Questionable Motives

September 2, 2010

How can we tell if reports about science are biased?

Filed under: Critical Reasoning,Media,Medicine,Religion,Science — tildeb @ 11:20 am

First there was this study from Britain’s National Council for Palliative Care published in the Journal of Medical Ethics titled The role of doctor’s religious faith and ethnicity in taking ethically controversial decisions during end-of-life care, that concluded:

Greater acknowledgement of the relationship of doctors’ values with clinical decision-making is advocated.

In other words, a doctor’s values has an affect on the decisions advocated.

According to the study’s results, ethnicity has very little effect whereas the specialty of the practitioner has the greatest effect. Hospital doctors discuss and use methods that could hasten death in the terminally ill at 10 times the rate of palliative care specialists. Of particular interest is the finding that doctors who are agnostic or atheist are twice as likely to use such methods as deeply religious doctors.

How do we interpret what that means?

Steve Novella at Neurologica explains:

To me the most interesting result is that specialty had a ten-fold influence on decision-making. This does reflect my anecdotal experience – that doctors who routinely treat the terminally ill in an in-patient setting are more comfortable and practiced in raising treatment questions that could influence the duration of life. Palliative care specialists, on the other hand, are focused on palliation and may not be as comfortable suggesting withdrawal of care or measures that might hasten death.

That sounds quite reasonable and makes good sense. But that’s certainly not the conclusion reached by Doctor Seale:

Dr. Clive Seale, a professor at Barts and the London School of Medicien and Dentistry, conducted a random mail survey of more than 8,500 doctors. Almost 4,000 responded and more than 3,000 described deaths of a patient.

Seale found doctors. many of whom care for elderly patients or are neurologists, who describe themselves as “extremely” of “very nonreligious” were twice as likely to report that the care for their last terminally ill patient included euthanasia practices such as deep sedation.

He found religious doctors were also less likely to keep patients in continuous deep sedation or to support legislation allowing assisted suicides.

“If I were a patient facing end of life care, I would want to know what my doctor’s views were on religious matters – whether they are non-religious or religious and whether the doctor felt that would influence them in the kind of decisions they were looking at,” Seale said. According to an AP report, Seale wrote that “nonreligious doctors should confess their predilections to their patients,” so they know they could become victims. (Bold added by me for emphasis.)

Is that doctor Seale’s conclusion or the writer of the article from which I have taken the excerpt? I suspect it is Seale’s when he uses the word ‘confess’ as if a doctor talking about all available treatment options with patients and their families were a sin rather than selecting and discussing only those treatment options that the doctor found agreeable with his or her religious beliefs! And the article’s writer seems to be in agreement with that because he starts his article with:

Patients worried about becoming a victim of euthanasia should ensure they find a doctor who holds strong religious views. That’s because a new study out of Great Britain finds physicians who are atheist or agnostic twice as likely to make decisions taking the lives of terminally ill patients. (Again, bold added by me for emphasis.)

I think we need to pay attention to words that indicate strong bias when we attempt to understand what studies mean and discriminate accordingly. As for this study’s conclusion, I think Novella gets it exactly right:

[…] this is not a controlled study but a self-reporting survey, and so the results are highly unreliable. At best it indicates that follow up research is warranted. But taken at face value, if anything this survey shows that culture in medicine still plays a large role in determining practice. And further it suggests that some doctors allow their religious faith to interfere with their decision-making when it comes to end-of-life care.

Accurate and informative science reporting is becoming something of a lost art these days. We need to be aware of the difference between what a study’s results may mean and how they are interpreted and reported to us. Going to the source is always a good strategy but we can also be much more aware of words that immediately reveal bias to affect our confidence in the accuracy of what we are reading.

1 Comment »

  1. But they could be ‘victims’ of euthanasia – because euthanasia is illegal in most western countries – therefore the patients are victims of crime; doctors who provide euthanasia as part of their offered treatment options would therefore be perpetrators of a crime and consequently revealing these options would actually be a confession.

    What I would like is for the ‘legal’ act of euthanasia to be owned by the one and only true authority – i.e. the individual who’s life it is; and in all other circumstances to be enacted by expert panels, who base their decision upon a legal framework that is foundered upon best practices derived from the best sources of medical information available – i.e. specialist experts.

    Euthanasia should be the safest (medically and financially), least painful, and most humane way to die.

    It’s not perfect, but it is much better than what is in place now, which is an unnecessary (and cruel) criminalisation of the patient/doctor relationship that allows the act of euthanasia to carry on behind closed doors without regulation or independent inquiry.

    Comment by misunderstoodranter — September 3, 2010 @ 3:30 pm | Reply

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