20 March 2009

Faith vs. Denial vs. Medicine

From the L.A. Times article "Aligning a medical treatment plan with God's plan:"

Faith in a higher power can often lead to more aggressive treatment than is medically warranted, research is beginning to show. As a result, the nation's medical community is now 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 Assn., 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 process. Such treatments didn't improve a person's long-term chances, however.

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 the Annals of Behavioral Medicine found that patients with advanced-stage lung or colon cancer were more likely to want CPR, mechanical ventilation and hospitalization if they believed in divine intervention. They were also less likely to have a living will.

And in a survey of 1,006 randomly selected Americans... More than half said God could heal patients whom doctors thought were beyond the reach of medicine.

What the article says (implicitly rather than explicitly) is that seriously ill patients can be in denial about their condition. Sometimes this denial is disguised as faith. But it is still denial. While it is understandable that a person in such a circumstance would have difficulty accepting it, the data shows that not confronting reality is likely to result in greater physical suffering, not having one's affairs in order, and not being as close with family & friends at the end of life. One study also showed it could save about 40% in associated medical costs:

In a study published last week in the Archives of Internal Medicine, Prigerson and her colleagues found that patients who discussed their wishes for end-of-life care ahead of time accrued $1,876 in medical expenses in their final week of life compared with $2,917 for patients who didn't. They were also less likely to be in physical distress, less likely to die in a hospital and more likely to be getting outpatient hospice care. "One-third of the Medicare budget goes to the last year of life, and 80% is for the last month," Prigerson said. "Most of that is being on a ventilator or from an ICU stay."

There was no difference in survival time between the two groups.

Nevertheless, this is one of those things that is easier to look at objectively when it is someone else's circumstance. How many of us could say with certainty that we would make all decisions on the basis of data alone? Maybe a person who can be 100% head and 0% heart in those circumstances is already dead, in a way.

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