A Consideration of Prayer in the Clinical Setting

To get at the heart of what Christian prayer truly is and what the implications are for the Christian physician, where should we begin? When asked to teach on the subject of prayer Martin Luther commented that any study should start with the Lord’s Prayer because it not only tells us how and for what to pray but, “since our Lord is the author of this prayer, it is without a doubt the most sublime, the loftiest, and the most excellent.  If he, the good and faithful Teacher, had known a better one, he would surely have taught us that too.”^[i]  In fact, in his “Personal Prayer Book” of 1522, Luther noted “I am convinced that when a Christian rightly prays the Lord’s Prayer at any time or uses any portion of it as he may desire, his praying is more than adequate.^[ii]

So, following Luther’s lead we will begin by looking at portions of the prayer. We find Jesus’ instructions recorded in Matthew 6:9-13:

⁹ “Pray then in this way:

Our Father in heaven,

hallowed be your name.

¹⁰ Your kingdom come.

Your will be done,

on earth as it is in heaven.

¹¹ Give us this day our daily bread.

¹² And forgive us our debts,

as we also have forgiven our debtors.

¹³ And do not bring us to the time of trial,

but rescue us from the evil one.  (NRSV)

We will begin by noting that the address “Our Father” demonstrates that prayer is, at its most fundamental level, a communication event with a personal God. As Andre van Oudtshoorn states “Prayer acts out the belief that God is more than a set of theological ideas, but is a person who esteems us enough to become open to us, to listen to our interpretations of reality and to respond to our prayers.”^[iii] The address further points to the fact that prayer is not only communication with a personal God who is open to our thoughts, but is the one true God with whom the pray-er shares a spiritually familial relationship. When Jesus led the disciples to pray, he did not call them to pray to the god of their choice or imaginations. “Father” was not a generic term for any being before whom they were in a subservient position. “Father” was a title full of rich meaning and which pointed to the God of Israel (Jn 5:18), the one true God (Jn 17:3) the only one through whom salvation is possible (Mt 7:21). Just as Jesus taught the woman of Samaria that “true worshippers will worship the Father (Jn 4:23), so “true” prayer would be that which is directed to the Father and him alone. 

For prayer to be true it must also be offered by those who stand in a positive familial relationship with the Father. The significance of this is made clear in the contrast that Isaiah presents between those who are in a positive relationship with the Father and those who are not. Isaiah describes those in a positive relationship as those whom recognize him as their salvation, strength and song; those who place their trust in him and count it joy to be the recipients of his grace; those who sing praises to his name and who tell others of his deeds in order that his name might be exalted (Jn 12:1-6). True prayer is offered to the one true God by those who know him and rejoice in him as Father.

These stood in contrast to those in Judah and Jerusalem who knew that God was the Father of their people but who did not respond to him as such. “Hear, O heavens, and give ear, O earth; for the LORD has spoken: ‘Children have I reared and brought up, but they have rebelled against me (Is 1:2)…they have forsaken the LORD they have despised the Holy One of Israel, they are utterly estranged” (vs. 4). These condemnations were not leveled against them because they failed to follow proper worship protocol. They offered multitudes of sacrifices (vs.11), entered into the temple courts (vs.12), burnt incense (vs.13) and observed appointed feasts (vs.14). Despite all of this, God declared “When you spread out your hands, I will hide my eyes from you; even though you make many prayers, I will not listen” (vs.15). These sentiments are echoed in Jesus’ teaching on prayer in Matthew 6:

⁵ “And whenever you pray, do not be like the hypocrites; for they love to stand and pray in the synagogues and at the street corners, so that they may be seen by others. Truly I tell you, they have received their reward. ⁶ But whenever you pray, go into your room and shut the door and pray to your Father who is in secret; and your Father who sees in secret will reward you. ⁷ “When you are praying, do not heap up empty phrases as the Gentiles do; for they think that they will be heard because of their many words. ⁸ Do not be like them, for your Father knows what you need before you ask him.

