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Does beleif in god justify how much should people be allowed to spend on end of life care?

The stats are all over the place, as to how many people are cured of cancer, meaning they live more than 5 years without detectable disease. But for many cancers, the outlook is likely death. A recent study says half of cancer patients spend their life savings within two years of diagnosis. We don't know the numbers of people with likely fatal diagnoses and very hard to treat cancers, or the quality of life they have during those last two years, but is it fair to their families when inherited wealth is shown to be the only reliable way for people to maintain or increase their social status? Why do people do this to their families? I think religion has something to do to this. Also it's not a coincidence that most cancer treatment centers are run by religious groups.

Here are some stats about cancer and also a link to an article about the recent study (including a link to the original study)

[en.m.wikipedia.org]

[dailymail.co.uk]

By MarkiusMahamius7
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29 comments

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5

The issue of a god or gods is peripheral, IMO, because there could be a god who decrees that we should not be too much of a burden on others, and that getting oneself out of the way can be a merciful act.

What is more relevant here is the question of an afterlife. If the next world is so much better than this world, then why not depart from this world by committing suicide? That is why the theologians have decreed that suicide is a sin, that it is gate-crashing, crashing the Pearly Gates.

Even aside from that, why not try to have a quick and painless death? If one's body is no longer a good home for one's soul, then why not move out before it becomes absolutely unlivable?

lpetrich Level 5 Mar 17, 2019
4

You know, it is their money they worked for their entire lives. If they choose to use it to save their own lives I for one will not criticize them. Religion or the lack thereof doesnt matter as none of us want an early demise.

misstuffy Level 7 Mar 29, 2019
4

The only valid justification in my view of expending a lot on attempting to stay alive with cancer or any other serious health issue is whether it offers any quality of life that's acceptable to the sufferer.

Western medicine assumes everyone wants to fight at all costs to have more time, regardless of quality.

I am not sure this can be pinned on religion. I think it has more to do with the general fear and loathing around the fact of mortality that most people don't bother to accept and integrate. Indirectly, it could be argued that religion fails, big time, to help with this issue.

But in terms of Christianity, this thrashing about, going through various puke-your-guts chemo and radiation therapies and the like, seems antithetical to a teaching that we go when it's god's time, we shouldn't "play god" trying to override his will, and when god "calls us home" we go to a place of bliss and glory forever where "every tear is wiped away".

If Christians really walked the talk, they would calmly accept their fate, and their decisions to prolong life would be solely about things like trying to complete obligations like raising children, weighed against the expense to the family's financial and energy resources, and other such pragmatic concerns.

For some reason we've had 3 fatal cancer diagnoses, a major stroke, and emergency open heart surgery in our little development in just the past year. We got word of the 3rd cancer diagnosis just 2 days ago. And we're not even living in an old people's community or something. So between that and all the loved ones I've lost (to expected and unexpected causes) we have had inordinate opportunity to think about this topic.

My wife and I both agree that if such a diagnosis comes our way, we will just accept it and let it run its course with palliative care (or if appropriate, rational suicide). We finished raising our children years ago, and we are not interested in spending our last days "calling Ruth on the great white telephone" because of chemo or radiation or bone marrow transplants or whatever -- adding a few weeks or months to an existence made more, rather than less, miserable.

mordant Level 8 Mar 16, 2019

I agree with your post on everything, except that I do not think that you can absolve religion, especially christianity, from its responsibility. Most of our modern thinking in the west is still basically Abrahamic or post Abrahamic, including our attitude to death which is still seen as an evil, rather than as the neutral thing it is. ( Here in Europe where some countries allow choice the main opposition still comes from churches. ) The proof of this is the many religions, for example pre-christian Europe, which have taken a quite different approach to death, and even celebrated the act, and hopefully if secularism enjoys a long period of dominance we will start to do the same in time.

The main reason of course why christianity leads to an exagerated fear of death, is because it uses all irational fears to control people and get money in the box, therefore anything it can do to make those fears worse is seen as a good thing.

@Fernapple I don't absolve religion, I am just not sure which came first, the chicken or the egg. How much does religion generate fear of the unknown, and how much of it is an opportunistic response to a preexisting fear? Fear of death has always struck me as a tendency of the human condition. I suppose in this I have been influenced by Ernst Becker, who seems to think religion arose out of the fear of death, rather than the inverse. Either way, the rational response is to stop resisting what you can't control, and accept it as the given that it is. And religion does not facilitate this rational response, to say the least.

