August 26th, 2010
08:45 AM ET

Docs' beliefs affect end-of-life care

If you think your beliefs are the only ones that affect your health care, pay attention to this: A doctor's own religious practice can become quite relevant to patient care, especially when end-of-life issues come into play.

A new study finds that doctors who are not religious are more likely to take steps to help end a very sick patient's life, and to discuss these kinds of decisions, than doctors who are very religious.

The study, published in the Journal of Medical Ethics, surveyed more than 8,500 doctors in the United Kingdom across a wide range of specialties such as neurology, palliative care, and general practice.

Researchers asked doctors about the last patient whom they had worked with who had died. The doctors answered questions about their own religious beliefs and ethnic background, as well as end of life care - did they give continuous deep sedation until death to the last patient who had died? Did they discuss decisions with the patient that would likely shorten the patient's life?

The study found that the strength of a doctor's religious faith is related to the incidence of continuous deep sedation until death, confirming findings of previous research. Researchers also found that a doctor who reported being "very or extremely non-religious" had an increased likelihood of taking these kinds of decisions to end a patient's life.

Doctors who said they were very religious were less willing to discuss decisions expected or partly intended to end life, the study found. This result corroborates what a 2007 New England Journal of Medicine study found: That more religious doctors are less likely to believe that they should give the patient information about procedures to which the doctors held moral objections.

Given that several studies have found similar patterns among religious and non-religious doctors, it's important for patients to find physicians who share their own values, said Paul Wolpe, bioethicist at Emory University, who was not involved in the study. But don't assume that just because a person comes from your ethnic background or faith that he or she shares all of your beliefs, he said.

It's important to have a health care surrogate who can make decisions for you in case you are in a critical health situation in which you can't speak for yourself, Wolpe said.

Is it a problem that doctors don't leave their religious beliefs at home? Some would argue yes, but Wolpe doesn't think so. The greater issue, he says, is finding a good fit between the desires and beliefs of patients their doctors.

"That’s more important than trying to achieve some unachievable ideal of all physicians behaving and believing the same way about controversial issues," he said.

What do you think? Share your thoughts in the comments.

soundoff (245 Responses)
  1. RGbrainstorm

    There is only one rational answer to the findings of these studies: DUH!!!! I can't believe people wasted time and money studying something that is so stupendously obvious, when there are many important things to be studied. If these researchers have any talent, they should be using it to do some good in the world and contribute to society in a meaningful way.

    August 26, 2010 at 11:59 | Report abuse | Reply
  2. John N Florida

    How is a Doctor who is Theologically Challenged any better or worse than a Doctor who is an Alcoholic? Neither is capable of providing the best Medical Care their 'customer' deserves. And make no bones about it, you, the patient, are the customer.
    Despite their 'God Complex', which is all too prevalent in the profession, Doctors are purveyors of services just like the Gas company or the grocery store.
    If a Doctor's theology prevents him/her from providing the best scientific practice available, s/he should disclose that just like the warning on a pack of cigarettes.
    I wouldn't presume to ask a devoutly Catholic Doctor to perform an abortion for me. At the same time, I would expect that same Doctor to inform his prospective patients that his gynecological practice is limited in scope.
    Pilots are not permitted to fly aircraft for which they have not been trained. Their license clearly states the types of aircraft they are competent to operate.
    Doctors should make full disclosure of the limits on their practice based on their theological convictions.

    August 26, 2010 at 12:00 | Report abuse | Reply
  3. Prometheus

    Re. end of life care.
    The mother of a friend of mine used to say that, when it come to end of life care, we treat our pets better than our relatives.

    August 26, 2010 at 12:10 | Report abuse | Reply
  4. clark1b

    that is why I would prefer a Christian doctor. Christ has told them to love others and take care of others. And yes, if they have integrity ... their beliefs effect every area of their lives ... they won't pidgin hole their religion into something that they only take out to display to others when they need something. Christians are less likely to give up on me, they are less likely to commit euthanasia on my grandmother, they are less likely to dismiss my concerns, they are less likely to abort my child .....

    August 26, 2010 at 12:14 | Report abuse | Reply
    • KDW

      The article never said they forced any one to speed death. It said they discussed the options and were willing to use them. If you want your grandmother to suffer terribly until she dies then good for you. I think however it is more appropriate that her doctor tell her all her options and let her make a decision for herself. I think what some people would truly want would surprise you.

