CAMLAW: Complementary and Alternative Medicine Law Blog

Healing at the Borderland of Medicine and Religion - Review

"Spirituality is a part of being human, the questions that occur to people at different times and how we answer them ourselves, or who we turn to supply us with those answers are part of who we are as people."

The following appeared in the Journal of the National Medical Association:

Healing at the Borderland of Medicine and Religion-Book Review

We need more thoughtful and thorough evaluations of other worldviews of health and illness. Medical students and practicing physicians need to know how our patients view themselves and their illnesses so we can care for them and fit the treatment to the patients' mindset. It goes along with starting from where the patient is and not where you think they should be.

Healing at the Borderland of Medicine and Religion by Michael H. Cohen is a needed addition to this field of knowledge. While it focuses broadly on a number of alternative medical disciplines, and not solely religion, it deals with healing outside of the biomedical model.

The goal of alternative healthcare providers, like conventional medical providers, is to heal the patient, and to bring them to optimal levels of health. The system used should not be based on negotiation or compromise; but as a matter of ideology. The physician's primary responsibility is and has to remain the patient. Finding ways to focus on the patient without getting lost in arguments between ideologies can be difficult. This book helps focuses on areas where problems can lead to better solutions for patients and providers.

Spirituality is a part of being human, the questions that occur to people at different times and how we answer them ourselves, or who we turn to supply us with those answers are part of who we are as people.

The battle between different explanatory models of health and illness is constant. Personal interest, financial incentives, identity and other issues all play a part in determining which model a person will look to for health. With the acceptance of multiple philosophies concerning health, and the emergence of a larger and larger complementary component, physicians have struggled to find a comfortable place to interact with spiritual advisors/providers who have a different way of looking at health and medical interventions.

That is what makes the need for a text on this topic important.

The Joint Commission for Accreditation of Healthcare Organizations (JCAHO) requires a spiritual assessment for every patient admitted into a hospital to include at the very least "the patient's denomination, beliefs, and what spiritual practices are important to the patient."

Spirituality is being taught in over 100 of the approximately 150 osteopathic and allopathic medical schools in the United States. Courses focus on spirituality as a factor that contributes to health, not as a system of treatment.

Patient interest in spirituality is heightened during the time of an illness, and the patient may request intervention by a spiritual advisor instead of or in addition to standard biomedical care of an illness.

Where do other providers, particularly spiritual healthcare providers fit into the medical system and what is the role of religion? Michael H. Cohen is a well-respected and thoughtful lawyer who has written about alternative healthcare systems and how they fit in our society. His previous book entitled Complementary & Alternative Medicine Legal Boundaries and Regulatory Perspectives should be required reading for any healthcare provider practicing outside of mainstream biomedical medicine. So, I was curious as to his thoughts on the role of religion in healthcare.

Michael Cohen's new book Healing at the Borderland of Medicine and Religion argues that the patient should decide where providers should fit into the system and patients will judge the results as well. This collection of articles previously published in places like the Vermont Law Review, the Journal of Law and Religion and medical journals like Epilepsy and Behavior looks broadly at Alternative Therapies as a whole and argues for inclusion in the biomedical system.

While we need to strain to refer to the system of healthcare that we have as a system, there is a clear choice architecture that exists within the system and a default mode that sends all patients through a biomedical model of care. Mr. Cohen argues that we need not have one default system, and that people might be better served with multiple defaults or shared responsibility for patients by many different systems.

But it is tough to argue that physicians trained in a biomedical model with science as a guiding principle should be required to have other guiding principles as well. And even as we talk about the standard medical model being bio-psycho-social, most people involved in conventional medical care interpret it more as a bio-bio-bio model.

One question that we need to address in the biomedical model is whether or not the public interest is more than what interests the public. Should performance be compared to the promises made prior to therapy or intervention? The legal aspects of care are well reviewed in this book and healthcare is looked at from directions where we don't focus on that much.

With more good questions than answers there needs to be some way to address the issues in a thoughtful and organized manner. Michael Cohen's book starts to provide a framework and gives us possible explanations and places for religion and alternative medicine in the current system of care. This book is a good place to look to start the discussion.

Tyler Cymet, DO
Associate Vice President for Medical Education
American Association of Colleges of Osteopathic Medicine

Assistant Professor of Internal Medicine
Johns Hopkins University School of Medicine

Thank you Dr Cymet. You ask good questions and frame my work in a way that leads me deeper into inquiry. I appreciate your thoughtful contribution.

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