Religious Cancer Patients Suffer More

pillsReligious cancer patients are more prone to seek aggressive, life-prolonging care compared to non-religious patients, a new study says:

The patients who were devout were three times as likely as less religious ones to be put on a mechanical ventilator to maintain breathing during the last week of life, and they were less likely to do any advance care planning, like signing a do-not-resuscitate order, preparing a living will or creating a health care proxy, the analysis found.

“People think that spiritual patients are more likely to say their lives are in God’s hands — ’Let what happens happen’ — but in fact we know they want more aggressive care,” said [Dr.] Holly G. Prigerson….

“To religious people, life is sacred and sanctified,” Dr. Prigerson said, “and there’s a sense they feel it’s their duty and obligation to stay alive as long as possible.”

Aggressive life-prolonging care comes at a cost, however, in terms of both dollars and human suffering. Medicare, the government’s health plan for the elderly, spends about one-third of its budget on people who are in the last year of life, and much of that on patients at the very end of life.

Aggressive end-of-life care can lead to a more painful process of dying, researchers have found, and greater shock and grief for the family members left behind.

When I am at the end of my life, and my suffering gets unmanageable, I want to die at home with friends and family. I want to have a nice meal, listen to my favorite music, talk around the dinner table, read some excerpts from my favorite books, and then take something to end my suffering and die in my sleep.

Too bad that’s illegal. The government has no right to tell me that I must suffer in a hospital bed for weeks instead of ending my life peacefully with friends. Hopefully those laws will be overturned by the time I need to ask a friend for help.

By the way, the best article I’ve read on assisted suicide is “At Death’s Window” by Anne Lamott — a Christian!

  • Sock

    I agree fully.

    I want to die with dignity if I have that option.

  • Deanna

    If they’re sure they’re going to heaven, what’s the problem with letting go? (asked out of curiosity and ignorance of the christian experience) I too would go with dignity.

  • http://www.iww.org.au/ Mike Ballard

    I think that those who believe in an afterlife are afraid to die because they might find some eternal damnation around the corner. People who know that this is it–when you’re dead there’s no more you except in the memory of others are more or less resigned to nothingness, except for the material of their bodies which can neither be created nor destroyed.

  • Confused

    I want to die at home with friends and family. I want to have a nice meal, [...] talk around the dinner table [...] and die in my sleep.

    You don’t think that’d be traumatic and upsetting for your friends and family? Either if they knew this was the end for you or if they came in next morning and you were dead?

    Hopefully those laws will be overturned by the time I need to ask a friend for help.

    and to Sock:

    I completely disagree. Don’t get me wrong, this is something I want passionately to be available on empathic terms – hell, I’ve been suicidally depressed for large chunks of my life, and I would readily choose euthanasia over, say, Alzheimers – but I can also see that ethically, legalising euthanasia is a really really bad idea.

    Personally, I think the best you should hope and lobby for is a relaxation on sentencing of those who assist in euthanasia, not for it to be legalised.

  • http://unreasonablefaith.com Daniel Florien

    I don’t know why legalizing assisted suicide would be “a really really bad idea [ethically].” I think it can be an act of compassion.

    Now if someone is preying on people, then they should go to jail. But it should definitely be legal to have someone help you die with dignity instead of slowly rotting away, if that is your choice.

    If it was too traumatic for friends & family, I wouldn’t invite them. But death is always traumatic. Yeah, it would be awkward — our last meal together. But I can’t see how it is any worse than everyone visiting you in the hospital for weeks as you slowly die in agony or with so many pain killers that you’re not yourself. I think that’s more traumatic.

  • http://oneartplease.wordpress.com/ Stephanie

    “You don’t think that’d be traumatic and upsetting for your friends and family? Either if they knew this was the end for you or if they came in next morning and you were dead?”

    I don’t think it would be any more traumatic than watching him slowly die in a hospital bed, in terrible pain.

    I agree with Daniel. I don’t want to die a slow, painful death in a hospital bed and I don’t think we should force other people to either.

  • Wytwolf

    I don’t see what’s wrong with euthanasia when it’s used on the terminally ill, or those that are on death’s doorstep. I think the person should be evaluated first. If it’s just depression, then there is no real medical reason to let them die. If they’re terminal or have a serious disease, there should be allowances.

