Bioethics Forum Essay
Spiritual But Not Religious: Human Experiences Integral to Bioethics
In a recent essay in Hastings Bioethics Forum, Nancy Jecker and colleagues argue for an appreciation of religious perspectives in the work of bioethics. I am confident that I am among many who see this as a welcome call for a better informed and more inclusive sense of both ethics and bioethics. Still, I worry that the notion of “religion” in their formulation of the task is too narrow. I aim to broaden their call.
In one sense, religious dimensions have never been absent from the practice of bioethics. Those who work in clinical settings have long known that practical resolutions to patient care problems are often couched in religious terms. For most Americans, ethics finds its rationale and grounding in religious thinking and practice. To expect that somehow patients, families, and even health professionals would shed this in biomedical decision-making is naïve. So, I take it that Jecker and her co-authors are saying that bioethics as a field should welcome religious perspectives in all of its work, including theoretical studies, advocacy, policy, and research.
My worries about using the terms “religion” and “religious” without some qualifications stem from my own clinical experiences. Several years ago, I was talking with a young, expectant mother whose fetus had been diagnosed with spina bifida, incomplete closure of the fetal spine with accompanying problems of paralysis and mental development. She was offered the option of participating in a clinical trial designed to find out whether prenatal surgery could lessen the developmental problems associated with spina bifida. I was trying to ensure that she and the others who entered this surgical trial understood what they were getting into.
This woman insisted that she wasn’t worried about the risks of the surgery. She said she felt the presence of God, mediated through her recently deceased grandfather, and that he had not warned her away from this procedure, so she knew the surgery would go well. “Oh,” I said, “is religion then a big part of your decision about whether to have this procedure?” To which she replied, “No.” Religion to her was churches, ministers, and the metaphysical furniture of Christianity, which had little meaning for her. But she felt and trusted the presence of God. By her own reckoning she was a “spiritual, but not religious” person.
My assumptions were too restrictive; I was thinking about spiritual matters from within a box labeled religion. What this young woman embodied was an innate human capacity for seeking and finding transcendent meaning at critical junctures in life. It is this capacity and its meaning that I fear may be absent from the definition of Jecker and her co-authors.
Rather than being an outlier, the young woman I describe above is one of many. According to a Pew Research report, 22% of Americans adults describe themselves as spiritual but not religious. How should this growing number of people be characterized? Robert C. Fuller, in his book Spiritual But Not Religious, claims that this phenomenon belongs to the rich tradition of American experiences articulated by Thoreau, Whitman, William James, and a wide range of other poets, writers, and theologians that stress the primacy of human experiences of the sacred over traditional religious teachings. Part of the meaning of spiritual is to capture those transcendent experiences.
Abraham Maslow, in his study of hundreds of such experiences, labeled them “peak experiences.” He characterized them as common to the human species and for which a wide range of human activities become conduits. In these highly concentrated and focused peaks the universe is perceived as a sublimely beautiful and integrated whole, with a superordinate reality and worth, in which ordinary ego concerns fall away. The human response to such experiences is wonder, awe, and humility in the face of something far more powerful than oneself; deep gratitude for belonging to such a reality; reverence; and perhaps worship.
In Maslow’s view these experiences are the raw materials of what have become organized religious traditions, which seek to pass onto others the peak experiences of the founders of these traditions. Sometimes this transference of the founders’ insights works well, but sometimes the teachings become restrictive dogma and the rituals empty shells. Maslow’s characterization is not meant to be inclusive or exhaustive, but illustrative of this pervasive phenomenon.
What bioethics needs is a rich working definition of spirituality as a common dimension of human life. Such a spirituality would honor religious traditions and practices as a large part of spirituality but would extend beyond it the kinds of experiences that James, Maslow and others describe. This would make the bioethics enterprise more difficult and complex in some ways, as we would have to ask in each circumstance just how spirituality functions for people and not assume it can be contained in a specific form knowable in advance. The data to be gathered are not official teachings of organized religion but transformative experiences of people as they are felt and known. What would result from this more careful attention to spirituality and religion is a pathway to better understanding of our fellow creatures and the ethical groundings of their decisions.