@mordant Very true although I do not think it is as simple as just chicken and egg, because there is a third case which is, grew side by side in symbiosis, which is where I would put my money (no certainties). For although we certainly started with a small fear of the unknown, the real terror is certainly religions fault, since we have a natural fear of things which may harm us, like animals with large teeth and high places, which served well enough to keep us safe in our primitive past, a highly evolved fear of death, which is an abstraction anyway and not therefore easy for evolution to work with, was needless.

@Fernapple I think what evolution had to work with was that creatures who run first and ask questions later tend to have the survival advantage in a setting filled with predators and rival tribes. That is of course the proximal source of confirmation bias and agency inference, however, what is beneath those two things is the survival instinct which involves a primal fear of death. Or that is my take at any rate.

There is plenty of blame for religion, I just tend to see them as opportunistically milking and amplifying what is already there. But ... I don't know that anyone can prove it either way. It is an interesting question. Maybe the fear of death I dealt with would have been 95% absent if religion hadn't conditioned me to it; I don't really claim to know for a fact.

@mordant Yes I agree. I don't think that religion is responsible for all of it, only that it made it worse. Nor can anyone ever hope to put exact figures on it how much of the fear is inherent and how much cultural. Yet I would still estimate that a very large part of it is culturally aquired, if only because what awareness would we even have of death without culture. And yes, I do know that some advanced social animals such as elephants do seem to show some understanding of mortality.

4

I don't understand why they would spend anything to prolong their agony on earth. Since they expect to be happy soon and forever, why hang around and risk saying/doing anything that would interfere with that?

Jacar Level 8 Mar 16, 2019

The "religious" mostly don't believe that there really is a heaven, hence the frantic effort to hold on as long as possible. It's demented.

3

Can you restate your point? Do you mean that dying people do not have the right to spend their money as they see fit? If so, it is their damned money and how they spend it is their damned business. My offspring need to be self reliant, and I plan to spend every bit of my savings before I die--whether by cancer, some other malady, or old age.

Geez, talk about entitlement.

3

If "inherited wealth is shown to be the only reliable way for people to maintain or increase their social status" - they don't deserve a penny and they are lazy idiots! Go, make your own money!

zesty Level 7 Mar 31, 2019

You hit the nail right on the head there, Babe! Touche'.

Randy

3

Does belief in the Easter Bunny justify how much should people be allowed to spend on end of life care?

ldheinz Level 7 Mar 29, 2019
3

What, pray, has "god" to do with how money is spent by anyone? Isn't there an inconvenient verse or two in the faerie story about giving away all you have to the poor? Or have we cherry picked those for this (bullshit) question?

3

it's the old story: everybody wants to go to heaven but nobody wants to die.
i despise those hypocritical religious fuck ups that won't leave until they've been laying in their own waste for months & have cost our healthcare system a lot of money which could have been much better spent.
there was a case in winnipeg in which a jewish man was terminal but the family would not agree to have him unplugged even though he was vegetative & they had difficulty keeping bed sores from his body which smelled badly.. it got so bad that a highly respected young doctor couldn't stand to have anything to do with this patient & family so he resigned.

3

Belief in any gods doesn't "justify" anything.

KKGator Level 9 Mar 16, 2019

It's often the only reason people pay for prolonged end of life care, even if it makes no sense to me or you. And there's a huge medical industry that revolves around those beliefs. I dunno if there's a good answer though. That customer base will always exist.

@MarkiusMahamius If people are going to be stupid enough to pay for that kind of thing, let them waste their money.

2

I think people should be able to live, and die, according to their beliefs.

Carin Level 8 Aug 12, 2019
2

This post has generated very interesting comments. I enjoy reading people who can articulate their opinions without resorting to personal attacks and labeling. Expressions like snowflakes and libtards are so tedious.

RDaneel Level 5 June 11, 2019
2

If anything, I would think a belief in the afterlife and salvation would make someone MORE willing to forego heroic measures than the reverse. And my guess is that many kids are more than willing to see their parents spend down their savings if it means a few more years to spend with them. It's kind of ghoulish to advance the notion that people with serious illnesses should forego treatment in order to maximize their kids' inheritances.

