Culture Wars in the ICU: When Medicine and Religion Collide

The overarching aim of this dissertation is to contribute to the research gap by investigating the experiences of Christian SDMs by asking two core questions: (1) Do covariates (Gender, Age, Education) and Religion predict satisfaction with care? and (2) Do covariates (Gender, Age, Education) and Religion predict satisfaction with decision making? This study contributes to the academic literature by addressing the gap in literature regarding the ICU experiences of Christian SDMs, and it extends John Kingdon’s Multiple Streams Theory (MST) to include its limitations in its failure to capture the political landscape within healthcare systems and the effect of institutional constraints on policy change. It then proposes MST Plus Theory that includes a fourth stream to capture the role and influence of biases in creating institutional constraints that prevent new policy outcomes. This study was conducted as a quasi-experimental survey of SDMs 18 years of age or older for a loved one in any United States (U.S) ICU. Data was collected using an anonymous online survey using cross-sectional analysis. Participants were solicited using social media. Data was analyzed using logistic regression to test for a statistically significant relationship between the variables. The hypothesis tested is that religion will have an impact on the two dependent variables (satisfaction with care and satisfaction with decision making). The study’s hypothesis advances the literature of bioethics and end of life decision making and the extension of MST to the contemporary problems of public policy research. Final analysis found that being a non-religious SDM was significantly associated with higher satisfaction with decision-making compared to being an Evangelical Christian SDM.