    Just my two cents.

  • http://thinkingforfree.blogspot.com/ Eamon Knight

    There are of course exceptions. Some years ago a Christian friend of mine — one of the most gung-ho fundamentalists you’d ever meet — died of cancer in his mid-30s. But when the doctor told him the choice was three or four months of aggressive chemo (during which he would be horribly sick the whole time), or maybe a month of palliative, he and his wife prayed over it — and chose the latter. This is one situation where prayer isn’t a waste of time: talking things over even with an imaginary friend, can help you put your thoughts in order and make a hard decision.

    However, I do have to quibble with the implication of the article that these people had “worse” outcomes — in whose opinion? There is always a tradeoff between quantity and quality of life in these situations — and ultimately, I think that only I get to choose the optimum point on that curve, and that choice doesn’t have to be “rational” — how the hell could it be? There is no universal calculus of pain and pleasure that can be used to determine that; there is only what I subjectively feel and value.

  • http://alphonsuspeck.wordpress.com/ alphonsuspeck

    Euthanasia happens all the time, regardless of the laws.

    A little extra morphine…withholding a simple, inexpensive care that might add an extra few hours to life…a flip of a switch.

    It’s just standard practice in health care…it’s called compassion and common sense. And if nurses or doctors suspect that a little extra dose was given, they just look the other way.

    And as to the pain with the loved ones at the loss? The pain is coming. Postponing it won’t make it any less painful. I cringe when I think of the pain my father may have been suffering in his last moments before the cancer took him. We took no extraordinary measures to extend his life a few extra days. All that would have resulted is more pain for him, and more pain for us.

    I’m scared of death. I admit it. I haven’t accomplished what I want to accomplish in this life yet. But the odds of me accomplishing that while in a pain wracked, vegetative state are pretty slim, I would say.

    Life is hard enough. Why make death harder then it needs to be.

  • http://oneartplease.wordpress.com/ Stephanie

    “I’m scared of death. I admit it. I haven’t accomplished what I want to accomplish in this life yet. But the odds of me accomplishing that while in a pain wracked, vegetative state are pretty slim, I would say.”

    Very good point. I wish more people would really think about this stuff rather than just wanting to prolong life because they think that’s what God wants them to do (because prolonging a person’s death with ventilators, etc. is somehow better than letting them die naturally).

  • Shelly

    I have to say that this country is woefully ignorant when dealing with death and dying. People used to die at home and then have viewings in the home before burial. This was the usual, the problem now is that the idea of death is so foreign to us as a culture. Our present culture is one of selfishness and “I want what I want when I want it”. It of course is usually sad when someone dies but it shouldn’t be something we can’t deal with.
    I worked with dying children for 25 years and I can count on one hand the number of “good” deaths. The best one was the death of a child hit by a car, who’s relatively un-religous mother gathered friends and relatives around the bed. They shared pictures and stories of the child’s life. It was amazingly quiet, dignified, and inspiring.
    Most of the religious families had an awful time accepting the diagnosis and always pushed for the most invasive horrifying treatments involving weeks or months of terrifying treatment.
    When the death occured, there was weeping, wailing, and lots of screaming. This often went on for hours and we had to try to find ways to quiet them down as not to frighten the other children and families out of their wits.
    This culture has so much to learn. Death can be welcome, comforting, can bring a family together, but yes it is usually sad for those left behind.

  • Shelly

    Oh man for want of a preview button.

  • Jabster

    Well here’s my story … my father died eight years ago of cancer and although my most abiding memory of him is that we finally sorted out our relationship and became good friends after what had been a struggle until I had grown up some what and he had accepted that I wasn’t quiet the son he thought he had. Leading on from this my last memory is of the shit and pain my father went through in the last few weeks of his life where his days where spent waking up and then taking morphine to control the pain that he was in and once the morphine had kicked in not really knowing where he was. My biggest regret is having visited him on Sunday with a few family and friends and when he was asked what he wanted to do replied he ‘I just want to die’ … I travelled back to work that evening and my Mum called me early next morning to say that he had died. I bitterly regret that I hadn’t been there to ‘see him off’ in his own house and to say my last goodbyes.

