Buddhist ethics and end-of-life care decisions

Buddhism

After Christianity, Judaism, and Hinduism, Buddhism is the 4th major religion of the world. The Pew Research Center estimates that as of 2020, about 500 million people (or 6.6% of the world's population) practice Buddhism. China has the largest Buddhist population at 254 million, followed by Thailand at 66 million, and then Myanmar and Japan at about 41 million.

Theravada Buddhism and Roman Catholicism on the Moral Permissibility of Palliative Sedation: A Blurred Demarcation Line

Although Theravada Buddhism and Roman Catholicism agree on the moral justification for palliative sedation, they differ on the premises underlying the justification. While Catholicism justifies palliative sedation on the ground of the Principle of Double Effect, Buddhism does so on the basis of the Third Noble Truth. Despite their theological differences, Buddhism and Catholicism both value the moral significance of the physician's intent to reduce suffering and both respect the sanctity of life. This blurs the demarcation line between Buddhism and Catholicism regarding the moral justification of palliative sedation.

Association between religious beliefs and discussions regarding advance care planning: A nationwide survey

BACKGROUND

The relationship between advance care planning and religious beliefs, which are important for palliative care, is controversial in Western countries and has not been verified in Asian countries.

AIM

To investigate the association between advance care planning discussions and religious beliefs in Japan.

DESIGN

A nationwide survey conducted in 2016 using a quota sampling method to obtain a representative sample of Japan's general population.

SETTING/PARTICIPANTS

We analyzed responses from 3167 adults aged 20-84 years (mean age ± standard deviation, 50.9 ± 16.8 years). The outcome was measured by asking whether the respondents had ever discussed advance care planning, and the main exposure by whether they had any religious beliefs or affiliations, and if so, their degree of devoutness. We analyzed religious beliefs, affiliations, and devoutness in relation to the occurrence of discussions using multivariable logistic regression models adjusted for possible sociodemographic covariates.

RESULTS

Compared with respondents without, those with religious beliefs had significantly higher odds of having had discussions (adjusted odds ratio: 1.45, 95% confidence interval: 1.22-1.73). The devoutness of religious belief was proportional to the propensity of the occurrence of discussions (p for trend < 0.001). In addition, Buddhists and Christians had higher odds of having had discussions than did nonbelievers.

CONCLUSION

The results suggest that holding religious beliefs, especially in Japanese Buddhism and Christianity, facilitates advance care planning discussions among Japanese adults, and thus, may help health-care providers identify those prioritized for facilitating engagement in advance care planning, especially in palliative and spiritual care settings.

Faith-sensitive end of life care for children, young people and their families

This article is part of an at a glance series on palliation and end of life care in paediatrics and focuses on the provision of faith-sensitive end of life care. Particular religions are discussed, with some key points for care of patients from some of the most prevalent religions within the UK. This article is intended to give points for discussion and consideration, but health professionals are encouraged to speak to every patient and family on an individual level to ensure an understanding of their personal beliefs. Although there is a range of literature discussing faith during end-of-life care, there is litte that outlines the practical specifics and for this reason some of the supporting literature in this article is dated and, where possible, this has been supported with contemporary sources.

Artificial Nutrition in Patients with Advanced Malignancy

Cancer is a progressive disease that can lead to malnutrition and cachexia. Artificial nutrition is a medical therapy used to combat malnutrition in these patients. In this article, the authors discuss factors affecting the decision to use artificial nutrition, including the patient's mental and physical health, technical factors of the procedures used to deliver artificial nutrition, and the oncologic factors affecting treatment. Through this review, the authors provide guidelines on who is and is not likely to benefit from therapy, available routes of administration, and necessary factors to consider for appropriate decision-making for palliative patients and those with advanced cancers."

The Adaptation of the Buddhist Death Acceptance Scale for Vietnamese Persons with Cancer

PURPOSE

This study reports on selected psychometric properties of the adapted Buddhist Death Acceptance Scale (BDAS) for Vietnamese persons with cancer.

