations of religious teaching’ involved in a number of cases.
Unfortunately, the consequences of these two observations are missed. Both undermine in different ways the involvement of religion as the proper locus of the claims made by these parents. First, it is quite clear even from the very brief descriptions of the parents that there are other things going on in these cases. Given the cultural and political histories of Islam and Africa in the last 100 years, how is it surprising that the parents who would not come around did not trust the combination of Western medicine, Western religious representatives and the secular view of doctors?
The second observation points to an equally important related point about interpretation. The attitudes of a university educated Roman Catholic in middle-class England to the use of contraception is likely to be vastly different from that of an uneducated poor Roman Catholic in rural Nigeria—and this is in spite of the fairly clear Church doctrine on the issue. Religion from the inside is about interpretation. It is no surprise, as the authors note, that people interpret the teachings of their religion in strange and (more or less) different ways.
But surely, the authors might respond, the parents explicitly refer to religion and their religious beliefs in the justification of their claims, and so it is the religious element of the reason that needs to be tackled. However, this response misses the role of the explanations suggested above. It is perfectly consistent with the account above for the parents themselves to interpret this as a challenge to their religious views—if it were possible for this problem (or any other practical moral problem for that matter) to be conceived as other than a religious one, then their religious views would be different. The argument for a proper interpretation of this problem does not preclude the parents being mistaken about how the problem should be understood.
Clinicians do need help and, in many cases, society's support in resolving these conflicts, but this support should not involve reference to religion. As suggested by the complex nest of broad social influences mentioned in the paper and the corresponding variability of interpretation of religious teaching, these issues are better interpreted in other ways. The focus should remain on the well-articulated ethical reasons that apply to all, not on whether the parents claim a specific kind of religious reason. What matters is that, like the blood transfusion case, society has judged that there are no reasons (religious or otherwise) that warrant failing to transfuse children. Polarising claims about religion are unproductive.
Competing interests None.
Provenance and peer review Commissioned; internally peer reviewed.