  • Question-I-Thority

    As a cancer survivor I have had to personally face this issue. I am for legalized euthanasia and completely support those who choose assisted suicide and am especially in favor of a bureaucracy of death so that family or friends don’t have to “pull the switch”. But I choose to not go that route myself (at least so far).

    Through my life I have had several bouts with depression where I was moderately nagged with thoughts about suicide. I have a child and friends who have had moderate to severe depressive periods. Almost always, as in non-terminal situations, suicide is a lousy choice. Unfortunately, thinking clearly is not a strong suit for someone in depression.

    The way we go out is a kind of communication. In several long, tender conversations my kids and I have shared our ideas on this. They understand I make my choice with them and their children in mind. Our love is strong.

  • jamesatracy

    That is a bit ironic, especially if you think that you are headed to eternal bliss in heaven. That sounds better than anything down here.

  • Melissa K

    I think assisted suicide should absolutley be legal and available to everyone. If I’m dying it is MY choice what I do with what’s left of MY life. I might have a week of partying for sure. Anyone who can’t handle it doesn’t have to be there. The mistaken notion that the dying person needs to think about how anyone else is feeling is ridiculous. If you don’t agree with what he/she wants don’t be there. For me, my partner knows what I want if I become unable to decide for myself. I want to die at home with all my people there(those who chose to be). Let’s stop making this issue one of how everyone else would feel and make it about dying with dignity. As for the comments about financial matters that should all be worked out head of time…

  • Annie

    I have to share this letter to the editor that appeared in our local paper. Our state recently passed the Death with Dignity Act, a near duplicate of the model used in Oregon. Numerous hospitals are now publicly “opting out” of this act, meaning they will not provide the medication to end one’s life. This letter reflects the general (and maddening) perspective of many of our locals:

    “I would like to applaud our local hospitals for opting out of the Death with Dignity Act. Our lives are not our own, but a precious possession of our loving Creator and Father.

    I have never had to witness a loved one suffer from a painful and terminal illness, however, I do believe that if we take our own lives, we rob God of doing something wonderful in our last few hours.

    See Jeremiah 29:11 ‘For I know the plans I have for you,’ says the lord,’They are plans for good and not for disaster to give you a hope.’

    I have been told before that some people do not believe in God. My reply? Believe it or not, my God lives and he has a beautiful plan for us all, and He has a plan for you also.”

    ….Justin R.

    Well, isn’t that special. Frankly we are more humane to animals than humans when it comes to end of life circumstances. I think many of the arguments boil down to self determination. The idea that our life is our own and we can, to some degree, determine our own destiny. I’d rather be in the driver’s seat when it comes to my life and body. Sorry, God. I hate to rob you of of the pleasure of extending my agony in those final hours.

  • 3D

    There is a good reason for the correlation found in this study. One of the biggest reasons people become religious is because they’re afraid to die; they cling to these made-up stories about what happens when you die.

    It makes sense that religious people would be the ones who go to greater lengths to extend life.

  • Ty

    My preferred method of dying would be my inability to get enough energy because the universe had experienced heat death.

    But since that seems unlikely, my second choice is to die in a hail of gunfire defending a dozen or so Swedish massage therapists from a gang of Nazi rapists.

    My third choice is to die when I accidentally speak the phrase that summons the elder gods back into our dimension.

  • elflocko

    We treat our pets with more compassion in death than we do our grandparents.

    Sad, really…

  • http://www.girlchild.wordpress.com mrsmarshall

    This study is meaningless.

    In the paragraphs following what was posted here, we find out that only 345 patients were surveyed – that’s not a great sample by any stretch of the imagination.

    Then, there’s this, further down in the article:
    “A vast majority of patients, religious or not, did not want heroic measures taken. Still, 11.3 percent of the most religious patients received mechanical ventilation during the last week of life, compared with only 3.6 percent of the least religious.

    The most religious patients were also more likely than less religious ones to be resuscitated in the last week of life and to be treated in an intensive-care unit as they died, although those differences may have been due to chance.”

    A VAST MAJORITY didn’t want any heroic measures taken, but a whopping 38 or so did receive ventilation during their last week of life. And some of the results the author reports may have been due to chance?

