Doctors' Religion Tied to End-of-Life Care

Aug. 26, 2010— -- The religious beliefs of physicians who treat patients at the end of life appear to influence clinical decision-making, a British survey shows.

Physicians in the U.K. who reported being very or extremely religious were less likely to endorse certain end-of-life decisions, including continuous deep sedation and initiation of treatment that would be expected to shorten life, Clive Seale of Queen Mary, University of London, reported online in BMJ.

They were also less likely to report discussing such options with patients or to support the legalization of euthanasia.

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"One potential response to the findings about the influence of religious faith is to suggest, as others have done, that religious doctors disclose their moral objections to certain procedures to patients so that patients can choose other doctors if they wish," Seale wrote.

However, he continued, "It is equally plausible to argue that non-religious doctors should confess their predilections to their patients."

But regardless of religious faith, he concluded, "it would seem advisable that doctors become more aware of how broader sets of values, such as those associated with religiosity or a non-religious outlook, may enter into their decision-making in end-of-life care."

Past research suggests that a patients faith influences the type of care they request, but the ultimate outcome depends on a collaborative effort between both the patient and the doctor, according to Holly Prigerson, director of the center for psycho-oncology and palliative care research at Dana Farber Cancer Institute in Boston, Mass.

"Everyone talks so much about personalized medicine, and it's more than just genetic profiling and tailoring medicines," said Prigerson. "This study says personalized medicine means doctors are people too and their views strongly influence the care patients should get."

Seale mailed surveys to 8,857 British general practitioners, neurologists, elderly care specialists, palliative care specialists, and physicians from "other hospital" specialities; 42.1 percent responded.

Religion Influences Doctors' End-of-Life Decisions

Compared with respondents to the British Social Attitudes survey of the U.K. general population, the physician respondents were less likely to be Christian (51.6 percent versus 71.6 percent), but more likely to be Buddhist, Hindu, Jewish, or Muslim.

Although ethnicity was unrelated, in general, to end-of-life decision-making, degree of religiosity did appear to influence it.

According to the study, physicians who reported being religious were less willing to talk about what type of end of care decision they made for their patients.

"We all know how important it is to talk about the options with the patient or family in the options so they can have a realistic appreciation of what's available and what's provided," said Prigerson. "There is a problem with the lack of willingness to discuss it."

In further analyses, physicians who reported being very or extremely non-religious reported higher rates of using continuous deep sedation, making a decision involving some intention to hasten the end of life, and supporting the legalization of euthanasia compared with those who held strong religious beliefs.

Non-religious physicians also were more likely to report having discussions about treatments that were expected to shorten life.

"This is similar to the finding from a U.S. study, which found more religious doctors to be less likely to feel they should disclose information about procedures to which they objected on moral grounds (birth control for adolescents, abortion and 'terminal sedation' in dying)," Seale wrote.

A physician's specialty was associated with end-of-life decision-making as well. With the exception of physicians who identified their specialty as palliative care, specialist doctors were more likely to report making a decision expected to shorten life and supporting the legalization of assisted dying.

Patients Should Know Doctors' Values

Seale acknowledged that the study was limited by the low response rate and the reliance on retrospective recall and responses to fixed-choice questions.

Prigerson said that for patients, the study suggests that it's important to understand what other values may also influence a physicians decision.

"Knowing where your doctor is coming from and why they recommend a type of care can't hurt and can only help in making treatment decisions," said Prigerson.