Balboni: Views of Clergy Regarding Ethical Controversies in Care at the End of Life

Abstract
Context: Although religion often informs ethical judgments, little is known about the views of American clergy regarding controversial end-of-life ethical issues including allowing to die and physician aid in dying or physician-assisted suicide (PAD/PAS).
Objective: To describe the views of U.S. clergy concerning allowing to die and PAD/PAS.
Methods: A survey was mailed to 1665 nationally representative clergy between 8/2014 to 3/2015 (60% response rate).
Outcome variables included beliefs about whether the terminally ill should ever be ‘‘allowed to die’’ and moral/legal opinions concerning PAD/PAS.
Results: Most U.S. clergy are Christian (98%). Clergy agreed that there are circumstances in which the terminally ill should be ‘‘allowed to die’’ (80%). A minority agreed that PAD/PAS was morally (28%) or legally (22%) acceptable. Mainline/Liberal Christian clergy were more likely to approve of the morality (56%) and legality (47%) of PAD/PAS, in contrast to all other clergy groups (6%e17%). Greater end-of-life medical knowledge was associated with moral disapproval of PAD/PAS (adjusted odds ratio [AOR], 1.51; 95% CI, 1.04e2.19, P ¼ 0.03). Those reporting distrust in health care were less likely to oppose legalization of PAD/PAS (AOR 0.93; 95% CI, 0.87e0.99, P < 0.02). Religious beliefs associated with disapproval of PAD/PAS included ‘‘life’s value is not tied to the patient’s quality of life’’ (AOR 2.12; 95% CI, 0.1.49e3.03, P < 0.001) and ‘‘only God numbers our days’’ (AOR 2.60; 95% CI, 1.77e3.82, P < 0.001).
Conclusion: Most U.S. clergy approve of ‘‘allowing to die’’ but reject the morality or legalization of PAD/PAS. Respectful discussion in public discourse should consider rather than ignore underlying religious reasons informing end-of-life controversies.

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