    I’m not saying these kinds of findings aren’t interesting, I just don’t think this tiny little sample of cancer patients – compared with the hundreds of thousands who die of the disease annually – isn’t thorough enough to base any statements like “Religious Belief Linked to Desire for Aggressive Treatment in Terminal Patients”.

  • http://thewordsonwhat.wordpress.com/ Rob

    “To religious people, life is sacred and sanctified,” Dr. Prigerson said, “and there’s a sense they feel it’s their duty and obligation to stay alive as long as possible.”

    To open a major can of worms, isn’t this in some sense counterproductive, anti-life even? To use a simple hypothetical, treatments used to extend life come from somewhere, and if they are given to one person they cannot be given to others. If person A is terminal, giving them treatment might extend their life for a few days. However, their treatment also means that person B and person C get less treatment, meaning that they die for want of treatment. If person A had instead been allowed to go peacefully, they would have died a few days earlier; however, treatment would then have been available for person B and person C, saving their lives.

  • http://thinkingforfree.blogspot.com/ Eamon Knight

    I have to play the hard-ass science card here and ask: was there any correction attempted for educational level or economic class? (Because religiosity also varies systematically with those). If you’re trying to infer causation, correlation isn’t enough if you only looked at one factor — especially when it’s a sociological sort of subject, which are notorious for having such complications.

  • marcion

    It makes sense if they had a lot of Calvinists in the study. I can see a Calvinist jumping off his death bed and cutting the doctor’s kidney out and trying to install it himself. They’re just nuts.

  • latsot

    The legality of assisted (or vanilla) suicide is one thing. Peer pressure by religions designed to make people feel they should die in agony on the basis of some dubious ideal is quite another.

    And worse still is when the former comes about as a result of the latter, which is where we find ourselves today.

    Mystifying. In theory, I might be dissuaded from suicide at the thought of causing pain to people close to me, but the idea that it is automatically wrong, regardless of the circumstances and furthermore that law should be based on this intolerable assertion is completely insane.

    It is nobody’s business but my own if I choose to die, regardless of the circumstances. I feel it’s my responsibility to consider the impact on others, but that’s just me. I hardly feel I could judge someone who disagreed.

    I’m all for laws to protect people, but let’s have them carefully considered rather than an obvious sop to religion.

  • http://www.anotherlife.com.au Beryl Shaw

    You’ve obviously struck that deep seated part of people that can make them feel really fragile. So many messages.
    So I’ll make mine really short.
    As a civil celebrant who has created and officiated at many funerals and memorials I’d like to disperse the idea of a ‘planned for’ death being in any way horrible. Picture a woman sitting at the top of a bed, cradling her dying husband, family saying goodbye, his favourite music playing. No tubes, no machinery, just great peace.
    When we understand it’s not about whether you believe in an afterlife or not it’s so simple.
    One vary sad friend had to take medicine by herself and say goodbye to her grown up sons, send them home, so they could ‘find’ her in the morning and not be charged with assisting. Now, THAT was terrible!
    Courage.

  • Shrubber

    A “Right to Die” law seems to be in order.

    A person should ALWAYS have that option, not just in the face of terminal illness.

    Consider: A convicted felon, with no prospects of release, decides to end his life, rather than endure years of incarceration.

    Or: An elderly man, married most of his life, loses his wife, and with her, his will to live. Why force him to hang around (possibly for years) suffering if he doesn’t WANT to?

    Think of the resources we could save. No extra guards or cells for “suicide watch”, no police/court time wasted with suicide attempts.

    If a person wants to die, let them. You can’t stop them, and it’s rude to try.

    -Shrubber

  • http://www.vidlord.com VidLord

    There is a hidden and little known way to die peacefully via euthanasia in america right now. I know because I saw it first hand.

    A family friend suffered with alzheimer’s for 10 years. He once looked out a backyard window at a grass lawn with trees and said, wow the waves are really choppy today huh? Due to poor circulation he needed to have both of his legs amputated and possibly an arm and/or hand. The family could not bare to see him without both of his legs and one arm…a circus freak. He was once a proud business owner who was very successful and deeply loved. He had 6 kids.

    They hired a live in nurse from Nigeria, a man who spoke little english – just off the boat if you will. If you look hard enough they are not hard to find. This nurse was to administer his daily regime of medicine, including morphine.

