After being diagnosed with Stage 4 breast cancer that had spread to her left lung, Gloria Bailey was told by her doctors that she should have a mastectomy followed by hormone therapy to fight the tumors that remained. She followed their advice, but she had a nagging feeling about the regimen.
“The Lord was just telling me, ‘They’re not being aggressive enough,’ ” Bailey recalled. So she sought out a new team of oncologists at the Cancer Treatment Centers of America’s Midwestern Regional Medical Center in Zion, Ill., more than 300 miles from her home in Michigan. Those doctors suggested she undergo a bone marrow transplant, a harrowing ordeal that put her in a coma.
Faith in a higher power can lead to more aggressive treatment than is medically warranted, research is beginning to show. As a result, the nation’s medical community is grappling with the best way to bring God into the doctor-patient relationship without subjecting patients to needless suffering before they die.
In a study published today in the Journal of the American Medical Association, researchers found that terminally ill cancer patients were nearly three times more likely to go on breathing machines or receive other invasive treatments if religion was an important part of their decision-making. Such treatments didn’t improve the patients’ long-term chances, however.
“There’s a sense that by not going for life-prolonging care, they’re letting God down,” said Holly Prigerson, director of the Center for Psycho-oncology and Palliative Care Research at the Dana Farber Cancer Institute in Boston and the study’s senior author. “But the more aggressive care you get, the worse your quality of life in that last week.”
Other recent studies have made similar connections. Religious cancer patients who had unsuccessful chemotherapy treatments were twice as likely to want heroic end-of-life measures, according to a report last year in the Journal of Clinical Oncology. A 2005 study in Annals of Behavioral Medicine found that patients with advanced-stage lung or colon cancer were more likely to want life-preserving CPR, mechanical ventilation and hospitalization if they believed in divine intervention. They also were less likely to have a living will.
In a survey of 1,006 randomly selected Americans, published last year in Archives of Surgery, two-thirds said religious faith would influence their decisions about medical treatment if they were severely injured. More than half said God could heal patients who doctors thought were beyond the reach of medicine.
Faith can influence medical decisions in many ways. For patients who believe only God can decide when life ends, the decision to remove a ventilator or decline CPR might be considered improper interference. In that context, refusing treatment is sometimes seen as the moral equivalent of euthanasia.
Extending life by days or even hours also buys time for prayers to be answered, in their view.
“They’re giving God every opportunity to operate as they believe that he can or will, which obviously leaves the door open for miracles,” said the Rev. Percy McCray Jr., director of pastoral care and social services at Midwestern Regional Medical Center, where Bailey was treated.
In light of these attitudes, health care providers are finding that their paramount goal of reducing suffering can be at odds with the wishes of devout patients.
Orthodox Jewish patients often express the belief that life is worth living no matter how debilitated the patient, and Christians sometimes welcome the opportunity to express their faith by enduring pain, said Betty Ferrell, a registered nurse who studies end-of-life care issues at City of Hope in Duarte, Calif.
“We’ve had patients who said, ‘Well, God suffered. Jesus suffered. So if I suffer, it’s going to make me more like God,’ ” she said.
With increasing evidence that patients can have dramatically different priorities than their caregivers expect, some health care providers are reconsidering what it means to have a “good death.”
To very religious patients, avoiding pain and suffering might not be the priority, Prigerson said. Of the 345 cancer patients who were followed until their deaths in the JAMA study, “patients who wanted aggressive care and got it had lower ratings of physical distress,” she said. The study was funded by the National Institutes of Health and a grant from the nonprofit Fetzer Institute to study spirituality at the end of life.
Doctors need to talk with their patients about their religious views to learn what is motivating their preferences for aggressive care, said David Magnus, director of the Center for Biomedical Ethics at Stanford Medical School in Palo Alto, Calif. Patients and their families need to understand that refusing treatment is not the same as choosing death, Magnus said. . Physicians also must be willing to talk with patients – and their religious advisers – about the role of prayer in the healing process, including its limitations, he said.
“Prayer is not the same as conjury,” he said. “It’s not a magic trick. It’s not like if you want something and you pray for it you’ll get exactly what you want. No major religion says that.”