The hypocrites knew that the synagogue was the “house of God” but their prayers were said in the hopes that others would notice how spiritual they were, not that their Father would notice their love for him. Likewise, the Gentiles approached prayer as a way to manipulate God, not commune with their Father. These prayers are likened to “empty phrases” which will not be heard. Abraham Kuyper likens such prayers to the sound of an out of tune harp. God, the master craftsman, created our harps (our hearts) which could produce the beautiful music of prayer.  Sin, however, has put the strings out of tune to the point that they make only noise which renders the harp useless in its effect.  The fact that the strings can still be plucked at all points to the craftsman and the original work, but the music is unpleasant and unacceptable to his ears. Unless he repairs the harp (through regeneration), no real music (“true prayer”) can ever be played. ^[iv]

This is not to say that there are not examples in the Bible in God responds in mercy to those who do not rightly worship him.  1 Kings 21:25 declares that “there was none who sold himself to do what was evil in the sight of the LORD like Ahab.” Yet, when Ahab mourned and fasted after hearing of God’s judgment against him, God declared to the prophet Elijah, “Have you seen how Ahab has humbled himself before me?  Because he has humbled himself before me, I will not bring the disaster in his days; but in his son’s days I will bring disaster upon his house” (vs. 29). In cases such as these, it is best understood that God was not responding because he found Ahab’s appeals (assuming his “mourning” included appeals to God) acceptable, but merely that he desired to put his mercy on display. Calvin makes this point noting that this should cause true worshippers to pray all the more as they see that “even ungodly wailings sometimes do some good.”^[v]  

It is worth noting that, in the case of Ahab, though evil, he acknowledged through his mourning that the God of Israel was real, had a legitimate case against him, as well as possessing the power to bring about judgment. If Ahab had been crying out to another god, however, we cannot be sure that God would have been so merciful.  Prayer is a practice common to most religions and, so common is it, that it has been noted that “one might, without much ado, write a history of religion by writing a history of prayer.”^[vi] In the exam room, a Christian physician will encounter those who may be receptive to the offer of prayer but who will insist on the prayers being made to their own particular deity. Desiring to be a source of comfort by being present with them in their times of anxiety or grief, it will be tempting for the physician to join with them in their time of prayer. Even though their prayers may contain the same emotive elements as those of Ahab, they fail to acknowledge the LORD as the only one who has power to help them. Rather, they seek help from false gods which is considered idolatry, an affront to God^[vii] and even likened to the worship of demons.^[viii]   No Christian should feel comfortable engaging in such an activity.

There will be other times when the physician will be confronted with a patient who seems to be making an attempt at prayer and yet they, too, are uttering but “empty phrases.” Bonhoeffer gave an example of this when he recounted an incident which took place during a bombing raid on the concentration camp he was being held in.  ‘As we were all lying on the floor yesterday, someone muttered “O God, O God”- he is normally a frivolous sort of chap- but I couldn’t bring myself to offer him any Christian encouragement or comfort.  All I did was to glance at my watch and say: “It won’t last any more than ten minutes now”.’^[ix] Bonhoeffer had concluded that the man was not truly praying, he was merely reacting in fear with words  that had no more significance to him than if he had said “oh my goodness!” The only comfort that Bonhoeffer could offer him was the hope that the raid would soon be over.   

Reflecting on Bonhoeffer’s experience Philips says: 

I do not know why some people have relied on such examples to prove that there is ‘a spark of divinity’ in all men.  Fosdick, for instance, claims that in such prayers uttered in times of distress, though they are far from Christian prayers, one sees the urge to pray which is latent in all men…But what do these prayers amount to?  One would have to know more about each case before one could answer that question, but it is sufficient for my argument to show that unless prayers play a certain role in the person’s life after the crisis is over, they are not characteristic of the religious role of prayer in the life of the believer.  These prayers are far nearer superstition: kissing a rabbit’s foot or touching wood.^[x] 

The language of “Our Father” indicates that true prayer is far from a desperate act of superstition but has as its center a relationship between the pray-er and the God to whom the prayer is offered.  As Barth notes: “Prayer as a human act cannot be a gossiping, a series of phrases or mumblings…prayer must be an act of affection; it is more than a question of using the lips, for God asks the allegiance of our hearts.  If the heart is not in it, if it is only a form which carried out more or less correctly, what is it then?  Nothing! All prayers offered solely by the lips are not only superfluous, but they are displeasing to God; they are not only useless, but they are offensive to God.”^[xi]

This does not mean, however, that the opportunity to commune with them in their time of need is lost. Barth makes the intriguing argument that this is a chance for Christians to pray on their behalf and, in so doing, both commune with the world and join Jesus in his work of praying for them:        

But even while we are in the communion of the saints, in the ecclesia of those who are brought together by Jesus Christ, we are also in communion with those who do not yet pray, perhaps, but for whom Jesus Christ prays, since he prays for humankind as a whole.  It is the object of this intercession, and we ourselves enter into the communion with the whole of humanity.  When Christians pray, they are, so to speak, the substitutes for all those who do not pray; and in this sense they are in communion with them in the same manner as Jesus Christ has entered into solidarity with sinners, with a lost human race.^[xii]

Here Barth not only encourages us to lead others in prayer, but he also touches on the question as to why we should pray.

