November 21, 2013

Views on End-of-Life Medical Treatments

Chapter 4: General Views on End-Of-Life Medical Treatment

In addition to asking about people’s preferences for their own end-of-life medical treatment, the Pew Research survey included a more general question to gauge views on the issue. In this question, respondents were asked whether there are any circumstances in which medical staff should allow a patient to die or whether doctors and nurses should do everything possible to save a patient’s life in all circumstances. The question does not address the role of the patient’s wishes in directing medical care.

end-of-life-chp4-1About two-thirds of U.S. adults (66%) say there are circumstances when a patient should be allowed to die, and 31% say that doctors and nurses always should do everything possible to save a patient. While still a minority, the share of adults who say all possible efforts should be made to save a patient’s life has grown from 15% in 1990 to 22% in 2005 to 31% today, a difference of 16 percentage points from 1990 to today. The uptick in belief that medical staff should do everything possible to save a patient in all circumstances comes from a decline of 7 percentage points in the share saying there are circumstances when a patient should be allowed to die and a 9-percentage-point increase in the share of the public that expresses an opinion about end-of-life treatment.

Differences Among Groups in Views About End-of-Life Treatment

end-of-life-chp4-2There are differences on this question by age. While about half or more of all age groups say there are circumstances when a patient should be allowed to die, this viewpoint is more common among older adults. Roughly seven-in-ten adults ages 50-64 (71%) say there are circumstances when a patient should be allowed to die, as do about three-quarters of those ages 65-74 (76%) and ages 75 and older (74%). By comparison, fewer younger adults say the same. About half of those ages 18-29 (54%) say there are circumstances when medical staff should let a patient die, as do 64% of adults ages 30-49.

There also are sizable differences in attitudes across racial and ethnic groups on this issue. About three-quarters of whites (76%) say there are times when a patient should be allowed to die, while a fifth (20%) says medical staff should do everything possible to save a patient’s life in all circumstances. By contrast, blacks and Hispanics are more inclined to say medical staff should do everything possible to save a patient’s life. Roughly four-in-ten blacks (43%) and Hispanics (38%) say there are times when a patient should be allowed to die, while about half or more say medical personnel should do everything possible to save a patient’s life in all circumstances (52% among blacks and 59% among Hispanics).

These patterns among racial and ethnic groups also are reflected in differences among religious groups. Hispanic Catholics are particularly inclined to say medical staff should do everything possible to save a patient’s life (66%), followed by black Protestants (54%). By contrast, only about a fifth of white Catholics (18%) take this position, while eight-in-ten (80%) say there are times when a patient should be allowed to die. There is a similar balance of opinion among white mainline Protestants and white evangelical Protestants. Among the unaffiliated, about three-quarters (73%) say a patient should sometimes be allowed to die, while 26% say medical staff should do everything possible to save a patient’s life regardless of circumstances.

end-of-life-chp4-3There also are differences by education level: Those with more education are more likely to say that medical staff should sometimes let a patient die (79% among college graduates vs. 54% among those with a high school degree or less schooling). Meanwhile, there are no differences on this issue by gender.

Respondents who have given at least some thought to their own end-of-life wishes prior to taking the survey are more inclined than those who have given little or no prior thought to these issues to say that medical staff should sometimes allow a patient to die.

Respondents with a close friend or relative who has had a terminal illness or been in a coma in recent years also are more inclined to say that medical staff should sometimes let a patient die (70%, vs. 62% among those without this experience).

Similarly, those who have written down or talked about their own wishes are more inclined than those who have not done so to say there are times when a patient should be allowed to die.

end-of-life-chp4-4Views about end-of-life treatment are not strongly related to political party. A majority of both Democrats and Republicans say there are circumstances in which medical staff should allow a patient to die. But Democrats are somewhat more inclined than Republicans to say medical staff should do everything possible to save a patient’s life in all circumstances (34% of Democrats vs. 27% of Republicans). These differences appear to be explained by the greater tendency of blacks and Hispanics to identify with the Democratic Party. Among non-Hispanic whites, there are no significant differences in overall views about end-of-life treatment by party affiliation.

Views About End-of-Life Treatment, Over Time

end-of-life-chp4-5While a majority of most social and demographic groups say there are circumstances in which a patient should be allowed to die, a larger share of the public today says that medical staff always should try to save a patient’s life compared with 1990, when the question was first asked on a Pew Research survey. The increased propensity to say medical staff should do everything possible to save a patient’s life regardless of circumstances is more pronounced among younger generations, those with fewer years of formal schooling and those who report not having given very much or any thought to their own treatment preferences prior to the survey interview.

Among those ages 18-29, 43% believe doctors always should try to save a patient’s life, up somewhat from 35% in 2005 and 20% in 1990. Similarly, the share of support for always saving a patient’s life has grown among those ages 30-49 (13% in 1990 to 33% today). The change among seniors, while in the same direction, is less pronounced. A fifth of those ages 65 and older (20%) believe medical personnel always should try to save a patient’s life; that figure was the same in 2005 and was 13% in 1990.11

An increase in the belief that doctors and nurses always should try to save a patient’s life also is more pronounced among those with fewer years of formal schooling. Among adults with no more than a high school degree, 43% say doctors and nurses should do everything possible to save a patient’s life, up from 27% in 2005 and 17% in 1990. There have been more modest increases in the same direction among those with some college or more education.

