Washington, D.C. Nov. 21, 2013 — At a time of national debate over health care costs and insurance, a new Pew Research Center survey on end-of-life decisions finds most Americans say there are some circumstances in which doctors and nurses should allow a patient to die. At the same time, however, a growing minority says that medical professionals should do everything possible to save a patient’s life in all circumstances.
When asked about end-of-life decisions for other people, two-thirds of Americans (66%) say there are at least some situations in which a patient should be allowed to die, while nearly a third (31%) say that medical professionals always should do everything possible to save a patient’s life. Over the last quarter-century, the balance of opinion has moved modestly away from the majority position on this issue. While still a minority, the share of the public that says doctors and nurses should do everything possible to save a patient’s life has gone up 9 percentage points since 2005 and 16 points since 1990.
When thinking about a more personal situation, many Americans express preferences for end-of-life medical treatment that vary depending on the exact circumstances they might face. The new survey finds that a majority of adults say there are at least some situations in which they, personally, would want to halt medical treatment and be allowed to die. For example, 57% say they would tell their doctors to stop treatment if they had a disease with no hope of improvement and were suffering a great deal of pain. And about half (52%) say they would ask their doctors to stop treatment if they had an incurable disease and were totally dependent on someone else for their care. But about a third of adults (35%) say they would tell their doctors to do everything possible to keep them alive – even in dire circumstances, such as having a disease with no hope of improvement and experiencing a great deal of pain. In 1990, by comparison, 28% expressed this view. This modest uptick stems largely from an increase in the share of the public that expresses an opinion on these questions; the share saying they would stop their treatments so they could die has remained about the same over the past 23 years.
These are some of the key findings from the Pew Research Center telephone survey, which was conducted on landlines and cellphones from March 21 to April 8, 2013, among a nationally representative sample of 1,994 adults. The margin of error for the survey is plus or minus 2.9 percentage points. This is the second of two survey reports on bioethics questions at the intersection of religion and public life, and follows Pew Research’s August report on radical life extension.
Other key findings include:
- A growing share of Americans believe individuals have a moral right to end their own lives. About six-in-ten adults (62%) say that a person suffering a great deal of pain with no hope of improvement has a moral right to commit suicide, up from 55% in 1990. A 56% majority also says this about those who have an incurable disease, up from 49% in 1990. While far fewer (38%) believe there is a moral right to suicide when someone is “ready to die because living has become a burden,” the share saying this is up 11 percentage points, from 27% in 1990. About a third of adults (32%) say a person has a moral right to suicide when he or she “is an extremely heavy burden on his or her family,” roughly the same share as in 1990 (29%).
- Americans remain closely divided on the issue of physician-assisted suicide: 47% approve and 49% disapprove of laws that would allow a physician to prescribe lethal doses of drugs that a terminally ill patient could use to commit suicide. Attitudes on physician-assisted suicide were roughly the same in 2005 (when 46% approved and 45% disapproved).
- Personal preferences about end-of-life treatment are strongly related to religious affiliation as well as race and ethnicity. For example, most white mainline Protestants (72%), white Catholics (65%) and white evangelical Protestants (62%) say they would stop their medical treatment if they had an incurable disease and were suffering a great deal of pain. By contrast, 61% of black Protestants and 57% of Hispanic Catholics say they would tell their doctors to do everything possible to save their lives in the same circumstances. On balance, blacks and Hispanics are less likely than whites to say they would halt medical treatment if faced with these kinds of situations.
- Despite the graying of America, a sizable minority of the populace has not thought about the kinds of medical decisions that people increasingly face as they age. Nearly four-in-ten U.S. adults (37%) say they have given a great deal of thought to their wishes for medical treatment at the end of their lives, and an additional 35% have given some thought to these issues. But fully a quarter of adults (27%) say they have not given very much thought or have given no thought at all to how they would like doctors and other medical professionals to handle their medical treatment at the end of their lives.
- Even among Americans ages 75 and older, one-in-four say they have not given very much or any thought to their end-of-life wishes. Further, one-in-five Americans ages 75 and older (22%) say they have neither written down nor talked with someone about their wishes for medical treatment at the end of their lives. And three-in-ten of those who describe their health as fair or poor have neither written down nor talked about their wishes with anyone.
- There has been only modest change over time in the level of public attention to, and preparation for, end-of-life medical decisions. The share of Americans who report having given a great deal of thought to their own wishes for end-of-life medical treatment (37%) is roughly the same as it was in a 2005 Pew Research survey and up modestly from 23 years ago, when 28% said they had given a great deal of thought to their wishes. About a third of all adults (35%) say they have put their wishes for end-of-life decisions into writing, whether in an informal document (such as a letter to a relative) or a formal, legal one (such as a living will or health care directive). That share is about the same as in 2005 (34%) and up from about one-in-six (16%) in 1990.
- Many Americans have faced end-of-life medical issues through experiences with friends or relatives. About half of adults (47%) say they have a friend or relative who has had a terminal illness or who has been in a coma within the last five years. This experience cuts across most social and demographic groups, including age, gender, education and religious affiliation.
Together with the survey results, Pew Research is releasing two accompanying reports. “To End Our Days: The Social, Legal and Political Dimensions of the End-of-Life Debate” presents an overview of the debate on end-of-life issues in the United States. “Religious Groups’ Views on End-of-Life Issues” summarizes the teachings of 16 major American religious groups on physician-assisted suicide, euthanasia and other end-of-life questions. Additionally, an interactive web timeline highlights U.S. court rulings, referendums and other notable events related to end-of-life issues from the last half-century.
Pew Research Center is a nonpartisan fact tank that informs the public about the issues, attitudes and trends shaping America and the world. It does not take policy positions. Its Religion & Public Life Project seeks to promote a deeper understanding of issues at the intersection of religion and public affairs.