The Views of United States Clergy Regarding Ethical Controversies in Care at the End of Life
Michael Balboni, PhD., Instructor, Harvard Medical School
Tracy A. Balboni, M.D., MPH, Departments of Radiation Oncology and Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Initiative on Health, Religion, and Spirituality within Harvard
Christine Mitchell, RN, MS, MTS, Harvard Medical School Center for Bioethics
Patrick T. Smith, MDiv., PhD., Harvard Medical School Center for Bioethics
Adam Sullivan, PhD., Department of Biostatistics, Brown University
Daniel P. Sulmasy, M.D., PhD., MACP, André Hellegers Professor of Biomedical Ethics, The Pellegrino Center for Clinical Bioethics, Senior Research Scholar, Kennedy Institute of Ethics, Depts. of Medicine and Philosophy, Georgetown University
James A. Tulsky, M.D., Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Division of Palliative Medicine. Department of Medicine,
Brigham and Women’s Hospital
Tyler J. VanderWeele, PhD.,Departments of Epidemiology and Biostatistics, Harvard School of Public Health, Initiative on Health, Religion, and Spirituality within Harvard
Danish Zaidi, MTS, MBE, Harvard Medical School Center for Bioethics
Methods. A survey was mailed to 1665 nationally representative U.S. clergy completed between 8/2014-3/2015. Outcome variables included beliefs about whether the terminally ill should ever be “allowed to die” and PAD/PAS. We hypothesized that opinions would be associated with medical knowledge and particular religious beliefs.
Results. The response rate was 60%. Most clergy said there are circumstances in which the terminally ill should be “allowed to die” (80%). Fewer agreed that PAD/PAS was morally (28%) or legally (22%) acceptable. Mainline/Liberal clergy were more likely to approve of the morality (56%) and legality (47%) of PAD/PAS, in contrast to others (6%-17%). Greater end-of-life medical knowledge was associated with moral disapproval of PAD/PAS (adjusted odds ratio [AOR], 1.51; 95% CI, 1.04 to 2.19), p=0.03). Those reporting distrust in healthcare were less likely to oppose legalization of PAD/PAS (AOR 0.93; 95% CI, 0.87 to 0.99, p<0.02). Religious beliefs associated with disapproval of PAD/PAS, included “life’s value is not tied to the patient’s quality of life” (AOR 2.12; 95% CI, 0.1.49 to 3.03, p<0.001) and “only God numbers our days” (AOR 2.60; 95% CI, 1.77 to 3.82, p<0.001).
Conclusion. Most clergy approve of “allowing to die.” Whereas a large majority of clergy do not agree in the morality or legalization of PAD/PAS, a notable minority are proponents. Public discourse may be improved through respectful discussion of the underlying reasons informing end-of-life controversies.
Tracy A. Balboni, M.D., MPH, Departments of Radiation Oncology and Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, Initiative on Health, Religion, and Spirituality within Harvard
Christine Mitchell, RN, MS, MTS, Harvard Medical School Center for Bioethics
Patrick T. Smith, MDiv., PhD., Harvard Medical School Center for Bioethics
Adam Sullivan, PhD., Department of Biostatistics, Brown University
Daniel P. Sulmasy, M.D., PhD., MACP, André Hellegers Professor of Biomedical Ethics, The Pellegrino Center for Clinical Bioethics, Senior Research Scholar, Kennedy Institute of Ethics, Depts. of Medicine and Philosophy, Georgetown University
James A. Tulsky, M.D., Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Division of Palliative Medicine. Department of Medicine,
Brigham and Women’s Hospital
Tyler J. VanderWeele, PhD.,Departments of Epidemiology and Biostatistics, Harvard School of Public Health, Initiative on Health, Religion, and Spirituality within Harvard
Danish Zaidi, MTS, MBE, Harvard Medical School Center for Bioethics
Methods. A survey was mailed to 1665 nationally representative U.S. clergy completed between 8/2014-3/2015. Outcome variables included beliefs about whether the terminally ill should ever be “allowed to die” and PAD/PAS. We hypothesized that opinions would be associated with medical knowledge and particular religious beliefs.
Results. The response rate was 60%. Most clergy said there are circumstances in which the terminally ill should be “allowed to die” (80%). Fewer agreed that PAD/PAS was morally (28%) or legally (22%) acceptable. Mainline/Liberal clergy were more likely to approve of the morality (56%) and legality (47%) of PAD/PAS, in contrast to others (6%-17%). Greater end-of-life medical knowledge was associated with moral disapproval of PAD/PAS (adjusted odds ratio [AOR], 1.51; 95% CI, 1.04 to 2.19), p=0.03). Those reporting distrust in healthcare were less likely to oppose legalization of PAD/PAS (AOR 0.93; 95% CI, 0.87 to 0.99, p<0.02). Religious beliefs associated with disapproval of PAD/PAS, included “life’s value is not tied to the patient’s quality of life” (AOR 2.12; 95% CI, 0.1.49 to 3.03, p<0.001) and “only God numbers our days” (AOR 2.60; 95% CI, 1.77 to 3.82, p<0.001).
Conclusion. Most clergy approve of “allowing to die.” Whereas a large majority of clergy do not agree in the morality or legalization of PAD/PAS, a notable minority are proponents. Public discourse may be improved through respectful discussion of the underlying reasons informing end-of-life controversies.