Principle of time [+/–]: Whether the principle of time is violated depends on the amount of time allotted to make and implement such a recommendation.
Since only 1, if any, of the principles is upheld in this clinical scenario, the recommendation is considered inappropriate.
Even when faced with a scenario like this, the perceptive physician will gain insight into how a patient copes with illness by taking a spiritual history. Simply asking the question, “What do you rely on in times of illness?” may help identify adjuncts to therapy that will be useful and more appropriate in a patient’s care.
Benefits of the EBQT paradigm
The EBQT paradigm was designed to help health-care providers regardless of their personal belief. Physicians with divergent points of view may use the 4 principles to come to similar, if not identical, conclusions on whether support of a patient’s spiritual practices is warranted. And, as illustrated in case 2, the paradigm allows recognition of inappropriate spiritually-based recommendations.
The cases discussed relate to organized religious practices, because it is in this arena we find the most controversy over physicians’ involvement with patients’ spiritual beliefs. However, we recognize that patients may seek spiritual sources of strength outside organized religion. The 4 principles are also helpful when encountering less formal and less controversial practices of spirituality as found in art, music, relaxation techniques, support groups, gardening, writing, etc. Furthermore, the principles are beneficial for evaluating the appropriateness of certain forms of alternative medicine—acupuncture, hypnosis, homeopathic or naturopathic therapies—regardless of whether these therapies are spiritual in nature.
Of course, conscience trumps all other principles. Caregivers should not compromise their own values. Nor should a patient be put into a potentially compromising position concerning his or her spiritual beliefs. Providing optimum care while avoiding such conflicts requires discernment. We find the EBQT paradigm, used with a careful spiritual assessment, provides helpful guidance in this regard.
Acknowledgments
The authors would like to acknowledge Ken Mueller, PhD, clinical psychologist in Anchorage, AK, and Dan Stockstill, PhD, professor of Bible and Religion, Harding University, for their thoughtful contribution to the development of the EBQT paradigm and the formation of this article. Disclosure: Robert T. Lawrence has served as a Christian minister since 1989. He completed medical school at the University of Washington School of Medicine and is currently a resident at the Greenwood Family Practice Residency in Greenwood, SC.
Corresponding author Robert T. Lawrence, MD, MEd., 110 Firethorn Rd, Greenwood, SC 29649. E-mail: blawrence@selfregional.org.
