Although the following story is already almost two months old, it continues to raise some important questions in my mind:

—– Study: Cancer Patients Of Faith More Likely To Get Intensive Treatments (Liz Szabo/USA Today; March 17)

Strong religious faith can comfort people who are dying of cancer, allowing patients to find meaning in their suffering and easing their passage out of life, experts say.

But faith can be a “double-edged sword,” says nurse Carol Taylor, director of the Center for Clinical Bioethics at Georgetown University. Some terminally ill patients latch on to stories of biblical miracles, hoping against hope to be cured, instead of using their little remaining time to make peace with God and loved ones.

Yet even Taylor, who has counseled many dying patients, says she was surprised by the findings of a study in today’s Journal of the American Medical Association, which examined the choices of dying cancer patients who rely strongly on their religious faith to cope with their illness.

These patients were three times more likely than others to receive intensive, invasive medical procedures – such as being hooked up to a ventilator or getting cardiopulmonary resuscitation when their hearts stop – even in their last week of life, the study shows.

The new study shows that those who used “positive” religious coping – such as those “seeking God’s love and care,” as opposed to people tormented by the belief that God was punishing or abandoning them – were more likely to want doctors to do everything possible to keep them alive. They also made fewer preparations for death, such as filling out “do not resuscitate” orders, writing living wills or giving someone power of attorney, according to the study of 345 patients. The patients lived a median of about four months after entering the study.

Interestingly, those tormented by spiritual questions were not more likely to get aggressive care, the study shows.

Although researchers considered other factors that could have affected patients’ treatment choices, such as race, income or psychological distress, religion remained the most important factor.

The religious people in the study may have believed that God could work through aggressive medical procedures, says study author Holly Prigerson, associate professor of psychiatry at Harvard Medical School.

“We suspect they are waiting for a miracle,” Prigerson says. “They are more likely to think that life is sacred and that their job is to prove their faith to God by staying alive as long as possible, so miracles can be performed.”

Yet aggressive procedures may intensify the physical suffering of people whose bodies are shutting down, says Taylor, who was not involved in the new study. Patients who are hooked up to ventilator machines aren’t able to talk, which can prevent them from having meaningful conversations with the people they’re leaving behind. The caregivers of patients who die in these circumstances often suffer more grief, as well, according to background information in the study.

“Needlessly prolonging dying isn’t a positive thing,” Taylor says. “I would think someone with a mature religious faith would be more at peace, more able to accept death. Certainly, you wouldn’t be afraid to die.”…

The following version of this story basically says the same thing but adds a few more details that might be of interest:

—– Use Of Religious Faith To Cope With Advanced Cancer Associated With Receiving Intensive Medical Care Near Death (MedicalNewsToday.com; March 17)

…. Andrea C. Phelps, M.D., of Beth Israel Deaconess Medical Center, Boston, and colleagues examined the relationship between 345 patients with advanced cancer and their use of religious coping at the start of the study and their receipt of intensive medical care during their last week of life. Positive religious coping was assessed by a questionnaire. Interviews at the beginning of the study also assessed psychosocial and religious/spiritual measures, advance care planning and end-of-life treatment preferences. Patients were followed up until death, a median (midpoint) of 122 days after the assessment at the beginning of the study.

Patients were asked about how much they rely on religion to cope with illness. A total of 272 patients (78.8 percent) reported that religion helps them cope “to a moderate extent” or more and 109 (31.6 percent) endorsed the statement that “it is the most important thing that keeps you going.” Most patients (55.9 percent) endorsed engaging in times of prayer, meditation, or religious study at least daily.

The researchers found that patients with a high level of positive religious coping at the start of the study had nearly three times the odds of receiving mechanical ventilation and intensive life-prolonging care in the last week of life compared with patients with a low level of religious coping.

A high level of positive religious coping was also significantly associated with preferring heroic measures (wanting physicians to do everything possible to keep the patient alive) compared with patients with a low level and was associated with less advance care planning in all forms: do-not-resuscitate order, living will and health care proxy/durable power of attorney.

“These results suggest that relying upon religion to cope with terminal cancer may contribute to receiving aggressive medical care near death,” the authors write.

