The issues relating to such faith healing practices can be looked from the lens of general principles of medical ethics, i.e. autonomy, beneficence, non-maleficence and justice [20
]. The first and the foremost is the principle of autonomy. Though the patients and/or their family members often exercise autonomy in making a decision on whether to seek treatment from faith healers, the procedure of faith healing is quite prescriptive and does not provide a menu of options to choose from. Coercion might exist in some forms of faith healing practices. Some instances of temple healing involving seclusion and restraint of individuals, and contravene the provision of least restrictive care [8
]. At times, decisions for seeking such are made by the family members and the individual just complies with the faith healing procedure suggested [6
]. At the same time, it must also be remarked that ‘modern’ medicine has also evolved over the decades from a paternalistic attitude in the past to a more collaborative informed decision-making process of present times.
Beneficence and nonmaleficence are next two ethical principles often considered together. The motivation of faith healers to treat patients probably includes altruism, apart from potential of monetary gain and rise in social stature. Many patients are benefitted and some do get personalized attention which might be difficult to obtain in busy emergency setting of public health-care services in South Asia. It has been seen that for certain disorders, patients and their family members are quite satisfied by the treatment offered by the faith healers [21
]. Some faith healers are able to judge what types of problems are unlikely to get better by their treatment, and promptly refer such cases to medical settings to remain in good grace of the clientele [3
]. However, there are other circumstances where use of faith healing techniques may have adverse consequences. Subjecting individuals to rigorous rituals like fasting for long duration may be detrimental to patients with diabetes or malnourishment. Similarly, as discussed above, procedures like branding with a hot iron-rod may have unintended malefic consequences like wounds. Efficacy of these practices is unproven, and whether such practices constitute a form of treatment at all can be debated.
From the standpoint of justice, i.e. allocating resources uniformly across all strata, treatment through faith healers might hold some promise. It has been noted that the scarce healthcare resources in South Asian countries are not equitably distributed [12
]. The users of modern medical services are primarily located in urban areas. In this situation, faith healers might provide an easy and acceptable alternative provision of healthcare services to the community. At the same time, whether faith healers provide any amount of effective care needs to be considered. Ease of access to care does not override the requirement of beneficence and nonmaleficence in this situation. Also, though some forms of faith healing like rituals in temples may provide access to many, specialized services like yagnas or rings to ward off evil spirits may be quite expensive and out of reach of the ordinary.
Other aspects in relation to treatment by faith healers include issues of confidentiality and double agentry. Often the services of faith healer are recruited by a close relative and not the patient himself/herself. The patient may share some information with the faith healer, but not with the close family member. In this circumstance, whether the faith healer maintains the confidentiality of the patient, or shares information with those who bring the patient may be a contentious issue. Each situation may be unique, and requires the discretion of the faith healer to judge the circumstance and decide accordingly. Clinicians dealing with patients might be forced to encounter issues relating to faith healing practices when patient/family request to additionally perform rituals along with continuation of the medical treatment. Such requests may generate counter-transference feelings and conflict in the mind of the physician. In such situations, it might be better to decide considering patient/family wishes, the medical disorder being treated and the faith healing practice being proposed. To further elaborate the issues, few case examples of ethical challenges with respect to faith healing are discussed in Table 1.
The issue of faith healers being needed in the current society in South Asia can be viewed from utilitarian and deontological ethical perspectives. Utilitarian perspective of what works best suggests that faith healers should continue their practice as they are beneficial to some individuals [3
]. Being allowed to work in regulated manner ensuring that they do no harm may be an acceptable course of action. Deontological principles suggest that ethical choices are uniform and not context based. From such a perspective, faith healing practices should not be tolerated if they are proved to be harmful. However, due to the heterogeneity of conditions treated by faith healing practices and the wide variety of practices themselves, it may be difficult to generalize about such practices.
Another point of concern which may arise in the future is when someone attempts to validate the benefits/efficacy of faith healing practices through the scientific method. As of present, scientific evidence about faith healing practices is lacking, barring a few anecdotal reports. But lack of evidence of efficacy does not equate to evidence of lack of efficacy. It is interesting to speculate how ethics committees would evaluate such proposals of rigorously testing faith healing practices, if at all they arise. While some committees might reject such proposals outright, others might be interested in allowing evaluation ensuring patient safety and dissecting out placebo effects. How informed consent is obtained in such studies would be a crucial question. This is because telling a prospective participant that no clear demonstrable mechanisms explain efficacy might deter participation and erode out ‘faith’ in the treatment. Yet, progressing from anecdotal to systematic evidence about faith healing would need further robust research.