UF study: Wide generation gap in belief in the right to die
GAINESVILLE, Fla. --- The closer people are to death, the more likely they are to believe in their right to die, suggests a University of Florida study that finds a wide generation gap on the subject of living and dying.
Grandparents are more than three times as likely as their grandchildren to believe strongly in an individual’s right to die, said Terry Mills, a UF sociologist who conducted the study published in the January issue of the journal Family Relations.
“Because of their advancing age, members of the oldest generation are much closer to experiencing a life-threatening illness that requires life-sustaining treatment than members of the second and third generations, for whom the situation is more a hypothetical scenario than approaching reality,” he said.
Mills studied 1,260 participants spanning three generations and found that all age groups strongly believe the family should make life-sustaining decisions for relatives unable to make those decisions themselves. This may involve issues such as organ transplantation, respirators, kidney dialysis or even chemotherapy.
There are differences within the family, however. Regardless of age, women were more likely to believe family members should have the right to choose, Mills found.
“Typically, women are more involved in family nurturing and more knowledgeable about the health records of family members,” Mills said. “Since they go to doctors more than men do, they’re more likely to be attuned to health conditions.”
Mills also found that people with strong religious views were much less supportive of entitling family members to make those life-and-death decisions.
The study suggests health professionals should take additional steps to involve families when a patient faces a terminal illness, Mills said. The 1990 Patient Self-Determination Act gives patients and families the right to decide what types of treatments they want – if any – in the event of life-threatening conditions, and more people are likely to face those decisions as life expectancy increases, he said.
“It speaks to the importance of families including discussions of death and dying in normal dinner-table conversations," Mills said. “In America, we really find this a morbid, frightful prospect. Family members may talk about who gets what in the will or where the burial plot is, but not about what lifesaving measures they would like taken if they can’t make the decision for themselves.”
Three generations of families – elderly parents, adult children and grandchildren – were asked to rate the importance of nine factors in how they would influence life-sustaining decisions. The sample of participants, whose ages ranged from 39 to 84, was drawn from the 1991 collection of data for the University of Southern California Longitudinal Study of Generations, a long-term study that began in 1971.
The mental capacity of the person facing death emerged as the No. 1 consideration for each generation and was the only factor to be ranked in the same position by all three, Mills said. Seventy-nine percent of the oldest generation identified it as extremely important in making life-sustaining decisions, followed by 78 percent of the middle generation and 67 percent of the youngest generation, he said.
The middle and younger generations diverge from their elders by ranking pain second in importance when evaluating the use of life-sustaining treatments, while older people were more concerned about whether they would become a burden to their families, Mills said.
When considering life-sustaining treatment for a parent, some differences emerged, such as the youngest generation identifying family opinion as the third-biggest factor. By contrast, the middle generation ranked it sixth.
“Perhaps it suggests there is a strong bond between grandchildren and their grandparents, illustrating grandchildren’s beliefs that (grandparents) are indeed part of the family,” Mills said. “The middle generation, or so-called sandwich generation, is probably conflicted between the obligations and responsibilities of caring for their parents versus the obligations and responsibilities of caring for their own children.”
Neither of the younger generations cared much about the cost of treatment possibly being a financial strain or whether the person was a family burden. Only 22 percent of the middle generation and 14 percent of the younger generation reported money as extremely important when considering the use of life-sustaining treatment for a parent, and 19 percent of the middle generation and 13 percent of the young generation said so of family burden.
Despite the Patient Self-Determination Act being more than a decade old, only about 15 percent of Americans have advance directives specifying the kind of treatment measures that should or should not be taken if they are incapacitated.
“My wife, who is a gerontologist, speaks to people about living wills, and she’ll get responses like, ‘What do I need that for? I don’t have a lot of possessions,’” Mills said. “People need to feel more comfortable about death because death is a part of life and a place where we all inevitably end up.”
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