The doors we open and close each day decide the lives we live. ~Flora Whittemore
We spend our lives making decisions that will impact the rest of our days on this earth. We pick a career, select a mate, decide to have children and how many, make lifestyle choices that effect our health, move away from family, take in–or decide not to–ailing relatives, switch our careers. Our time here is defined by these ‘doors we open and close.’
And then, if faced with a terminal illness, we often come to have another decision, one that will no longer decide the life we’ll live, but rather the death we’ll face.
End-of-life choices are complex and painful, and many factors play into our final decision. But if we’re listing all the factors, I’ve got one that we wouldn’t have counted as part of our thought process.
Ready for my surprise factor?
Turns out the religiosity of the treating doctor may play a significant role in our end-of-life decisions.
Clive Seale of Queen Mary, University of London, ran a postal survey of 2923 English doctors, asking about their care of the last patient who died under their watch.
And what should he find, but that doctors who reported themselves as ‘very’ or ‘extremely’ non-religious reported
- Greater likelihood of having had discussions about treatments that would shorten life
- Higher rates of usage of continuous deep sedation
- Having more frequently made decisions involving some intention to hasten death, and
- A greater likelihood of supporting legalizing euthanasia.
In fact, these doctors were almost twice as willing to make decisions that might hasten death, when compared with their religious counterparts.
In stark contrast, doctors who reported themselves as religious were signficantly less likely to discuss end-of-life care decisions with their patients at all.
Seale’s results did not come out of a vacuum.
In 2004, Niel S. Wenger from UCLA School of Medicine and Sara Carmel, from the Center for Multidisciplinary Research in Aging Head in the Department of Sociology of Health and Gerontology at Ben-Gurion University in Israel, controlled for the variable of religion, in studying only Israeli Jewish doctors at four hospitals in Israel.
When the question arose about withdrawing sustaining treatment, a gap opened between religious and non-religious doctors:
[V]ery religious physicians were less likely than moderately religious or secular physicians to agree that there are circumstances in which a life-sustaining treatment should be withdrawn (11% vs.36% vs. 51%, respectively…). Consistent with this view, very religious physicians were much less likely to report that they had withdrawn life-sustaining treatment from a patient.
The very religious were also less likely to prescribe pain meds that would hasten death (69% vs. 80% moderately religious vs. 85% for secular), or to approve of euthanasia (5% vs. 42% vs. 70%).
Practices seem to boil down to this finding:
More religious physicians were more likely to report that their behavior in treating a terminally ill patient was influenced by their personal religious beliefs, the patient’s religious beliefs, and the belief that the physician has a duty to prolong life.
The question then arises: Does one’s end of life care depend on the happenstance event of the religiosity of the treating physician? And how can that be avoided?
Back to Dr. Seale, who wrote:
One potential response to the findings about the influence of religious faith is to suggest. . . that religious doctors disclose their moral objections to certain procedures to patients so that patients can choose other doctors if they wish.*
But really that begs the question of whose opinion is more ‘right’: the religious doctor’s or the non-religious one’s? Why should religious doctors be required to ‘out’ themselves, so to speak, as if the default option of what anyone would want is in the hands of a secular practitioner?
Seale himself seemed aware of the conflict. He added:
It is equally plausible to argue that nonreligious doctors should confess their predilections to their patients.*
What does seem clear, though, is that when it comes time for a person to make their final decision, and they’ve scrutinized their souls, looked deep into their hearts, consulted spouses, children, other loved ones–there’s still one factor they need to know will influence their decision, and it comes out of left field.
It’s the religious convictions of their doctor.
(*Both quotes taken from Neale’s article)
Neale T. Docs’ Religion Tied to End-of-Life Care at http://www.medpagetoday.com/PublicHealthPolicy/Ethics/21889
Seale C. The role of doctors’ religious faith and ethnicity in taking ethically controversial decisions during end-of-life care. Journal of Medical Ethics 2010; 36(11):677-682.
Wenger NS, Carmel S. Physicians’ religiosity and end-of-life care attitudes and behaviors. Mt. Sinai Journal of Medicine 2004; 71(5):335-43.