Doctors Don't Treat Patients Differently at End of Life Despite Politics
Republicans and Democrats in the U.S. rarely see eye-to-eye across a spectrum of issues, and that's only become more true since the 2016 election. But according to new research published in the BMJ, physicians don't let partisan politics get in the way of treating patients -- at least not when it comes to end-of-life care.
Researchers looked for treatment patterns among doctors within the same hospitals, discovering no differences in the studied groups in regard to end-of-life spending, the likelihood of a hospice referral and the use of life-sustaining treatments or intensive resuscitation like breathing or feeding tubes.
For the study, researchers analyzed the care of nearly 1.5 million patients admitted to thousands of hospitals between 2008 and 2012, all of whom died there or a short time later. They then compared this data alongside Federal Election Commission reports of political contributions by the patients' corresponding physicians. Among the patients, 93,976 were cared for by 1,523 Democrats; 58,876 were cared for by 768 Republicans; and more than 1.3 million were cared for by 23,627 non-donor physicians.
The study authors came from Massachusetts General Hospital, Columbia University, Cornell University, Stanford University and New York University.
Health care issues have become heavily politicized and public debate, at times, has divided along party lines -- think female reproductive issues, as well as debates over vaccinations and health insurance. Study author Dr. Anupam Jena says another issue discussed has been how we should think about counseling and treating patients at the end of their lives, something that came up as Obamacare was developed.
End-of-life issues today include aid-in-dying legislation and right-to-try laws involving patients' rights to try medicines not yet approved by the Food and Drug Administration, and Jena -- also an associate professor of health care policy at Harvard Medical School and internist at Massachusetts General Hospital -- says end-of-life care became a political issue for several reasons. One reason, he says, is that efforts to prolong life naturally align with religious and political beliefs. Another aligns end-of-life care more generally with health care, tying it into the ongoing debate surrounding the federal government's involvement in the health care decisions that physicians make for patients.
Previous research on physician political beliefs published in 2016 relied on survey data, meant to gauge political opinions and how physicians would react in hypothetical scenarios. It implied that physicians' personal beliefs related to abortion, gun safety and birth control were associated with how they cared for patients, according to a statement released with this new research. That was not the case for the latest study.
Dr. Monya De, a wellness-focused internal medicine physician in Los Angeles, was not surprised by the new er study's findings.
"I do not know any physicians on a personal crusade to demonstrate saving money in the totality of the health care system by ending life support early or diverting patients away from chemotherapy," she said in an email.
De says that doctors hate to pull support when they know patients may need more time in a medically-induced coma. In those cases, she says doctors take financial costs into consideration and give patients "all the options with acknowledgment that an experimental treatment in the hundreds of thousands of dollars, with an insurance plan that will not cover it, might not make sense to someone in the advanced stages of illness."
"Hospice and palliative care physicians are growing in number precisely because their colleagues tend to err, as a pretty uniform group, on the side of doing too much and spending too much," she added.
Jena says researchers chose to focus on end-of-life care because of the Medicare data available for this older population, and the Federal Election Commission data allowed researchers to generate large-scale information on the physicians' political affiliation. The study, though, may be missing physicians who potentially have strong beliefs but chose not to donate to a specific party, Jena says.
But what explanations can researchers give for the study results? Possible reasons include that physicians may have strong preferences but ultimately respect the opinions of their patients, or that one doctor in an in-patient hospital setting has a limited impact on the direction of care a patient receives given all the medical professionals who care for patients. Still, he says, ultimately one physician is responsible for all care.
In an opinion piece in USA Today, two of the study authors conclude: "Benjamin Franklin once wrote that nothing in this world is certain, except death and taxes. Democrats and Republicans, it seems, can agree on how to approach death. Taxes are another story."
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David Oliver is a social media associate editor at U.S. News & World Report. Follow him on Twitter, connect with him on LinkedIn, or send him an email at doliver@usnews.com.
