Religious preference and practice

[NontradICUdoc]

I work in a Catholic Hospital and of course our ICU gets a variety of patients from all different religions like everyone else. As Intensivists, we get very frustrated with families of patients who are in essence living in a people farm with a trach and a PEG, or the patient is terminal in the ICU in the vent however, the family wants everything done (happened to me yesterday), but my question to the group is would your frustration change if you were to know that the reason for this decision is due to their religious beliefs? Are you aware of the different beliefs associated with dying patients and how to either help the families make the decision that is best for the patient while still adhering to their belief or direct them to where they can find the answer; especially in Jewish, Catholic, or Muslim patients. Are you aware of the various beliefs regarding death and dying among the more dominant religions in the areas that you work.

I am curious about other people's experiences.

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[DrMetal]

but my question to the group is would your frustration change if you were to know that the reason for this decision is due to their religious beliefs?

No, it would not change my mind. Whatever the reason (religion, money) , families insist on such measures because they don't understand the futility of medicine when patients are this far gone. I suppose it's our job to convince them of this, but some people you just can't convince.

The main problem is, here in Western medicine, we physicians can't say "No! I'm not going to intubate/trach/PEG your 94-yo metastatic grandma so she can live on with no quality of life". If we developed good mechanisms by which a physician can legitimately say "No" (refuse services) and be supported by her institution, we'd be much better off. (I'm seeing that more via Ethics Committees etc, but it doesn't happen often enough).

 

[aafisahar]

The notion of religion is laughable in medicine and especially the ICU. The whole point of the icu is to keep God out.

 

[lunaire]

In this situation, I think that our function is to offer expert advice, and follow the care plan that the patient or family requests. It doesn't matter if the decision is made due to faith, beliefs, denial, or lack of intelligence.

You SHOULD try your best to provide the correct amount of information in an understandable format, and steer the decision maker towards an optimal decision. If they still want everything done, then trach/peg and ship them to LTAC. Don't waste too much more time/resource in the issue.

 

[chessknt]

In this situation, I think that our function is to offer expert advice, and follow the care plan that the patient or family requests. It doesn't matter if the decision is made due to faith, beliefs, denial, or lack of intelligence.

You SHOULD try your best to provide the correct amount of information in an understandable format, and steer the decision maker towards an optimal decision. If they still want everything done, then trach/peg and ship them to LTAC. Don't waste too much more time/resource in the issue.

One hospital I work at will actually tell a family that if they can't take their vegetative loved one home to care for him/her we won't do a trach because there are no facilities that will take them on their garbage insurance and the hospital won't get saddled with someone who can't be discharged. It has been glorious to see how that plays out.

 

[Candidate2017]

Look to the neurologists. They are very good.

Generally, they ask family to designate a rep to round up interested parties/family members to meet at an appointed time, at which they have the full team of attending, residents, med students and nurses stand in an impressive circle of white coats in the hall. Family are asked to share memories of their loved ones, after which everyone proceeds into the room. The neurologist opens their black doctor's bag of neuro tools and does a brain death exam, explaining to the med students what they are doing, what reflexes they are looking for, and what the reaction/nonreaction means. It is very quiet and solemn. Aside from the machines, you can hear a pin drop. At the conclusion of the exam, the neurologist repeats some of the wonderful things family said about the patient and asks them to take some time to decide amongst themselves what this wonderful patient would have wanted at the end of life. Then the full team files out single file, white coat after white coat.

Takes about 15 minutes. Family almost always does the right thing.

Medicine itself is a religion and families do appreciate the rituals of medicine. Humans inherently appreciate the power of rituals (hence religion), including physical exams, stethoscopes, white coats. It's a lot more powerful than saying, "Um yeah, grandma's being kept alive by machines."

 

[chessknt]

Look to the neurologists. They are very good.

Generally, they ask family to designate a rep to round up interested parties/family members to meet at an appointed time, at which they have the full team of attending, residents, med students and nurses stand in an impressive circle of white coats in the hall. Family are asked to share memories of their loved ones, after which everyone proceeds into the room. The neurologist opens their black doctor's bag of neuro tools and does a brain death exam, explaining to the med students what they are doing, what reflexes they are looking for, and what the reaction/nonreaction means. It is very quiet and solemn. Aside from the machines, you can hear a pin drop. At the conclusion of the exam, the neurologist repeats some of the wonderful things family said about the patient and asks them to take some time to decide amongst themselves what this wonderful patient would have wanted at the end of life. Then the full team files out single file, white coat after white coat.

Takes about 15 minutes. Family almost always does the right thing.

Medicine itself is a religion and families do appreciate the rituals of medicine. Humans inherently appreciate the power of rituals (hence religion), including physical exams, stethoscopes, white coats. It's a lot more powerful than saying, "Um yeah, grandma's being kept alive by machines."

I can barely get a neurologlist to see a stroke patient (in a stroke center nonetheless) within 24 hours. They don't answer pages for hours. There are no trainees. They have some of the worst people skills I've ever seen and will usually not talk to the family in the room at all unless directly spoken to.

Must be nice to have that at your facility but not generalizable at all.