Worse than ghoulish, more like ego maniac selfish and stingy! Each of us is different from the rest, so there's no telling how someone will react when they get that kind of news. If they want to spend more time alive instead of rushing into the arms of death, why not let them make their own choices? If they want to blow THEIR savings on treatments or maybe booze, gambling and wild times, who has the right to stop them?

Randy

2

Not sure where ‘inherited wealth’ and ‘increased social status’ fit into this debate. Are you saying that a parent should be left to die so the heir can receive their legacy before it is frittered away on something as trivial as healthcare? Don’t get the religion aspect either.

2

you say you think religion has something to do with "this" but you just throw it in, almost as an afterthought; we probably wouldn't even notice that throwaway if it were not for the question, and what you describe isn't even end of life care (you talk about survival, not end of life care). you don't give a clue WHY you think religion is relevant to the topic. i personally do not think religion is the least bit relevant to the topic. money is.

g

genessa Level 8 Mar 16, 2019

I disagree that prolonging someone's inevitable death for 2 years isn't end of life care. It is. It's not the hospice level end, but it's nothing else but the end. I think religion is relevant because it's the tool that allows money to be reframed as hope or some sort of free will, at the expense of families and patients.

@MarkiusMahamius well, it is not what those who spend the money CALL end of life care, and for that matter, everyone eventually dies, so even birth could be framed as end of life care, since everything we do from birth on is just prolonging life. i don't know what medical facilities you frequent but the ones i go to, including one with a religion in its name, do not hand out religion in lieu or, or even in addition to, medicine and medical treatment. so my experience and my observation outside of my experience do not back any of this.

g

2

Even believers have a fear of death and this guides the end of life thoughts. They don't admit it but this is true. Why else would my lifelong theist friend tell a non-believer at a senior's meeting that his age should cause him to give god and the afterlife some serious thoughts? I find it hilarious! Casper, please come save me.

DenoPenno Level 8 Mar 16, 2019

Everyone who believes in heaven, doesn t want to get there. Yup

2

I work in a cancer center and we collaborate with many others. I do not know one that is medically reputable and religiously affiliated, though there is certainly a lot of God in cancer care, it comes from the patients and families and is rooted in personal beliefs, not professional ones. Clinicians provide care based on guidelines determined by high quality research to provide the best outcome for prolonging life and survival, as is their professional responsibility. I see the main reason many people engage in prolonged end of life care being the fact that our laws do not allow dying people to go with dignity and compassionate assistance, and they desire their loved one to be comfortable as their body breaks down.
I also read the abstract to the article and there isn't any mention as the reason why people choose to want to live as long as possible. It appears to be a purely economic retrospective study.

Amzungu2 Level 7 Mar 16, 2019

But the real stats for "prolonging life and survival" don't seem to match up with beliefs, which is how people can ge convinved to spend so much money. That knowledge gap in patients understanding, points to something unethical by the people who are charging for care.

@MarkiusMahamius I am somewhat confused by your comment. I don't know what 'real stats' you are comparing with belief, or how one can even make such a comparison. What I have seen more than clinicians trying to convince people into care that isn't likely to realistically prolong their life with some modicum of quality remaining is patients (more often families that the actual patients) demanding every possible thing be done regardless of the education provided and the knowledge and understanding of what that means. Maybe that is related to beliefs, but then that is a personal decision and it is the professional obligation of clinicians to respect that. A perfect example is a patient we recently saw who was very much dying. His PET scan showed so much widespread cancer that every Dr in our practice ended up in our office reviewing the imaging in absolute disbelief that this man was still alive. Granted, he was very ill. There were things that could be done to improve small areas of his disease progression, but the risks and cost and trauma to the patient did now warrant recommending them, as they were not likely to improve even the quality of life he had remaining. They were actually recommended against. But the family was adamant about doing everything possible to prolong what little time he had left and were not able to understand the reality no matter how many people offered knowledge, education, and potential for better understanding.

@Amzungu2 yeah I don't know how often these types of decisions are made solely by the family, and how often the family thinks they are doing what the patients wants, or not. Or if the family/patient is only saying they are relying on religious beliefs to justify their decisons. I cited another study about religion and end of life decision making a couple of posts down.

