J Pain Symptom Manage. 2017 Aug 14. pii: S0885-3924(17)30366-4. doi: 10.1016/j.jpainsymman.2017.05.009. [Epub ahead of print]

The Views of Clergy Regarding Ethical Controversies in Care at the End of Life.

Balboni MJ1, Sullivan A2, Smith PT3, Zaidi D3, Mitchell C3, Tulsky JA4, Sulmasy D5, VanderWeele TJ6, Balboni TA7.

Author information

1

Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA; Initiative on Health, Religion, and Spirituality within Harvard, Boston, MA. Electronic address: michael_balboni@dfci.harvard.edu.

2

Department of Biostatistics, Brown University, Providence, RI.

3

Harvard Medical School Center for Bioethics, Boston, MA.

4

Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA; Division of Palliative Medicine. Department of Medicine, Brigham and Women's Hospital, Boston, MA.

5

University of Chicago Medical and Divinity Schools, Chicago, IL.

6

Initiative on Health, Religion, and Spirituality within Harvard, Boston, MA; Departments of Epidemiology and Biostatistics, Harvard School of Public Health, Boston, MA.

7

Initiative on Health, Religion, and Spirituality within Harvard, Boston, MA; Departments of Radiation Oncology and Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA.

Abstract

CONTEXT:

While religion often informs ethical judgments, little is known about the views of American clergy regarding controversial end-of-life ethical issues including allowing to die and physician-aid in dying or physician-assisted suicide (PAD/PAS).

OBJECTIVE:

To describe the views of U.S. clergy concerning allowing to die and PAD/PAS.

METHODS:

A survey was mailed to 1665 nationally representative clergy between 8/2014 to 3/2015 (60% response rate). Outcome variables included beliefs about whether the terminally ill should ever be "allowed to die" and moral/legal opinions concerning PAD/PAS.

RESULTS:

Most U.S. clergy are Christian (98%). Clergy agreed that there are circumstances in which the terminally ill should be "allowed to die" (80%). A minority agreed that PAD/PAS was morally (28%) or legally (22%) acceptable. Mainline/Liberal Christian clergy were more likely to approve of the morality (56%) and legality (47%) of PAD/PAS, in contrast to all other clergy groups (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 U.S. clergy approve of "allowing to die" but reject the morality or legalization of PAD/PAS. Respectful discussion in public discourse should consider rather than ignore underlying religious reasons informing end-of-life controversies.