Translate this page into:
Religion-Healthcare and concordance, with a special emphasis on Sikhism
*Corresponding author: Samay Singh Verma, Certified Pharmacy Technician (CPhT), School of Arts, Humanities and Social Sciences, Elmhurst University, 190 South Prospect Avenue, Elmhurst, Illinois 60126, United States. sverm8679@365.elmhurst.edu
-
Received: ,
Accepted: ,
How to cite this article: Verma SS. Religion-Healthcare and concordance, with a special emphasis on Sikhism. J Global Oral Health. 2025;8:61-3. doi: 10.25259/JGOH_3_2025
Abstract
This review article explores the intersection of healthcare, religion (specifically Sikhism), and biomedical ethics through some defining principles of ethics. These principles are autonomy, beneficence, and justice, specifically in patient-provider relations. The main pillar of the review is a 2019 American Medical Association case, which highlights the complexities and ethical strain when a patient requests a physician of a specific religion. This paper offers insight from experts Dr. Farr Curlin and Mr. Jacob Blythe, who have studied this topic in detail. The importance of this review is from the personal experience of an aspiring Sikh healthcare professional, who is considering visible markers of faith in his religious journey. Through examining multiple patient interactions, this review underscores the importance of biomedical ethics, upholding autonomy, acting in the patient’s best interest, and ensuring equitable treatment of all, no matter their demands. Finally, Dr. Sanjeet Singh Saluja’s service during the COVID-19 pandemic is examined. Ultimately, fostering a respective, diverse, and inclusive healthcare environment is essential in our diverse society.
Keywords
Bioethics
COVID-19
Religion
Sikhism
Visible articles of faith
INTRODUCTION
You see a man walking down the street; he is wearing a cross, he is a Christian; a steel bangle, he is a Sikh; and red threads on his wrist, he is a Hindu. Religion is one of the most potent forces in the world, yet we fluster with how to coexist with others. Biomedical ethics navigates through tough questions in relation to healthcare and religion. While simple biomedical principles such as autonomy, beneficence, and justice can lead us to the answer, the spark of religion further complicates the matter. This review article explores the three mentioned biomedical principles and patient-physician concordance.
A 2019 American Medical Association (AMA) case explores how physicians should respond to requests of Religious Concordance. The AMA follows all rules and requirements as stated in the Health Insurance Portability and Accountability Act. This includes pseudonyms being used to uphold patient privacy and confidentiality while discussing the case. The case is presented as Dr. O seeing 78-year-old Ms. L, who asks about Dr. O’s religious beliefs. Ms. L continues to ask if there is a Christian doctor here as her religious beliefs greatly matter to her. The commentary from the case is provided by Dr. Farr Curlin, Professor of Medical Humanities and Co-director of Theology Medicine at Duke University, and Mr. Jacob Blythe, a third-year medical student with an M. Div in Divinity. The authors of the commentary simply provide an explanation of how to handle each situation on an individual basis. The authors suggest that the physician remains calm and flexible. It is also advised against automatically saying no, as the doctor-patient relationship is under consideration. Although the authors of the commentary provide a great response in a very tough situation, it is just as important to dissect this case further using three biomedical principles.
Personal connection
The study of this case is quite important for me since as a Sikh, I may choose to wear a turban in the future, as all Sikhs should have unshorn hair, but many don’t. If I choose to wear a turban, my religion can automatically be inferred as Sikh or be misinterpreted by people. An example of this is the 2012 Wisconsin Sikh Temple shooting as a white nationalist killed 7 and wounded 3, and the killing of Balbir Singh Sodhi in Mesa, Arizona, after the 9/11 attacks as he was mistaken as a Muslim by his killer, Frank Silva Roque. A 2021 study from the West Journal of Emergency Medicine discusses the turban in medical settings. The authors state, “For example, when a patient declines care from a physician who is a racial minority, hospital staff often seek out another physician to care for the patient. When a patient yells racial slurs at physicians or tells them to ‘go back to their country,’ the physician is expected to respond to the patient courteously.”[1] The study further includes a scenario from one of the Sikh authors Dr. Harajeshwar Kohli, “A Sikh attending emergency physician evaluates a young intoxicated male patient cursing at staff from the stretcher. When the patient sees the physician, who wears a turban, he begins yelling, ‘I don’t want to see a foreign doctor! I want to see an American doctor!”[1] The study of this case is important now more than ever since, as a rising Senior in the fall, I will be in Dental school soon, at least wearing the Sikh steel bangle and Hindu wrist threads, but maybe even a turban on my head. A 2008 study from the Rutgers Journal of Law and Religion elaborates: “Because non-Sikhs tend to associate Sikhs’ turbans with Osama bin Laden, Sikhs with turbans have become a superficial and accessible proxy for the perpetrators of the 9/11 attacks. As a result, turbaned Sikhs in America have been victims of racial violence and have had their identity challenged by calls for immigrant groups to assimilate into Western societies.”[2]
Respect for autonomy
The first biomedical principle we can apply in this case is Autonomy. An in-class text used in Biomedical Ethics courses at Elmhurst University: Principles of Biomedical Ethics, explains that autonomy comes from the Greek words autos and nomos, which quite literally translate to self-rule or self-governance. The text further explains autonomy as the capacity to understand, reason, deliberate, manage, and independently choose.[3] This can be applied to the AMA case study as Ms. L’s desire for a Christian physician may stem from genuine autonomy. The commentary discusses this as “Facilitating such requests is obviously unacceptable, and it is possible that Ms. L is motivated less by a desire for shared moral language than by a disdain for non-Christians.”[4] Although there is no way to confirm whether Ms. L had a desire for autonomy or a dislike since the physician was non-Christian, this further proves that a case-by-case approach will serve both the patient and provider the best. Finally, the text also acknowledges the importance of shared decision-making and informed consent, which can also be seen as patient autonomy, further bolstering the case-by-case approach.
