Dying the good death


The LA Times reported yesterday on a study that found that religious patients are more likely to consent to, demand, and recieve aggressive treatment toward the end of their lives. This includes such things as bone marrow transplants for breast cancer (which sounds extremely aggressive, but doesn’t work), life support, and ICU admission. They were also less likely to have living wills, powers of attorney, or DNRs. Given the preoccupation that many religions have with death and the afterlife, this seems a little contradictory; shouldn’t those who expect rewards in the afterlife be most eager to get there?

Two of my favorite ScienceBloggers tackled this apparent contradiction. PZ Myers over at Pharyngula said that religion preys on fear, and attracts the most fearful people, so it’s not surprising that religious people respond with fear rather than reason. Orac responded, saying that PZ’s explanation is overly simplistic, and that it’s more likely a result of religious people believing that God is the ultimate arbiter of life and death, and to refuse treatment is equivalent to defying Him, or that by suffering they become closer to God.

To be honest, I’m skeptical of both of them. PZ’s is definitely overly simplistic. For one, these people are willingly taking on horrible pain because they believe it’s God’s will. I’ve had severely invasive and painful surgery before, and met with people dealing with similar pain, and I know that it takes a certain amount of fortitude, if not courage, to face life and not give up. (By “give up” I don’t necessarily mean suicide. It could just be self-neglect or resignation to disability.) These religious people aren’t acting fearful; they’re acting like they’re coping.

I think that Orac is partially right, but it’s missing something. Their desire to follow God’s will or to become closer to God might explain their demands for aggressive treatment (though, interestingly, religious people have historically argued that medicine thwarts God’s plans for death), but it doesn’t explain the fact that they don’t have powers of attorney or living wills set up. Living wills or power of attorney would be useful to instruct next of kin — who might not share or know about the patient’s desires for aggressive treatment — to extend life as long as possible. 

I think that religious practice and belief act as a coping mechanism during the dying process. As a species, we seem to be very bad at conceiving of death. As Pascal Boyer talks about in Religion Explained, we aren’t instinctively able to conceive of death, so we make things up about it (this is a simplification, go read the book). We have to do something to deal with the unpleasant idea that we won’t be around much longer. Atheists, agnostics, and sort-of-kind-of spiritual folks do things that are actually useful, like spend time with family, ease the pain at a hospice, and make plans (incidentally, all things that have been shown to be useful in reducing stress). Religious people cope by denying. They start by denying that they’re going to cease to exist: instead they’re going to go to heaven/be reincarnated. Denial is a habit; if you cope with the stress of work by denying to yourself that you’ll lose your job if you don’t finish the project on time, you’ll probably also deal with stress in a relationship by denying that there’s actually a problem. So religious people deny that they’re going to die and so demand aggressive, often useless treatment.

For at least one person, this denial had very bad consequences. Gloria Bailey was diagnosed with Stage IV breast cancer that had metastasized to her lung. I’m not an expert, but what from what I can find on-line that means she had less than a 10% chance of surviving five more years. She decided that she wasn’t going to die.

“The Lord was just telling me, ‘They’re not being aggressive enough,’ ” Bailey recalled. So she sought out a new team of oncologists at the Cancer Treatment Centers of America’s Midwestern Regional Medical Center in Zion, Ill., more than 300 miles away from her home in Michigan. Those doctors suggested she undergo a bone marrow transplant [which no one does anymore because clinical trials show it doesn’t work for breast cancer], a harrowing ordeal that landed her in a coma.

It’s a pretty classic, and tragic, case of a patient denying that they’re in serious trouble, and seeking out an alternative practioner that will give them something — anything — that they claim will cure them. More often than not, the scam artist alternative practioner gets rich, and the patient gets no better. (That’s if they’re lucky; these unproven treatments can be dangerous as Gloria Bailey demonstrates.) Religious patients seem to deny it to the end.

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