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    What America Thinks
    Last Requests: How We Want to Die

    By Richard Morin
    Washington Post Polling Director
    Monday, Dec. 15, 1997

    This is how Americans say they want to die: at home, not in a hospital. We want to pray before we die, or have people praying for us. We want the doctor who attends our final hours to be a friend, not merely a health care provider. We want less technology and more family and friends at our bedsides. We want less effort to prolong our lives and more attention to matters of the spirit.

    Those last wishes, some poignant, some entirely practical, emerged from a new survey of 1,200 randomly selected adults conducted by the Gallup Organization for the Nathan Cummings Foundation and Fetzer Institute.

    "Americans want to reclaim and reassert the spiritual dimension of dying," wrote George H. Gallup Jr., chairman of the Gallup Organization, in a preface to the study report. "It is also clear that there are many gaps between what people want and what the realities are today."

    In particular, Gallup charged that the poll findings should serve as "a wake-up call for the clergy." According to the survey, only 36 percent of respondents expected that a member of the clergy would offer real comfort to them in their dying days; overwhelming majorities expected to receive such support from family or friends.

    "Not many see the clergy poviding broad spiritual support. . . . Furthermore, the findings suggest that faith communities need to address more and effectively the concerns pople have about what happens after death, matters such as guilt and forgiveness."

    That's a stunning indictment of the clergy, made even sharper by another set of findings. Although Americans don't expect much spiritual help from clergy members, majorities "say it would be very important to have the opportunity to pray alone, to have someone praying for them, to have someone help them become spiritually at peace, or to have someone praying with them" as they lay dying.

    The poll also asked people what they thought would happen when they die. "Most Americans believe they will exist in some form after death; the experience is positive; that they will be on a journey of some kind; will experience spiritual growth; that the quality of existence will depend on things done in one's life and one's spiritual state at the time of death," survey analysts wrote.

    What concerns us most about dying? Nearly three out of four say they are worried not about how they would die, but about how they would spend their final months or years: 73 percent said they worried "a great deal" or "somewhat" about the possibility that they would live in a "vegetable-like state for some period of time."

    Just as large a percentage said they are worried about a hasty or unexpected death that would deprive them of "the chance to say goodbye to someone." Other top concerns are more practical. Two out of three said they worried about the "possibility of great physical pain before you die." A similarly large majority – 65 percent – said they were concerned about how their "family or loved one will be cared for," while 64 percent worried that their death "will be the cause of inconvenience and stress for those who loved you."

    Younger people identified "many more specific concerns worrying them when they think about their death than those who are older." Those under 35 expressed concerns about "medical and spiritual matters": Will they die a painful death? Are they spiritually prepared for the end of their lives?

    One concern most did not express: Fears that they will go to Hell. The survey suggests two reasons why most Americans aren't worried that they will spend the hereafter in the Underworld.

    Many of us simply don't believe in Hell (though proportionally more of us do believe in Heaven). According to the survey, slightly more than half of those surveyed – 56 percent – said they believe in Hell, yet only 4 percent said they believe their chances of going there are "excellent" or "good." Seven in 10 believe there is a Heaven, and most say their chances were good to excellent that they'll go there.

    Where do we want to die? According to the survey, 70 percent said they would prefer to die at home. "This preference was strongest among those younger than 55. Those 55 and over were more likely than all other age groups to choose to die in a hospital, although only one-quarter of them expressed this preference," analysts wrote.

    Gallup acknowledges that the fact that people want to die at home is "old news." But what he said this result underscores is that this yearning "has been largely ignored by institutions such as hospitals and health care organizations. The strong support for the growing hospice movement is an accurate reflection of people's preferences."

    One result that surprised researchers emerged from survey questions that asked Americans what they would choose to do if they had only a one in four chance of living. "Most – 70 percent – chose a plan of care that would relieve them of their pain and shorten their life, rather than a plan of care that would extend their life but with more pain and discomfort."

    Researchers had hypothesized that the stronger a person's spiritual or religious beliefs, "the more willing one would be to release the physical bonds of life." Much to their surprise, they found that "this does not appear to be true: Those with less interest in spiritual matters chose to relieve pain at the cost of shortening life," while those with the stronger religious or spiritual beliefs chose to prolong their lives, even if it meant living in pain.

    Richard Morin is director of polling for The Washington Post. "What Americans Think" appears Mondays in The Washington Post National Weekly Edition. Morin can be reached at

    © Copyright 1997 The Washington Post Company

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