A 31-year-old Hispanic woman, a wife and mother of two children ages three and five, telephoned the Hemodialysis Center on Friday morning. "I won't be coming in for my run this afternoon," she told the nurse and then her physician. "I have decided to seek healing through faith alone." A nationally known faith healer would be at her church Sunday, and it was time for her to put her life and future into God's hands. Yes, she continued, her husband and she had discussed her decision. "He supports me and believes in God's power to heal my kidneys."

Throughout history, physicians have accommodated faith frequently as an alternative, as well as complement, to their knowledge, skills, and medicines. Doctors have often encouraged patients with medically incurable conditions or symptoms to pray when conventional medical treatment had nothing more to offer. And physicians have also used placebos — inert or unproven substances — that depend on the healing power of the patient's own faith to aid recovery. This practice reflects the mysterious dimension of all healing, and the important role of the patient's spirit in maintaining or restoring health.

Medicine itself seems ambivalent about the healing power of faith. On the one hand, medicine from its origins has acknowledged the mysterious nature of healing and the vitally important and equally mysterious power of patients' faith in the processes of healing and recovery. On the other hand, medicine in its current scientific incarnation conveys a suspicion and negative judgment of "faith" when patients choose it as an alternative to conventional treatments.

How can faith be incorporated into the healing process? Are faith and medicine mutually exclusive?

When the woman's case was brought before the hospital's ethics committee — with her consent — her primary care physician shared his concerns: "I have known Brenda as an end-stage renal patient for several years. She's a wonderful person, a terrific wife and mother. She's getting close to the top of the list of persons eligible to receive a kidney transplant, so she wouldn't need to deal with the disruption of her dialysis treatments every week.

"But she needs her treatments now, or she'll deteriorate rapidly into a coma and die. I need to decide whether I should abide by her wish, or seek legal methods of preventing her from committing suicide until she comes to her senses. In other words, should I seek a court order to admit her to a psychiatric facility on the basis of my duty to prevent suicide? While she's there, she could receive dialysis. And intensive psychiatric treatment might help her come to her senses."

The ethics committee — composed of physicians, nurses, a chaplain, a social worker and an ethicist — heard Brenda's physician review her medical history, including their initial discussions about hemodialysis treatments and possible kidney transplants. Brenda was not at the meeting, but her physician reported she had always been conscientious about her diet and her treatment schedule, and had earned the affection of the staff at the dialysis center.

At one point in the discussion the physician was asked, "If Brenda were a Jehovah's Witness and she refused a life-saving blood transfusion on religious grounds, would you try to get a court order?" He sighed. "No. I guess the bottom line is that she had the right to give consent to the treatments in the beginning, and she has the right to withdraw her consent now."

The physician decided to ask to see Brenda again, in order to change her mind. If she maintained her current position, however, he would accept it. "These damned faith healers," he concluded, "they're like quacks in medicine — dangerous and destructive, yet so hard to corral."

But the story soon became more complicated. After the ethics committee meeting, the chaplain and one of the nurses — who belonged to Brenda's church — set up a weekend meeting with her pastor and Brenda's husband. "I feel fine," Brenda told the pastor. "I believe that asking for no help save the Lord's will bring me healing."

She reiterated her conviction that the time had come for her to "step out onto the lake" and show her unreserved faith. Her minister, acknowledging her good intentions, gently confronted her: "Do you remember Jesus' words to the tempter in the desert: 'Thou shall not put the Lord thy God to the test?' Brenda, are you testing God?"

The question caused Brenda to reconsider, and on Monday morning she came in for her regular treatment.

What does this case show about the relationship between faith and medicine? Like Brenda herself, the physician had come to wonder whether he had defined the problem too rigidly. Her dilemma had been: dialysis or faith? His dilemma had been: force her to undergo dialysis or let her kill herself?

Brenda's case raised other questions. Where had the ethics committee erred? Its chair, of course, was concerned when he learned that the chaplain and the nurse had made contact with Brenda's pastor on their own. In the ethics committee review, the consensus was that the chaplain and the nurse misused their roles in contacting the patient's pastor; and that the physician should have asked Brenda's permission to contact her pastor.

Perhaps accentuating the positive would be more respectful of the mysteries of healing and belief and more nurturing of physician-patient relationships. Brenda's physician's initial response to her decision to eschew dialysis for faith healing should have been to affirm her need and her commitment to seek wellness. Rather than questioning her initial response, the physician should have explored with Brenda the concerns and interests leading to her decision and looked for ways to join her in her quest for wholeness.

Daniel O. Dugan is the former co-director of CHESS at the Park Ridge Center. He now lives in California.