The March 18, 2009 issue of The Journal of the American Medical Association , otherwise known as JAMA, contained an article entitled "Religious Coping and Use of Intensive Life-Prolonging Care Near Death in Patients With Advanced Cancer." It's not often JAMA publishes something with a religious bent and it got my attention.

Unfortunately as I read the comment section at the end I was disturbed by what they found. The study, in a nushell, looked to see if people who identify themselves as religious make different decisions about end of life care, especially with regard to life prolonging treatments. When a person goes into a hospital or nursing home, or is signed onto hospice, we open a dialogue that we called "Preferred Intensity of Care" (PIC). We ask the person these questions: "I you reach a point where you can no longer tell us your wishes, do you want measures to be taken to prolong your life? For example, if your heart stops beating, do you want cardiopulmonary resuscitation (CPR) or would you rather have an order that says "do not resuscitate (DNR)?" "If you can no longer breath on your own do you want to placed on a respirator/ventilator where the machine breathes for you?" There are a few other questions, but this gives a good flavor.

The dilemna for many of us (especially on hospice) is that these measures may increase the length of a person's life but virtually never improve the quality of life. I'm not talking about a car accident here: if you have a terminal illness and your heart stops beating, even CPR will probably not get it to start again. In the unlikely event that your heart does start again, you will almost certainly have to go to the hospital and be placed in the intensive care unit where a respirator will breath for you. It's also very unlikely that your body will ever be able to breath on its own again.

Getting back to the JAMA article it appears that people who identify themselves as religious tend to opt for more aggressive treatment. Here are some examples from the Comment section at the end:

This study demonstrates that most patients with advanced cancer rely on religion to cope with their illness and that greater use of positive religious coping is associated with the receipt of intensive life-prolonging medical care near death.

In a study of 68 ethnically diverse patients with advanced cancer, belief in miracles, seeking guidance from God, and spiritual coping were associated with a preference for resuscitation, ventilation, and hospitalization in near-death scenarios.