Larry R. Churchill, PhD, is Ann Geddes Stahlman Professor of Medical Ethics Emeritus at Vanderbilt University and a Hastings Center Fellow.
Larry, thank you for calling out this important aspect of wholistic care that we as Ethicists should embrace. In my work with older adults, I would venture to say it is an even higher number who define their spirituality separately from religion. With well defined or simple explanations they articulate how this spirituality shapes their sense of the importance of advance care planning to include this essential component of who they are into healthcare decision making. When approached in a value neutral way, the are able to speak to this in discussion. Thank you for raising this up!
A lovely and informative piece, Larry, for which I’m grateful. I’d be interested to know what you think about two questions your essay raised for me.
First, I fully agree with your thesis that in attending to the importance of religious views for people for whom “bioethics” seems secular, as Jecker et al. urge, we should look beyond the formal teachings of organized religion to a much wider range of individuals’ transcendent experiences. The result of giving “more careful attention to spirituality and religion,” you conclude, would be “a pathway to better understanding of our fellow creatures and the ethical groundings of their decisions.” I wonder whether you think it would also be helpful–in terms of improving our understanding–if practitioners and researchers, as well as the clinical bioethicists to whom they turn for advice and assistance, particularly when they have ethical concerns about the decisionmaking of patients/research subjects, also thought more about spirituality’s presence or absence in their own lives. Might we do better in “understanding our fellow creatures” if we understood this dimension of ourselves better?
The second question relates to your initial observation about the intended scope of the article by Jecker et al. You note that the role of religion is so self-evident in clinical bioethics that you assume that Jecker et al. must be arguing that bioethics “should welcome religious perspectives in all of its work, including theoretical studies, advocacy, policy, and research.” I totally agree that that was their intention, and in my comment in the Bioethics Forum on their piece–having like you noted that individuals’ religious traditions are often components of clinical ethics consultations–I suggested that the “secular” concepts of bioethics have religious roots. So, since your illustration the utility of broadening “religion” to spirituality was a clinical one, do you have thoughts about the ways that spirituality can intersect with, and enrich, bioethics theory, advocacy, and policy?
Larry,
Thank you so much for contributing this wonderful and insightful piece, which takes the argument my colleagues and I developed to the next level.
I agree with you that spiritual and transcendent experiences should have a place in bioethics discourse in addition to religious contributions. This is perhaps especially important for global bioethics, and our longer paper in Journal of Bioethical Inquiry gives the example of witchcraft in Ghana’s Northern Region to illustrate.
While I agree with you that religion can become rote and rituals can become “empty shells,” I am sure you would agree that this is not inevitable or universally the case among religious people. I was surprised by (and disagree with) your comment about the irrelevance of the teachings of organized religion for bioethics. It strikes me that what is needed is not spirituality or religion, but both.
Thanks again for this thoughtful contribution which brought my thinking about this topic to a new level.
Nancy Jecker
Thanks Pat and Alex for your appreciation and encouragement. In response to Alex’s questions, I think that spirituality is a dimension of human life more generally, whether well-recognized or not, and as such has a potential role in decisions and practices in a large number of human activities and undertakings, including being a patient or research participant, doctoring, care-giving more broadly, being a researcher, and work in policy and advocacy. I don’t see a natural limit on areas of human concern in which an appreciation for spirituality–both our own and that of others– may be relevant. I understand spirituality as a natural human capacity, like reasoning, feeling, imagining, remembering, and so on. It is a flawed model of human moral decision-making that confines a good process to rational methods, something we have been working our way out of since Kant, Mill, and the Enlightenment sense of what makes us humans distinctively human, but that’s a longer story for another time. Thanks for the conversation.
