Religious Beliefs and End-of-Life Ethical Decision-Making among Healthcare Professionals in Chile: A Mixed-Methods Study
Keywords:
Advanced Directives, Bioethical Autonomy, Clinical Paternalism, Dysthanasia, Limitation of Therapeutic Effort, Sanctity of LifeAbstract
This study evaluated the influence of personal religious beliefs on end-of-life clinical decision-making among healthcare professionals in Chilean public and private hospitals, identifying the socio-legal and psychological mechanisms guiding clinical choices. A convergent parallel mixed-methods design was implemented. Quantitative survey data were gathered from 412 intensive care, oncology, and palliative care clinicians across six metropolitan healthcare facilities using the Duke University Religion Index alongside standardized end-of-life clinical scenarios. Concurrently, qualitative data were collected via semi-structured depth interviews with 28 clinicians and processed using structural text analysis. Multivariate logistic regression demonstrated that high intrinsic religiosity significantly predicted clinical resistance to withdrawing mechanical ventilation (Odds Ratio = 3.42, 95% Confidence Interval [2.15, 5.44], ) and withdrawing artificial nutrition and hydration (Odds Ratio = 4.18, 95% Confidence Interval [2.62, 6.68], ). The qualitative analysis identified three central thematic concepts: the moral weight of divine sovereignty over life, the persistent influence of historical medical paternalism, and the cognitive dissonance experienced when navigating Chilean Law 20.584 on patient rights. Personal religious frameworks remain a primary factor shaping end-of-life clinical practice in Chile, often creating conflicts with contemporary legal mandates designed to protect patient autonomy. To bridge this gap, healthcare networks must implement standardized bioethical training and strengthen the role of institutional ethics committees to ensure objective, patient-centered care.
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