      August 26, 2010 at 12:17 | Report abuse |
    • Nonimus

      ... and, apparently, less likely to put your needs and wishes before their own beliefs.

      August 26, 2010 at 16:09 | Report abuse |
  5. Paul

    Not surprising, who else would be greedy enough to run up useless medical bills in the name of God.

    August 26, 2010 at 12:15 | Report abuse | Reply
    • brad

      Today I was asked for a ride by a woman on the street. I would rather not have since she was obviously stoned. In her condition, she thanked me in the name of Jesus and asked for a couple of bucks to get something to eat.
      This is only a real-life response to your somewhat testy comment.

      August 26, 2010 at 14:45 | Report abuse |
  6. Henry Miller

    "That more religious doctors are less likely to believe that they should give the patient information about procedures to which the doctors held moral objections."

    Withholding information from patients who need it is contemptible at best, and ought to be criminal. Docs are perfectly at liberty to adhere to any silly superstition that pleases them, but it's wildly inappropriate for them to to make those superstitions a factor in treating patients.

    August 26, 2010 at 12:16 | Report abuse | Reply
  7. Servant

    Hippocrates created the Hippocratic oath some ca. 450 BC. It prescribes boundary conditions for the ethical practice of medicine. It includes a commitment to never accelerate a patient's death and never conduct an abortion. Even 2500 years ago we humans understood and practiced ethics. Unfortunately, we understood and practiced ethics far better than we do today.

    There's nothing wrong with sedating a patient and ensuring their comfort, but doctors should heal and not hurt.

    August 26, 2010 at 12:17 | Report abuse | Reply
  8. Brickell Princess

    I will never trust my end of life care to a medical doctor. I would rather jump out of a plane and not open my parachute. I have already made arrangements for spiritual end of life care. It is not an alternative, it is a first choice! !

    August 26, 2010 at 12:18 | Report abuse | Reply
  9. usa48312

    Commandment #6: You shall not murder

    A new study finds that doctors who are not religious are
    more likely to take steps to help end a very sick patient's life,
    and to discuss these kinds of decisions, than doctors who are
    very religious... Consciously, this is Murder

    Life on earth is a short journey... after life is eternally.

    August 26, 2010 at 12:23 | Report abuse | Reply
    • Ituri

      No, thats called "medicine," and the practice thereof. Giving patients end of life care and ALL their options is the moral path for doctors, not restricting those options and care based on the doctors religious personal beliefs. If you advocate that a religious person withholding proper medical information is good, then you've no counter to any Hindu, Muslim, or ANY religion interfering with YOUR medical care either. Or do you only advocate for Christian perspectives on end of life care?

      August 26, 2010 at 12:39 | Report abuse |
  10. brad

    Apparently, religiophobes find it easier to mock the religious doctor than to do the lethal injections themselves.

    August 26, 2010 at 12:30 | Report abuse | Reply

    Not funny, but every argument that a Non-believing person presents or says is mentioned in the Bible. I would not waste anytime arguing with a hardened heart person that did not want to hear or care to know. Not worth it IMO, to be carried away in senseless comments.

    August 26, 2010 at 12:31 | Report abuse | Reply
  12. justanotheropinion

    End of life decisions are about as personal as it gets....and only to the very person whose life is ending. All terminal patients should have the right to die in any manner they wish. After all, it is their final goodbye. Doctor's should do whatever needs to be done to follow the wishes of their patients. If their religion does not allow them to do that, then maybe they should rethink the profession they chose.

    August 26, 2010 at 12:40 | Report abuse | Reply
  13. Sarah

    Doctors who refuse to appropriately treat dying patients should lose their licenses.

    August 26, 2010 at 12:44 | Report abuse | Reply
  14. Irma

    I think a person should go with a doctor that has similar beliefs to their. I personally wouldn't only want a doctor that's regilious but one that totally believe that there is a God and that God is in total control of ous lives. Have mercy Lord on those that don't belief that they should have a God fearing doctor taking care of their medical needs.

    August 26, 2010 at 12:49 | Report abuse | Reply
    • Ituri

      "Have mercy Lord on those that don't belief that they should have a God fearing doctor taking care of their medical needs."

