I’d like to use as an example case that my colleagues and I wrote about,5 in which a patient refused postoperative pain medication because he believed that God wanted him to suffer because he had “done wrong” and deserved to be in pain.5 This is certainly not my religious viewpoint, but it was that of the patient. After consultation with colleagues, it was decided that if the patient had refused anesthesia during surgery, it would be so detrimental to his health that the request could not be granted. If, however, the patient’s experience of severe pain would not in and of itself be damaging, I would have to respect his choice.

Situations such as abortion or end-of-life care often raise difficult questions for clinicians whose religious beliefs might go counter to those of the patient. The overriding factor in these instances, however, should still be the physician’s commitment to the health of the patient and not necessarily the unqualified protection of the physician’s religious beliefs. Physician objections to controversial practices need not be religious in nature and frequently there are more robust arguments from abstention from such practices that do not exclusively invoke religion.

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Do you think that physicians should pray with their patients?

I absolutely think that it is appropriate, under certain circumstances, for physicians to pray with patients. It requires a good deal of thought and attention to the patient’s needs and religious/spiritual orientation, and it takes a lot of time to be able to assess what would suit the patient best in that moment. One challenge is lack of time to actually sit with patients and discern what is best for them; being short on time is a problem in all areas of healthcare.

I think that it should usually be up to the patient to initiate the request for prayer. This is one area in which, since there is a power differential, physicians can overstep their bounds and make patients uncomfortable. Physicians don’t want to interject their own beliefs into the picture. But if a patient initiates a request, I will always pray with them, whatever their religion.

There are rare instances in which it’s okay for a physician to initiate the offer to pray together, but one has to know the patient very well so that the offer won’t backfire or appear coercive. Of all the patients I have encountered in training so far, I have offered to pray with only one patient and his family. I had gotten to know them well, they had been through some hard times, and I felt that the suggestion would be received well, which it was.

If a patient wants to pray and the physician doesn’t want to join, it is okay to say, “I will be here with you when you pray.” But I don’t think physicians should go beyond their comfort zone. If they are uncomfortable even being in the presence of prayer, I would suggest calling the chaplain.

Do you have any additional thoughts to share?

The idea that we can cleanly separate religion and medicine, as pertains to both doctors and patients, is artificial because religion is not only a characteristic but for many people, it is a foundational orientation to the world. The physician’s sacred obligation to alleviate suffering and foster the patient’s health is paramount. The real question isn’t whether religion has a place in medicine, but how it can be integrated into the clinical setting in a way that honors physicians as well as their patients, allowing for good care and avoiding pitfalls, coercion, and harm.

This article originally appeared on MPR