 

[CCM-MD]

Look to the neurologists. They are very good.

Generally, they ask family to designate a rep to round up interested parties/family members to meet at an appointed time, at which they have the full team of attending, residents, med students and nurses stand in an impressive circle of white coats in the hall. Family are asked to share memories of their loved ones, after which everyone proceeds into the room. The neurologist opens their black doctor's bag of neuro tools and does a brain death exam, explaining to the med students what they are doing, what reflexes they are looking for, and what the reaction/nonreaction means. It is very quiet and solemn. Aside from the machines, you can hear a pin drop. At the conclusion of the exam, the neurologist repeats some of the wonderful things family said about the patient and asks them to take some time to decide amongst themselves what this wonderful patient would have wanted at the end of life. Then the full team files out single file, white coat after white coat.

Takes about 15 minutes. Family almost always does the right thing.

Medicine itself is a religion and families do appreciate the rituals of medicine. Humans inherently appreciate the power of rituals (hence religion), including physical exams, stethoscopes, white coats. It's a lot more powerful than saying, "Um yeah, grandma's being kept alive by machines."

You’re living in some fantasy world. At the end of the meeting does everyone hold hands and sing kumbaya? Lol.

 

[Hamhock]

I work in a Catholic Hospital

There's no such thing as a 'Catholic Hospital' like there is no such thing as a 'Catholic child'.

[Credit: Dawkins]

As much as I hate tribal hate , fantasy here is the problem, OP. You are framing your intrapersonal uncertainty in terms of the fantastical beliefs of religious peoples.

Let the hyper-religious babble. Let them propose. Ultimately, these people are just expressing anxiety, fear, and uncertainty (lack of education).

HH

 

[InternistDO]

Look to the neurologists. They are very good.

Generally, they ask family to designate a rep to round up interested parties/family members to meet at an appointed time, at which they have the full team of attending, residents, med students and nurses stand in an impressive circle of white coats in the hall. Family are asked to share memories of their loved ones, after which everyone proceeds into the room. The neurologist opens their black doctor's bag of neuro tools and does a brain death exam, explaining to the med students what they are doing, what reflexes they are looking for, and what the reaction/nonreaction means. It is very quiet and solemn. Aside from the machines, you can hear a pin drop. At the conclusion of the exam, the neurologist repeats some of the wonderful things family said about the patient and asks them to take some time to decide amongst themselves what this wonderful patient would have wanted at the end of life. Then the full team files out single file, white coat after white coat.

Takes about 15 minutes. Family almost always does the right thing.

Medicine itself is a religion and families do appreciate the rituals of medicine. Humans inherently appreciate the power of rituals (hence religion), including physical exams, stethoscopes, white coats. It's a lot more powerful than saying, "Um yeah, grandma's being kept alive by machines."

If a neurologist is doing a brain death exam, all this theatre is completely unnecessary since the patient will be legally dead at the end of the exam, regardless of family opinion (unless you're in New Jersey). The issue (at least in my residency) is for patients who are still brain-alive, but with 0 functional status or hope of recovery.

I sympathize with families in this position, in can often feel like we're putting the decision to "kill their loved one" on their shoulders. But as others have said, the issue is that medico-legal environment in most states that prevents physicians from declaring futile care which means that we often feel like salespeople trying to sell families on the idea of palliative care.

 

[drmwvr]

The irony (to me) of the original post is that it was prefaced by the fact that the poster is at a Catholic hospital. It isn't an uncommon association that if you're 'religious' you want 'everything' done, rational or not. The reality is that even rudimentary Catholic bioethical principles would mostly align with the sentiments on this thread and, more importantly, would soothe the consciences of the families that clearly, although 'religious', are completely unaware of what their religion teaches (assuming they're Catholic, but most other Christian faith traditions don't nearly approach the work that the Catholics have accumulated over centuries of effort). Would that Catholic hospitals were more 'Catholic'.

 

[SurfingDoctor]

Tell them you can only prescribe based on the Church of Satan and that you’d be happy to prescribe Ivermectin and Vitamin C…

 

[FutureInternist]

“There’s a difference between Living and Existing…
Your (relative) is barely existing”

 

[Siggy]

I've never really seen Catholics refuse hospice/end of life care based on religion. Heck, one of our local hospice services is a Catholic based hospice service.

 

[BigRedBeta]

Perhaps I'm just good at being manipulative, but finding out the degree of the family's religiosity is helpful in my experience. Able to use that concept of the afterlife and being made whole as an alternative to ease acceptance of the current state. Having practiced mostly in the South and completing fellowship in Chicago, I have not practiced in areas with heavily Orthodox Jewish patient populations, so I'm not sure how that would play out. Generally have not had many issues with non-Christian families.

Brain death is always easier, and I don't give families any options. I don't see why having the family offer memories is of any relevance. It's nice for some of you that Neurology is willing to do one of the exams, as more often than not, I'm having to fight them over what degree of hypernatremia is acceptable (including one who insisted on a normal sodium and could not be made to understand that a sodium level of 157 has never in the history - nor will in the future - of medicine ever caused a child to appear brain dead when they actually aren't...he doesn't get called to do brain death testing anymore).