Up for Debate: Religion’s Impact at End of Life

You’ve probably read about the study published in the Journal of the American Medical Association (JAMA) that came out of the Dana Farber Cancer Institute in Boston.  The study found that patients who self-identified as religious were three times as likely to request more aggressive medical care as those who said they were not religious.  More aggressive care has no bearing on survival rates, by the way. 

 

The study got a lot of press because the findings were counterintuitive for some – wouldn’t you think that religious people would be more accepting of the end of life, and not choose the more aggressive route, while nonbelievers would be the ones to push for more aggressive care, and put their faith in the medical system?  The researchers suggest that religious patients believe in the sanctity of life and therefore want to stay alive as long as possible.  Alternatively, the additional medical interventions could be a “stalling” tactic to give God more time to work a miracle.

 

Clearly the study highlights that for many people, particularly at the end of life, religion is a significant factor in the healthcare decision-making process and for example, can influence whether or not they sign a DNR or end up in the intensive care unit.  While I’m not sure what to make of the study’s findings, the debate has branched off in interesting directions.  I happened to browse through the comments on the ABC news’ take on the study, and I was fascinated at the number and breadth of comments offered. 

 

Most of the posts seemed to be about how to approach death with many contradicting the study, and saying that as devout Christians, they don’t fear death and would not want to prolong their passing.  (Is the old joke true, that the fear of public speaking is worse than death?)  A significant number of posts were against the kinds of aggressive treatment at the end of life mentioned in the study, saying that these interventions decrease quality of life and cause unnecessary pain, suffering and financial issues for those left behind.  Others commented on the researchers’ definition of religion, saying that it was too broad and doesn’t capture the range of beliefs and practices of people who consider themselves of faith.

 

Do you think the study’s findings would hold true for you? Or does it match your experiences with a family member or friend at the end of life?

 

Just as an example, the New York Times has been doing an interesting series on Immigration. A recent article features Hennepin County Medical Center, a hospital in Minneapolis that is figuring out the cultural and religious nuances of treating their large numbers of Somali and Hispanic immigrants, among other communities.  The article mentioned a Muslim Somali patient who had refused to allow blood to be drawn because it was during the month of Ramadan.  He was concerned that having the blood work done would be a sin.  The doctors at Hennepin called an Imam who reassured the patient that drawing blood wasn’t a sin.  Hennepin was able to resolve the impasse in a way that was respectful of the patient’s religious beliefs.  I am impressed by Hennepin’s handling of the situation and left wondering, how many other hospitals would do the same?  Aside from end of life, which lends itself particularly well to discussions of religion and faith, there are countless other examples of ways in which practitioners need to be aware of patients’ religious beliefs and wishes.  Both patients and practitioners need to become more comfortable talking about religion as part of truly patient-centered care.

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