METHODS

The original 13-item BDAS was developed based on Buddhist perspectives toward death and life and was translated from Thai into Vietnamese. Item content checking with five Vietnamese local experts suggested three items of the original BDAS were irrelevant in Vietnamese culture and hence should be excluded. Psychometric properties of the 10-item BDAS Vietnamese version were tested using a convenience sample of 193 Vietnamese Buddhists with cancer.

RESULTS

The internal consistency coefficient of the scale was found to be 0.73. Exploratory factor analysis showed that the 10 items of the BDAS Vietnamese version constituted 2 factors, explaining 51.1% of the variance of death acceptance. The first factor was "acceptance of natural process of death" and the second was "preparing for death." Both factors reflected explicitly Buddhist viewpoints toward death acceptance and were consistent with the original Thai BDAS. However, although similar factors were found, some items in the Vietnamese BDAS did not load to same factors as in the Thai BDAS.

CONCLUSIONS

The BDAS Vietnamese version provides an initial suitable measurement for death acceptance among Vietnamese Buddhists. Its availability will enable cross-cultural research to investigate death acceptance among Buddhist patients with cancer in Vietnam. However, the differences in item loadings between the Thai and Vietnamese scales suggest that further conceptual and empirical works to refine the measurement are needed.

Perception of Medical Assistance in Dying Among Asian Buddhists Living in Montreal, Canada

In the Western world including Canada, grievous and irredeemable health conditions, which cause unbearable suffering, has given support to the legalization of medical aid in dying (MAiD). It is unknown how Asian Buddhists who are in contact with the Western culture perceive MAiD. In this qualitative study, 16 Asian Buddhists living in Montreal took part in a semi-structured interview. Contrary to general findings in the literature, religious affiliation do not always determine moral stances and practical decisions when it comes to MAiD. Some participants were willing to take some freedom with the doctrine and based their approval of MAiD on the right to self-determination. Those who disapproved the use of MAiD perceived it as causing unnatural death, creating bad karma, and interfering with a conscious death. End-of-life (EoL) care providers have to remain sensitive to each patient's spiritual principles and beliefs to understand their needs and choices for EoL care.

Good Deaths: Perspectives on Dying Well and on Medical Assistance in Dying at Thrangu Monastery Canada

Anthropological, sociological, and bioethical research suggest that various agencies affect one’s relationship with the dying process and end-of-life decisions. Agencies include the media, medical professionals, culture, and religion. Observing the prevalence of meditations and rituals relating to death at Thrangu Monastery Canada, I wanted to investigate how the latter two agencies in particular, namely culture and religion, impacted the monastery members’ views on the dying process. During 2018 interviews, I asked their opinions on the meaning of dying well, and on Medical Assistance in Dying (MAID), which was legalized in Canada in 2016. Although some scriptural examinations have suggested that voluntary euthanasia is contrary to Buddhist teachings, the majority of the monastery’s respondents support MAID to some degree and in some circumstances. Moral absolutes were not valued as much as autonomy, noninterference, wisdom, and compassion.

A best-practice position statement on pregnancy after kidney transplantation: focusing on the unsolved questions. The Kidney and Pregnancy Study Group of the Italian Society of Nephrology

Kidney transplantation (KT) is often considered to be the method best able to restore fertility in a woman with chronic kidney disease (CKD). However, pregnancies in KT are not devoid of risks (in particular prematurity, small for gestational age babies, and the hypertensive disorders of pregnancy). An ideal profile of the potential KT mother includes "normal" or "good" kidney function (usually defined as glomerular filtration rate, GFR ≥ 60 ml/min), scant or no proteinuria (usually defined as below 500 mg/dl), normal or well controlled blood pressure (one drug only and no sign of end-organ damage), no recent acute rejection, good compliance and low-dose immunosuppression, without the use of potentially teratogen drugs (mycophenolic acid and m-Tor inhibitors) and an interval of at least 1-2 years after transplantation. In this setting, there is little if any risk of worsening of the kidney function. Less is known about how to manage "non-ideal" situations, such as a pregnancy a short time after KT, or one in the context of hypertension or a failing kidney. The aim of this position statement by the Kidney and Pregnancy Group of the Italian Society of Nephrology is to review the literature and discuss what is known about the clinical management of CKD after KT, with particular attention to women who start a pregnancy in non-ideal conditions. While the experience in such cases is limited, the risks of worsening the renal function are probably higher in cases with markedly reduced kidney function, and in the presence of proteinuria. Well-controlled hypertension alone seems less relevant for outcomes, even if its effect is probably multiplicative if combined with low GFR and proteinuria. As in other settings of kidney disease, superimposed preeclampsia (PE) is differently defined and this impairs calculating its real incidence. No specific difference between non-teratogen immunosuppressive drugs has been shown, but calcineurin inhibitors have been associated with foetal growth restriction and low birth weight. The clinical choices in cases at high risk for malformations or kidney function impairment (pregnancies under mycophenolic acid or with severe kidney-function impairment) require merging clinical and ethical approaches in which, beside the mother and child dyad, the grafted kidney is a crucial "third element".