It's also really hard to tease out the "professional ethics" of a profession that is ultimately based on trading money for health, or money for the illusion of health, since obviously some people choose to pay for care that doesn't benefit them. "They just gave me money, I didn't make them do it" is an excuse that hasn't worked in many a trial for racketeering or protection-schemes.

@MarkiusMahamius Do you think it would be more ethical to have refused to perform the surgery, which in itself was at risk for doing zero harm and did effectively resolve one small problem among a multitude of others? We knew it would not make a real difference in his prognosis, and made that clear to the family. There were days spent utilizing supportive resources and additional medical opinions trying to provide them with the understanding of why we were recommending against it. In the end, they asserted informed consent and wished to proceed. At that point, the only ethical thing to do is respect their personal decision. You call it 'illusion of health' but many people who are faced with the permanent loss of a loved one call it HOPE. Is it ethical to refuse that simply because we see little of it and recognize that the cost for services provided are not in line with the realistic benefit they will physically provide?

@Amzungu2 respecting someones decisoon, aka "you do you" is not the same as just taking their money and putting your professional skills to use for no conceivable good. For people who choose to become licensed and sanctioned in a line of work that is based on selling hope over outcomes, it makes ethical sense to do exactly that- sell hope over outcomes. Informed consent isn't really a thing when the people selling have all the power, and the people consenting only have hope.

I realize it's a tough choice. For instance, medical providers who choose to perform FGM (female genital mutilation) are responding to a heartfelt demand and are undoubtedly preventing worse injury if their patients seek that same surgery elsewhere. I'm sure they make sure that the families grant informed consent as well. But that doesn't automativally make what they do "ethical".

@MarkiusMahamius Your statement of no conceivable good is not exactly accurate, but based on your opinion of what good is. It fixed a small problem and probably did prolong his life for a few days or so, and while that is not statistically significant in the arena of survival statistics, for the family, those few extra days likely meant a whole lot more than the cost incurred by acquiring them. Again, are you saying it is more ethical to refuse them those few extra days because the financial cost is too high and death is imminent regardless? Because I am not sure I want that decision being made by others.

@Amzungu2 yes to your final question, and I guess having that decision made by others is kinda irrelevant, since you said families are the ones driving these decisions. I'd much prefer qualified professionals to make the call, than any of my relatives.

@MarkiusMahamius Things simply cannot function that way, where would be the line in the sand? How many more days equals a dollar of cost? What level of benefit has to be displayed in order for care to be provided and not refused? It's a really slippery slope that approach would put us on, but it might solve some of our overpopulation issues.

@Amzungu2 lots of countries with some sort of universal care do have formulas, and then committees, to guide those decisions. Healthcare isn't a limitless resource, and for it to be available to everyone despite socioeconomic status, there has to be impartial allocation by a third party. Some examples [ncbi.nlm.nih.gov]

@MarkiusMahamius Those formulas are designed for guiding decisions concerning funding of care and allocation of resources. Those already exist in the US within Medicare and insurance companies, though admittedly, there is not perfect system and ours leaves a lot to be desired on the cost end of things, so much improvement could and should be pursued. But I am talking about direct patient care decisions. They are two different things. I simply do not see superior ethics in denying care based on ones inability to pay for the cost of those services. Economical sense, perhaps, but not superior medical professional ethics.

@Amzungu2 so you don't only see patients who want care that they can afford to demand? Yes, Medicare and most all insurances also use formulas to allocate care, and hopefully won't spend money on cases like the one you described earlier. So I'm assuming that was a family with the means to make that kind of request.

I think the study I firstmentioned here, refers to cancer patients in general, not just those with financial resources, so they get railoaded (if survival stats are correct, though thye are hard to decipher) into squandering everything they've saved. I'm wondering if religion is how this type of gouging is done. Though you may be right, it could be medical practioners themselves.

@MarkiusMahamius You speak as if people are being railroaded into receiving healthcare when they should just be told to go on with dying, whether that means days out or years out (by your response to another comment even two years of life isn't a cost effectively reasonable request). You do realize that at any time people can choose to stop receiving care and no one is going to force it on them? Not to mention a lot of the people included in that study very likely survived well beyond a 2 year mark. Very few cancers are an automatic imminent death sentence these days (even using your 2 year life expectancy mark), unless, of course, they are left untreated. Economics and ethics are two very different beasts.

