What to do when religion meets EMS

Suggestions on how to handle conflict between EMS treatment recommendations and a belief system

A group of women in one of the country's largest Orthodox Jewish communities is proposing to join up with Hatzolah as emergency medical technicians to respond in cases of labor or gynecological emergencies. Editorial Advisor Art Hsieh points out that, as evidenced by this story, America’s right of religious expression can cause conundrums in emergency medicine.

Our nation holds several values near and dear to our collective hearts — freedom of speech, freedom to assemble, and freedom of religious expression. The last one can cause conundrums in medicine, especially in emergency care situations. As this article points out, the conflict between a religious viewpoint of the sexes and the needs of a woman in labor can be difficult to resolve. I suspect that it'll be some time before there is any movement.

Religion is a belief system. Whether Christian, Jewish, Muslim, Hindu, there is the requirement that you must have faith in its teachings and ideals. Almost by definition, there is no scientific evidence for the faith to rest on. And there doesn't have to be, which is the wonder and criticism of faith.

Over my career I have encountered several situations where there was some conflict between the care I was providing and the belief system of the patient or family. I'd love to tell you that each was resolved without fuss, but that would not be true. If I wasn't comfortable about the end result, I was pretty sure that the patient sure wasn't. This is especially true in situations where children are involved.

Here are some suggestions to consider if you ever find yourself in a similar situation:

1. Be tolerant

You may subscribe to a certain faith, or you may be agnostic or atheist. Regardless, the patient in front of you deserves your respect of their belief system, even if it conflicts with yours. Your role is as a caregiver, in a situation that demands careful consideration of all of the environmental factors.

2. If your patient is critically ill or injured, your duty is to tend to the patient

You may need the assistance of law enforcement to secure the scene while you extricate the patient. Carefully and completely document the reasons why you initiated care and transport over any objections.

Caveat: a patient who is awake, alert, and can clearly demonstrate decision-making capacity who is objecting to your care for religious reasons will be a significant legal challenge to manage. You may need to contact your medical command and enlist the help of clergy to convince the patient to consent to care.

3. If the patient is not critical but requires further medical care, prepare to spend time and effort in convincing the patient and/or family

Remember that rational; science-based thinking may not be convincing to someone who is basing his or her decision on faith-based practices. Again, a member of that faith's clergy may be of assistance in these situations.

4. If the patient is a minor and the parents are refusing care, be careful!

The obligation of the state to protect children will run headlong into the right of a family to express its religious views. You will need to clearly understand the laws of your state in terms of child abuse and neglect in order to steer a reasonable decision-making process. In more extreme cases you may need an emergency court order to initiate care.

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