Public Opinion About Life and Death

LIFE AFTER DEATH

Since the dawn of history, many people have believed that human beings do not simply cease to exist once they die. Many religions and cultures teach that the physical body may die and decompose but that some element of the person goes on to what many call the afterlife.

Between 1972 and 1982, when the Roper Center for Public Opinion Research (http://www.ropercenter.uconn.edu/) asked the American public, “Do you believe there is life after death?” 70% said they believed in an afterlife. In 1996, when the Roper Center asked the same question, 73% of respondents said yes. The National Opinion Research Center at the University of Chicago revealed similar results in its General Social Survey 2002 (http://www.cpanda.org/cpanda/getDDI.xq?studyID=a00079). Seventy-two percent of those polled said they believed that there is a life after death. More recently, the article “Poll: Majority Believe in Ghosts” (CBSNews.com, October 30, 2005) notes that 78% of adult Americans believe in life after death.

These data suggest that the proportion of the U.S. population believing in an afterlife is growing, from about 70% between 1972 and 1982 to about 78% in 2005. Data from the General Social Survey agree. (See Figure 11.1.) These data show that the percentage of Jewish Americans who said they believed in an afterlife rose dramatically between 1973 to 2004. In 1973, 16.7% of Jewish Americans believed in an afterlife, but by 2004 the percentage was 35.1%. The percentage of Protestant and Catholic Americans believing in an afterlife rose as well during this period. The percentage of Catholics who believed in an afterlife rose from 68.8% in 1974 to 77.3% in 2004. The percentage of Protestants who believed in an afterlife rose from 75.6% in 1973 to 77.7% in 2004.

Are there differences between those who attend religious services and those who do not? The article “Poll: Majority Believe in Ghosts” indicates what the most and the least religiously observant Americans said on the subject of afterlife. About 90% of those who attended religious services weekly or almost every week believed that humans transition to an afterlife after the physical body dies. About 70% of those who rarely or never attended religious services believed in an afterlife.

Frank Newport of the Gallup Organization notes in Americans More Likely to Believe in God Than the Devil, Heaven More Than Hell (June 13, 2007, http://www.gallup.com/poll/27877/Americans-More-Likely-Believe-God-Than-Devil-Heaven-More-Than-Hell.aspx) that when asked in polls about an afterlife and what that “eternal destination” might be, many Americans expressed a belief in heaven, where people who led a good life are eternally rewarded after death, and hell, where unrepentant people who led a bad life are eternally punished. Newport determines that belief in the existence of heaven and hell increased over time as has the more general belief in an afterlife. From 1997 to 2007 a majority of respondents (72% in 1997 and 81% in 2007) acknowledged a belief in heaven. (See Table 11.1.) In addition, a majority of respondents (56% in 1997 and 69% in 2007) acknowledged a belief that hell exists in the afterlife. (See Table 11.2.)

FEAR AND ANXIETY ABOUT DEATH

In “Poll Analysis: Aging in America” (Los Angeles Times, April 2, 2000), Susan Pinkus, Jill Richardson, and Elizabeth Armet find that people over age sixty-five think about and fear death the least, whereas those aged eighteen to twenty-nine think about and fear it the most. In 2000, 7% of those aged sixty-five and older said they were afraid to die, whereas 20% of eighteen- to twenty-nine-year-olds expressed a fear of dying.

Linda Lyons of the Gallup Organization indicates in What Frightens America's Youth? (March 29,2005, http://www.gallup.com/poll/15439/What-Frightens-Americas-Youth.aspx) that those younger than eighteen are also

R. J. Russac et al. of the University of North Florida conducted studies not only to examine the consistent assertion in the medical literature that young adults typically report higher levels of concern about death than do older adults but also to examine the assertion that women typically report higher levels of concern about death than men do. The researchers report in “Death Anxiety across the Adult Years: An Examination of Age and Gender Effects” (Death Studies, vol. 31, no. 6, July 2007) that the results of their studies support these findings and that anxiety about death peaks at about age twenty. Their results also support previous findings that women report higher levels of concern about death than men do. However, the results also show that the decline in death anxiety after age twenty differed between men and women. Concern about death declined after age twenty in both sexes, but in women a secondary peak in anxiety about death occurred in their early fifties.

concerned about death. She finds that death and dying was the second greatest fear of U.S. teens aged thirteen to seventeen in 2005. (See Figure 11.2.) This number-two spot was shared with a fear of spiders. The number-one fear of teens in this age group was terrorist attacks. Teens were more concerned about death than about war, gang violence, and not succeeding in life.