I had hesitations similar to those identified by Larry Churchill, but lacked his clarity to articulate a way around my disappointment. “Religion” is a too tight category of inquiry and discernment to describe the ideal role of an ethics consultant at the bedside of a patient facing unfamiliar choices. When I did that work, I too often failed to inquire deeply and with sufficiently open terms about the patient’s or surrogate’s spiritual orientation. And, given my education and professional experience, I was probably better at it than many.
Larry Churchill offers the useful observation that even when patients proclaim or practice no religion, they often bring with them a kind of spirituality that colors how they make decisions.
Here is my concern: Churchill has chosen 20th century humanistic psychologist Abraham Maslow, father of Positive Psychology, as his exemplar of spirituality. Maslow, Churchill reports, views spirituality as a manifestation of “’peak experience’ (in which) the universe is perceived as a sublimely beautiful and integrated whole.” But my daily encounters as a medical oncologist with patients sick from progressive cancer, for whom the universe may not appear sublimely beautiful, runs counter to this representation.
Maslow is retreating from the crucial insight of one of the other thinkers that Churchill cites, William James. James, in his The Varieties of Religious Experience, crucially adds a note of caution, even critique, missing from Maslow. For James, the positive outlook, what James calls the “once born” or “healthy mindedness” that Maslow seemingly endorses, is fine but only “as long as it will work.” Unfortunately, “evil facts are as genuine parts of nature as the good ones,” James argues, and any system that ignores these evil facts is “formally less complete than systems that try at least to include these elements in their scope.”
This has practical significance for the case that Churchill discusses, the young woman whose spirituality had convinced her that proposed surgery would go well. It is not a physician’s role to challenge a patient’s form of spirituality.
But physicians are required to give a thorough and honest accounting of risks and benefits and to support a patient regardless of the outcome. In this case, we would certainly hope that the surgical procedure succeeds, but hope (unlike optimism) includes the possibility that it will not. A physician with awareness of the patient’s belief structure would be prepared in the latter case, for not only a medical, but also a potential spiritual crisis.
Thanks to Dr. Astrow for his thoughtful response to my short essay. You have my respect as a person who does some of the most challenging work I know of. My citing of Maslow’s notion of “peak experiences” was not intended as a full account, but only, as I say, as illustrative of a dimension of human experience I think is essential to bioethics work. I have never thought of Maslow as the “father of positive psychology”, a title I associate with Martin Seligman. Perhaps Maslow pays too little attention to the darker sides of human experiences. For my own part, I am well-acquainted with suffering and evil, and the possibilities for spiritual growth are sometimes present in spite of suffering. Still, I don’t think it is naive optimism Maslow is promoting, nor would I. Whether anyone’s larger spiritual beliefs and practices, have a robust enough place for suffering and evil is perhaps an individual question, but I don’t know of any “spiritual but not religious” persons who see life through a Pollyanna lens. Of course some forms of naive denial may be joined with spirituality for some people, just as traditional religion is sometimes so joined. In short I don’t think spirituality is necessarily grounded in lack of realism about the world, and our understanding of things, as James said, will be far better informed by looking at many examples, rather than drawing generalizations. Thanks again for your helpful post.
Thank you, Larry. Last thoughts: I agree that religion is not necessary for spirituality (nor is religion necessary for ethics). Religion can be deadly dull and worse, and to say that someone is “spiritual but not religious” ought not be seen in any way as a pejorative. But religion at its best provides a home for spirituality (and ethics), a space for study, reflection, protection, and transmission of our highest values and just as religions are rightly critiqued when they fall short, the same goes for the various manifestations of spirituality.
Yes, William James describes a wide range of spiritualities, but as a pragmatist, he also offers judgments about the usefulness of the different forms. A spirituality that excludes or minimizes the probability that things will not always go our way leaves us unprepared for the various trials we are all destined to face in living.