The BBC website is likely to shock the world today with a headline of staggeringly obvious accuracy:
Better sit back and absorb that one. The report begins:
Doctors with religious beliefs are less likely to take decisions which could hasten the death of those who are terminally ill, a study suggests.
So, before we go on to look further at the BBC’s report, why don’t we ask why the corollary of the headline wasn’t addressed instead. The item could – with equal validity – have begun with:
Doctors with no religious beliefs are more likely to take decisions which could hasten the death of those who are terminally ill, a study suggests.
(‘Suggests’? Why not ‘concludes’? Or would that make the story less worthy of coverage?)
The report goes on:
The London University research urges greater acknowledgement of how beliefs influence care. Doctors and campaigners described the findings as “concerning”.
I guess my question is the one I keep banging on about in various posts here: is it only religious beliefs that are to be ‘acknowledged’ or all beliefs? All human beings have a world view based on assumptions about why the world is the way it is, what matters (and why) and how moral decisions should be made. This is not the sole preserve of ‘religious’ people. Every human decision – including medical ones – are influenced consciously or unconsciously by the world view of the decision-taker. There are no exceptions.
This simply means that we should be asking of the (unidentified and unquantified) ‘doctors and campaigners’ what are the implications of their own world views on the treatment or advice they give to their patients about end-of-life options. What the report really seems to ‘suggest’ is that religious people might be more open, more honest or more clear about the moral or philosophical basis of their moral approaches.
Let’s try it a different way. I have just been in Berlin and looking afresh at the rise of the Nazis in Germany in the 1920s and 1930s. The question keeps being raised as to how human beings could possibly have done to other human beings what the Nazis did. It is dangerous to over-simplify such enormous matters, but it can be said at the very least that the disconnection came partly from an accommodation with a world view that reduced some people to (a) categories that are (b) sub-human. As we also saw in Rwanda in 1994, see people as vermin and you find it easier to treat them as vermin.
This is NOT to say that non-religious people are to be equated with Nazis or other genocidal psychopaths. Conscious atheism or agnosticism should be demonstrate equal consistency and be examined for inherent weakness in the same way as religious beliefs should be subjected to rigorous scrutiny. But, atheism cannot simply be assumed to be the neutral default position from which any other ‘belief’ is a dangerous deviation.
The point is simple. Religious beliefs and convictions should influence doctors – but so should non-religious doctors allow that their assumptions and beliefs (about the way the world is, why the world is that way, where human beings derive their value – and why – and what happens when we die… and why this matters).
The British Medical Association said: “Decisions about end-of-life care need to be taken on the basis of an assessment of the individual patient’s circumstances – incorporating discussions with the patient and close family members where possible and appropriate.
Absolutely right – except that there is no mention of the basis on which these ‘decisions’ are to be taken.
The religious beliefs of doctors should not be allowed to influence objective, patient-centred decision-making. End-of-life decisions must always be made in the best interests of patients.
The ‘best interests of patients’. According to which criteria? Who decides and who defines?
Again, the corollary of that statement is: “The non-religious beliefs of doctors should not be allowed to influence objective, patient-centred decision-making.”
The unidentified and unquantified ‘doctors and campaigners’ might well be ‘concerned’ – but so should the rest of us be concerned at their naivete, selectivity and the poor philosophical thinking behind the ‘suggestions’ or ‘conclusions’ they derive from their research. Perhaps they are simply bringing the wrong questions to the data in the first place? Perhaps this is a matter of using language properly – for the language used in these statements gives the game away.
Update 27 August 2010: Much fuller analysis to be found here.
August 26, 2010 at 8:54 am
I don’t even think it is a case of ‘atheism being taken as the default position’ – that would at least imply some thought somewhere, sometime into what position to take.
Rather I think it’s sloppy assumptions and language that ‘pure science’ including medicine is always by definition neutral and objective I’ve only got a BSc but even I know that’s absolute rubbish. Heisenberg’s uncertainty principle, anyone?