    But this nurse was there for one purpose and that was to give him a little too much morphine – so that he would die peacefully in his sleep. The nurse was there two days – I believe he upped the dose slowly over the course of those two days. This man died peacefully in his sleep.

    He didn’t have to ask, why are my legs gone? His family didn’t have to watch him suffer even more, in an undignified way. I see nothing wrong with this. I challenge anyone to tell me why they should not have done this.

  • bubbaj30

    Agreed, I don’t understand why people have a problem with this. Do they believe that there will be mass suicides everywhere when and if it is made legal?

    I have found that when a person is “rotting”in a hospital, unable to care for, or make decisions for themselves they are kept alive only for the sake of loved ones who cannot come to grips with the fact that the end for that person is at hand.

    Understandable I suppose, but selfish non the less.

  • Elemenope

    Well, there is potential for abuse, especially of patients who are uncommunicative. People get nasty when it comes to money, and the largest transfer of assets in most people’s lives is the execution of a will. When the Netherlands legalized assisted suicide, they had many problems with this sort of base predation until they figured out a system that had quite a few checks and safeguards, a death bureaucracy if you will.

    So it doesn’t make it a bad idea (I think it’s a good one to have some method for people who wanna go out that way), but it is not an unproblematic one, and it has to be approached carefully.

  • Confused

    What about a situation where the patient in question would require expensive palliative care to keep going? Or depends on the constant support of family members? Or, as Elemenope says, there is an inheritance which will go to a carer who is giving counsel to the patient? You have to understand that those who would consider euthanasia – the elderly, or the terminally ill – are usually extremely vulnerable.

    There are many, many conditions under which a patient can be put under pressure – either by themselves, not wanting to overburden their family, or by family who effectively want rid of them for whatever reason – to consider assisted suicide. They would all be completely impossible to regulate, or prove culpability if they happened.

    It is genuinely tragic that people who want to die are legally prevented from doing so, but this is the price to protect people from being coerced into ending their own lives. While I am empathically outraged at the former, ethically, I can’t accept waiving that protection.

  • Confused

    And I fully agree that I would like to have my last goodbye somewhere familiar, but I would also find the enforced normality of something like a last meal completely unbearable.

    I guess if it *was* a normal thing, that you were home for a week or something and spent that week living normally and this was just the last one, it would be easier to bear; but it kind of sounded a bit like you were throwing a dinner party to celebrate your own death.

    I wasn’t saying it was wrong or anything, just that it could be quite uncomfortable.

  • Elemenope

    Christians tend to think (by unfortunate dint of the notion that their God is both a nice dude and all-powerful) that all suffering is purposeful. Combine that with a “life is sacred” thingee (which sort of but not really is Biblically based, more of a modern reaction to the Abortion question than anything else) and you have a situation where Christians often come to believe that suicide even in terminal cases is so grievous a sin that it should be prevented at all costs, with the full weight of the law if necessary.

    The short version is that they believe you can’t suicide your way into Heaven.

  • Wytwolf

    I also agree. I’d rather die in my own bed in familiar surroundings. It’s my space and they’ll know I’m happier being there then a sterile hospital room. If that’s my last dying wish, I think my friends and family would be happy to let me have my way, and be at peace knowing I passed away how I wanted.

  • Elemenope

    …he and his wife prayed over it — and chose the latter. This is one situation where prayer isn’t a waste of time: talking things over even with an imaginary friend, can help you put your thoughts in order and make a hard decision.

    Not to go off on a tangent (but I’m about to go off on a tangent…) But, why is this not OK generally? I mean, the vast majority of Atheists will say that when a person is praying, they are merely talking to themselves. I’d hazard it’s a simple externalization of the superego (if we wanted to go all Freud and stuff).

    If that’s the case, and many people have a psychological need to externalize the repressive aspect in order to have an internal conversation about a decision, why is that a bad thing? Why do we make fun of it, rather than recognize its apparent necessity for people not us?

  • Elemenope

    Speak it brother! (Sister?)

  • Shelly

    Sister, thank you lol.