      You can save the false pity. I would no more want a religious doctor in your preference than you would apparently want an athiest doctor. The point is that regardless of religious leaning, medicine is medicine and the patient should not be limited by the doctors belief system. If I were to have a "God fearing doctor taking care of" my medical needs, I would find it obnoxious and appalling, especially if my situation were grim, for him to peddle his faith instead of medical knowledge that might even slightly improve my situation. If you can't understand this point, all the more reason it must be stressed, lest we suddenly have a legal tenant that doctors must be Christian to practice medicine in this country... much like Christians set up the political situation in this country already, so don't think it wouldn't happen if you could swing it.

      August 26, 2010 at 13:00 | Report abuse |
  15. sisco

    I am a medstudent with countless hours in Emergency Room settings. I have witnessed the toll these kind of decisions take on a doctor. They are an incredible burden. Most of you are quick to judge and give ignorant opinions saying things such as, "The doctor should act more professional and learn how to separate his religion and his vocation." This is true, however, a doctor is but a human. He too feels for his patients and cares for them. Most of the time, the doctor is not acting out of his own religious beliefs, he is acting out of his medical duty. "Primum non no cere" is the oath doctors must live by. This means, "Do no good if it causes more harm." Being a doctor is a great responsibility. Before you judge him, please, attempt to understand his position.

    August 26, 2010 at 12:50 | Report abuse | Reply
    • Pego

      The point of much of this kerfuffle is that these "Religious" doctors are taking the whole thing upon themselves and are NOT informing their patients, NOT sharing a patient's OWN decisions WITH THAT PATIENT. The problem is not that these people are religious, nor that they struggle with these decisions, but that they have the criminal hubris to take that away from the patient. This is why new laws are coming into being to require informing patients fully. Yes, sometimes a doctor has no way of informing and consulting with a patient and must take this decision upon themselves. What now of so many of these doctors who choose to take MORE of these decisions. That is not care, that is a god complex.

      August 27, 2010 at 20:36 | Report abuse |
  16. Mike

    There are those who say people should leave their religious beliefs at home. Others have ased, 'if your god is so great, why are you afraid dying?' People wh are truly religious, thei faith and its tenets are an integral part of who they are and hw they live. Most valid religions stress the importace of placing God and His wishes first and foremost. Religious freedom was never intended by the founders to be limited to the church building or one's home. Rather, it pertains to the right to worship, practice, obey and behave in accordance wth one's religous beliefs anywhere, under all circumstances, in any context. Part of those religious beliefs for most people include the firm conviction that God is author and giver of life and, therefre, only He as the authority to take it. Part of the reason the world, partiularly the west, is in the present circumstances is that we have sought to compartmentalize our lives such that religious belief and practice is frowned upon f not denied even in private let aone public contexts.

    August 26, 2010 at 12:51 | Report abuse | Reply
  17. Joe Obvious

    Docs' beliefs affect end-of-life care...


    August 26, 2010 at 12:55 | Report abuse | Reply
  18. AshannaK

    When you mix religion/belief with profession occupation, you run into trouble. The birth control pill was originally meant to help regulate a woman's period. Now it's something that can cause you to be excommunicated. What does a doctor do when his patient is in extreme pain and giving medication that would end the pain would also end the life? Does the doctor administer the medication knowing what it might do or does he or she stand by and watch the patient suffer? When my time comes, I hope my wishes will be followed, that I am not resusitated, that I am not given any extraordinary care that would perlong my life if said life would only mean that I'm a vegetable, that I am made pain-free, even if it means giving me extra medication that might – and I say 'might' – end my life. I am the one who must answer for my decision. My doctor and my family shouldn't have to.

    August 26, 2010 at 12:59 | Report abuse | Reply
  19. Tricia Warner, MD

    As a Christian and a Physician, I find it easier to discuss end of life issues with patients. I have served as Medical Director for our county hospice. It also gives me a chance to witness and comfort patients with the love and teachings of Jesus.

    August 26, 2010 at 13:05 | Report abuse | Reply
    • Michelle

      Tricia, it's lovely for you that you get to comfort fellow Christians during end-of-life care, but what about your patients who aren't Christian, and who don't want the STRESS of having someone preach to them during their last days? Do you give them dignified care, without the trappings of religion, or do you still try to push your views into the care you provide? I'm not only talking about atheists, as so many people here seem to think, but also people with other religions. Do you try to convert them? Push your religion over theirs? Or do you simply offer the best patient care and compassion you can provide, including ALL legal options for end-of-life care, regardless of your patient's religion?

