The role of religious beliefs in ethics committee consultations for conflict over life-sustaining treatment

Abstract

Previous research has suggested that individuals who identify as being more religious request more aggressive medical treatment at end of life. These requests may generate disagreement over life-sustaining treatment (LST). Outside of anecdotal observation, however, the actual role of religion in conflict over LST has been underexplored. Because ethics committees are often consulted to help mediate these conflicts, the ethics consultation experience provides a unique context in which to investigate this question. The purpose of this paper was to examine the ways religion was present in cases involving conflict around LST. Using medical records from ethics consultation cases for conflict over LST in one large academic medical centre, we found that religion can be central to conflict over LST but was also present in two additional ways through (1) religious coping, including a belief in miracles and support from a higher power, and (2) chaplaincy visits. In-hospital mortality was not different between patients with religiously versus non-religiously centred conflict. In our retrospective cohort study, religion played a variety of roles and did not lead to increased treatment intensity or prolong time to death. Ethics consultants and healthcare professionals involved in these cases should be cognisant of the complex ways that religion can manifest in conflict over LST.

The Association of Surrogate Decision Makers' Religious and Spiritual Beliefs With End-of-Life Decisions

“…(1,2) Religion has been found to be central to conflict over life sustaining treatment decisions in about 25% of cases and often involves family requests for life sustaining treatments on the basis of miracles or other religious beliefs. (3)(4)(5)(6) Although surrogates often rely on faith to make decisions and cope (7)(8)(9)(10) there is evidence that clinicians do not discuss religious beliefs in family meetings, even when they are an important concern of the family. (11) Although prior research on patients making their own decisions has found that more religious patients tend to prefer and receive more life sustaining treatments at the end of life than those who are less religious, (12)(13)(14) there is very little research describing the role that religion and spirituality play in surrogate decision making.…”

“…This may be positive, such as feeling comforted by prayer, or negative, such as feelings that a negative event is a punishment for past wrongdoing or sin. (18) Finally, because of evidence that belief in miracles often arises in end of life decision making, (3,5) we addressed this dimension of belief.…”

Assessing Relationships Between Muslim Physicians’ Religiosity and End-of-Life Health-Care Attitudes and Treatment Recommendations: An Exploratory National Survey

“…One source of ethical challenge may relate to differing valuations of life between patients/families and their treating physicians on account of religion. Indeed, religious values impact some patient (and family) treatment decisions strongly, [1][2][3][4][5] and similarly, the attitudes of religious physicians toward end-of-life care treatment decisions can differ substantially from their nonreligious colleagues.…”

Chaplaincy Care in the MICU: Examining the Association Between Spiritual Care and End-of-Life Outcomes

“…Initial evidence suggests such integration may result in pro-active involvement in supporting gravely ill patients and their family surrogates and assisting them in coming to terms with their condition and making difficult treatment decisions. 20,22,23,38 In a prior report, when we examined the chaplains’ descriptions of their care we found evidence for a low level of pro-active integration. 33 Only 15% of the care provided by the chaplains had any focus on decision-making and less than 5% described involvement in family meetings.…”