Many patients with life-threatening conditions find comfort in religion; how would you counsel a patient who feels therapy can be adjusted because of faith in God (Allah, etc.)?

"Adults have the right to make decisions about their bodies. However, one pitfall of religion is that adults sometimes keep devotion to religion at a childhood level. This means that perhaps they are not making medical decisions as an adult when based on religious tenets of a child. I would ask that such a refusal be agreed upon by loved ones, spouse, other family, and church representatives. Including them may introduce some sobering facts for the patient to consider, since they have a lot at stake with the final decisions. I would make sure everyone in this 'team' understood the gravity of the disease, the treatment, the lack of treatment, and the outocome."

This is similar to the other question in which a patient refuses chemotherapy, and like that, it's not your basic non-compliance situation. But unlike that question, you have the reason for the patient's refusal, which gives you a starting point to begin your discussion. As an educator, that discussion could very well end up a negotiation, so you should ask if a representative of his or her faith could be there when you discuss the situation. This is no different than a Jehovah's Witness refusing blood products in a hemorrhagic life-and-death crisis.

"If the patient were to use a faith-based argument to refuse treatment, I would want a higher authority (for the patient) in that faith than the patient him- or herself. I would ask that his church leader take part in our discussions."