      August 26, 2010 at 13:39 | Report abuse |
    • brad

      @ Michelle: what you are doing is suggesting the doctor act against her own beliefs and instead act according to yours. Do you irreligious people want Christians to show integrity only when it suits you? You should also consider that it is on the doctors conscience (I think we know what that is) and not yours. Perhaps you should do the injections and let people act according to their own beliefs – a right which you demand for yourself.

      August 26, 2010 at 14:16 | Report abuse |
    • Nonimus

      I would suggest the doctor act according to the patients beliefs and wishes, not his or her own.

      August 26, 2010 at 15:47 | Report abuse |
  20. AshannaK

    I have to add another word, this tim to HisNameBePraised: I can't help but think that had you be raised by a Christian or Jewish family that your faith would be as theirs. You believe in Allah. Yet if you REALLY believe, you would see and understand that Christians, Muslims, and Jews FOLLOW THE SAME GOD. They only address Him differently. No one, except God, has a monopoly on truth. That is left to the Father of us all. We, His children, are imperfect and are striving to be as He would wish us to be. True believers, whatever their faith, will follow the wishes of their god and will recognize ALL as brothers and sisters, children of that God.

    August 26, 2010 at 13:05 | Report abuse | Reply
  21. Brian

    I wonder how many of these "religious" doctors are sincere in their "deep" beliefs. I have seen these holy doctors perform heroic operations on very elderly patients – and the patients died a day after the operation. I somehow suspect that if we took the financial incentive out of this that the situation would change and it would change very abruptly. Religion in this country is a mile wide and an inch deep.

    August 26, 2010 at 13:14 | Report abuse | Reply
  22. Nina

    This is not a Christian or non-Christian debate. This is about having a relationship with your physician. If you don't have one, work on it. Tell your doctor what you want. Remember, the doctor is not a god, they are hired help with a lot of education. Stop treating them as if they know everything and are mind-readers.

    August 26, 2010 at 14:07 | Report abuse | Reply
  23. vel

    I wonder, should we require doctors to declare their philopophical views on their "shingle" and if they will or will not try to force their own choices on their patients?

    August 26, 2010 at 16:02 | Report abuse | Reply
  24. Ally

    As a health professional, I would like to clarify the meaning of "end of life care". End of life care, otherwise known as "palliative care" is put into place when a patient is terminally ill. The goal of end of life care (palliative) is not to "cure" the patient, but simply to make them as comfortable in their last days as possible. How a doctor might go about making a patient "comfortable" could vary, however, pain management is key. End of life care is not the same thing as euthanasia. Patient assisted suicide was requested of Dr. Kevorkian by clients who would not qualify as being "terminally ill."

    August 26, 2010 at 16:17 | Report abuse | Reply
  25. gubba

    So funny... not only is a doctor not supposed to make money, be at your beck and call 24/7 and sit down for hours on end listening to how firm your your bowel movements are, now they are supposed to discuss their religious beliefs with you all in 15 minutes vist. Given the shortage of Docs these days, good luck finding "Dr Right" Also, here is a news flash everyone, EVERYONE DIES, its built into the system. Mr Death doesnt give a crap what god you pray to, we all end up in the same place. So dont be shy about being DNR – you will save yourself some broken ribs and needle sticks when your time comes

    August 26, 2010 at 16:35 | Report abuse | Reply
  26. Xtine

    That the patient doesn't receive the information about the option is the absolute worst thing that could happen to a patient and family, and yes, there is no guarantee that the doctor is going to be entirely forthcoming with you, especially if it is someone you have not had a lot of dealings with – you just can't tell what he or she is going to do. I have often wished there was a mediating presence in these situations, an open minded family advocate. I've seen people die in agony from terminal diseases because the doctor did not want the patient to "become addicted", ha ha. Sick.

    August 26, 2010 at 16:57 | Report abuse | Reply
  27. Liz

    This is a very important discussion to have. It had not occurred to my family that my mom's doctor would not prescribe palliative care during her last hours, and she died in a great deal of pain. One of my greatest regrets is that we didn't find another hospital while it was still possible to move her. We got the "she could become addicted" story and heard that it was immoral to reduce her life by a few hours.

