Religious Traditions in Health Care Case Discussion

33 y/o female comes to establish care. She’s recently moved to Chicago with husband who was transferred here by work. Past Medical Hx: Diabetes, Type I with CRI Rheumatoid Arthritis Fibroids, heavy menstrual periods Anemia, iron deficiency Surgical Hx: Appendectomy Ob/Gyn G0 P0 M- 13 I- 28 days D- 7 (heavy) Medications: Insulin Methotrexate Iron tablets Allergies: None Social Hx: Occupation: Office Receptionist Married, Lives with Husband Tobacco: None Alcohol: None Religion: (Hindu, Buddhist, Catholic, Jewish, Muslim, Protestant Christian) Has not yet joined a faith community in Chicago. ROS: Wrist pain, swelling Heavy, painful menses RTHC – Case Discussion

The physician takes a spiritual history and finds that faith and religious practice are important to her. The physician inquires as to how best to address the patient’s needs per her faith and spirituality. To help the physician understand the religious dimension of her life she explains the following: Briefly describe your religion’s view of the doctor- patient relationship and list some significant beliefs, expectations and practices from your respective religions…

RTHC – Case Discussion The patient’s rheumatoid arthritis has been well controlled on Methotrexate. The physician inquires into the patient’s wishes for having children, explaining that should she get pregnant her current medication could not be continued and substituting Prednisone would likely complicate her diabetes. They discuss the alternatives, including switching medications, as well as the pts views on pregnancy prevention, including contraception, tubal ligation, abortion. Discuss your religion’s perspectives on contraception, sterilization and abortion…

RTHC – Case Discussion Completing the discussion on child-bearing, the physician inquires into the patient’s views on assisted reproductive technologies. (In vitro fertilization, GIFT –gamete inter-fallopian transfer, surrogacy, etc.) Discuss your religion’s views on Assisted Reproductive Technologies…

RTHC – Case Discussion 15 years later that patient has develops ESRD- End Stage Renal Disease from her diabetes. The physician discusses the management options including dialysis, and renal transplantation. Discuss your religion’s perspectives on transplantation and organ donation…

RTHC – Case Discussion The patient’s menstrual blood loss and painful periods become significant enough that an elective hysterectomy is scheduled. The physician inquires into the patients views on peri- operative blood transfusion Discuss the religious perspective on blood transfusion…

RTHC – Case Discussion Upon admission to the hospital the Pastoral Care team visits the patient inquiring into her spiritual needs and wishes while hospitalized. Discuss the spiritual needs of a patient from your religious perspective…

RTHC – Case Discussion The post operative period is significant for multiple complications that lead to multi-system failure. The patient is in the ICU, nonresponsive, on a ventilator, requiring dialysis. The staff discuss the poor prognosis with the patient’s family, and discuss End of Life management… Discuss your religions views on End of Care for the patient…

RTHC – Case Discussion The patient is taken off the ventilator and comfort control measures are carried out per the families wishes. The following day the patient dies… The hospital staff approach the family asking permission to perform an autopsy to understand better what led to the patient’s demise… Discuss your religion’s perspective on autopsy, and the care for the body after death…