Was there any discussion in this report about the Hippocratic oath and doing ‘no harm’ and how ‘no harm’ might be defined for those who are terminally ill in their ‘best interests’?
August 26, 2010 at 10:53 am
[...] UPDATE: Bish Nick Baines has now blogged on this. If you have stumbled onto this blog please do take a few moments to read [...]
August 26, 2010 at 11:21 am
Firstly: Atheism is a default position, in that, if children weren’t raised in a particular religion, it’s unlikely they would take up a religion (90% of religious people follow that of their parents, and religions aren’t evenly distributed across the globe).
It’s also, surely, the only default position available. All religions are different.
Secondly: Why is prolonging life necessarily the right (morally) and correct thing to do? Is it worth prolonging someone’s life, if the extra months aren’t going to be the most pleasant?
Pure science is neutral and objective, it’s just that people get in the way of it with, as Nick says: “All human beings have a world view based on assumptions about why the world is the way it is, what matters (and why) and how moral decisions should be made.”
Thankfully, we can cut through people’s prejudices (whether these are from their beliefs, or lack thereof), with statistics, so that data can be looked at dispassionately.
“The non-religious beliefs of doctors should not be allowed to influence objective, patient-centred decision-making.”
In what way would they?
Sometimes it is better to let people die.
August 26, 2010 at 11:44 am
Nick you wrote, ‘The question keeps being raised as to how human beings could possibly have done to other human beings what the Nazis did. It is dangerous to over-simplify such enormous matters, but it can be said at the very least that the disconnection came partly from an accommodation with a world view that reduced some people to (a) categories that are (b) sub-human.’ Perhaps you need to add centuries of Christian theology too in part contributed to an environment in which Jews could be regarded as subhuman creating an environment in which Nazi ideology could flourish. Yes belief – shock, suprise – can affect choices in all sorts of ways. Whilst away from your specific point on care of the dying, within our own communion, what about the treatment of homosexuals in Africa and elsewhere, the climate of hate, disgust, loathing and fear whipped up by people of faith that diminishes human beings? I can’t remember which prelate said it but he referred to homosexuals as no better than animals. (Rownan is in Uganda now. What will he be saying about this? Anything?) The general point is that we need not necessarily assume that religion will come at issues from a benign standpoint and pat ourselves on the back. Yes, indeed these questions are far from simple. (Sorry if I’m off your specific point but I think this general point has always to be born in mind.)
August 26, 2010 at 2:30 pm
Nick,
this is a very timely post in light of the God Delusion which aired on More 4 last night (and you touched on in your blog the other day).
Dawkins’ skills as a polemicist are crude and clumsy. But the worry is that many watching will see his credentials and presume he knows what he’s talking about when it comes to faith.
He argues atheism is the only ‘rational’ worldview. You’ve consistently argued otherwise. And for my money yours is the eminently more sensible position…
Andy
August 26, 2010 at 4:28 pm
Doesn’t all this remove our thought from what seems to me the real question. How should we (those with faith and those with faith that there is nothing to have faithy in) react to keeping people alive?
As an elderly person myself I am presently enjoying an active life. And I mean enjoying. The thought of being incarcerated in an Old people’s home where I can’t remember who people are and can’t do anything fills me with horror. I do not want to be a burden on society.
My Christain faith leads me to conclude that I cannot ask others to kill me at that point, neither should I kill myself. However I feel very strongly that I should be able to stop people keeping me alive, through drugs and through over protection, when I don’t want that to happen and when my quality of life has gone or severely diminished. Not everybody will feel the same, but because to me death is not the end, it is less threatening.
How to deal with this? How to stop doctors and politicians inflicting their personal views and beliefs on me. Why do we keep people alive and then complain about the cost of doing so? We need a good debate and I am not hearing it at the moment. Rather I am hearing people being treated as machines.
August 27, 2010 at 8:45 am
@BigDaveSB
But the point about atheism that the good bishop is making is that it is to all intents and purposes a religion as much as any other. Just because it is a religion with a vastly different idea of god than others (in effect reason gets set up as a god in atheism), doesn’t mean it isn’t a religion, and therefore judgements made based on the assumptions of that particular system should be just as much subject to scrutiny as judgements based on a Christian/Muslim/etc. viewpoint.
