Public Opinion About Life and Death - Concerns About Death

Americans say they are not afraid of death. In a 1999 survey conducted by the Los Angeles Times) 83 percent said they were not afraid to die. Fear of death seems to decline with advancing age. Among adults ages 18 to 44, 18 percent said they were afraid to die, while 79 percent were unafraid. Among respondents age 65 and over, only 7 percent reported a fear of death, while 90 percent said they were not afraid (Roper).

In the same survey, about half the respondents (49 percent) said that they very seldom think about death, and 10 percent claimed that they never think at all about their own deaths. A September 2000 survey found that the largest proportion of respondents (38 percent) think about their own deaths just a few times each year.

Teens are not much different from young adults in how much they think about their own deaths. In a 2004 Gallup Youth Survey, 1,302 teens aged 13 to 17 years were queried on this topic. Again, the largest proportion FIGURE 11.1
Public opinion on the belief in life after death, February 2002
FIGURE 11.3
Public opinion on existence of hell, selected years, 1997–2004 of respondents (35 percent) thinks "hardly at all" about their own deaths. An additional 25 percent never thinks about their own deaths, while 30 percent only sometimes thinks about it. Only 2 percent of teens "almost always" think about their own deaths. (See Figure 11.4.)

In addition to not being preoccupied with thinking about their own deaths, 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 percent of teens aged 13 to 17 years responded that they were somewhat FIGURE 11.2
Public opinion on existence of heaven, selected years 1997–2004 likely to die from a car accident before they reached adulthood. (See Figure 11.5.) This belief parallels National Center for Health Statistics data, which show that motor vehicle accidents are the leading cause of teen death. In contrast, only 24 percent of teens thought they might die at a young age from violent crime, 21 percent from disease, and 18 percent 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, 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 percent of respondents were "very fearful" or "somewhat fearful" about dying alone (Roper).

The 1997 Gallup Organization survey reveals that when they think about their own death, the majority of Americans (70 percent) express some or a great deal of concern about "not having the chance to say goodbye to someone." Sixty-four percent of respondents also feared causing loved ones stress and inconvenience, and 65 percent FIGURE 11.4
How often teens think about death, 2004 worried about how their families or loved ones would be cared for (Roper).

The same survey found that nearly three-quarters of respondents (73 percent) fear the possibility of being in a persistent vegetative state before dying, and more than two-thirds (67 percent) are afraid they will suffer "great physical pain" before death. About half (49 percent) are concerned about having others make medical decisions for them, and 41 percent are concerned about being in the hospital while dying.

The Yankelovich Partners/ Time /CNN survey found that the majority of people (73 percent) 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 percent) believed they were likely to die at home—28 percent thought they were likely to die in a hospital, nursing home, or hospice.

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 the general population (Roper). While dying at home appears to be a priority for many Americans, only 35 percent of the seriously ill named dying at home as a priority, making it last on their FIGURE 11.5
Teens' self-assessed likelihood of dying from particular causes, 2003 list of concerns. Their top priorities were being kept clean (99 percent), having a nurse with whom they felt comfortable (97 percent), knowing what to expect about their physical conditions (96 percent), trusting their physician (94 percent), and being free of pain (93 percent).

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