Polling on Choices at the End of Life

John Benson is a Senior Research Scientist and is Managing Director of the Harvard Opinion Research Program. At Harvard since 1992, John has directed numerous national and international polling projects leading to more than 80 publications in JAMA: The Journal of the American Medical Association, New England Journal of Medicine, Health Affairs, Public Opinion Quarterly, Clinical Infectious Diseases, Social Science Research, and other domestic policy and polling journals.

Ill father lying in hospital bed and his worried son

Over the years, in responding to public concerns about their end-of-life care, professional and lay groups have proposed making various choices available to individuals at the end of their lives.  The public supports, at least in principle, the availability of many of these choices.  However, fewer Americans recommend some of these choices in specific circumstances.

In a book chapter published about a decade ago, a co-author and I looked at public support for a wide range of end-of-life options. The earlier chapter examined not only the public’s views on the topics covered here, but also their worries about end-of-life care and attitudes about other choices such as palliative care, hospice, spiritual comfort, and medical marijuana.  Our major conclusions were as follows:

  • A majority of the public supports in principle the availability of a wide range of choices at the end of life.
  • However, the chapter found that many do not recommend some of these choices in specific circumstances and they themselves often would not choose to exercise them. In addition, many have misgivings about the potential of a “slippery slope” from choice to coercion.
  • Trend data presented in the chapter showed a growth through the 1970s into the early 1980s in support for various consensual practices that result in the death of terminally ill patients, with relative stability in public opinion after that.
  • The chapter also found that across various controversial end-of-life issues such as withdrawal of life support, physician-assisted suicide, and euthanasia, Black Americans were significantly less likely than white Americans to express support for those options. Also, more-religious adults were significantly less likely than less-religious to express support.

The following discussion will update and summarize public opinion on a few of the more controversial topics among end-of-life options, using the Roper Center’s Health Poll Database.

Major organizations of health care professionals make careful distinctions when discussing ethics in end-of-life care. The American Medical Association (AMA) endorses the duty of physicians to respect the wishes of competent patients to forgo life-sustaining treatment. The AMA does not, however, endorse voluntary active euthanasia (VAE) or physician-assisted suicide (PAS).2

Forgoing Life-Sustaining Treatment. In 2009, about three-fourths (67%) of U.S. public favored withdrawing life support systems, including food and water, from hopelessly ill or irreversibly comatose patients if they or their families request it.3

Voluntary Active Euthanasia (VAE). VAE involves the physician administering medication or treatment the intent of which is to end the patient’s life. VAE is often confused with physician-assisted suicide in news reports, making it difficult to distinguish support for one or the other. However, the public is able make a distinction between the two acts when they are described.

Public opinion questions about VAE and PAS have specified three different circumstances. Currently, nearly three-fourths (74%) support VAE when a patient has an incurable disease.4 Earlier polls have shown majority public support for VAE when a patient is dying (70%)5 and in the case of degenerative disease (58%).3

Physician-Assisted Suicide (PAS). PAS differs from VAE in that the person takes his or her own life, assisted by the physician, who would typically give the patient a prescription for a lethal drug.

Public support for PAS when a patient has an incurable disease is currently 61%.4 Earlier polls have shown that half (50%) of the public supports PAS in the case of terminal illness,6 56% in the case of degenerative disease.7

Polling shows that the public generally expresses a higher level of support for VAE than it does for PAS, a point we made in our book chapter a decade ago using primary General Social Survey data for VAE,1 but which is clearly shown over time by a trend figure in a recent Gallup Poll release.8 The lower level of support for PAS than for VAE provides an interesting insight into some of the forces that undergird public opinion on end-of-life issues, such as an instinctive aversion to and religious proscriptions against suicide or fear that the suffering patient might act too rashly or botch the attempt.

Suicide Not Involving Health Professionals. Currently a majority (63 percent) of the public believes that a person has a right to end his or her own life if that person has an incurable disease.9

An important caveat should be noted when interpreting these polls: there is a significance difference between wanting an option available and actually choosing that option.

Because of advances in medical technology, the process of dying may now take years and sometimes involves complicated decisions that will affect the quality and duration of the dying person’s life. A majority of the public supports in principle the availability of a wide range of choices at the end of life, but also seems able to differentiate broadly among various end-of-life situations.