Religion, Disease, and Autonomy: A Test of Faith

Illness tests us in every sense. It impairs our ability to live normally and may threaten our very life. The connection between disease and death links health to big existential questions and can cast sickness not just as a challenge to our immune systems, but also as a test of faith. While the impact of disease is stark, what should be done in response often remains unclear. This is not just because there are multiple medical opinions about every ailment, the confusion also reflects the complexity of our beliefs about disease. Religion and spirituality shape our ideas about ourselves, the nature of reality, and the hereafter, and can play a major role in our understanding of both illness and its treatment.

Refusal of treatment

Spiritual interpretations of disease and healthcare run the gamut from acquiescence to medical authority to rejection of it. The latter taken to the extreme results in refusal of care, or the rejection of medical intervention. Christian Scientists are the most famous example of this worldview. Because they believe that what we experience as material reality is actually an expression of a spiritual existence, they view illness as a spiritual sickness, not as a biological problem. From this perspective, medical intervention is not merely ineffective (how can a corporeal act address a spiritual need?), but potentially detrimental. Reliance on worldly treatments may interfere with efforts at spiritual healing, ensuring failure1. In this context, medical care is problematic because it signals a loss of faith. If you turn to a doctor for help, you are turning away from God.

Even in less philosophically extreme faiths, medical intervention can be interpreted as an offense to the divine. Jehovah’s Witnesses are an excellent example. Members of this tradition are devout students of the Bible, and view adherence to its tenets, including an admonition to ‘keep from blood’, as a covenant with God. Consequently, although they will accept other medical treatment, Jehovah’s Witness’ refuse blood transfusions4. Interestingly, this religious conservatism has spurred medical innovation. Jehovah’s Witness’ rejection of transfusions was a major driver for the development of blood-saving treatment methods2.

“Inappropriate” interventions

Refusing treatment is not the only way patients uphold faith in the face of disease; many spiritual traditions imbue illness with symbolic meaning, and have specific practices that address it. This is particularly true of terminal illnesses, because of the necessity for spiritual preparation for the afterlife. These practices or beliefs sometimes require what are called inappropriate interventions, medical care beyond what would normally be performed. Physicians may be asked to prolong life support in anticipation of conversion or in adherence to the religious principle of protecting life3. Spiritual healing may also be offered to supplement medical care. In contrast to refusing care, these situations see the efforts of medicine and raise it zeal.

autonomy
Ante up.

The importance of autonomy

Despite their apparent opposition, refusal of care and inappropriate intervention both hinge on the same legal basis in American society: autonomy5. The principle of autonomy protects the right of an individual to self-determination and is the backbone of patients’ rights. Ideally, autonomy operates so that a fully informed, competent person can make their own choices about medical treatments, and guards against medical paternalism, where the advice of the doctor is unquestioningly followed.

Unfortunately, this ideal, like so many others, is much easier to strive for than achieve. There are endless complications around the evaluation of competence (how do you determine if someone is in their right mind?), and understanding (how can you tell if someone truly understands something?). Things become even more fraught in debates about the rights of children. Ordinarily parents would determine the course of treatment for their children, but when their wishes deviate from what is medically advised, the government may intervene.

The issue of autonomy in healthcare highlights one of the most devastating aspects of disease: it erodes our confidence. It causes us to question ourselves and can make everyday tasks daunting. To add insult to injury, we are often asked to make huge, life-altering decisions when we feel most vulnerable. It is unsurprising that people fall back on their core values in these moments, as they seem to be the only things left that can be relied on. Perhaps this is also why illness is often seen as a reckoning, a turning point, or a time of clarity, presenting a contradictory aspect of illness: you can gain strength from sickness. While disease is indeed a trial by fire, it can teach us to have greater faith, both in what we believe, and in ourselves.

References

1. May, L. (1995). Challenging medical authority: The refusal of treatment by Christian Scientists. The Hasting Center Report, 25(1): 15-21.

2. Niebrój, LT. (2006). The influence of religious beliefs on health care: Between medical futility and refusal of treatment. Journal of Physiology and Pharmacology, 57: 241-249.