 In the Lord’s Prayer, Jesus instructed his disciples to pray that the Father would provide them with their “daily bread.” Immediately afterwards, however, Jesus tells them to not be anxious about what they should wear or eat for, “your heavenly Father knows that you need them all. But seek first the kingdom of God and his righteousness and all these things will be added to you” (Mt 6:32-34). Seeing that God knows what we need and is so desirous to provide these things to us, one would be forgiven for asking “Then why must we pray at all?”

Augustine wrestled with this and concluded that to ask that question is to misunderstand prayer. Prayers serve not to inform God of our needs but, instead to inform ourselves of our spiritual state.  They reveal to us the strength of our desires and prove to be demonstrations of our spiritual progress. In this way, prayers actually serve as a tool to admonish us when we are spiritually weak.  On the other hand, when we witness God’s answering of our prayers, we are spurred on to grow in our faith and pursue him all the more diligently.^[xiii] If Augustine is correct, then that would certainly inform the way in which a physician might approach prayer in the clinic. Diagnosis and treatment of the soul rather than the body would be the primary concern. A physician would find that their willingness, or lack thereof, to pray, as well as the content of the prayers themselves, as barometers of their own spiritual life and a part of their own spiritual development. They would also understand the prayers to be primarily a tool for the admonishment or encouragement of believing patients and for evangelism to the unconverted. This would seem to fit well with Paul’s concern in 1 Timothy 2:1-7 that prayers would be said in light of God’s desire that all would be saved. But is this all there is to it?

Aquinas agreed with Augustine that the purpose of our prayers was not to inform God of conditions or needs that he is unaware of. But he diverged from Augustine by positing a scenario in which God has already determined what will happen in this world as well as the means by which these things will happen. The events he refers to as “effects” and each effect has a “cause.” Aquinas argued that God has predetermined the effects and also what their causes shall be. Some effects are brought about by “natural causes.” Other effects will have as their cause the prayers of his people. Quoting Gregory, he says that we pray "that by asking, men may deserve to receive what Almighty God from eternity has disposed to give."^[xiv] Stanley Grenz echoes this understanding of prayer writing,

God wants to act in the world. But in certain areas God has decided not to act apart from prayer. Or, to restate the point positively, God has decided that the needed divine action will come only in response to prayer. In this sense, O Hallesby was surely correct when he wrote, ‘God has voluntarily made Himself dependent upon our prayers.’^[xv]

If they are correct, then that adds a touch of urgency to the prayers said within the clinics and the hospitals. If it is possible that God has determined that the effect of healing will come via the cause of the prayers of the faithful, then a Christian physician would be hard pressed to justify a lack of prayer in their daily practice. It is important to note that Aquinas does add that the act of prayer is not only about “causes” and “effects.” He writes that prayer is “moved by the will of charity” as we, first, seek to be united to God and, secondly, connected to those whom we pray.^[xvi] But is Aquinas right?

Eleanor Stump is not so sure. Responding to Aquinas’ argument, she writes, “Now surely, there can be no doubt that according to Christian doctrine, God wants men to pray and answers prayers; and consequently it is plain that God’s plan for the world includes human prayers as causes of certain effects.  The difficult lies in explaining how such a doctrine makes sense.  Why should prayers be included in God’s plan as causes of certain effects?”^[xvii]

