The political leanings of American physicians do not appear to have any effect on the end-of-life care they provide for their patients, according to a study published recently in the The BMJ (formerly the British Medical Journal).
The study found no differences between Republican and Democratic doctors in how much and what kind of care they offered their terminally ill patients.
“Our findings are reassuring evidence that the political and ideological opinions of physicians don’t seem to have any discernible impact on how they care for patients at the end of life,” said Dr. Anupam Jena, an internist and an associated professor of health care policy at Harvard Medical School, in a released statement. “Physicians seem to be able to look past their politics to determine the best care for each patient’s individual situation.”
As background information in the study points out, a 2016 study found that the political affiliation of U.S. physicians was linked to how seriously they looked upon particular health issues and how they counseled patients — at least, in hypothetical settings — about those issues. For example, Democratic doctors were more likely to say that they would advise patients to avoid keeping guns in their homes. Republican doctors, on the other hand, were more likely to report that they would encourage patients to stop smoking marijuana and to avoid future abortions.
Research has also revealed that doctors who identify themselves as being politically liberal are more likely to support the Affordable Care Act. They are also more likely to believe that they and their medical colleagues are obligated to care for uninsured patients.
Interestingly, the political leanings of physicians have shifted in recent years. “A generation ago, most US physicians identified as Republicans, but recent evidence suggests that doctors are now evenly split between Republicans and Democrats,” Jena and his colleagues write in their paper.
“Men, older physicians, and higher paid specialists favor Republican affiliations; whereas women, younger physicians, and lower paid specialists lean toward Democrat affiliations,” they add.
‘A heavily politicized area of medicine’
For the current study, Jena and his co-authors wanted to see if physicians’ political beliefs were associated with end-of-life care — in real, not in hypothetical, settings.
As Jena and study co-author Dr. Dhruv Khullar, a physician and researcher at Cornell University, write in an article for USA Today, end-of-life care is “a heavily politicized and value-laden area of medicine” — a factor that could influence care.
“Let’s say you’re admitted to the hospital with a terminal condition,” they explain. “You and your family are trying to make important, agonizing decisions about what you want in your final days — weighing complex trade-offs of quality and quantity of life. The doctor caring for you is either strongly Democrat or strongly Republican and has donated to political candidates in recent elections. Are you more or less likely to get a breathing tube? To be admitted to the I.C.U. or, instead, be discharged to hospice? To receive a feeding tube for artificial nutrition? Will the health system spend any more or any less?”
To conduct their study, the researchers began with treatment data from almost 1.5 million Medicare patients who died in a hospital or shortly after being discharged from a hospital between 2008 and 2012. They then compared that data with the political contributions of the patients’ attending physicians, looking to see if the intensity of the care given the patients and the amount of money spent on their end-of-life care varied by the physicians’ political affiliation (Democratic or Republican).
The researchers compared physicians working in the same hospitals to avoid having the study’s results affected by regional differences in end-of-life care.
Similar treatment approaches
The study’s findings were unequivocal. Democratic and Republican physicians provided similar care to their terminally ill patients.
“Among patients who die in the hospital, patients treated by Republican doctors don’t get more feeding or breathing tubes, don’t receive dialysis more often and don’t have higher end-of-life spending compared to patients treated by Democratic doctors,” write Jena and Khullar in their USA Today article. “For patients who survive hospitalization but are expected to die within months, those treated by Democratic doctors aren’t any less likely to be discharged from the hospital directly to hospice care. Total end-of-life medical spending is the same whether doctors are Democrats, Republicans or neither.”
The researchers say the findings have several possible explanations. It may be that the political preferences of physicians just don’t substantially affect their beliefs — not to mention their actions — regarding end-of-life care. (Religious beliefs, which this study did not examine, may, however.)
It may also be that end-of-life care, particularly in hospitals, is such a multidisciplinary team effort, that the care preferences of a single physician — even if he or she is the patient’s primary physician — become “diluted.”
Limitations and implications
The study comes with several caveats. It was an observational study, and therefore its results shouldn’t be interpreted as proving a cause-and-effect relationship (or non-relationship) between physicians’ political affiliation and the end-of-life care they provide. In addition, the study involved only physicians working in hospitals. The results might be different among physicians working with patients in other settings.
Also, the physicians’ political affiliations were determined solely by monetary donations to political parties. Many physicians with strong political preferences may not contribute financially to such groups — a factor that may have skewed the results in some way.
Still, the findings are interesting — and, perhaps, comforting.
“In an increasingly polarized era, when conservatives and liberals can’t seem to agree on what color the sky is, our research suggests there are still de-politicized zones,” write Jena and Khullar. “It suggests that, at least in this case, medical professionalism trumps political ideology. And it reflects a belief that doctors and patients of both parties share: Patients and their families should dictate the care they receive at the end of life.”
“Benjamin Franklin once wrote that nothing is this world is certain, except death and taxes,” they add. “Democrats and Republicans, it seems, can agree on how to approach death. Taxes are another story.”