“God Will Heal My Foot”: Evaluating Religious Aspects of Medical Decision-Making

Abstract

Objectives 1. Develop strategies for discussing medical decision-making with patients and families who are hoping for a miracle. 2. Discuss ways to ease the burden of family members who must make difficult decisions on behalf of the patient. Mrs. S was a 74-year-old African American woman with a history of diabetes and limited adherence to medical treatment. She was admitted to the hospital with a gangrenous foot from an untreated diabetic ulcer. Despite intravenous antibiotics, the infection progressed, and the surgeons advised her that the only treatment that would save her life would be amputation. However, the patient refused, saying, ‘‘God will heal my foot.’’ The palliative medicine service was consulted to help the patient and family decide if hospice care would be appropriate. Our discussion with Mrs. S revealed that she did believe that God does work through medical treatment and doctors. She was willing to take medications to treat the infection, but to her, amputation would be against God’s will. She did not want to die and did not think she would die if she refused amputation. To Mrs. S, God’s physical healing of her gangrenous foot was not just a miracle to be prayed for, but a certainty. She would not explain further or entertain the possibility that the healing might not take place. Psychiatry assessed that her capacity to understand the consequences of her decision was limited. Mrs. S’s stance was consistent with her previous decision-making, reliance on religious faith, and avoidance of medical procedures. Four years previously, Mrs. S had refused an amputation for the same reasons, and her daughter had signed consent. Since then, the patient had seemed content to be mobile in wheelchair and enjoyed living with her daughter’s large family. She expressed no resentment against her daughter. However, the patient’s daughter had been haunted by guilt about her decision to go against her mother’s wishes. It was uncertain if Mrs. S would fare as well with both legs amputated, especially as her overall medical condition had worsened.