Talking about death is an emotionally fraught and daunting topic, and we applaud the growing number of congregations that are giving their members tools and resources to have such conversations with their families and loved ones around end-of-life preferences.
But as important as these discussions are for families, they are only half the story when it comes to end-of-life planning.
It is also crucial that health care providers are prepared to have end-of-life conversations with their patients, especially when religion plays a role in the patient’s health care decision-making.
To be sure, the “faith factor” is not uncommon. In the United States, a country where 89 percent of people believe in God and 78 percent say that religion is important to their lives, religion will inevitably emerge in health care.
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In fact, one study has actually found that 41 percent of patients can think of a time when religion influenced one of their health care decisions. The impact of religion on medical treatment can involve anything from patients’ need to have a kosher, halal or vegetarian meal when in the hospital, to their requests to coordinate medical procedures around prayer times.
The most profound intersection between religion and health care, however, may be in end-of-life care.
The truth is that religion can influence the procedures patients want to receive, or reject. Are they comfortable starting artificial nutrition, hydration and respiration, for example? Or removing these supports once they are in place? Do they accept brain stem death as the moment of death? Or do they want a religious figure to be involved in the end-of-life decision-making process?
Religious beliefs may affect patients’ beliefs about the afterlife and help frame their illness in a context that medical professionals need to understand.
And yet, health care providers are often ill-equipped to discuss religion when it does come up, with one study finding that 20 percent of medical residents reported being unprepared to care for patients whose religious beliefs affected their treatment.
This discomfort, coupled with doctors’ lack of training around end-of-life care, means that important conversations about how religion affects patients’ end-of-life decisions simply never happen.
Take, for instance, the story of Mohammad Kochi, a Muslim who immigrated to the U.S. from Afghanistan. Kochi was diagnosed with gastric cancer and his doctors recommended a continuous infusion pump for chemotherapy. When Kochi refused the continuous infusion pump, his doctors never asked why; instead, they assumed that his religious beliefs had led him to decline all medical treatment because he believed it was his time to die.
In reality, Kochi refused the pump because he wouldn’t be able to follow his practice of praying five times a day if something broke his skin, which the pump would do. (In some cases, religious authorities say that an open cut or bleeding can impede a Muslim’s fitness to pray.)
He would have accepted other kinds of chemotherapy, but they were not offered. This miscommunication, and the health care team’s failure to ask Kochi how his beliefs influenced his decision-making, led to a significant and costly delay in his care.
It doesn’t have to be this way. But it can only change if systematic, preparatory training is provided to medical students and residents, to nurses and nurses’ aides – training that goes beyond a one-off course in cultural competence.
They need expertise in taking a spiritual history – i.e., asking patients appropriate questions about whether they have religious or spiritual beliefs or practices that may impact their care – as a routine part of taking a patient’s history.
Even when patients don’t know right away what their care might entail or how religion may be relevant for them, asking these initial questions can open the door to further conversations and make the patient more comfortable voicing their beliefs if and when they become relevant. The result can lead to better care every day, and certainly as life draws to a close.
But clinicians need to learn even more. Like recognizing signs of spiritual distress so they can refer patients to pastoral care for spiritual support and guidance.
These should be skill sets that we expect from our providers, skill sets they are trained to execute, without ever imposing their own beliefs on their patients.
Today, we do see more and more organizations and communities, including religious communities, promote open, honest and proactive conversations around end-of-life preferences.
As that trend continues, it is important to make sure that health care providers are also prepared. They need the training and resources to ask about a dimension of many people’s lives that influences their health care choices, and then incorporate their patients’ religious beliefs and practices into a plan for care.
As patients and family members of patients, we should expect nothing less.
(Eliza Blanchard is assistant director for Workplace and Health Care Programs at the Tanenbaum Center for Interreligious Understanding)