Stump offers a solution of a different sort. She begins with the biblical notion that God loves humankind and desires to be loved in return. Corresponding to these desires, God is determined to experience something along the lines of a true friendship with humankind. This goal is made difficult by the fact that God is omniscient, omnipotent and perfectly good while people are not.  This difference between them opens up the possibility of two dangers.  The first is that the person will be so overcome by God’s superiority that they will dispense of any notion of having their own will and desires but will, instead, become but a slave seeking to replicate God’s personality. The second danger is that of becoming spoiled and self-indulgent because of their connections to the Almighty. Either way, true friendship would be difficult to come by.  The manner in which these dangers are avoided is through prayer.  When someone must ask for what they want, they are acknowledging that God is not an “interfering God” and will not impose upon them anything apart from their requests. In this way, they are protected from being overwhelmed by him and are free to be themselves. In addition, when there is no certainty that they will actually receive what they ask for, they are guarded against being spoiled. She comments, “God must work through the intermediary of prayer, rather than doing everything on his own initiative for man’s sake. Prayer acts as a kind of buffer between man and God.”^[xviii] If a physician were to embrace Stump’s scenario prayer in the exam room, while seeking for the healing of an ailment, would be concerned primarily with the relationship between the pray-er (and the pray-ee) and God. A physician might introduce the offer of prayer by encouraging the patient that God desires to befriend them and that prayer is a means by which such a friendship can be nurtured or begun.

Murray and Meyers also believe that prayer serves to guard believers from certain dangers.  Like Stump they argue that if all that we need and desire was provided for us apart from prayer we would take it all for granted.  In this case, rather than expressing gratitude to God for what we have, we would, instead, “degenerate into a pampered silence or, worse, contemptuous indifference.” ^[xix] By making God’s provision dependent upon our prayers, God insures that we recognize our dependence upon him and respond with the genuine gratitude he is due.  Murray and Meyers anticipate the question as to how this could possibly be fair for those who do not believe in God and, therefore, do not recognize the role that prayer plays in the provision of their daily needs. They respond that the provision that God makes for our daily needs serves differing ends for those who believe than those who do not. For those who do not believe, God could not possibly expect them to benefit in their understanding of him by his withholding goods from them. His provision for their needs, despite their lack of prayer, however, might be what leads them to faith.  Believers, on the other hand, must pray for their daily bread.  In this way, as they witness the dynamic of their prayers being directly answered by God, their faith is cultivated and grown.^[xx] There are certain similarities in the approach of Murray and Meyers with the others we have considered. The prayers of a physician for the healing of believing patient would have, as its primary goal, their encouragement in the faith. While it may seem that prayers for unbelievers are not necessary, it is implied that prayers would be commended in the hopes that they would see a correlation between their improved health and the prayers of their physician which would, in turn, lead to their coming to the faith.

Philip Clements-Jewery feels that arguments such as those of Murray, Meyers and Stump are not ultimately helpful in that they don’t adequately address questions such as “Why would God withhold a good from someone until they are prayed for by another?”  He answers that the solution is found in God’s desire for a universe that reflects the unity of the Godhead. So valuable to him is the unity between himself and humankind as well as the unity among the members of humankind, that he determined prayer to be great unifier. Prayer aims “at producing more fully personal human beings in communion with one another and with God. It is thus a prime instance of faith working through love.”^[xxi] In the clinic setting, then, prayer becomes an opportunity to become “one” with the patient as they engage in a spiritual journey to become unified to God.

While these are only a few of the many attempts to understand the purposes and motivations for prayer, there is an important common thread which runs through all of them. Each make the point that prayer is not only, or even primarily, motivated by the desire to receive things from God (or, from his perspective, to provide things to people).  Rather, the goal of prayer has ultimately to do with the formation and strengthening of relationships. Even though each of the theorems differ in the particulars, their overarching concerns accurately reflect what we find reflected within the Scriptures. Repeatedly in the Psalms, we find the prayers of the author followed by a response by God which results in a deepened relationship between the two.  A few examples are worth noting.  Psalm 3 presents David declaring “I cried aloud to the LORD, and he answered me from his holy hill. I lay down and slept; I woke again, for the LORD sustained me. I will not be afraid of many thousands of people” (3:4-6a). In Psalm 4 David says “the LORD hears when I call to him…you (God) have put more joy in my heart than they have when their grain and wine abound. In peace I will both lie down and sleep; for you alone, O LORD, make me to dwell in safety” (4:3b, 7-8). In Psalm 27:7-8, the Psalmist asks the LORD to hear his prayers and God responds with a relational request: “Hear, O LORD, when I cry aloud; be gracious to me and answer me! You have said, ‘Seek my face.’ My heart says to you, ‘Your face, LORD, do I seek.’” 

