Physicians' Religiosity and End-of-Life Care Attitudes and Behaviors

BACKGROUND: Physicians play the central role in decisions to initiate, withhold and withdraw life-sustaining medical care. Prior studies show that physicians= religiosity is related to end-of-life care attitudes and practices, which if not in concert with the patient or family may be a source of conflict. The authors surveyed physicians of one religion to describe the relationship between religiosity and end-of-life care. METHODS: Cross-sectional survey of 443 Jewish physicians at four Israeli hospitals, which characterized religiosity and asked about attitudes and communication with patients about end-of-life issues and care practices. RESULTS: Very religious physicians, compared to moderately religious and secular physicians, were much less likely to believe that life-sustaining treatment should be withdrawn (11% vs. 36% v. 51%, p<0.001), to approve of prescribing needed pain medication if it will hasten death (69% vs. 80% vs. 85%, p<0.01), or to agree with euthanasia (5% vs. 42% vs. 70%, p<0.001). Religiosity was not related to withholding most life-sustaining treatments, but even after adjustment for physician and practice characteristics, very religious physicians were much less likely to ever stop life-sustaining treatment provided to a suffering terminally ill patient (p<0.0003). Religiosity was unrelated to physician-patient communication or to desire for support concerning end-of-life care. Desire for support was universally high. CONCLUSIONS: Physicians' religiosity can have a major effect on the way their patients die, including whether patients receive adequate analgesia near death. Patients may need to query physicians' religious perspectives to ensure that they are consistent with patients' end-of-life care preferences. Evaluation of religiosity-related clinical behavior in other cultures is needed.