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Israeli doctors are told what to do when medicine and religion clash

BMJ 2006; 333 doi: (Published 29 June 2006) Cite this as: BMJ 2006;333:14
  1. Judy Siegel-Itzkovich
  1. Jerusalem

    The ethics bureau of the Israel Medical Association has released a position paper to guide its members on how to act when their medical training clashes with their patients' faith and beliefs.

    Avinoam Reches, chairman of the ethics bureau and a senior neurologist at Hadassah University Medical Centre in Jerusalem, said he hopes the guidelines—published in the latest issue of the association's Hebrew language magazine, Zman Harefuah—would help colleagues in a country where religion and faith in general often have a powerful influence.

    “This is especially true when medicine has no solution, and patients and their families are desperate,” said Professor Reches. “Doctors may then find themselves facing advice and ‘treatment’ from the clergy, ‘healers,’ or charlatans that run counter to their professional knowhow or world view.”

    Israel's Patients Rights Law, passed about a decade ago, gave patients the freedom to choose among the various possibilities within conventional medicine and outside it. Professor Reches said, “This choice may frequently conflict with the doctor's autonomy, but the doctor can forgo some of his power in such cases.”

    The rule of thumb is that doctors should allow the use of services that are based on beliefs or religion but cannot be forced to supply them themselves. Where treatments go against their professional knowledge doctors may, Professor Reches noted, refuse to be involved but can acquiesce as long as the patient, medical staff, and other patients are not harmed and the treatments do not come at the expense of medical resources needed to treat others.

    He gave as an example the practice, rather common among ultra-Orthodox Jews, of healers using pigeons to treat jaundiced patients. Seven pigeons are used in sequence, with the healer pressing the bird's anus on the patient's navel, “releasing the poison” into the bird. The birds inevitably die, either as a result of the “poison” or of the pigeon handler breaking its neck in the process.

    Professor Reches noted that some members of the clergy try to interfere with doctors' work, advising patients to undergo tests or treatments that doctors do not recommend. “But if they come to pray or place amulets near the patient we should not interfere. We have to set boundaries between medicine and faith, which can have psychological, moral, and even placebo value. We mustn't chase faith out of the hospital, but it must remain in the proper dimensions.”

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