Professor Clive Seale: The role of doctors’ religious faith and ethnicity in taking ethically controversial decisions during end-of-life palliative care
I wondered why the BBC website was suddenly posing the question as to the relevance of a doctor’s religion and now I know why.
Professor Clive Seale has published some fascinating and quite disturbing research today over at the Journal of Medical Ethics which appears to confirm that atheist or agnostic doctors are twice as likely to take decisions that might shorten the life of somebody who is terminally ill as doctors who are deeply religious.
I can only access the Abstract free of charge, so here it is:
Background and Aims The prevalence of religious faith among doctors and its relationship with decision-making in end-of-life care is not well documented. The impact of ethnic differences on this is also poorly understood. This study compares ethnicity and religious faith in the medical and general UK populations, and reports on their associations with ethically controversial decisions taken when providing care to dying patients.
Method A postal survey of 3733 UK medical practitioners, of whom 2923 reported on the care of their last patient who died.
Findings Specialists in care of the elderly were somewhat more likely to be Hindu or Muslim than other doctors; palliative care specialists were somewhat more likely to be Christian, religious and ‘white’ than others. Ethnicity was largely unrelated to rates of reporting ethically controversial decisions. Independently of speciality, doctors who described themselves as non-religious were more likely than others to report having given continuous deep sedation until death, having taken decisions they expected or partly intended to end life, and to have discussed these decisions with patients judged to have the capacity to participate in discussions. Speciality was independently related to wide variations in the reporting of decisions taken with some intent to end life, with doctors in ‘other hospital’ specialities being almost 10 times as likely to report this when compared with palliative medicine specialists, regardless of religious faith.
Conclusions Greater acknowledgement of the relationship of doctors’ values with clinical decision-making is advocated.
And the moral of the story is if you or a loved one is facing an “end-of-life” situation, it may be prudent to find out your doctor’s views were on religious matters, as there appears to be a strong link between religious belief (or lack thereof) and clinical decision making.
UPDATE: More at the BBC, here and here (Radio interview with Prof. Clive Seal & Baroness Finlay)
ANOTHER UPDATE: Bish Nick Baines has now blogged on this.
AND ANOTHER: Michael Merrick of Outside In has also blogged this one in the style of a good ol’ fashioned BBC fisking.
Tags: Christianity, Education, News, Science & Medical
August 26th, 2010 at 2:14 pm
This is of particular interest to me. I’m a medical writer and have naturally had a lot to do with doctors.
I think attitudes have changed partly because medicine has changed. Palliative care is a lot more effective than it was: pain relief in particular has improved. This means patients can await death, as it were, relatively comfortably.
In previous generations there was often a stark choice between heavy sedation or conscious agony. Doctors often – maybe even usually – opted for heavy sedation .
Now the medical approach can be more nuanced. However there are still situations where the choice applies and, were I in that position, I would pray – devoutly – for a medic who would prioritise pain relief over a few more conscious agonising hours.
As you know, webmaster, terminal illness and the agony that accompany it are things I know too much about. If someone is already reconciled to God and aware that death is near, then I think all that matters is that they leave this world with as much dignity and as little distress as possible.
August 26th, 2010 at 3:54 pm
I am tempted to mention Mother Teresa here. What was it she said about pain being “the kisses of Jesus” therefore she did not believe in pain relief. An extreme example of course, but I think there is an element of this with many religious people.
August 26th, 2010 at 6:43 pm
Hmmm… “… quite DISTURBING research [...] which appears to confirm that atheist or agnostic doctors are twice as likely to take decisions that might shorten the life of somebody who is terminally ill as doctors who are deeply religious.”
From the abstract: “… doctors who described themselves as non-religious were more likely than others to report having given continuous deep sedation until death, having taken decisions they expected or partly intended to end life, AND TO HAVE DISCUSSED THESE DECISIONS with patients judged to have the capacity to participate in discussions.”
Yes… that is QUITE disturbing. It seems to suggest that doctors who ARE religious DO NOT discuss such decisions with their patients, which further suggests that many terminal patients are left to needless, prolonged suffering, in a hopeless situation…
Ah, yes… just as I suspected. In the BBC interview (link above), Professor Seale says that religious doctors are LESS LIKELY discuss such decisions with their patients.
You know, Mr. Blogger… if I were you, I’d consider revising my misleading warning, and instead, say something like: “… quite DISTURBING research [...] which appears to confirm that RELIGIOUS doctors are twice as likely to NOT honestly discuss your situation and give you the opportunity to knowledgeably participate in decisions that might reduce the unnecessary and prolonged suffering of somebody who is terminally ill as doctors who are NOT deeply religious.”
