In a recent interview in the Psychiatric Times (Podcast here: http://www.psychiatrictimes.com/display/article/10168/1483619?verify=0) psychiatrist and ethicist Dr. Cynthia Geppert discusses the interesting issue of whether or not it is ethically acceptable for psychiatrists to pray with their patients. Geppert’s discussion is prompted by the case of a patient who had recently been diagnosed with breast cancer and who asked her psychiatrist to join her in prayer. It seems that many patients, particularly at times of crisis, ask their psychiatrists to join them in prayer. Furthermore, it seems that the majority of patients would like their physicians to be willing to pray with them, at least on some occasions.
Geppert suggests that there a number of conditions which should be met before it can be ethically appropriate for a psychiatrist to join a patient in prayer. Most of these conditions seem unremarkable and hard to disagree with. It is suggested that the psychiatrist should only join the patient in prayer if the patient requests this; which seems right. Vulnerable psychiatric patients should not have to be exposed to proselytizing from their psychiatrists. A second suggestion, which is hard to argue with, is that if the psychiatrist is to join the patient in prayer then they should make sure that they know enough about their patient’s religious beliefs and background as to ensure that they do not say or do something insensitive or disrespectful.
However, two of Geppert’s conditions seem rather odd. The first is that a psychiatrist should only agree to pray with the patient if they are praying about a ‘…serious, some would say, a life threatening matter …’. It seems that it is ethically acceptable to join the patient in a prayer about cancer, but not about low level depression or about the difficulty of relating to a family member. The invocation of this distinction is most mysterious. What is the point of participation in prayer? Either, to create a sense of comfort and well being in the patient, or to request divine intervention (or both). If it is the former then, given that prayers are free and generally not very time consuming, and given that the psychiatrist is in the business of helping people cope with many issues that are not life threatening, it seems that the psychiatrist would be ethically justified in joining the patient in prayer whenever prayer succeeds in creating a sense of comfort and well being in the patient, regardless of how serious or life threatening the issue at hand is. If the later, then surely the issue that needs to be considered is whether God will intervene or not. Is there some reason for thinking that God will only intervene when matters are serious and/or life threatening? There may be reasons for this assumption that are particular to some religious traditions, but Geppert is offering advice that is supposed to be applicable to all patients regardless of their religion, so it is very hard to see how she could be justified in restricting participation in prayer in this way.
Although Geppert thinks it is sometimes ethically appropriate for psychiatrists to pray with their patients, she also thinks that is ethically inappropriate (and ‘theologically problematic’) for them to pray for ‘direct healing’. So, her second odd condition is that psychiatrists should only pray for ‘strength’, ‘hope’ or ‘peace of mind’. Consider again the distinction which we made between the two possible purposes of participation in prayer. If the point of participation is simply to provide comfort and well being, and it turns out that praying for a cure to a medical problem will provide more comfort and well being than praying for a strength, hope or peace of mind, then it seems that the psychiatrist ought to go along with a prayer for a cure and it would seem mean spirited to only offer up a less useful prayer. On the other hand, if the point of prayer is to request divine intervention then it is hard to see why one should only request indirect intervention. How could it be ethically legitimate to ask God to intervene and make one’s patient strong enough to cope with cancer if it is ethically illegitimate to ask God to intervene and cure one’s patient of cancer? I suspect that some implicit theological presuppositions lurk behind Geppert’s reasoning. Either she is presuming that God does not actually exist, or that God does exist but does not answer prayers, or that God only answers prayers indirectly. These are theological assumptions that are not easy to justify and many psychiatric patients will not share them. They do not belong in a general account of the ethics of psychiatry.