    August 26, 2010 at 20:08 | Report abuse | Reply
  28. Liz

    This is a very important discussion to have. It had not occurred to my family that my mom's doctor would not prescribe palliative care during her last hours, and she died in a great deal of pain. One of my greatest regrets is that we didn't find another hospital while it was still possible to move her. We got the "she could become addicted" story and heard that it was immoral to RISK reducing her life by a few hours. The issue was whether or not morphine was appropriate.

    August 26, 2010 at 20:15 | Report abuse | Reply
    • Despr8Caregiver

      I'm so sorry this happened to your mother Liz. Palliative care should be available to all patients at any point in their illness and does not preclude also receiving medical treatment. It differs from hospice care in that regard. It is hard to understand why a doctor would prefer his patient to die in agony. I hope you have reported him to his State Board or whatever regulatory agency he is governed by.

      August 26, 2010 at 21:47 | Report abuse |
    • anne

      It seems religious beliefs still pervade every part of our lifes and laws whether we want it to or not. When will these archaic notions give way to logic? How sick is it to deny a dying person relief from pain just because of some vague notion that maybe it's a 'sin'?

      August 27, 2010 at 08:19 | Report abuse |
  29. Steve

    As a physician, I feel it is important that if a physician will not provide care to a patient because of the physician's personal beliefs, then that physician is obligated to inform the patient about that care, and refer the patient to another physician who will provide that care. Unfortunately, I have debated this with physicians who disagree.

    August 26, 2010 at 20:38 | Report abuse | Reply
  30. anne

    This article is mostly discussing sedation in end of life issues, though they aren't doing a good job of articulating that. The main problem seems to be that very religious doctors are afraid of using adequate pain meds even on someone who they know is about to die, for fear of 'speeding up' death. The less religious doctors are more concerned with keeping the dying patient pain free, even if it might mean they'll die somewhat sooner. It seems like torture in the name of religion if you ask me.

    August 27, 2010 at 08:14 | Report abuse | Reply
  31. mabel floyd

    i spent 16 years in hospice work–both teaching and practicing - believe me it is most important to have a talk with your doctor and doctors caring for a close family member. it definitely makes a huge difference in pain control. dying in a more comfortable state or in painful state-big difference. i do not know why more supposed christians think that prolonging the dying state brings one closer to God. a painful death without dignity has no grace. talk to your doctor. do you really think he wants to die in pain? do you really think he would withhold pain meds to his wife and mother? some people say you can not interfere with God,s plan. rubbish-everything we do in medicine changes the path of illness. God did not bless man with a brain to use as a decoration.

    August 27, 2010 at 10:41 | Report abuse | Reply
  32. Crayg

    Note to self: find atheist hospitals.

    August 27, 2010 at 13:41 | Report abuse | Reply
  33. Canonscottage

    My primary care physician talk easily about end-of-life issues - I'm a Christian clergy person and he defines himself as Christian but not connected w/a church. His observation over 15 years in practice is that those individuals and families who identify as "committed Christians" tend more to want mother to be kept alive at all costs; those who identify as "Christian" but without any attachment to a congregation or no particular faith seem to be more open to discussing the reality of the situation and have a sense of when it's time to "let go." I would have expected the opposite - my faith is that death is part of life and it's OK.

    August 27, 2010 at 19:18 | Report abuse | Reply
  34. Edu

    Look, maybe there are a lot of post already, but I want to espress that Doctors have to stay firm to waht the patient or his/her family want. Maybe I'm religious, yes in fact I am, but just think about it. If it would be your case which option you'll take in case you could. Sincerely I wouldn´t want to die by my doctor. I mean is not good to be killed, who gave the authority to the doctors to kill their own patients at will.

    August 30, 2010 at 20:53 | Report abuse | Reply
  35. Oliver Katt

    The two most destructive forces on this planet, now and since the dawn of mankind's descent from the trees, have been religion and nationalism. If we could get rid of both of them, we'd have a peaceful planet devoid of hate and war.

    September 6, 2010 at 10:39 | Report abuse | Reply
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    corect sorakaaya anakaayva evainaa elaa tinaalo alaane tinaali.anni padaardhaalu sareeraaniki kaavaali antay kaani pachhevi tinaali ,oil lekundaa tinaali ani chepatam puurtigaa avivekam.maa vullo okadu visham taaginaa batikaadu atlaa ani visham taagi andaruu batakaleru.kaavunaa pasuvulu anni pachhigaa tintunnai kaabatti manushulu alanay tinaali ani cheppay vaariki idi manchi vudaahaarana.

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