  • Confused

    Is it not okay generally? Damn, I’ve been un-okay for quite a while then…

    Do people often make fun of people meditating on a problem, whether verbally or not? I can’t say I’ve noticed that.

    People make fun of prayer because it is purported to be a) communication with God, and b) capable of influencing external events. People make fun of prayer when it is used in lieu of action.

    Personally, I don’t make fun of prayer when it is used to the same end as meditation; either looking for answers introspectively or using it to psychologically prepare oneself for a challenge. In both of these conditions it can be useful. Of course neither requires there to be a God there listening, and the assertion that there is, to some, will make the exercise worthy of ridicule.

  • http://progressatallcost.blogspot.com/ markbey

    ” If that’s the case, and many people have a psychological need to externalize the repressive aspect in order to have an internal conversation about a decision, why is that a bad thing? ”

    mark: I have No problem with prayer. Although I really think when Christians (and all other believers) are praying it really is meditation and not prayer.

    If a believer prays during a terminal illness, since god doesn’t answer all prayers a believer has no way of knowing whether or not the decision they made was influenced by god or not.

    If a believer first prays for the cancer to go away but that prayer is not answered, how can one be sure whether the advice they claim god gave them during prayer was god communicating with them or just voices in there head. Or wishful thinking.

    Let says say the person in this story could live another 2 years but in extreme agony, sickness and incoherence do to the medication. Or they could live without treatment for another six months without nearly as much suffering.

    A person who prays in this circumstance would never, ever know if their prayer worked or not. I mean hell they already prayed for the illness to go away and that didn’t work.

    If god doesn’t answer all prayers then how does one know if gods advice to not fight the cancer aggressively is actually gods advice or not. Or if they don’t fight the cancer how do they know they were following gods advice in this case.

    Isn’t it entirely possible to pray over whether or not to prolong a painful and illness plagued life vs to not do anything and die sooner. Isn’t it possible that any decision a person and their family makes in this circumstance has nothing to do with god.

    Because if god doesn’t answer all prayers then how does one know whether or not god would communicate with them during a decision such as this.

    I don’t think believers have any way of knowing whether or not a decision they made was advised or influenced by god or not. Because once again god does not answer all prayers.

    So in this instance I agree I don’t see a problem with prayer, it wont help at all but I don’t problem it

    However meditation (which is mainly what Christians are doing during prayer anyways) can be a good thing in this situation as it would give the person and his family a chance to deeply ponder this situation and figure out what is best for patient and his family.

    I agree with Daniel I would want to be with family and friends during an terminal illness, I wouldn’t want to suffer and have everyone around me watching me slowly die.

    However I also think this is a slippery slope, simply because some are chronically depressed and might make a decision based on that.

    But what do you do about greedy family members trying to guilt trip the elderly, disable or chronically ill into killing themselves.

    I’m not saying this would happen ofter but I do believe it would happen.

  • Confused

    The problem is that even among the terminally ill there are good reasons and bad reasons to consider euthanasia. Unless we have a clear and reliable way of evaluating those – I would argue that we don’t – making allowances will lead to people being coerced into dying.

    You may be willing to accept that, in which case go ahead and lobby your government to make it legal. I am not. I will be lobbying in the other direction.

  • LRA

    Thank you for sharing that! It was very moving!

    :)

  • LRA

    Thank you, Jabster!

  • Elemenope

    If they characterize it as “I prayed on that [issue]“, yeah, it does get made fun of a lot, at least in my experience.

  • Jabster

    Certainly agree with that … I’m basically totally cynical with science reporting in the UK mainstream media and I see no reason why the US media would be any different. It may be a good starting point to look at the facts behind a story but to believe the story itself — I think not!

  • http://wmute.livejournal.com wintermute

    I have been told before that some people do not believe in God. My reply? Believe it or not, my God lives and he has a beautiful plan for us all, and He has a plan for you also.

    Unless, of course that plan is to have a nice doctor help you have a peaceful death. Then we must do everything we can to thwart God’s plan.

  • http://www.atheistnexus.org/profile/RosemaryLYNDALLWEMM49 Rosemary LYNDALL WEMM

    If you are terminally ill then you do not need to be “coerced into dying”. You are going to die sometime soon regardless. It would simply be a lot saner to die with less pain and suffering than more.


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