Bioethics and Food Restrictions by Religious Motivations: Decision Making Processes in Health
Bioethics reflects about much health related issues. Spiritual aspects involved in decision making are one of them. The inclusion of spiritual aspects in the Bioethics arena does not remove the secular character of bioethical reflection. In contrast, considering spiritual aspects may gave a broad and more complex understanding about motivations associated with the decisions that people make the Clinical Bioethics Committee of the Hospital de Clínicas de Porto Alegre, since 1993, had the mission to assist health professionals, patients and families in bioethical issues associated with the decision making process.
Individual food choices can be conditioned by a great variety of factos, cultural issues and religious beliefs are examples. In hospitals the religious influence in food is often omitted by the inpatients, mainly for fear of stigmatization by health professional.
A cross-sectional study was conducted involving inpatients at the Hospital de Clinicas de Porto Alegre (HCPA), a university hospital, located in Porto Alegre, Brazil. A sample of 271 adults inpatients from clinical and surgical units were interviewed about dietary restrictions. Sample size was estimated using an expected food restriction rate of 5% at a significance level of 95% and 3% of absolute accuracy . The semi-structured interview has a set of four questions about food restrictions and related motivations, and embarrassment about this issue. Socio-demographic data was also recorded. Religious denominations were grouped according to the Brazilian census classification Foods were classified into nine groups: Group 1 – Grains, Breads, Tubers, Roots; Group 2 – Vegetables; Group 3 – Fruits; Group 4 - Legumes; Group 5 - Meat and Eggs; Group 6 - Milk; Group 7 – Sugar and Sweets; Group 8 - Oils and Fats; Group 9 – others, like alcoholic beverages, salt, etc.
male, median age 51 years, range 16-85 years. The educational level, declared by the patients, ranged from illiterate to university degree. Most participants (61%) had education corresponding to elementary education, consistent with the vast majority of patients treated at the Hospital. As for the religious denomination, 232 (86%) patients reported having had some practice linked to a specific group. Were cited 25 different religious denominations, which were classified according to Brazilian census criteria the most frequently reported categories were the Roman Catholic Church (55%) and Evangelical Churches (15%). Of the 271 patients evaluated, 118 (44%) reported not having any food restriction. The remaining 153 (56%) subjects reported 286 different food restrictions, which were grouped into nine food groups (Philipp, ST et al, 1996
Not liking as a food restrictions were reported by 92 patients. This category was associated to 176 foods. Two different groups of food was mainly reported Group 2 - vegetables (48.3%) and Group 5 - of meat and eggs (25.3%). Food restrictions associated to health problems were associated to 74 food restrictions reported by 44 patients. Group 5 - especially red meat (25.3%), and Group 2 – vegetables (20.0%) was the most cited. A group of 17 Patients reported 35 different types of foods restricted by religious motivations. Group 5 – meat and eggs was the most cited (76, 0%). It’s important to refer pork and foods with blood as the most cited in this group. The second was Group 9 - other foods (14, 0%), like drinks with alcohol or caffeine. Group 2 – vegetables (12, 0%) only two food types was cited: tomatoes and chayote, and Group 6 – milk (6, 0%) was also cited. Other group was not cited
• Based on these results, it’s possible to conclude that
• food restrictions was reported by a great number of inpatients; food restrictions by religious motivations was reported by a restricted number of inpatients;
• meat was the most cited food restrictions by religious motivations;
• expression of coercion reported by inpatients didn’t presents statistically significant differences between groups with and without dietary restrictions, and between different motives reported, but issignificantly higher than that seen in outpatient clinics;
• inpatients realize they can express their opinion about food restrictions, but recognize that it is not taken into account by health professionals in the dietary decision making process; • the vast majority of inpatients related no embarrassment about questions about religious practices. These findings highlight the importance of shared decision-making with patients, to include other aspects in this process and enhance the role of personal opinions, beliefs and traditions. The dialogue between patients, families and health professionals builds trust and mutual understanding, and can increase adherence to treatment. Hospitals could evaluate the operational and financial impact on offering dietary options to inpatients.
Journal of Clinical Research and Bioethics
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