Wednesday, July 03, 2013

Hanging on to Dear Life?

My first impression of the following conclusion of a research paper was, "That doesn't make sense."
"Terminal cancer patients with strong religious support were more likely to receive invasive treatments when near death than those without such connections,"
This was recently published in the Journal of the American Medical Association. Here are some of the details,

Objective: To determine whether spiritual support from religious communities influences terminally ill patients' medical care and quality of life (QoL) near death.
Design, Setting, and Participants: A US-based, multisite cohort study of 343 patients with advanced cancer enrolled from September 2002 through August 2008 and followed up (median duration, 116 days) until death. Baseline interviews assessed support of patients' spiritual needs by religious communities. End-of-life medical care in the final week included the following: hospice, aggressive EoL measures (care in an intensive care unit [ICU], resuscitation, or ventilation), and ICU death.
Results:  Patients reporting high spiritual support from religious communities (43%) were less likely to receive hospice, more likely to receive aggressive EoL measures, and more likely to die in an ICU. Risks of receiving aggressive EoL interventions and ICU deaths were greater among high religious coping; and racial/ethnic minority patients. Among patients well-supported by religious communities, receiving spiritual support from the medical team was associated with higher rates of hospice use, fewer aggressive interventions and fewer ICU deaths; and EoL discussions were associated with fewer aggressive interventions.
 Conclusions and Relevance:  Terminally ill patients who are well supported by religious communities access hospice care less and aggressive medical interventions more near death. Spiritual care and EoL discussions by the medical team may reduce aggressive treatment, highlighting spiritual care as a key component of EoL medical care guidelines.
(Reference JAMA Article here)

I guess I had assumed that the researchers would find the exact opposite. In our small church, I have seen less use of aggressive interventions and few ICU deaths in our terminally ill. I wonder what that says about our level of religious support.

I also wonder how most people reconcile Christian belief in an afterlife with this human tendency to try to hold onto mortal life at all costs, even when terminally ill. After all didn't the Apostle Paul admit,

"We are confident, I say, and willing rather to be absent from the body, and to be present with the Lord." (2 Corinthians 5:8).
"For to me to live is Christ, and to die is gain." Philippians 1:21
“That I may know him, and the power of his resurrection, and the fellowship of his sufferings, being made conformable unto his death;
If by any means I might attain unto the resurrection of the dead.” (Philippians 3:10–11) 
I have to speculate as to why the findings are what they are...

1) There is great diversity in religious practice, teachings, and beliefs in the United States.
2) American religious practice does not prepare people for death as well as it should.
3) Culture (look young, feel young, act young) trumps religion once again.

In their conclusion, the researchers suggest that doctors need to improve their spiritual support of the terminally ill, but what about the religious communities responsibility?  

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