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.

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.

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

Randy

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.

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

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.

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

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.

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.

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

Yeah I kind of overlooked that creepy wording!