Fearful Aspects of Dying

Russac et al. wondered why young people would be more anxious and fearful of dying than older people. Other researchers, they note, suggest that older Americans come to terms with death as they age. Other hypotheses include that death is more appealing to those in old age than to younger people (especially to older people with chronic conditions and illnesses), that older people are more religious and this affected their views, and that older people have more experience with death over their lifetime so are less anxious about it. Russac et al. instead consider why young people would be anxious about death and suggest that it might have to do with the concurrent peak in their reproductive years. Their concerns might actually be about their children and wondering what would happen to their youngsters if they were to die. Likewise, some researchers suggest that women report more anxiety about death than men because they are the primary caretakers, not only of children but also of the elderly and those who might be dying. One hypothesis for the peak of anxiety about death in the fifties is that women reach menopause during those years and this change of life may remind women that they are getting older and closer to death.

Even though they may not fear death or spend much time thinking about their own death, Americans are fearful about some aspects of dying. In a survey published in 2001 and conducted by Yankelovich Partners, Time magazine, and CNN, two-thirds of respondents expressed much or some concern about dying in pain. Another two-thirds said they were “very fearful” or “somewhat fearful” of leaving loved ones behind, and 43% of respondents were “very fearful” or “somewhat fearful” about dying alone.

The Yankelovich Partners/Time /CNN survey found that most people (73%) would prefer to die at home rather than in a hospital, hospice, or nursing home. Despite these expressed wishes to die at home, less than half (43%) believed they were likely to die at home—28%thought they were likely to die in a hospital, nursing home, or hospice.

The Seriously Ill Have Different Concerns

In “What Matters Most in End-of-Life Care: Perceptions of Seriously Ill Patients and Their Family Members” (Canadian Medical Association Journal, vol. 174, no. 5, February 28, 2006), Daren K. Heyland et al. find that when patients with advanced chronic illnesses and advanced cancer were asked whether they agreed or strongly agreed about the importance of a variety of end-of-life issues, their concerns were quite different from those of the general population. Even though dying at home appears to be a priority for many Americans, dying in the location of choice (home or hospital) was twenty-fourth on the patients' ranked list of concerns. Their top priorities (very or extremely important) were trusting their physician (ranked first), not being kept on life support when there was little hope (ranked second), having their physician communicate with them honestly (ranked third), and completing things and preparing for death (resolving conflicts and saying good-bye) (ranked fourth). Seriously ill patients also revealed that they did not want to be a physical or emotional burden on their families (ranked fifth), wanted to have an adequate plan of home care were they to be discharged from the hospital (ranked sixth), and wanted to have relief from their symptoms (ranked seventh).

GETTING OLDER

Living to Age One Hundred

The ABC News/USA Today poll “Most Wish for a Long Life—Despite Broad Aging Concerns” (October 24, 2005, http://abcnews.go.com/images/Politics/995a1Longevity.pdf) reveals that in 2005 only one-quarter of a random national sample of one thousand adults wanted to live to be one hundred years or older. Twenty-three percent stated they would like to live into their nineties and 29% into their eighties.

Those surveyed by the ABC News/USA Today poll were asked how likely they thought it was that they would live to be one hundred years old and still have a good quality of life. Thirty-five percent thought it very or somewhat likely, whereas 64% thought it somewhat or very unlikely.

Concerns about Aging

The aging of the baby boomers (the generation born between 1946 and 1964) and the growing number of people living longer have focused much attention on concerns that come with aging. The ABC News/USA Today poll finds that even though respondents wanted to live longer, most were concerned about losing their health (73%). Seven out of ten worried about losing their mental abilities (69%) and losing their ability to care for themselves (70%). The respondents were also worried about being a burden to their families (54%) and living in a nursing home (52%).

Opinions on Nursing Homes

The Henry J. Kaiser Family Foundation conducted a national survey that included questions about nursing homes and reported its findings in Toplines: Update on the Public's Views of Nursing Homes and Long-Term Care Services (December 2007, http://www.kff.org/kaiserpolls/upload/7719.pdf). When asked if they thought that during the past five years “the quality of nursing homes in this country has gotten better, gotten worse, or stayed about the same,” only 14% thought they had gotten better. Thirty-one percent thought nursing homes had gotten worse, whereas 32% felt that they had stayed about the same.

More than half (53%) of respondents felt nursing homes were understaffed, and only 19% believed nursing homes “have staff who are concerned about the well-being of their patients.” (See Table 11.3.) Forty-three percent thought there was not enough government regulation of

these facilities. Only 12% believed that nursing homes provide high-quality services.

