Physicians' religiosity and end-of-life care attitudes and behaviours

Objective - To describe how physicians' religiosity is related to end of life care attitudes and practices in the context of patient care. Design - Quantitative Study. Setting - Some Selected Hospitals in Israel. Materials and 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moderately religious and secular physicians, were much less likely to believe that life sustaining treatment should be withdrawn (11% vs. 51%, p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 adjustments 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 behaviour in other cultures is needed.