They're Not in Any Hurry to Get to Heaven

I still haven't quite figured out why God wants you on a mechanical ventilator.

Religious Belief Linked to Desire for Aggressive Treatment in Terminal Patients

By RONI CARYN RABIN
Published: March 17, 2009

Terminally ill cancer patients who drew comfort from religion were far more likely to seek aggressive, life-prolonging care in the week before they died than were less religious patients and far more likely to want doctors to do everything possible to keep them alive, a study has found.

The patients who were devout were three times as likely as less religious ones to be put on a mechanical ventilator to maintain breathing during the last week of life, and they were less likely to do any advance care planning, like signing a do-not-resuscitate order, preparing a living will or creating a health care proxy, the analysis found.

The study is to be published Wednesday in The Journal of the American Medical Association.

“People think that spiritual patients are more likely to say their lives are in God’s hands — ’Let what happens happen’ — but in fact we know they want more aggressive care,” said Holly G. Prigerson, the study’s senior author and director of the Center for Psychosocial Oncology and Palliative Care Research at the Dana-Farber Cancer Institute in Boston.

“To religious people, life is sacred and sanctified,” Dr. Prigerson said, “and there’s a sense they feel it’s their duty and obligation to stay alive as long as possible.”

Aggressive life-prolonging care comes at a cost, however, in terms of both dollars and human suffering. Medicare, the government’s health plan for the elderly, spends about one-third of its budget on people who are in the last year of life, and much of that on patients at the very end of life.

Aggressive end-of-life care can lead to a more painful process of dying, researchers have found, and greater shock and grief for the family members left behind.

The new study used both a questionnaire and interviews to assess the level of reliance on religious faith for comfort among 345 patients with advanced cancer. The patients, most of them belonging to Christian denominations, were followed until they died, about four months on average.

A vast majority of patients, religious or not, did not want heroic measures taken. Still, 11.3 percent of the most religious patients received mechanical ventilation during the last week of life, compared with only 3.6 percent of the least religious.

The most religious patients were also more likely than less religious ones to be resuscitated in the last week of life and to be treated in an intensive-care unit as they died, although those differences may have been due to chance.

“Doctors don’t always acknowledge, and I’m pretty sure patients are telling us, that God is really important in their lives,” said Dr. Gerard Silvestri, a cancer specialist at the Medical University of South Carolina in Charleston, S.C., who has studied end-of-life decision making.

A study by Dr. Silvestri in 2003 found that while cancer patients listed their oncologist’s recommendation as the most influential factor affecting their decisions about medical care, their faith in God was the second-most-influential factor, ranking higher than the recommendations of their family doctors, their spouses and children, and even information about whether treatment would cure the disease