An Examination of end-of-life decisions in younger- and middle-aged adults
Previous research has found that choices about end-of-life decisions are typically not made prior to terminal diagnosis (Bomba & Sabatino, 2009). Although research has examined end-of-life decision making after receiving a terminal diagnosis, few studies have investigated proactive end-of-life decision making. Similarly, few studies have focused on those who may be making such proactive decisions (i.e., young and middleaged adults) with the majority of research focused on older adults. This study examined proactive end-of-life decision making by comparing younger adults and their selected middle-aged adults in choosing whether to select life-sustaining treatment after imagining fictional diagnoses of terminal illness with one month to live (with or without loss of cognitive functioning). In addition, the influence of religiosity, self-control, and other factors that have been demonstrated to contribute to reactive end-of-life decision making were assessed (Cicerelli, MacLean & Cox, 2000; Mishra & Lalumiere, 2010; Winter, Dennis & Parker, 2009). One-hundred-sixty-one younger and middle-aged adults (82% women) were surveyed in person, through mail or via email. Participants imagined being diagnosed and then decided whether they would select life-sustaining treatment, rated the influence of factors contributing to their decision and completed a religiosity and self-control survey. Findings from this study indicated that, regardless of age, less than 50% of participants had communicated about end-of-life decisions with friends and loved ones and even fewer had communicated with medical care providers. Consistent with research, surrogates were more likely to select treatment for others who are faced with a terminal illness than when faced with their own terminal illness. In addition, having hope that the disease will improve was a significant predictor of selecting life-sustaining treatment while making peace and being ready to move on was predictive of not selecting lifesustaining treatment. Unlike the older adult reactive research (Carr & Moorman, 2009), this study found no relationship between proactive treatment decisions and religiosity, religious affiliation, or self-control. This suggests that treatment decisions may differ when they are not fictitious or may differ by age group. Future research should continue to compare treatment decisions by age group. Further, research should continue to investigate what factors influence treatment decisions among all age groups. If confirmed, these findings will allow researchers, medical staff and clinicians to better understand influences on proactive end-of-life treatment decisions and may assist in guiding the treatment process.
Psychological aspects of death