Readers have much to consider when evaluating Greenblum and Hubbard’s conclusion that ‘physicians have no business doing theology’.1 The two central arguments the authors offer are fairly convincing within the confines they set for themselves, the provisos they stipulate and their notions of ‘privacy’ and ‘public reason’. However, I would ask readers to consider two questions, the answers to which I believe the authors leave opaque. First, what is theological negotiation? Second, what makes chaplains the singular group of healthcare professionals (...) responsible for theological negotiation? In this Commentary, I explore these questions not with the goal of rejecting the authors’ conclusion, but rather with the goal of highlighting relevant considerations when evaluating the authors’ central tenets. First, I would like readers to consider Greenblum and Hubbard’s descriptions of theological negotiation. They categorise theological negotiation into metaphysical, normative and alternative responses, and hold that this kind of negotiation is, for the most part, impermissible for healthcare professionals, save chaplains.1 The examples of Dr Chatterjee and Dr Thompson expand theological negotiation to include instances where physicians add a theological veneer to their clinical recommendations. In both the examples, the physician has made the case for accepting or rejecting a certain intervention—for Dr Chatterjee, accepting …. (shrink)

Jake Greenblum and Ryan K Hubbard argue that physicians, nurses, clinical ethicists and ethics committee members should not cite religious considerations when helping patients (or their proxies) make medical decisions. They provide two arguments for this position: The Public Reason Argument and the Fiduciary Argument. In this essay, I show that the Public Reason Argument fails. Greenblum and Hubbard may provide good reason to think that physicians should not invoke their own religious commitments as reasons for a particular medical decision. (...) But they fail to show that it is wrong for physicians to cite the patient’s own religious commitments as reasons for a particular decision. As such, if Greenblum and Hubbard’s thesis is to survive, the Fiduciary Argument (or some unmentioned argument) will have to do the bulk of the work. (shrink)

Religious considerations in medical decision-making have enjoyed newfound attention in recent years, challenging the assumption that the domains of biological and spiritual flourishing can be cleanly separated in clinical practice. A surprising majority of patients desire their physicians to engage their religious and spiritual concerns, yet most never receive such attention, particularly in cases near the end of life where such attention seems most warranted.1–3 As physicians Aparna Sajja and Christina Puchalski recently wrote in the AMA Journal of Ethics theme (...) issue on ‘Religion and Spirituality in Healthcare Practice’, modern medical training is ‘falling short of preparing physicians to help patients with the metaphysical needs of their illness’.4 It would seem then that both patients and physicians might challenge the conclusions proffered by philosophers Jake Greenblum and Ryan Hubbard in ‘Responding to Religious Patients: Why Physicians Have No Business Doing Theology’, in which they claim that physicians ought not to engage religious reasoning for medical decisions. Their conclusion relies on two core arguments: a ‘public reason’ argument and a ‘fiduciary argument’, both of which contend that theology and religious considerations have no place in medical reasoning. We find that two central errors undergird these arguments. First is the fraught notion of an epistemically and ethically normative public reason, and second is a fundamental mischaracterisation of the fiduciary nature of the patient–physician relationship and the nature of medicine itself. In response, we argue that all physicians essentially ‘do theology’ and that, rather than divorcing theology from medical practice, clinicians should make it their business to do theology well. To support the exclusion of religious reasoning from medical decision-making, the authors open with a ‘public reason argument’, suggesting that physicians serve in roles closely resembling those of public officials. As such, the physician as public official ought to limit himself …. (shrink)

A survey of the recent literature suggests that physicians should engage religious patients on religious grounds when the patient cites religious considerations for a medical decision. We offer two arguments that physicians ought to avoid engaging patients in this manner. The first is the Public Reason Argument. We explain why physicians are relevantly akin to public officials. This suggests that it is not the physician’s proper role to engage in religious deliberation. This is because the public character of a physician’s (...) role binds him/her to public reason, which precludes the use of religious considerations. The second argument is the Fiduciary Argument. We show that the patient-physician relationship is a fiduciary relationship, which suggests that the patient has the clinical expectation that physicians limit themselves to medical considerations. Since engaging in religious deliberations lies outside this set of considerations, such engagement undermines trust and therefore damages the patient-physician relationship. (shrink)

Greenblum and Hubbard argue that physicians are duty-bound by the constraints of Rawlsian ‘public reason’ to avoid engaging their patients’ religious considerations in medical decision-making.1 This position offers a number of appealing benefits to physicians. It will appear plausible because Rawls’s philosophical tradition of Political Liberalism enjoys the status of ideological orthodoxy in institutions tasked with forming the moral imaginations of physicians and other elites.2 3 It casts the physician in the role of a ‘reasonable person’ occupying the space of (...) public reason whose medical and ethical judgments are opposed by ‘sectarian’ religious patients who refuse to be reasonable. This narrative authorises the exclusion of patient religious considerations from medical decision making when they do not ‘translate’ into reasons recognised by ‘reasonable’ medical professionals and manages the trauma of overwhelmed physicians by legitimising disengagement from difficult interactions with religious patients. The authors’ arguments depend on concepts from Rawls’s Political Liberalism 4 and are presented as if the premises of Liberal theory are incontestable—despite the fact that a large body of philosophical literature challenging its premises and core concepts has existed for decades.3 5–7 This ‘nothing to see here, move along’ approach saves more space for anecdotes about religious people, at which …. (shrink)