Are religion and religiosity important to end-of-life decisions and patient autonomy in the ICU? The Ethicatt study

This study explored differences in end-of-life (EOL) decisions and respect for patient autonomy of religious members versus those only affiliated to that particular religion (affiliated is a member without strong religious feelings).

In 2005 structured questionnaires regarding EOL decisions were distributed in six European countries to ICUs in 142 hospital ICUs. This sub-study of the original data analyzed answers from Protestants, Catholics and Jews.

A total of 304 physicians, 386 nurses, 248 patients and 330 family members were included in the study. Professionals wanted less treatment (ICU admission, CPR, ventilator treatment) than patients and family members. Religious respondents wanted more treatment and were more in favor of life prolongation, and they were less likely to want active euthanasia than those affiliated. Southern nurses and doctors favored euthanasia more than their Northern colleagues. Three quarters of doctors and nurses would respect a competent patient’s refusal of a potentially life-saving treatment. No differences were found between religious and affiliated professionals regarding patient’s autonomy. Inter-religious differences were detected, with Protestants most likely to follow competent patients’ wishes and the Jewish respondents least likely to do so, and Jewish professionals more frequently accepting patients’ wishes for futile treatment. However, these findings on autonomy were due to regional differences, not religious ones.

Health-care professionals, families and patients who are religious will frequently want more extensive treatment than affiliated individuals. Views on active euthanasia are influenced by both religion and region, whereas views on patient autonomy are apparently more influenced by region.