We recently argued that—contrary to what we call the dominant view— physicians ought to avoid engaging patients on religious grounds.1 The six responses to our article present an array of concerns and have provided us with the opportunity to consider further aspects of our view. While we cannot reply to all the relevant issues, our aim here is to reply to the most significant concerns. Against our Public Reason Argument, Nick Colgrove maintains that physicians are not relevantly akin to public (...) officials and should therefore not be constrained by public reasons. Colgrove does not take issue with the idea that it may be reasonable for public officials to justify their policymaking according to public reasons because their policies affect a diverse population. But since ‘the [medical] decision being made is not binding for other patients,’ physicians need not be constrained by public reasons.2 Colgrove’s criticism hinges on the claim that deliberation ought to be constrained by public reason only if the outcome of such deliberation is a policy or a rule that a diverse group of people must follow (ie, to which they are bound). We disagree with this claim. We do not believe, nor did we argue, that this is a necessary condition for when we are morally required to cite public reasons. Instead we believe that three facts together provide sufficient reason for why physicians should generally be constrained by public reasons: physicians are directly and indirectly paid by the state via Medicare and Medicaid; physicians allocate public resources; and physicians are regulated by the state. Colgrove takes particular issue with our ‘Dr Chatterjee case’, which is meant to illustrate why citing religious reasons is inappropriate. And our explanation for why we find this case jarring …. (shrink)

Every clinical ethics consultant, no matter their own spirituality, will meet patients, families, and healthcare professionals whose spiritualities anchor their moral worldviews. How might ethicists respond to those who rely on spirituality when making medical decisions? And further, should ethicists incorporate their own spiritual commitments into their clinical analyses and recommendations? These questions prompt reflection on foundational issues in the philosophy of medicine, political and moral theory, and methods of proper clinical ethics consultation. Rather than attempting to offer definitive answers (...) to these questions, this essay prompts readers to consider their own answers to these questions. Specifically, it offers a taxonomic analysis of six (6) distinct responses: assessment, delegation, examination, translation, incorporation, and assertion. Furthermore, this essay describes the role of the ethicist’s own spiritual commitments during the responses. Each section also names several strengths and weaknesses that ethicists ought to consider when evaluating the purpose and scope of each response. This paper prompts readers to consider circumstances under which they might promote, critique, or incorporate spiritual worldviews—their own and those of their patients—when offering clinical analyses and recommendations. (shrink)