2

I don’t see how religion plays into this at all in the way you are thinking. I think people fairly universally do not want to die. That’s about it. What they do with their money is a moral decision that they alone get to decide. I would actually say that a belief in an afterlife would cause less people to spend all their money on prolonging their lives.

Stats don't bear that out, when it comes to health care spending on keeping people alive. Its almost always a decision made in the name of religion, when it comes to delaying the inevitable for as long as possible. Of course, most people self identify as religious, so you might be right that they are just using those words.

@MarkiusMahamius I didn’t see anything in the two links about religion. I’m honestly not sure how religion comes into it when making these decisions. Maybe it’s because I’m not religious, but I think it’s more about people not wanting to die.

@indirect76 here's one link, the discussions towards the end have the most relevant information [ncbi.nlm.nih.gov]

@MarkiusMahamius Thanks. The article linked goes into great detail on the reasoning behind how a religious person would want to choose to use life extending care. They are all things I had not considered.

I certainly have no death wish but that being said, I do not want to live forever. I would like to die a healthy person, continuing to be out and about doing the activities that provide me with happiness and a life worth living as opposed to dying with some catastrophic health issue in a healthcare facility or a hospital. Your mileage may vary.

2

Point 1) I have seen no reason to believe that anyone REALLY. believes in god or heaven. We all know that this life is all there is. Our “beliefs” collapse at the end of our one and only life.

Point 2) when grasping at straws one does not count the cost. End of life care can be as expensive as the providers want it to be. It is the ultimate seller’s market.

Point 3) there is one organization that is mean enough, cruel enough, and unprincipled enough to rob dying people. Guess what it is.

Detritus Level 7 Mar 16, 2019

Guessing... The church? The medical industry? The IRS? My skeezy neighbor and his friends?

1

Allowed to spend?.... IamNotSure that I understand the question

IamNobody Level 8 June 19, 2019

Yeah I kind of overlooked that creepy wording!

1

"Inherited wealth is shown to be the only reliable way for people to maintain or increase their social status" !! Yikes that is really cruel and selfish. My daughter is going through cancer for the 4th time. I want her to be in my life for as long as she can live and wants to live - actually perhaps outliving me. No amount of money can ever replace her in my life and if my social status cannot be maintained or increased why would I care about that over her being.
I honestly hope you are not saying that someone should not do everything within their power to stay alive, if that is what they want just because you should get what is left of their money before they go doing something silly like spending it on what they want.

1

Half of all people in the US spend half their life savings within two years... Other countries like the UK, Canada, Japan, and others don't have to file for bankruptcy because their health care systems are not run by Wall Street death panels. Conservatives scream endlessly about single payer health care saying it will create death panels that will deny them care if they get sick but the reality is a non-profit system has no need for a death panel because it incentivises saving lives while for profit systems incentivise letting people die to save money... A death panel is a bunch of Wall Street bankers sitting around a huge polished boardroom table saying "fuck these guys it will cost too much to save their lives and I won't get a huge enough bonus at the end of the year on top of the 50 million dollar paycheck I already get for running this country..." After all why save lives when you can buy a private jet or another vacation mansion with that money.... Religion incentivises frauds claiming to be faith healers scamming the gullible out of their savings to have the cancer wished away....

1

I'm not sure I would be on side of the family members. The will to live is strong to say the least. Also, it is their money. If someone close to me had the funds for expensive therapeutic treatment, I would want them to use their resources as they saw fit.

RDaneel Level 5 June 11, 2019
1

One has nothing to do with the other, in my opinion. No one SHOULD be told how to spend her/his monies about anything. What and how a person spends their money should be up to that person, unless of course the person is in a mental state that requires a health care attorney. In which case, the HC attorney makes the decisions.

RRRR Level 4 June 8, 2019
1

Okay I have now had a chance to unpack this. The references here are of no real value. The Wikipedia references do not give a link to any studies regarding the issue. They are reports about cancer survival rate and do not refer back to any financial aspects.

The Daily Mail linked report is not academically constructed. The ‘references’ are footnotes and I cannot find a reference to Gilligan.

Having read the abstract of the study cited in the Daily Mail, Death or Debt, I am sure the data is correct. The focus is on the link between the financial costs and cancer treatment.

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