Printed from: https://www.cmf.org.uk/news/?id=188
A paper published in the Journal of Medical Ethics on 25 August by the respected researcher Clive Seale attracted much media comment. Under the title The role of doctors' religious faith and ethnicity in taking ethically controversial decisions during end of life care he described a postal survey of 3,733 UK medical practitioners, 2,923 of whom further reported on the care of their last patient who died. We know a number of CMF members were among those quizzed. From the abstract, his Findings were
'Specialists in care of the elderly were somewhat more likely to be Hindu or Muslim than other doctors; palliative care specialists were somewhat more likely to be Christian, religious and 'white' than others. Ethnicity was largely unrelated to rates of reporting ethically controversial decisions. Independently of speciality, doctors who described themselves as nonreligious were more likely than others to report having given continuous deep sedation until death, having taken decisions they expected or partly intended to end life, and to have discussed these decisions with patients judged to have the capacity to participate in discussions. Speciality was independently related to wide variations in the reporting of decisions taken with some intent to end life, with doctors in 'other hospital' specialities being almost 10 times as likely to report this when compared with palliative medicine specialists, regardless of religious faith.'
He drew the very reasonable conclusion: 'Greater acknowledgement of the relationship of doctors' values with clinical decision-making is advocated'.
Surprisingly, some sections of the media saw this research as a reason for criticising doctors with faith. Under the heading 'Religion may influence doctors' end-of-life care' the BBC website reported 'Doctors with religious beliefs are less likely to take decisions which could hasten the death of those who are terminally ill, a study suggests…those with a strong faith were also less likely to discuss end-of-life treatment options with their patient'.
While this may have been an acceptable way of describing one half of the findings, they continued 'Doctors and campaigners described the findings as "concerning"' and gave space to Dr Ann McPherson from the pro-euthanasia organisation Dignity in Dying: 'The fact that some doctors are not discussing possible options at the end of life with their patients on account of their religious beliefs is deeply troubling. Whilst entitled to their beliefs, doctors should not let them come in the way of providing patient-centred care at the end of life.'
The British Medical Association is quoted as saying: 'Decisions about end-of-life care need to be taken on the basis of an assessment of the individual patient's circumstances – incorporating discussions with the patient and close family members where possible and appropriate. The religious beliefs of doctors should not be allowed to influence objective, patient-centred decision-making. End-of-life decisions must always be made in the best interests of patients.'
But surely this comment was back to front? Didn't the spin need reversing? Who were the bad guys here? Surely the good doctors were those who did not discuss something with patients, or do something to them, which was unnecessary and unethical, and, arguably, sometimes illegal?
Wouldn't the summary 'Doctors without religious faith are more likely to take decisions they expect or partly intend to end life' be at least as accurate, and far more significant for patient care?
It is interesting that so many early comments were wrong. The BMA has a commendably firm anti-euthanasia position, and ought also to be aware of the General Medical Council's clear statement: 'All doctors have personal beliefs which affect their day-to-day practice'. For that is the point: whether we are aware of it or not, we all have worldviews.
As John Wyatt says in his CMF File: 'Worldviews are the understandings each one of us has about the way the universe is. All our thoughts, beliefs and actions are based on these fundamental presuppositions about reality, and they are therefore critical in medical ethics. Different worldviews will sometimes lead to radically different decisions.'
Seale's research illustrates this superbly. And his conclusion, that both sides of this particular debate about end-of-life decisions need to acknowledge the influence of their worldviews, is the real lesson that needed highlighting.
Steven Fouch (CMF Head of Communications) 020 7234 9668
Alistair Thompson on 07970 162 225
Christian Medical Fellowship (CMF) was founded in 1949 and is an interdenominational organisation with over 5,000 doctors, 900medical and nursing students and 300 nurses and midwives as members in all branches of medicine, nursing and midwifery. A registered charity, it is linked to over 100 similar bodies in other countries throughout the world.
CMF exists to unite Christian healthcare professionals to pursue the highest ethical standards in Christian and professional life and to increase faith in Christ and acceptance of his ethical teaching.
