Public Opinion About Life and Death - Concerns About Death

Most Americans say they are not afraid of death. A September 2000 Los Angeles Times poll called "Aging in America" reported by Susan Pinkus, Jill Richardson, and Elizabeth Armet found that people over age sixty-five think about and fear death the least, while those ages eighteen to twenty-nine think about and fear it the most. Only 7% of those age sixty-five and older say they are afraid to die, while 20% of eighteen- to twenty-nine-year-olds express fear of dying.

Although a greater proportion of young people appear to think about and fear death than older persons, most are not preoccupied with or fearful of it. In a 2004 Gallup Youth Survey, 1,302 teens ages thirteen to seventeen years were queried about death. The largest proportion of respondents (35%) thinks "hardly at all" about their own deaths. An additional 25% never think about their own deaths, while 30% only sometimes think about dying. Only 2% of teens "almost always" think about their own deaths. (See Figure 11.3.)

In addition, American teens appear to have a realistic attitude about the possibility of their dying at an early age. In a 2003 Gallup Youth Survey, 48% of teens ages thirteen to seventeen responded that they were somewhat likely to die from a car accident before they reached adulthood. (See Figure 11.4.) This belief parallels National Center for Health Statistics data, which show that motor vehicle accidents are the FIGURE 11.1 Public opinion on existence of heaven, selected years 1997–2004 Albert L. Winseman, "Belief in Heaven," in "Eternal Destination: Americans Believe in Heaven, Hell," The Gallup Poll, May 25, 2004. Copyright © 2004 by The Gallup Organization. Reproduced by permission of The Gallup Organization.FIGURE 11.2 Public opinion on existence of hell, selected years 1997–2004 Albert L. Winseman, "Belief in Hell," in "Eternal Destination: Americans Believe in Heaven, Hell," The Gallup Poll, May 25, 2004. Copyright © 2004 by The Gallup Organization. Reproduced by permission of The Gallup Organization.FIGURE 11.3 How often teens think about death, 2004 Linda Lyons, "About How Much of the Time Do You Think about Your Own Death?" in "One in 10 Teens Thinks Often about Own Death," The Gallup Poll, June 29, 2004. Copyright © 2004 by The Gallup Organization. Reproduced by permission of The Gallup Organization.leading cause of teen death. In contrast, only 24% of teens thought they were somewhat likely to die at a young age from violent crime, 21% from disease, and 18% from terrorism.

Fearful Aspects of Dying

Although they may not fear death or spend much time thinking about their own deaths, 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 the majority of 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.

FIGURE 11.4 Teen's self-assessed likelihood of dying from particular causes, 2003 Steve Hanway, "How Likely Do You Think You Are to Die from Each of These before You Are an Adult?" in "Teens Cast a Wary Eye on Their Own Mortality, " The Gallup Poll, October 21, 2003. Copyright © 2003 by The Gallup Organization. Reproduced by permission of The Gallup Organization.

The Seriously Ill Have Different Concerns

When patients with advanced chronic illnesses were asked, in a 1999 survey conducted by Karen E. Steinhauser for the Program on the Medical Encounter and Palliative Care, 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. While dying at home appears to be a priority for many Americans, only 35% of the seriously ill named dying at home as a priority, making it last on their list of concerns. Their top priorities were being kept clean (99%), having a nurse with whom they felt comfortable (97%), knowing what to expect about their physical conditions (96%), trusting their physician (94%), and being free of pain (93%).

In this same survey seriously ill patients also revealed that they felt it was very meaningful to have someone who would listen to them (95%), and more than nine out of ten said it was important to them to maintain both their dignity (95%) and sense of humor (93%). Almost all believed it was vital to name someone to make decisions for them if they became unable to make them (98%) and to have their financial affairs in order (94%). They did not wish to be a burden to their families (89%) or to society (81%). While only half of seriously ill respondents felt it was important to be able to discuss their spiritual beliefs with their physicians (50%), more than two-thirds (69%) wished to meet with a clergy member, and 85% valued prayer. The highest spiritual priority for seriously ill patients was coming to peace with God (89%).