The Economist / Kaiser survey on end of life care reveals a gap between how people want to die and what the medical community offers
LONDON, UNITED KINGDOM - APRIL 27, 2017 - Nearly two years after The Economist came out in support of making assisted suicide legal (http://econ.st/1ml9xtc), the newspaper today announced results of a new survey about attitudes on end-of-life care, conducted in partnership with the Kaiser Family Foundation, an American non-profit. The survey, conducted in Italy, Japan, US and Brazil, found that the majority of respondents said they would prefer to spend their final days before death at home but that few expect to do so. The survey results are part of The Economist’s cover report entitled “How life ends” and online here: http://econ.st/2q9ICLt
Key findings from US respondents:
- Americans are the most open to discussing care at the end of life (just over half at 56%), having had a conversation with a loved one about their own wishes for end-of-life care at some point. In Italy it was just 48%, in Brazil 34% and Japan 31%. Fewer say they have talked to a doctor about their wishes (11%)
- Nearly nine in ten Americans say that patients and their families should have a greater say than doctors in decisions about which medical treatments to pursue for seriously ill patients, and about half say most people in the US have too little control over their own medical care at the end of life. Eight-five percent say that making sure their wishes for medical care are followed is extremely or very important when it comes to their own death
- Only about one in ten US adults and one in five US seniors say they have discussed these wishes with a doctor or other health care provider
- White Americans (35 percent) are more likely than Blacks (15 percent) and Hispanics (11 percent) to say they have their wishes for end-of-life medical treatment in a written document. This is also true of Americans with higher levels of income and education compared with their lower-income and less-educated counterparts
Key findings from all respondents:
- Consistent across all four countries, particularly among Americans (71%), was the desire to die at home, but only 41% of survey respondents expected to do so. And 24% of Americans expected to die in hospital
- Almost half of black Americans, and nearly as many Latinos, said that health care placed too little emphasis on preventing death, compared with just 28% of whites
- Efforts to extend life for as long as possible did not appear to align with the wishes of patients. Respondents in the US, Italy and Japan said that living as long as possible was least important among the seven priorities asked about in the survey. Brazil was the exception
- In America and Japan, not burdening families with the costs of care was the highest-ranked priority among respondents. In Brazil, the leading priority at the end of life was being at peace spiritually. For Italians was for their loved ones to be around them
- Discussing end of life care with medical providers is uncommon across countries. Just about one in ten in each country say they’ve had a serious conversation about their wishes for end-of-life medical treatment with a doctor or other provider (rising to 22 percent among seniors in the US)
- In the US, Italy, and Japan, majorities of at least two-thirds say that when it comes to health care at the end of people’s lives, helping people die without suffering pain, discomfort, and stress is more important than preventing death and extending life as long as possible
- Among those who experienced the death of a loved one in the past 5 years, majorities across countries say their loved one’s wishes about medical care were followed, that their spiritual and religious beliefs were respected, and that they died with friends or family present
- Still, substantial shares of those who experienced the death of a loved one (particularly in Japan and Brazil) say the person experienced more pain than was necessary (four in ten in Brazil, three in ten in Japan, and a quarter in the US and Italy) or that they did not have access to appropriate medical treatments for prolonging life (four in ten in Japan and Brazil, one-third in Italy, and 18 percent in the US). About one in five of those experiencing the death of a loved one across countries say their loved one received medical care that placed an undue burden on the patient’s family
The Economist’s cover article argues that the medical community is not set up properly to meet the wishes of patients, but is slowly realising that there is a better way to care for the dying. The way care is paid for and the way doctors are trained encourages poor treatment. Hospitals are typically paid for doing things to people, not for preventing suffering and pain. Yet, nearly a third of elderly Americans undergo surgery in their final year and often it does them no good.
Public policy editor for The Economist, John McDermott, writes that healthcare providers should integrate palliative care with conventional treatment. Better communication about death with doctors and patients can help ensure that more people get the care they want.
“As the end nears people tend to have goals that matter more than eking out every last second. Yet too few are asked what matters most to them. Our end of life survey is evidence of this. But there are reforms that the medical community can make—and are making — to improve with how it deals with death. If they become widespread, the effects could be profound,” said Mr McDermott.
The four-country survey is part of a polling partnership between Kaiser and The Economist. Findings are featured in two Foundation reports, one on Americans’ views and experiences, and one that captures the results across all four countries. The poll was designed and analysed by survey researchers at Kaiser in collaboration with a team from The Economist. Each organisation is solely responsible for the content it publishes based on the survey.
The poll was conducted by telephone from March through November 2016 among random digit dial telephone (landline and cell phone) samples of adults in the U.S. (1,006), Italy (1,000), Japan (1,000) and Brazil (1,233). The margin of sampling error for results from each country is plus or minus 4 percentage points. For results based on subgroups, the margin of sampling error may be higher.
Link to The Economist’s article: http://econ.st/2q9ICLt
Link to survey highlights: http://econ.st/2oMmx3C
Link to full survey results: http://kaiserf.am/2pCUHfk
For more information or to interview The Economist’s public policy editor, John McDermott, please contact:
For more information, please contact:
US - LaurenHackett@economist.com or +1 (212) 541 0583
TomAmos@economist.com or +1 (212) 554 0639
UK - HollyDonahue@economist.com or +44 20 7576 8379
About The Economist (www.economist.com)
With a growing global circulation and a reputation for insightful analysis and perspective on every aspect of world events, The Economist is one of the most widely recognised and well-read current affairs publications. The paper covers politics, business, science and technology, and books and arts, concluding each week with the obituary. In addition to the web-only content such as blogs, debates and audio/video programmes available on the website, The Economist is available to download for reading on Android, Blackberry PlayBook, iPhone or iPad devices. The Economist Espresso, our daily briefing smartphone app, is also available for download via iTunes App Store or Google Play.