A new study from the UK suggests that doctors’ religious faith strongly influences end of life care, with agnostic and atheist doctors nearly twice as willing to take decisions that speed up end of life for very sick patients compared to their deeply religious peers.

Dr Clive Seale, a professor in the Centre for Health Sciences at Barts and The London School of Medicine and Dentistry, Queen Mary University of London, wrote about the findings in a paper published online 23 August in the Journal of Medical Ethics.

Data for the study came from a postal survey of UK doctors working in a range of specialisms where end of life decisions are most likely to occur, such as care of the elderly, palliative care, intensive care, certain hospital specialties, and general practice.

The survey asked participants questions about their own faith and religious beliefs, ethnicity, and views on assisted dying and euthanasia. It also asked them a series of questions about the care of their last patient who died (if relevant), including whether they had given them continuous deep sedation until death, and if they had talked to the patient about decisions judged likely to shorten life.

3,733 doctors responded to the survey (42 per cent of the total invited). Of these, 2,933 answered questions on the care of a patient who died.

The results showed that:

  • Specialists in care of the elderly were more likely to be Hindu or Muslim.
  • In contrast, specialists in palliative care were more likely to be Christian or white and to agree to the question asking them if they were “religious”.
  • However, overall, white doctors, the largest ethnic group, were the least likely to report having strong religious beliefs.
  • Doctors with strong religious beliefs were less likely to discuss treatments judged likely to end life with their patients.
  • On the whole, ethnicity was not linked to rates of reporting ethically controversial decisions, but it was linked to support for assisted dying or euthanasia legislation.
  • There was a strong link between specialty and reporting decisions that were expected or partly intended to hasten the end of a sick patient’s life.
  • Hospital specialists were nearly 10 times more likely to report such decisions than palliative care doctors.
  • However, doctors who said they were “extremely” or “very” non-religious were nearly twice as likely to report having made these kinds of decisions than peers who described themselves as having religious beliefs, and this was regardless of specialism.
  • There were only a few cases of the most religious doctors having made such decisions (ie expected or partly intended to hasten end of life), but those that did were also signficantly less likely to have discussed them with their patients than their less religious peers.
  • There was a similar pattern regarding support for assisted dying and euthanasia legislation.
  • Palliative care specialists and those with strong religious beliefs were the most strongly opposed to such legislation.
  • Asian and white doctors were less opposed than doctors from other ethnic groups.

Seal concluded that there is a need to acknowledge more strongly the links between doctors’ religious beliefs and values and the clinical decisions they make.

Some medical organizations and charities have expressed concern about the study’s findings, saying that doctors should put patient needs before their own beliefs.

Dr Ann McPherson CBE, a patron of Dignity in Dying, a charity that promotes the idea that people should have greater choice, control and access to high quality care at the end of life, said in a statement that the study results are a concern and that:

“Important decisions, on withholding and withdrawing treatment and/or on levels of pain relief, should always where possible be taken in conjunction with the patient, whose views are of paramount importance.”

She said the research shows there is still some way to go before we reach the standard set by the recent end-of-life decision making guidelines from the General Medical Council (GMC) , and “the fact that some doctors are not discussing possible options at the end of life with their patients on account of their religious beliefs is deeply troubling”.

“Whilst entitled to their beliefs, doctors should not let them come in the way of providing patient centred care at the end of life,” she urged.

The British Medical Association also said doctors should not allow their beliefs to influence decisions about patient care, which should be taken on the basis of individual assessment and include discussions with the patient and close family, if possible and appropriate.

“End-of-life decisions must always be made in the best interests of patients,” said the BMA, according to a BBC report.

“The role of doctors’ religious faith and ethnicity in taking ethically controversial decisions during end-of-life care.”
Clive Seale.
J Med Ethics, Published online 23 August 2010.

Additional sources: Queen Mary University of London, Dignity in Dying, BBC News.

Written by: Catharine Paddock, PhD