I agree with you that in some cases prolonging life may not be inherently a good thing. However, as Erica said in the first comment, it comes down to how do we define do “no harm” given the range of options open to medical science in its current state.
And regarding statistics, as one man put it “one death is a tragedy, a million deaths is a statistic.” Sometimes statistics don’t tell us everything!
August 27, 2010 at 12:32 pm
I agree Tom, we need checks and balances to guide society’s ethical actions – wars, medicine etc. Isn’t that why we have Bishops and others in the House of Lords? Isn’t that why an elected parliament is so important. When we cede power to unelected and untested people (Quangos, The European Commission etc.) wse lose the moral compass.
I am not saying only Christians are right, i am saying that we need people to challenge and inform decisions and we need the decisions to be democratic.
August 27, 2010 at 1:14 pm
@BigDaveSB
Tom (above) makes similar points, but I want to stick my oar in too!
“90% of religious people follow that of their parents”
And what about atheists? I may be more likely to be raised a Muslim if I am in Pakistan, but I am also more likely to be raised an atheist if I am in Oslo (I would imagine). The knife cuts both ways.
“Secondly: Why is prolonging life necessarily the right (morally) and correct thing to do?”
The point of this post is that the article highlights religious belief as if it’s deviation from the norm. That point, not the specific issue being considered, is the topic of this post.
“Thankfully, we can cut through people’s prejudices (whether these are from their beliefs, or lack thereof), with statistics, so that data can be looked at dispassionately.”
Statistics do not help with final moral judgements. You start with data (and the more the better), but what you do with it is something else.
August 27, 2010 at 3:38 pm
This is perhaps one of the most disturbing articles from the good bishop that I have ever read.
He starts by discussing the problems that doctors have in treating seriously ill patients, and how their pesonal belief systems might affect their decisions. This is a valuable debate.
He then introduces the Nazis, and then of course, the atheists.
In 3 simple steps the good bishop conflates Nazis with atheists, and with those doctors with whom his personal faith system disagrees.
The good bishop is careful, “This is NOT to say that non-religious people are to be equated with Nazis or other genocidal psychopaths”.
It is good to hear that I am not a genocidal psychopath.
K
August 27, 2010 at 4:46 pm
Kevin, that is not a ‘conflation’; it is an ‘illustration’. And I thought I had made it clear in the piece what the point of it was.
August 28, 2010 at 3:57 am
Nick, I agree with you that the headline you began with was “staggering” but not that it was “accurate”. It was crass. Of course a Dr’s beliefs [religious or otherwise] must influence their end-of-life care. How could it be otherwise? And how /why would anyone state this only as a possibility? I thought this was just a case of sloppy head-line writing on the part of a secular broadcasting media but then found the same on the EChurch Christian Blog: “And the moral of the story is if you or a loved one is facing an ‘end-of-life’ situation, it may be prudent to find out your doctor’s views were on religious matters, as there appears to be a strong link between religious belief (or lack thereof) and clinical decision making.” Appears to be?? This looks like disingenuousness rather than sloppiness but the effect is the same. The misleading notion being communicated [as I think you point out] is that decisions might be made by Drs, irrespective of their beliefs, and the equally misguided one [stated by Erica] that pure science “including medicine is always by definition neutral and objective”.