SUICIDE

The General Social Survey 2002 and the General Social Survey 2004, both conducted by the National Opinion Research Center (http://www.norc.org/homepage.htm), found that 58% of respondents in each survey approved of suicide if a person had an incurable disease, but only a small minority approved of it if the person had gone bankrupt (8% in 2002 and 11% in 2004), had dishonored his or her family (9% in 2002 and 11% in 2004), or was simply tired of living (15% in 2002 and 16% in 2004). In comparison, a survey from 1977 found that a much lower percentage of people (38%) thought suicide was acceptable if one had an incurable illness. Suicide in other situations was also found less acceptable in the 1977 survey than in the 2002 and 2004 surveys.

According to the Centers for Disease Control and Prevention (March 20, 2008, http://www.cdc.gov/ncipc/wisqars/default.htm), in 2005 suicide was the eleventh-leading cause of death in the United States, the second-leading cause of death among young people aged twenty-five to thirty-four, and the third-leading cause of death among young people aged ten to twenty-four. In Nearly Half of Teens Aware of Peer Suicide Attempts (May 25, 2004, http://www.gallup.com/poll/11776/Nearly-Half-Teens-Aware-Peer-Suicide-Attempts.aspx), Coleen McMurray of the Gallup Organization reports that 22% of American teens (aged thirteen to seventeen) had “ever talked or thought about committing suicide.” Girls were more likely (28%) than boys (16%) to have had suicidal thoughts. When asked if

they had ever tried to commit suicide, only 4% of boys and 9% of girls had.

PHYSICIAN-ASSISTED SUICIDE AND EUTHANASIA

Many advocates of physician-assisted suicide believe that people who are suffering from uncontrollable pain should be allowed to end their life with a lethal dose of medication prescribed by their physician. U.S. public opinion rose slowly from 1996 to 2001 in favor of physician-assisted suicide, from 52% in 1996 to 68% in 2001. After 2001 a slow decline occurred, with 56% in favor of physician-assisted suicide in 2007. (See Figure 11.3.) Results of the same polls show that, in general, a greater percentage of Americans support euthanasia—allowing a doctor to end the life of a patient who is suffering from an incurable disease and wants to die, without requiring the patient to administer the drugs to him- or herself. Figure 11.4 shows that support for euthanasia has increased considerably since the 1940s.

Joseph Carroll of the Gallup Organization indicates in Public Divided over Moral Acceptability of Doctor-Assisted Suicide (May 31, 2007, http://www.gallup.com/poll/27727/Public-Divided-Over-Moral-Acceptability-DoctorAssisted-Suicide.aspx) that in 2007 more Democrats than Republicans supported euthanasia (77% versus 64%, respectively) and physician-assisted suicide (62% versus 49%, respectively). Support of both euthanasia and physician-assisted suicide also varied by frequency of attendance of religious services. Those who seldom or never attended services were the most supportive of both euthanasia (84%) and physician-assisted suicide (73%). Those who attended almost weekly or attended monthly were the next most supportive: 70% supported euthanasia and 52% supported physician-assisted suicide. The least supportive were those who attended religious services each week: 47% supported euthanasia and 35% supported physician-assisted suicide.

Oregon Physician-Assisted Suicide Law

In 1994 Oregon became the first jurisdiction in the world to legalize physician-assisted suicide when its voters passed the Death with Dignity Act. Under the act, Oregon law permits physician-assisted suicide for patients with less than six months to live. Patients must request physician assistance three times, receive a second opinion from another doctor, and wait fifteen days to allow time to reconsider.

Before the Death with Dignity Act could take effect, opponents of the law succeeded in obtaining an injunction against it. Three years later, in November 1997, Oregon's legislature let the voters decide whether to repeal or retain the law. Voters reaffirmed the Death with Dignity Act. The Harris Poll indicates in “Majorities of U.S. Adults Favor Euthanasia and Physician-Assisted Suicide by More Than Two-to-One” (April 27, 2005, http://www.harrisinteractive.com/harris_poll/index.asp?PID=561) that in August 1997, before voters' reaffirmation of the law, 68% of those surveyed said they would approve of a similar law allowing physician-assisted suicide in their state. Asked again in 2001 whether they would favor or oppose such a law in their own state, 61% of respondents indicated they favored such legislation. In April 2005, 67% favored such a law.