“Taken together, these results highlight the need for clinicians to recognize and be sensitive to the influence of religious coping on medical decisions and goals of care at the end of life. When appropriate, clinicians might include chaplains or other trained professionals (e.g., liaison psychiatrists) to inquire about religious coping during family meetings while the patient is in an intensive care unit and end-of-life discussions occurring earlier in the disease course. Because aggressive end-of-life cancer care has been associated with poor quality of death and caregiver bereavement adjustment, intensive end-of-life care might represent a negative outcome for religious copers. These findings merit further discussion within religious communities, and consideration from those providing pastoral counsel to terminally ill patients with cancer.”

Ok, so it’s just one study involving fewer than 350 people. More and better studies involving many more people would allow us to draw conclusions that are more likely to reflect the truth. Even so, this seems to be a respectable study conducted by medical professionals whose findings merited publication in the Journal of the American Medical Association. That makes it a much better basis for discussion than the anecdotes we might share about the way our religious relatives have or have not dealt with end of life issues.

Here’s part of the discussion that it prompted within my head:

—– “Strong religious faith can comfort people who are dying of cancer….” Yes, well, so can strong painkillers. That doesn’t mean religious faith is true – and it doesn’t mean we ought to be injecting it into children in Sunday School or encouraging healthy adults to get hooked on it.

—– “Some terminally ill patients latch on to stories of biblical miracles, hoping against hope to be cured, instead of using their little remaining time to make peace with God and loved ones.” In other words, people who base their beliefs on Bible stories can end up clutching to fantasies in a way that interferes with their ability to deal with the real world in an optimal way. Why am I not surprised?

—– “The new study shows that those who used ‘positive’ religious coping – such as those ’seeking God’s love and care,’ as opposed to people tormented by the belief that God was punishing or abandoning them – were more likely to want doctors to do everything possible to keep them alive.” Why? I’ve heard it said that “Everyone wants to go to heaven, but nobody wants to die” but why should those who seem to believe in heaven the most be the ones who seem the least likely to want to die? Are they disproportionately likely to be conservative Catholics and evangelicals who have in recent decades elevated the “right to life” above most others and lost their perspective in the process? Or do they perhaps actually have much less confidence in the existence of heaven than they let on? Could their embrace of both religion and of extraordinary end-of-life treatments have a common source in a secret fear that atheists are right about gOd and heaven and the afterlife?

—– Although these articles don’t address the issue, I have to wonder how many religious people who insist on extraordinary medical care for themselves (as well as for premature babies, unfortunate people in comas like Terri Schiavo, etc.) also condemn birth control and/or cloning and/or homosexuality because it’s “unnatural.” Given that dying is a very natural thing to do and extraordinary medical care is very unnatural, these religious people (however great or small their numbers) seem to me to be thinking very inconsistently, to say the least.

—– The articles also don’t address the issue of cost but it’s one that weighs heavily upon me whenever I personally have to deal with medical care. I know that every dollar spent on me and my care is a dollar that isn’t spent on others. Given that thousands of children around the world die every day because they didn’t get food and/or medicine costing a few pennies, how can I morally justify my asking anyone to spend thousands of dollars to extend my life for a few days? In my mind, I can’t. I have given my doctor written instructions not to even try. Why are the religious people in these articles acting so much more selfishly than I am? Why do they think the prolongation of their lives is worth thousands and thousands of dollars when there are so many children out there who could be helped far more significantly at a fraction of the cost? I’d be appalled by their behavior and sense of priorities in any event, but I am especially appalled when I think that many of them almost certainly think of themselves as good Christians who are morally superior to atheists like me and much more likely to find favor with a perfect judge.

—– “[A]ggressive end-of-life cancer care has been associated with poor quality of death and caregiver bereavement adjustment….” So, clinging to your devout religious beliefs and practices at the end of life can actually make things worse not only for you but for those you love the most. Were I a cruel person, I might call that poetic justice (especially given the way many people’s devout religious beliefs and practices may well have hurt others through the years in a vast number of ways). Since I am not a cruel person, I can only hope that news of this study receives the broadest dissemination possible and that religious people accordingly adjust their beliefs and practices in a way that reduces the amount of pain and suffering for everyone. Will they? I’d be very surprised….

If these articles sparked any thoughts in you, I’d love to know what they were. :-)