August 26th, 2010 at 6:47 pm
T’is a fair criticism DuckPhup.
August 26th, 2010 at 7:09 pm
@ Gordon: Not all Catholics take Mother Teresa’s position, thank God. But some do, and I’ve been told hospital staff’s hearts sink if certain types of Catholic became involved in the care of a dying patient. That sort of person is so obsessed with their own ethical position that they prioritise it over their duty to the patient, a duty I consider sacred.
To permit your patient to endure agony for the sake of your precious conscience is like a nurse refusing to touch a vomiting patient in case it soils her nice crisp uniform. I’ve heard from more than one medic that staff known to hold such extreme positions either don’t get jobs or, once employed, are sidelined into areas where they can do no harm.
A GP once gave me an example of choosing the correct ethical path. He had a dying patient who was so frail that coughing had broken several ribs. This caused immense pain. Opiates would relieve the pain but might also suppress her respiration with potentially fatal results.
The GP rang the chest physician for ethical and medical advice. His advice was unhesitating. The GP must use whatever dose was necessary to make the patient comfortable. “But what if this suppresses the patient’s breathing?” the GP asked. The physician said this was irrelevant. The doctor’s duty was to act in the best interests of his patient which, at this stage, for this lady, was limited to symptom relief. Euthanasia is illegal and killing people is wrong. That’s a given. However if the correct treatment resulted in the patient dying a little sooner than predicted, that should not be a consideration. It was the patient’s welfare that concerned them and neither the medical authorities nor any higher court would take issue with this decision.
The GP prescribed. The patient died eventually – as was inevitable – and the GP never knew whether the painkillers hastened this process or not. As a Christian, he said he felt entirely at ease with what he and the consultant had decided. I find the logic behind the decision entirely satisfactory.
August 26th, 2010 at 7:19 pm
The doctrine of double effect….I’ve come across this also…..
August 26th, 2010 at 7:21 pm
@ DuckPhup: I hadn’t seen your post when I posted, but your observation marries up rather neatly with mine.
It’s disturbing to think that very religious doctors are less likely to discuss end-of-life issues with their patients. It would seem to me that if a patient is dying and steps to make them comfortable may have the effect of slightly hastening the end, then a religious person should surely not see this is as a terrible consequence. Death for believers is not the end.
One might think that atheists would be the most determined to prolong life at all costs on the basis that this life is all there is.
August 26th, 2010 at 7:34 pm
@ webmaster: The doctrine of double effect. Thanks for that (and for the other thing). I didn’t know there was a name for it. It often comes up with the care of the dying.
August 27th, 2010 at 3:13 am
@ Sophie: There is an anecdote from the Cold War, describing a boxing competition between the USA and the Soviet Union. The Soviets were resoundingly defeated… but back in the USSR, it was reported that in an international boxing competition, the Soviets came in 2nd… and the Americans came in next-to-last. They neglected to mention that those two countries were the only teams in the competition.
I don’t know whether that tale is TRUE, or not… but that doesn’t really matter. What DOES matter is that the manner in which THIS story is presented brought it to mind.
August 27th, 2010 at 7:43 am
The abstract possesses the dubious attribute of being rather too easily interpreted according to the predisposition of the reader.
Without further detail it is hard to draw any firm conclusions. For instance, was account taken of the likelihood of the responses within some ethnicities or religions being less candid than others? I suspect not. For instance, one could envisage two doctors giving identical doses of morphine to an identical patient, but their action being perceived and reported by them quite differently.
August 27th, 2010 at 7:00 pm
I’m with DuckPhup and Sophie on this one.
Both Dr Seale’s comments on his research and the way it has been presented in some areas of the Press seem to hint at, or imply, that Doctors who are not religious are some how hastening the death of their patients… for *some* reason.
Personally I find those implications disgusting – that is to say: the people making such statements have no basis for making such accusations and should be ashamed of their attitudes.
As DuckPhup pointed out:
” It seems to suggest that doctors who ARE religious DO NOT discuss such decisions with their patients, which further suggests that many terminal patients are left to needless, prolonged suffering, in a hopeless situation…”
From this link:
http://www.usatoday.com/news/religion/2010-08-28-dying27a_st_N.htm
“To ensure doctors are acting in accordance with their patients’ wishes, Seale wrote that “nonreligious doctors should confess their predilections to their patients.” ”
Interesting choice of language by Dr Seale. What exactly needs ‘confessing’ ?