Jump to comment:

• Religious Discourse
  Zoe B.McC. Fritz
  Published on: 18 May 2017
• Religion and discussion of end of life care: The hunt for the hidden confounder must begin
  Richard Body
  Published on: 18 May 2017
• Doctors in dilemma
  Daksha P Trivedi
  Published on: 18 May 2017

• Published on: 18 May 2017

  Religious Discourse

  • Zoe B.McC. Fritz, Doctor

  Dear Editor,

  I read Dr. Seale's article with interest, but am concerned that his findings may not represent the actual activity of the medical profession, whatever their beliefs. The questionnaire asked doctors to state their religion, then how religious they were. They were then asked to recall the last patient who died and to answer questions about "ethically controversial decisions". Isn't it possible (or...

  Show More

  Dear Editor,

  I read Dr. Seale's article with interest, but am concerned that his findings may not represent the actual activity of the medical profession, whatever their beliefs. The questionnaire asked doctors to state their religion, then how religious they were. They were then asked to recall the last patient who died and to answer questions about "ethically controversial decisions". Isn't it possible (or even likely) that this may have altered the mindset, or the recall of the doctors? In being asked to think about their religion, and examine how religious they were, were the investigators not biasing their results so that religion would play a greater role in the doctors responses? Would someone who considered themselves "extremely religious" be less likely to recall or record an activity which could be considered in conflict with their religious teachings? It might be useful to repeat the experiment on a group of doctors, without asking about their religion, and see if the same spread of answers was achieved.

  The above caveat taken into consideration, Seale's evidence suggests those who were "very or extremely non-religious" were more likely to have discussions, as well as being more likely to perform actions which might ease their suffering and, by secondary intent, hasten death. I wonder whether it was precisely because discussions were had that the increase in sedation etc. occurred: were the non religious doctors simply carrying out their patients' wishes? There is a significant body of evidence that patients wish to have end of life issues, for example resuscitation, discussed with them (1, 2) but despite this, doctors are still reticent in initiating such conversations. As Dr.Seale suggests in his conclusion, we should all be more mindful of the influences at play in deciding not only which treatments to give, but whether or not we are respecting patient autonomy.

  Dr. Zoe Fritz

  Bibliography
  1. Morgan R, King D, Prajapati C, Rowe J. Views of elderly patients and their relatives on cardiopulmonary resuscitation. BMJ 1994;308:1677-8.
  2. Cotter PE, Simon M, Quinn C, O'Keeffe ST. Changing attitudes to cardiopulmonary resuscitation in older people: a 15-year follow-up study. Age Ageing 2009;38:200-5.

  Conflict of Interest:

  I am not religious.

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top
• Published on: 18 May 2017

  Religion and discussion of end of life care: The hunt for the hidden confounder must begin

  • Richard Body, NIHR Clinical Lecturer

  Dear Editor,

  I would first like to congratulate Dr. Seale for producing a thought- provoking piece of research that has captured the imagination of the nation's media. I would also like to point out an interesting discordance that I have noted with regard to the findings of this important research, which ought to stimulate further discussion.

  Although religious doctors were significantly less likely tha...

  Show More

  Dear Editor,

  I would first like to congratulate Dr. Seale for producing a thought- provoking piece of research that has captured the imagination of the nation's media. I would also like to point out an interesting discordance that I have noted with regard to the findings of this important research, which ought to stimulate further discussion.

  Although religious doctors were significantly less likely than their non-religious colleagues to provide continuous or deep sedation until death or to provide treatment with at least some intent to shorten life, when religious doctors did provide such treatment they were significantly less likely to have discussed this with their patient.

  This is the opposite of what would be expected if the religion-driven values of the doctors were the key influence on the decision to provide or withhold treatment with the potential to shorten life. If the religious beliefs of some doctors may make them reluctant to choose such a treatment option, in those instances in which they do choose that course of action, we would perhaps expect them to have been more likely to have involved the patient in the decision. Why, when these doctors do provide such treatment, should they be less inclined to discuss this with their patient? These findings warrant further exploration.

  Given these findings, I strongly suspect the presence of an undetected confounder. For example, perhaps in the cases where religious doctors provided (or withheld) treatment with some intent to shorten life, the distribution of reasons for doing so was different to that in non- religious doctors who took the same decisions. Perhaps the religious doctors only felt compelled to do so in cases when they felt the patient's suffering was particularly intolerable, whereas the threshold may have been slightly lower for non-religious doctors who have a more favourable opinion of treatment options that may shorten life. Thus, in the context of such extreme and apparently intolerable suffering, the doctors providing potentially life-shortening treatment may have felt that it was inappropriate (and even unethical) to delay treatment in order to engage in a discussion about this treatment option with their patients.

  Of course, this is speculation. However, this hypothesis, together with other viable hypotheses, certainly warrant further investigation in order to explore important confounding factors and resolve this apparent discordance in the findings of this research.

  Yours faithfully,

  Richard Body

  Conflict of Interest:

  Richard Body is a practising Catholic.

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top
• Published on: 18 May 2017

  Doctors in dilemma

  • Daksha P Trivedi, Senior Research Fellow

  Dear Editor,

  I read with interest the findings from Professor Seale's study and listened to the discussion with the author on Radio4's Today programme on the 26 August 2010.

  I commend the author's conclusions that "Greater acknowledgment of the relationship of doctors' values with clinical decision-making is advocated". The study opens up a wider debate about the relationship of both doctors' and nurs...

  Show More

  Dear Editor,

  I read with interest the findings from Professor Seale's study and listened to the discussion with the author on Radio4's Today programme on the 26 August 2010.

  I commend the author's conclusions that "Greater acknowledgment of the relationship of doctors' values with clinical decision-making is advocated". The study opens up a wider debate about the relationship of both doctors' and nurses' values with the whole process of care. The Liverpool Care Pathway for the dying recommends that patients and their families receive appropriate care, which includes their spiritual needs. If the professionals' own values drive the quality of care provided to the dying patient, then the findings of the study raise questions about the extent to which the mismatch between the professionals' and the family's spiritual beliefs and values impact on patient care.

  Better engagement of doctors and nurses with the concerned family from the outset should enable the professionals to examine their own beliefs and values in light of the family's spiritual needs. This requires a paradigm shift in the way we think, and a constant awareness of the complex needs of people from different religious beliefs. If a doctor does not believe in God, he or she needs to find a way to understand the needs of those who do and provide appropriate care. Whatever our religious beliefs, the term 'spirituality' is considered to encompass the general human impulse to reach out towards those on their end of life journey, and meeting the needs of the 'whole' person.

  Although there is some empirical evidence on factors considered to be important at the end of life by patients, family, physicians, and other care providers (1), there is a dearth of research examining the impact of differences in professionals' and patients' spiritual beliefs and values on end of life care. Professor Seale's study provides a platform for such future evaluations.

  1. Steinhauser et al (2000)JAMA; 284:2476-2482

  Dr Daksha Trivedi, Evidence Based Practice,Centre for Research in Primary and Community Care, University of Hertfordshire, UK

  Disclaimer: The views and opinions expressed are those of the author and do not reflect those of the author's affiliated institution.

  Conflict of Interest:

  None declared

  Show Less

  Conflict of Interest:
  None declared.

  • Back to top