Using Federally Controlled Drugs for Assisted Suicide

After the Death with Dignity Act took effect in November 1997, Timothy Egan reports in “Threat from Washington Has Chilling Effect on Oregon Law Allowing Assisted Suicide” (New York Times, November 19, 1997) that Thomas Constantine (1938–) of the U.S. Drug Enforcement Administration (DEA) announced that “delivering, dispensing, or prescribing a controlled substance with the intent of assisting a suicide” would be a violation of the federal Controlled Substances Act of 1970. The U.S. attorney general Janet Reno (1938–) overruled Constantine.

In November 2001 the U.S. attorney general John D.

Ashcroft (1942–) overturned Reno's ruling in an attempt to again allow the DEA to act against physicians who prescribe lethal doses of controlled substances under Oregon's physician-assisted suicide law. In December 2001 the Harris Poll asked adults nationwide whether they considered Ashcroft's effort to overrule the proposition right or wrong. More than half (58%) of respondents believed his action was wrong. On April 17, 2002, Judge Robert E. Jones (1927–) of the U.S. District Court for the District of Oregon agreed, noting that “to allow an attorney general—an appointed executive …—to determine the legitimacy of a particular medical practice … would be unprecedented and extraordinary.” Jones's ruling reaffirmed the Death with Dignity Act. The U.S. Department of Justice appealed the ruling to the Ninth Circuit Court of Appeals. On May 26, 2004, the court upheld Jones's ruling against Ashcroft.

In February 2005 the U.S. Supreme Court agreed to hear the Bush administration's challenge to Oregon's physician-assisted suicide law. The debate of this issue was heard in October 2005 before the High Court. On January 17, 2006, the Court ruled 6–3 that the state's authority overrode federal authority with regard to the Oregon's Death with Dignity Act, thereby upholding the lower courts' rulings.

WITHHOLDING NUTRITION AND HYDRATION: THE TERRI SCHIAVO CASE

The death of Terri Schiavo in March 2005 and the events leading up to her death resulted in an intense debate among Americans over end-of-life decisions and brought new attention to the question of who should make the decision to stop life support, most specifically nutrition and hydration. Schiavo died on March 31, 2005, after her feeding tube was withdrawn days earlier. Schiavo had been in a persistent vegetative state (PVS) since 1990. Her husband, Michael Schiavo, believing that she would never recover and saying that his wife did not want to be kept alive by artificial means, petitioned a Florida court to remove her feeding tube. Her parents, however, believed that she could feel, understand, and respond. They opposed the idea of removing the feeding tube. After years of legal disputes, the feeding tube was removed permanently and Schiavo died.

Two primary questions emerged as the nation watched the Schiavo case unfold: (1) If you were in a PVS would you want to be kept alive by artificial means?, and (2) Who should have the final say in the matter if you had not left an advance directive (living will)? Lydia Saad of the Gallup Organization reports in Americans Choose Death over Vegetative State (March 29, 2005, http://www.gallup.com/poll/15448/Americans-Choose-Death-Over-Vegetative-State.aspx) that in 2005, 53% of respondents worried “a great deal” about “the possibility of being vegetable-like for some period of time.” In exploring this issue more deeply, Dalia Sussman and Gary Langer report in “Two-Thirds Back Spouse in Right to Die Cases” (March 15, 2005, http://abcnews.go.com/images/Politics/975a3Schiavo.pdf) on an ABC News/Washington Post poll, which asked: “If you were in this condition [that of Terri Schiavo] would you want to be kept alive, or not?” Only 8% said “yes,” whereas 87% said “no.” When asked who should have the final say, 65% felt that the spouse should have the final say, whereas 25% believed it should be the parents.

It may be hard to determine the effect of the Terri Schiavo case on the American public, but in an attempt to do so, a FOX News/Opinion Dynamics poll (http://www.foxnews.com/projects/pdf/033105_poll.pdf) of March 31, 2005, asked the question: “Prior to the recent coverage of the Terri Schiavo case, had you ever discussed end of life medical decisions with your spouse, family or friends?” A huge majority (78%) reported that they had. Only 20% had not. Thus, a majority of the American public had dealt with this question before it was highlighted in the media. Nonetheless, the case appeared to generate strong interest in living wills as suggested by a March 25, 2005, poll (http://www.srbi.com/TimePoll-Final_Report-2005-03-25.pdf) by Time /SRBI. Results of the survey revealed that 93% of respondents had heard of a living will, but only 37% had executed such a document. When those who had no living will were asked, “Has the Schiavo case made you think about drafting a living will or discussing with your family your wishes for medical treatment should you be unable to communicate them yourself?” 69% responded “yes.”