The report itself, however, poses another problem. It deals, as most reports of this nature do, with overall tendencies, so that the abstract claims “doctors who described themselves as non-religious were more likely than others to report having given continuous deep sedation until death, having taken decisions they expected or partly intended to end life, and to have discussed these decisions with patients judged to have the capacity to participate in discussions.” What struck me was that, although those classed as “religious” were separated into the various faiths viz Christian, Hindu, Muslim etc, the “non-religious” were lumped together as a homogenous mass. This results in a very misleading dichotomy. ‘Non-religious’ is not necessarily synonymous with ‘irreligious’. I class myself as non-religious to the extent that I don’t attend a church or practise any religion formally but that doesn’t mean that my thinking is uninfluenced by what might be categorized as religious ideas. How could it be? As has been reiterated in this blog, our culture is imbued with the language and traditions of the Christian faith – we are a liberal culture and so, to this, has been added the languages and traditions of many other faiths and practices. If I were a Dr I would have all of this to draw on, and more, and practising Christian or not would be mindful of injunctions about not killing as well as injunctions about loving my neighbor as myself. I don’t know the religious beliefs or otherwise of those in the House of Lords who made the final ruling in the case of Tony Bland but this would be a good example of a case that was decided in a secular court but that would be consistent with both church and non-church thinking.
How, in the final analysis, do we differentiate between those with religious beliefs and those without? And separate decisions which are ‘religious’ from those that aren’t?
August 28, 2010 at 10:07 am
Dubious, that is a really helpful observation. You are right about the ‘religious’ versus ‘non-religious’ categorisation which ignores the differences between those of non-religious worldviews and lumps them into a single undifferentiated category. Thank you.
August 28, 2010 at 10:08 am
Kevin, I meant to add to my earlier response to your comment that what I wrote could have been written by an atheist. It is not dependent on my ‘personal faith’, but is an observation based on reason – that there is no neutral, objective stance.
August 28, 2010 at 1:35 pm
Nick,
I have re-read your blog and will withdraw my earlier remarks, though I am still very worried by this.
George W. Bush persuaded the American people to go to war by conflating Iraq with Al-Qaeda. He would make a speech, talk about the horrors of Saddam, and then about the horrors of 9/11. He quite deliberately conflated the two issues, though in reality they were quite distinct.
I doubt that GWB would have described this as ‘illustration’ rather than ‘conflation’, mainly because the poor pathetic man cannot understand long words, but the result was (as we now know) a disaster.
In your article, you talk about the reported differences between the treatment offered by religious and non-religious doctors; a useful and interesting debate. Then you talk about Nazis, and Rwanda. You talk about people who treat others as ‘sub-human’.
I will accept that you mean this as an illustration, and that it was not deliberate conflation, but surely you see the danger here?
I wonder if an alternative illustration for your article might have been the murder of black people by the Ku Klux Klan, or the slaughter of Moslems by the crusaders, or the indoctrination of young minds in our ‘faith schools’.
K
August 28, 2010 at 3:15 pm
Kevin, that’s gracious of you. I think my choice of illustration was driven by having been in Berlin a couple of days before and by writing a lecture in German at the same time as I was blogging. Point taken.
But do you see how easily I could have taken your comments to conflate me with George W Bush? That’s the weakness of the medium!
August 28, 2010 at 4:27 pm
Nick,
Thanks for your reply.
My comments were meant as an illustration, not a conflation, but I thank you too for being gracious.
In no way would I ever conflate you with GWB, and I apologise if I have done so. GWB is a moron, you are not!
Despite our differences I have absolutely no doubt that you are a decent, honorable & peaceful man. I suspect that the only thing you have in common with GWB is that you both speak English, and that you both believe in a supernatural god.
I disagree that this medium shows weakness, it is our strength. We can review our comments, admit our mistakes, reinforce our opinions where appropriate.
Regards
KK
August 28, 2010 at 5:05 pm
Kevin, you think GWB speaks English? Blimey!
August 28, 2010 at 6:03 pm
Sorry Nick, I misunderestimated you.
(( unable to express emotion, KK simply smiles ))
K
August 30, 2010 at 4:10 pm
There seems to be an underlying assumption in this discussion, which I believe to be wrong. The assumption is that doctors make decisions. Decisions these days arfe made by accountants and they have only two parameters:
how can we reduce the cost;
how can we avoid being sued?
It is the latter that affects their decisions on keeping people alive, It is clearly cheaper to let them die, but the risk is legal action from relatives. So, once again rational decisions go out of the window and are replaced by backside covering.