In addition, those who have not given very much or any thought to their own wishes about end-of-life treatment prior to taking the survey are more inclined today than in earlier years to say that medical staff should do everything possible to save a patient’s life (43% today, 31% in 2005 and 20% in 1990).

The share of both whites and blacks who say medical staff should do everything possible to save a patient’s life is higher today than in 1990. This change is particularly pronounced among blacks. About half of blacks (52%) say medical staff always should do everything possible to save a patient’s life, up 18 percentage points, from 34% in 1990. However, views about end-of-life treatment have been largely stable among blacks since 2005. While there is no 1990 data available on Hispanic opinion, Hispanics are more likely to say medical staff always should do everything possible to save a patient’s life in 2013 (59%) than they were in 2005 (40%).12

The increase in the share of adults saying that medical personnel should do everything possible to save a patient’s life in all circumstances occurs to roughly the same degree among white evangelical Protestants, white mainline Protestants and white Catholics. Comparisons of other religious groups over time are not possible due to small sample sizes in earlier surveys of groups such as black Protestants and due to changes in the survey question used to identify religiously unaffiliated people.

General Views About Medical Care

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The survey also asked people other general questions to gauge their beliefs about today’s medicine overall. A majority of the general public (54%) considers medical treatments these days “worth the costs because they allow people to live longer and better quality lives,” while roughly four-in-ten (41%) say that medical treatments “often create as many problems as they solve.” And while about a quarter of adults say they have a lot of confidence that new medicines and treatments are carefully tested, a similar share does not have much or any confidence that this occurs. Nearly half of U.S. adults (47%) say they have some confidence.

These general views about modern medical treatments are strongly related to views about end-of-life treatments. Those who are more skeptical about the value of medical treatments overall are, not surprisingly, more inclined to say there are circumstances when a patient should be allowed to die. Similarly, those who express less confidence that medical treatments have been carefully tested also are more inclined to say a patient should sometimes be allowed to die.

end-of-life-chp4-7The public also tends to vary in its perception of health care providers’ attention to patients’ wishes when it comes to end-of-life treatment issues. Roughly a third of adults (36%) say that doctors and nurses pay a lot of attention to a patient’s instructions on these issues, 44% say medical staff pay some attention, and 16% say medical staff pay very little or no attention to a patient’s instructions for end-of-life treatment.

The perception that medical staff pay a lot of attention to patients’ wishes has risen over time, from just a fifth of adults in 1990 to three-in-ten in 2005 and 36% today. However, perception of medical staff behavior is, at most, weakly related to general views about end-of-life treatment. And those with a close friend or relative who has suffered from a terminal illness or been in a coma in the past five years are neither more nor less likely to say today, compared with 2005, that medical staff pays attention to patients’ instructions about end-of-life treatment.

Other Beliefs Related to Life and Death

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Attitudes about end-of-life treatment tend to be related to other beliefs about life-and-death issues, such as capital punishment and abortion. For example, a majority of adults (55%) favor the death penalty for persons convicted of murder, while 37% oppose it, and those who oppose the death penalty are more inclined to say that medical staff should do everything possible to save a patient’s life in all circumstances.

Similarly, views about the morality of abortion are associated with views about end-of-life medical treatment. About half of U.S. adults (49%) say they personally believe that having an abortion is morally wrong, while 15% say having an abortion is morally acceptable, and 23% say they do not consider abortion a moral issue.13 Four-in-ten of those who consider abortion morally wrong also say that medical staff should do everything possible to save a patient’s life in all circumstances. By comparison, fewer of those who consider abortion morally acceptable or say it is not a moral issue say that doctors and nurses should do everything possible to save a patient’s life in all circumstances (22% of those who consider abortion morally acceptable say this, as do 24% of those who say abortion is not a moral issue).

  1. There have been changes in the composition of the U.S. population over this time period as well. According to data from the U.S. Census Bureau, younger generations today are especially likely to be more racially and ethnically diverse than were the younger generations of 1990. It is possible that these kinds of differences in the composition of the population explain the generational differences over time on this issue. However, the increase over time of the share that says medical staff should do everything possible to save a patient’s life also is more pronounced among younger white adults (ages 18-29) than among older white adults. Thus, changes in the composition of the U.S. population may contribute to this pattern but do not wholly account for the more pronounced opinion change by age.
  2. Comparisons of Hispanic opinion over time should be made with caution; the 2005 survey was conducted in English only while the 2013 survey was conducted in both English and Spanish. In addition, due in part to the smaller size of the U.S. Hispanic population in 1990, that survey did not ask about Hispanic origin. Thus, whites and blacks in 1990 likely included some respondents of Hispanic origin. In 2005 and 2013, figures for whites and blacks refer to non-Hispanics in each race group; figures for Hispanics include those of any race.
  3. For details on views on the morality of abortion, see the Pew Research Center’s August 2013 report “Abortion Viewed in Moral Terms.”