By Dave Andrusko

Put another way, there aren't many Joe Friday "just the facts, ma'am" stories these days. Take a story from this morning's Los Angeles Times, "Aligning treatment plan with God's plan; Faith drives some patients to fight, and suffer more at the end." (The BBC's headline is punchier and far less judgmental: "Pious 'fight death the hardest.' People with strong religious beliefs appear to want doctors to do everything they can to keep them alive as death approaches, a US study suggests.")

Both stories addressed an article in the Journal of the American Medical Association, whose lead author is Holly Prigerson, director of the Center for Psycho-oncology and Palliative Care Research at the Dana-Farber Cancer Institute in Boston. Funded by the National Institutes of Health and a grant from the Fetzer Institute, it was (according to Times reporter Karen Kaplan) to "study spirituality at the end of life." Sounds pretty neutral, or even respectful, right?

The BBC account pretty much sticks to the story. "Those who regularly prayed were more than three times more likely to receive intensive life-prolonging care than those who relied least on religion." But for those with eyes to see and ears to hear, from the first sentence to the last in the Times story, you can't miss the tone: who are these crazy people of faith who are much more likely to fight terminal cancer until the very end? 

We learn from Kaplan that "Faith in a higher power can often lead to more aggressive treatment than is medically warranted, research is beginning to show." An alarm instantly went off in my head. Sure enough, the next sentence is, "As a result, the nation's medical community is now grappling with the best way to bring God into the doctor-patient relationship without subjecting patients to needless suffering before they die."

In the Times story there are lots of little hints that those who are unwilling to go quietly into the night border on masochism, who in their religiosity miss the point: they oughtn't to want a few more days (or weeks? or months?) if their "quality of life," according to Prigerson, is "worse."

The Times story puts what is to the researchers a disturbing trend--"To very religious patients, avoiding pain and suffering may not be the priority," according to Prigerson-- in the larger context of other recent studies.

"Religious cancer patients who had unsuccessful chemotherapy treatments were twice as likely to want heroic end-of-life measures, according to a report last year in the Journal of Clinical Oncology," Kaplan writes. "A 2005 study in the Annals of Behavioral Medicine found that patients with advanced-stage lung or colon cancer were more likely to want CPR, mechanical ventilation and hospitalization if they believed in divine intervention."

[Notice the next sentence: "They were also less likely to have a living will."]

And then there a survey published in 2008 in the Archives of Surgery. 1,006 randomly selected Americans "said religious faith would influence their decisions about medical treatment if they were severely injured. More than half said God could heal patients whom doctors thought were beyond the reach of medicine."

There is a lot of back and forth--and a few bones thrown to those of us who don't think these people are whackos--and then Kaplan gets, one suspects, to the real agenda, of the study: "Some healthcare providers are now reconsidering what it means to have a 'good death.'"

Please don't miss what's being suggested. In light of these patients' irrational insistence on not giving up the ghost at the time we think they ought to, we, as omnipotent physicians and hospital administrators, are reconsidering what a "good death" is. Very scary stuff.

The story proceeds with examples of doctor-knows-best run amuck, although obviously neither the reporter nor Prigerson would see it that way. All of this in service of the preferred answer: "Accepting death, on the other hand, can provide an opportunity to get one's religious affairs in order and make the most of remaining time with family and friends."

Conveniently, this greater willingness just happens to address the nexus of quality of life and quantity of cash. "If doctors are more successful at bridging the divide between religious beliefs and end-of-life care," Kaplan writes, "the financial savings could be significant." We learn, "In a study published last week in the Archives of Internal Medicine, Prigerson and her colleagues found that patients who discussed their wishes for end-of-life care ahead of time accrued $1,876 in medical expenses in their final week of life compared with $2,917 for patients who didn't."

To be sure, the researchers in the study acknowledged "that religion had been widely associated with an improved ability to cope with the stress of illness," as the BBC put it. But "'because aggressive end-of-life cancer care has been associated with a poor quality of death and caregiver bereavement adjustment, intensive end-of-life care might represent a negative outcome for religious copers', defined as those who regularly used prayer or meditation for support."

I haven't a clue what that means in English. Just guessing it probably means exactly what the researchers don't approve of. That in exchange for some additional time, "more aggressive treatment" is tendered "than is medically warranted."

But, of course, it is not up to medical personnel to unilaterally decide what is "warranted," or to flash their medical degrees to pressure the patient (or the family) into making decisions they don't want to make. About that we have in Part Two ("Defeat for Futile Care in New Jersey") a perfect illustration of just how far hospitals want to go.