Abstract
Background
To enhance knowledge about religious objections to brain death/death by neurologic criteria (BD/DNC), we surveyed hospital chaplains about their experience with and beliefs about BD/DNC.
Methods
We distributed an online survey to five chaplaincy organizations between February and July 2019.
Results
There were 512 respondents from all regions of the USA; they were predominantly Christian (450 of 497; 91%), board certified (413 of 490; 84%), and employed by community hospitals (309 of 511; 61%). Half (274 of 508; 56%) of the respondents had been involved in a case in which a family objected to BD/DNC on the basis of their religious beliefs. In 20% of cases involving a religious objection, the patient was Buddhist, Hindu, Jewish, or Muslim. Most respondents believed that a person who is declared brain dead in accordance with the American Academy of Neurology standard is dead (427 of 510; 84%). A minority of respondents believed that a family should be able to choose whether an assessment for determination of BD/DNC is performed (81 of 512; 16%) or whether organ support is discontinued after BD/DNC (154 of 510; 30%). These beliefs were all significantly related to lack of awareness that BD/DNC is the medical and legal equivalent of cardiopulmonary death throughout the USA and that organ support is routinely discontinued after BD/DNC, outside of organ donation.
Conclusions
Hospital chaplains, who work at the intersection between religion and medicine, commonly encounter religious objections to BD/DNC. To prepare them for these situations, they should receive additional education about BD/DNC and management of religious objections to BD/DNC.
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Data availability
Data collected for this study will be made available via email request to the corresponding author.
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Acknowledgements
The authors would like to thank all the chaplains who completed this survey and acknowledge the assistance of Rafael Goldstein (Neshama: Association of Jewish Chaplains), Stephen King (Association of Professional Chaplains), David Lichter (National Association of Catholic Chaplains), Judy Ragsdale (Association of Clinical Pastoral Education), and Jaye Starr (Association of Muslim Chaplains), who distributed this survey.
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AL was responsible for conception and design, analysis and interpretation of data, drafting of the manuscript, statistical analysis, and final approval of the manuscript. EK was responsible for design, analysis and interpretation of data, critical revision of the manuscript, and final approval of the manuscript. AL takes responsibility for the data and accuracy of data analysis.
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This article is related to the Invited commentary available at https://doi.org/10.1007/s12028-021-01251-y.
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Lewis, A., Kitamura, E. The Intersection of Neurology and Religion: A Survey of Hospital Chaplains on Death by Neurologic Criteria. Neurocrit Care 35, 322–334 (2021). https://doi.org/10.1007/s12028-021-01252-x
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DOI: https://doi.org/10.1007/s12028-021-01252-x