March 27, 2009
More on the Christians/Aggressive Measures Study
A correction/clarification on my column, "Man Up, Christians"
Michael Balboni, a Ph.D. candidate at Harvard, responded to my column, "Man Up, Christians," and corrects/complements what I was trying to say there:
I appreciate your article and point of view. I am part of the research team at Dana-Farber which conducted and published this study [you refer to]. While it would initially appear that this specific patient population is "clinging to life" or are afraid of death, we do not believe that this is the best interpretation. In fact, patients who were positive religious copers were far more likely to recognize that they were terminally ill cancer patients! So they are pursuing aggressive measures despite the fact that they knew they were dying! So what gives?
We believe that part of the answer lies in a forthcoming research study from our group that finds that their is a direct connection between patients who receive spiritual care from the medical system (particularly doctors and nurses) and their decision to enter hospice care (which is a choice leading to non-aggressive care). When you put these two studies together, we believe that the problem is that religious people who are dying (and remember that this patient population was almost entirely Christian - 95%+) along with their families are not receiving spiritual counsel IN THEIR MEDICAL DECISION MAKING. The patients are not clinging to life but are instead not being counseled in how to die. Patients who received spiritual care from the medical system did vastly better in measures of quality of life at the end of life and choosing hospice over cure.
Based on this, we hypothesize that there is a gap about formation of death for religious communities. It would appear that Christians as a pattern do not talk about death, model a good death, or articulate the characteristics of faithful dying. Terminal patients and their families are left alone in making these decisions -- and there is a significant minority (we are guessing between 10-30%) who are receiving aggressive care at the end of life because they do not know how to navigate the spiritual intersection involved in the complexities of medical decision making.
We believe that this is a place where religious communities have a major role to play in educating their congregations on the intersection of faith and medicine. We also believe that religious physicians and nurses have the potential role of helping those who are sick and dying in understanding how to navigate the spiritual complexities of dying because they are much more familiar with the world of medicine.
Dana-Farber Cancer Institute