3. Orr, RD, & LB Genesen. (1997). Requests for “inappropriate” treatment based on religious beliefs. Journal of Medical Ethics, 23: 142-147.

4. Ridley, DT. (1999). Jehovah’s Witness’ refusal of blood: Obedience to scripture and religious conscious. Journal of Medical Ethics, 25(6): 469-472.

5. Wreen, MJ. (1991). Autonomy, religious views, and refusal of life-saving medical treatment. Journal of Medical Ethics, 17(3):124-130.

Image credit: By Pascal Terjan from London, United Kingdom (IMG_0337 Uploaded by Edelseider) [CC BY-SA 2.0 (http://creativecommons.org/licenses/by-sa/2.0)], via Wikimedia Commons

Epilepsy: The Sacred Disease

Aliases: epilepsy, falling sickness, St. Valentine’s disease, sacred or divine disease

A malady referred to as the ‘divine disease’ was an obvious choice for December’s theme of religion. The connection between epilepsy and spirituality has existed throughout recorded history. While some cultures have revered the illness as an indication of prophetic powers, most have viewed it as an affliction caused by demonic forces, heaping social stigma on top of a challenging medical condition.

Although Hippocrates, the father of medicine, denied any spiritual cause and hypothesized that epilepsy resulted from a dysfunction in the brain, it took about 2000 years for that idea to gain acceptance4. The earliest descriptions of the disease, dating from 2000 BCE, attributed it to a curse of the moon goddess3.  The pallor of otherness proved hard to cast off. In the Middle Ages epilepsy was considered characteristic of witchcraft, and epileptics continued to suffer social and legal persecution well into the 20th century in America4. A spiritual understanding of the disease led to spiritual treatments, including exorcisms and appeals to the illness’ patron saint, Saint Valentine.

epilepsy
Love and seizures: makes sense.

Because of the spiritual connotations of the disease, a diagnosis of epilepsy may be used to reinforce the mystical status of religious figures. In fact central figures of many major faith traditions, including the Buddha, Mohammed, and St. Paul, have been identified as possible epileptics4. The afflicted may also perceive the illness as a religious experience; there have been cases of epilepsy-related conversion experiences1 (this is not meant to discredit these experiences, only to say they occurred during a seizure).

Cause: Epilepsy is a neurological condition (an ailment that affects the central nervous system) that results in disordered nerve cell activity in the brain. The underlying causes of this illness are diverse, and include genetic predisposition (though this is not easily identified; greater than 500 genes are estimated to be related to the disease), head injury, and infectious diseases that cause inflammation in the brain or spinal cord, such as meningitis2.

Consequence: The abnormal brain activity may affect one region (focal) or the whole brain (generalized) and results in seizures. Although generally thought of in their most extreme form, seizures can be quite subtle. They vary in presentation from a blank stare and confusion to losing consciousness and jerking limbs. The disease most commonly emerges during early childhood or after age 602.

Cure: Epilepsy is generally treated with the suite of drugs aptly named anti-epileptics. These are anti-seizure medications that decrease the frequency and intensity of seizures. After a few years of treatment, many patients are able to discontinue their medication and remain seizure-free. In fact, half of people newly diagnosed with epilepsy will become seizure-free after treatment with their first medication. Focal epilepsy (where the disease is localized in the brain) is sometimes treated with surgery where the affected region of the brain is removed2.

References

1. Devinsky, O & G Lai. (2008). Spirituality and religion in epilepsy. Epilepsy &Behavior, 12:636-643.

2. Epilepsy. Mayo Clinic, 31 May 2013. Web. 1 December 2013. http://www.mayoclinic.com/health/epilepsy/DS00342

3. Magiorkinis, E, K Sidiropoulou, & A Diamantis. (2010). Hallmarks in the history of epilepsy: Epilepsy in antiquity. Epilepsy & Behavior, 17:103-108.

4. Masia, SL & O Devinsky. (2000) Epilepsy and behavior: A brief history. Epilepsy & Behavior, 1:27-36.

Image credit: Attribution: cafecesura, via Creative Commons