Beneficence
The second biomedical principle that can be applied to this case is beneficence. The in-class text uses the concept of nonmaleficence to explain beneficence. The text states that while non-maleficence is the concept of doing no harm, beneficence takes it to the next level by ensuring that you are doing good things and taking positive steps to help others.[3] Furthermore, the concept of beneficence is seen in the commentary as the authors discuss that acting in the best interest of the patient can help improve the relationship between them and the provider. The text also strongly states that fostering trust and having a sense of understanding can lead to better patient outcomes. The concordance of any topic, be it religion, politics, etc., can help the physician respond to each patient’s specific needs and values. The authors also state, “Concordance, in this case, enhances the practice of medicine.”[4]
Justice
The third and last principle that applies in this case is Justice. The in-class text defines Justice as “fair, equitable, and appropriate treatment in light of what is due or owed to affected individuals and groups.”[3] This can be seen in our scenario with Dr. O and the provided commentary. Justice provides us with a reminder of the strict professional neutrality that healthcare professionals need to have. For example, if religious concordance was asked by Ms. L, it’s Dr. O’s job to make sure his treatment is fair, and that this fairness doesn’t go away while dealing with the situation at hand. The text suggests to us that asking for concordance or accommodations (such as requesting a Christian doctor) may hinder patients from receiving quality care from their team. The commentary from the case study reads: “Physicians who resist requests for concordance may have uncritically accepted a role as an anonymous functionary working in a culture of no culture”[4] A 2016 study looks at the association between discrimination and the health of Sikh Asian Indians. It further concludes: “Participants who wore turbans/scarves reported higher levels of discrimination than those who did not wear turbans/scarves.”[5] A cause of this discrimination may be requests by turbaned Sikhs for head coverings in the hospitals and the removal of the steel bangle during MRI, X-ray, and CT-scan tests. This discrimination may simply stem from not knowing why accommodations are being requested by the appropriate healthcare or dental staff.
Real-world example
An example of this is Dr. Sanjeet Singh Saluja, a Quebec doctor who made the decision to shave his beard as an emergency medicine doctor during the COVID-19 pandemic. Dr. Saluja is the co-Associate Director of Emergency Medicine at the McGill University Health Center, one of the larger hospitals in Montreal. As Dr. Saluja shaved his beard to properly wear an N95 mask, he could’ve elected to not see COVID-19 patients where he wouldn’t need an N95 mask.[6] Dr. Saluja refused as this violates the Sikh pillar of seva, which translates to selfless service. As Dr. Saluja shaved his beard to serve patients, this embodies what healthcare should be: service to the patient, selfless service to humanity, and doing what is necessary for the greater good. As it is necessary to embody what Dr Saluja did, so is empowering people to be accepting of others and coexist with other religions.
CONCLUSION
With the given case, constraints, and principles of biomedical ethics, I, as a future healthcare professional who might wear a visible article of faith, recognize the significance of respecting patient autonomy, promoting beneficence, and upholding justice. I also understand that I might face a situation like Dr. O had. As a result, I support a strategy that respects the fundamentals of biomedical ethics while also being patient-centered. In my opinion, a case-by-case strategy, rather than one that strictly follows rules or protocols, is essential to building a trustworthy patient-provider relationship. I will try my hardest to accommodate my patients’ requests and maintain professional boundaries, all while recognizing the importance of trust and communication with my patients. It’s important to embrace cultural diversity and promote mutual respect, as coexistence is vital in this age. The world is a diverse place, and healthcare is a diverse field. The only way we can enhance it is to consider ethics and follow what it teaches us.
Ethical approval:
The Institutional Review Board approval is not required.
Declaration of patient consent:
Patient’s consent was not required as there are no patients in this study.
Conflicts of interest:
There are no conflicts of interest.
Use of artificial intelligence (AI)-assisted technology for manuscript preparation:
The author confirms that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.
Financial support and sponsorship: Nil.
References
- Racial discrimination from patients: Institutional strategies to establish respectful emergency department environments. West J Emerg Med. 2021;22:898-902.
- [CrossRef] [PubMed] [Google Scholar]
- The Sikh turban: Post-911 challenges to this article of faith. Rutgers J Law Relig. 2008;9.2:60.
- [Google Scholar]
- Principles of biomedical ethics. 2019. (8th ed). United Kingdom: Oxford University Press; Available from: https://global.oup.com/ushe/product/principles-of-biomedical-ethics-9780190640873?cc=us&lang=en&
- [Google Scholar]
- How should physicians respond to patient requests for religious concordance? AMA J Ethics. 2019;21:E485-92.
- [CrossRef] [PubMed] [Google Scholar]
- The association between discrimination and the health of Sikh Asian Indians. Health Psychol. 2016;35:351-5.
- [CrossRef] [PubMed] [Google Scholar]
- Sikh doctor shaves beard in order to keep serving COVID-19 patients. 2020. McGill reporter McGill University. Available from: https://reporter.mcgill.ca/sikh-doctor-shaves-beard-in-order-to-keep-serving-covid-19-patients [Last accessed on 2025 Feb 08]
- [Google Scholar]