This case was first published in the AMA Journal of Ethics, What Should Physicians and Chaplains Do When a Patient Believes God Wants Him to Suffer?

March 2021

Human Suffering and Patient Religious Beliefs Bioethics Case Study

Landon is a 47-year-old father of two who has a history of alcohol abuse but has been sober for over a year. He was admitted from the emergency department, where he presented earlier this morning with acute abdominal pain. He was diagnosed with pancreatitis and biliary colic, indicating the need for a cholecystectomy (a laparoscopic procedure to remove the gallbladder to prevent gall stones, pain and infection).

However, before the procedure takes place, Landon states that he does not want pain medication after the surgery because, as he said, “God wants me to be in pain.”

The medical team, unsure how to proceed, delays the surgery. Dr. Jordan, a fourth-year surgery resident, met with Landon to discuss his request and quickly reach a resolution, as the medical team did not want to delay the procedure for more than 24 hours. After Landon explained why he did not want pain medication, Dr. Jordan stated, “You are going to feel a lot of pain after this surgery. Sometimes the pain is so extreme that patients have difficulty breathing. The pain medication helps you be able to take full breaths, which reduces the likelihood of getting pneumonia.” Dr. Jordan then asked Landon if he would be willing to speak with a chaplain about his ideas of what God wants for him. Landon agrees. Dr. Jordan consults with the chaplain on call, Chaplain Keith, and explained Landon’s case. “We can’t, in good conscience, not give him pain medication,” she said. “It’s just bad care. I respect his beliefs, but I can’t be forced to give him what I know to be bad care because of his beliefs. We need to manage the pain to help him heal, if not to be compassionate.” Chaplain Keith suggested, “I’ll speak with him to get a better understanding of his spiritual concerns. Why don’t we talk after I meet with him?”

Chaplain Keith visits Landon. They spend some time getting to know each other and, eventually, Chaplain Keith asks, “So would you tell me more about why you think God wants you to be in pain after your surgery?” Landon nodded his head and lifted his hand. “I’ve done a lot of wrong in my life and hurt a lot of people. I haven’t been a good father to my kids. And from the way I see it, God wants me to be in pain— God wants me to suffer through this so I can atone for some of my sins. And God’s right—I don’t deserve the pain meds and I don’t want the pain meds.”

Dr. Jordan and Chaplain Keith now meet and consider how to proceed.