# Docs' Religion Tied to End-of-Life Care



## Ernest Nagel (Aug 26, 2010)

I suppose this should come as no real surprise?

http://www.medpagetoday.com/PublicHealthPolicy/Ethics/21889

*Docs' Religion Tied to End-of-Life Care*
By Todd Neale, Staff Writer, MedPage Today
Published: August 26, 2010
Reviewed by Zalman S. Agus, MD; Emeritus Professor
University of Pennsylvania School of Medicine and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner 

* Note that the medical population contains a higher proportion of people from ethnic minority backgrounds than the general population, particularly so for Asian and Asian British doctors.


* Point out, however, that ethnicity was unrelated, in general, to end-of-life decision-making.

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

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, PhD, 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.

"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 nonreligious 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 nonreligious outlook, may enter into their decision-making in end-of-life care."

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

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% versus 71.6%), but more likely to be Buddhist, Hindu, Jewish, or Muslim (P<0.0001 for all).

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

In multivariate analyses, physicians who reported being very or extremely nonreligious reported higher rates of using continuous deep sedation (OR 1.45, 95% CI 1.02 to 2.06), making a decision involving some intention to hasten the end of life (OR 1.83, 95% CI 1.35 to 2.48), and supporting the legalization of euthanasia (OR 5.47, 95% CI 4.04 to 7.40) compared with those who held strong religious beliefs.

Nonreligious physicians also were more likely to report having discussions about treatments that were expected to shorten life (P<0.0005).

"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, specialties were more likely to report making a decision expected to shorten life (ORs ranging from 6.46 for those who care for the elderly to 9.64 for "other hospital" specialities) and supporting the legalization of assisted dying (ORs ranging from 2.66 for those who care for the elderly to 4.45 for "other hospital" specialities) (P<0.0005 for all).

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


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