Turning the New Testament, we find the prayers that were lifted up by Paul, for example, consistently had at their center an expression of his concern and love for those about whom he prayed. A clear example is seen in his address to the church in Philippi: “I thank my God in all my remembrance of you, always in every prayer of mine for you all making my prayer with joy, because of your partnership in the gospel from the first day until now” (Phil 1:3-5). Similar expressions of love can be found in his greetings to the churches of Corinth, Ephesus, Colossae, and Thessalonica. In each instance his prayers are motivated by and are expressions of his love for the Christians he was addressing.  We not called to pray only for fellow believers, however.  As we have seen in 1 Timothy 2:1, Paul urges that prayers be made for all people. These prayers include prayers of “thanksgivings” on their behalf with the motivation that God “desires all to be saved” (2:4). We would conclude that “all people” would include the enemies that Jesus called us to pray for as well. The desire would be that they would cease to be enemies and become brothers or sisters. To pray for another is to invite them into a relationship for which you are thankful. A part of our bearing the image of the Triune God is the desire to live in community with others.  As such, an invitation from others to unite with them is generally responded to in a positive manner. Studies have shown that up to 81 percent of patients say that the relationship between them and their physician would show a significant improvement if the physician would engage them on a spiritual level. ^[xxii] This should not be any surprise as our praying for them is demonstration of the fact that we are willing to carry their burdens before the LORD. A consideration of our role as members of the priesthood of believers is helpful here.

[i]Martin Luther, “An Exposition of the Lord’s Prayer for Simple Laymen,” in Luther’s Works, Eds. Jaroslav Pelikan and Helmut T. Lehmann,  (St. Louis: Concordia Publishing and Philadelphia: Fortress Press, 1955–1986) 42:21.

[ii] Martin Luther, “Personal Prayer Book,” in  Luther’s Works, ed. Jaroslav Pelikan and Helmut T. Lehmann (St. Louis: Concordia Publishing and Philadelphia: Fortress Press, 1955–1986), 43:12. 

[iii] Andre van Oudtshoorn, “Prayer and Practical Theology,” International Journal of Practical Theology: Berlin 16:2 (2002): 291.

[iv] Abraham Kuyper, The Work of the Holy Spirit, trans. Henri De Vries (Chattanooga: AMG Publishers, 1995), 666.

[v] John Calvin, Institutes of the Christian Religion, ed. John T. McNeill, trans. Ford Lewis Battles (Philadelphia: The Westminster Press, 1960), 871.

[vi] Quoted in Friedrich Heiler, Prayer: A Study in the History and Psychology of Religion, ed. and trans. Samuel McComb (New York: Oxford University Press, 1932), xvi.

[vii] Ex 20:3-5; Lv 19:4; Is 45:20; 1 Jn 5:21

[viii] 1 Cor 10:19-20

[ix] Dewi Philips, The Concept of Prayer (London: Routledge and Kegan Paul, 1965), 116.

[x] Ibid.

[xi]Karl Barth, Prayer, 50^th Anniversary Edition, ed. Don E. Saliers, trans. Sara F. Terrien (Louisville: Westminster John Knox Press, 2002), 20.

[xii] Ibid., 23.

[xiii] Augustine, “Letter 130,” in  Nicene and Post-Nicene Fathers, First Series, Vol. 1, ed. Philip Schaff. (Peabody, MA: Hendrickson Publishers, 2004), 465.

[xiv] Thomas Aquinas, The Summa Theologica of St. Thomas Aquinas, trans. Fathers of the English Dominican Province. (Online Edition, New Advent CD-ROM Version 2.1), 2.2, q.83, a.2.

[xv] Stanley J. Grenz, Prayer: The Cry for the Kingdom, rev.ed. (Grand Rapids: Wm. B. Eerdmans Publishing Company, 1988), 51.

[xvi] Aquinas, 2.2, q. 83, a.1.

[xvii]Eleonore Stump, “Petitionary Prayer,’ American Philosophical Quarterly, Vol. 16, No. 2 (April 1979), 86. https://www.jstor.org/stable/20009745

[xviii] Stump, 90

[xix] Michael J. Murray and Kurt Meyers, “Ask and It Will Be Given to You,” Religious Studies  316.

[xx] Ibid., 318.

[xxi] Philip Clements-Jewery, Intercessory Prayer: Modern Theology, Biblical Teaching and Philosophical Thought (Aldershot, England: Routledge, 2005), 109.

[xxii] H. Koenig, Spirituality and Patient Care, 499, 501.