Experiences and perspectives of older people regarding advance care planning: A meta-synthesis of qualitative studies

BACKGROUND

Studies have indicated that family members or health professionals may not know or predict their older relatives' or patients' health preferences. Although advance care planning is encouraged for older people to prepare end-of-life care, it is still challenging.

AIM

To understand the experiences and perspectives of older people regarding advance care planning.

DESIGN

A systematic review of qualitative studies and meta-synthesis was conducted.

DATA SOURCES

CINAHL, MEDLINE, EMBASE, and PsycINFO databases were searched.

RESULTS

A total of 50 articles were critically appraised and a thematic synthesis was undertaken. Four themes were identified: life versus death, internal versus external, benefits versus burdens, and controlling versus being controlled. The view of life and death influenced older people's willingness to discuss their future. The characteristics, experiences, health status, family relationship, and available resources also affected their plans of advance care planning. Older people needed to balance the benefits and burdens of advance care planning, and then judge their own ability to make decisions about end-of-life care.

CONCLUSION

Older people's perspectives and experiences of advance care planning were varied and often conflicted; cultural differences amplified variances among older people. Truthful information, available resources, and family support are needed to enable older people to maintain dignity at the end of life. The views of life and death for older people from different cultures should be compared to assist health professionals to understand older people's attitudes toward advance care planning, and thus to develop appropriate strategies to promote advance care planning in different cultures.

The Associations Between the Religious Background, Social Supports, and Do-Not-Resuscitate Orders in Taiwan: An Observational Study

Prior studies have demonstrated important implications related to religiosity and a do-not-resuscitate (DNR) decision. However, the association between patients' religious background and DNR decisions is vague. In particular, the association between the religious background of Buddhism/Daoism and DNR decisions has never been examined. The objective of this study was to examine the association between patients' religious background and their DNR decisions, with a particular focus on Buddhism/Daoism.The medical records of the patients who were admitted to the 3 surgical intensive care units (SICU) in a university-affiliated medical center located at Northern Taiwan from June 1, 2011 to December 31, 2013 were retrospectively collected. We compared the clinical/demographic variables of DNR patients with those of non-DNR patients using the Student t test or χ test depending on the scale of the variables. We used multivariate logistic regression analysis to examine the association between the religious backgrounds and DNR decisions.A sample of 1909 patients was collected: 122 patients had a DNR order; and 1787 patients did not have a DNR order. Old age (P = 0.02), unemployment (P = 0.02), admission diagnosis of "nonoperative, cardiac failure/insufficiency" (P = 0.03), and severe acute illness at SICU admission (P < 0.01) were significantly associated with signing of DNR orders. Patients' religious background of Buddhism/Daoism (P = 0.04), married marital status (P = 0.02), and admission diagnosis of "postoperative, major surgery" (P = 0.02) were less likely to have a DNR order written during their SICU stay. Furthermore, patients with poor social support, as indicated by marital and working status, were more likely to consent to a DNR order during SICU stay.This study showed that the religious background of Buddhism/Daoism was significantly associated with a lower likelihood of consenting to a DNR, and poor social support was significantly associated with a higher likelihood of having a DNR order written during SICU stay.