Attitudes Toward End-of-Life Processes

Attitudes Toward End-of-Life Processes:

Gender, Personality, and Life Experiences

Chelsea N. Hettenhausen

Abstract

End-of-life processes such as euthanasia, physician-assisted suicide, and the death penalty are controversial topics that society has contrasting views on. Gender, the person's personality, or their previous life experiences, especially those relating to death may influence these views. To find out if these were contributing factors, a survey was administered to 120 students attending a small Midwestern university (52 men, 68 women). The survey was given in the class setting. The results indicated that religion, whether one is liberal or conservative, and experiences with death did have a significant influence on participants' beliefs of euthanasia, physician-assisted suicide, and the death penalty. However, gender and certain personality characteristics did not. This research is beneficial because it provides more information on what does/does not influence society's views of end-of-life processes, a controversial issue which could have an impact on our future.

Death and dying seem to have always been sensitive subjects in American culture. When a family member dies, the family mourns the loss of that person by sharing memories, holding services, etc. What happens if that family member is suffering or is in a persistent vegetative state? The family would then have some decisions to make as to whether to continue with treatment, keep the person on a ventilator, or to just keep them comfortable until they passed. If they chose to keep the person comfortable until they died by taking them off of a ventilator or taking out their feeding tube, this would be considered a form of euthanasia. Euthanasia and physician-assisted suicide may be considered a form of murder by many, but what if they were faced with the decision with one of their own family members?

There are two kinds of euthanasia, active and passive. Active euthanasia is when the physician assists in some way, whether it be prescribing or administering the medicine. The other type is passive euthanasia, where the physician allows the patient to die by choosing not to treat them or by withdrawing life support (Weir, 1986). The difference between the two types is 'it is considered acceptable to allow terminal patients to die without prolonging their life' (Isaacs, 2003), which is viewed as passive euthanasia. The main criteria for performing euthanasia are the patient must be suffering or no longer has a good quality of life. In other words, the patient has lost their personhood. Loss of personhood is a big factor in deciding whether or not to take someone in a persistent vegetative state off of a ventilator.

When it comes to performing passive euthanasia on these people, there is not as much of an argument because in most cases the patient never regains consciousness. Sometimes passive euthanasia is even seen as putting a person out of their misery. These patients have lost their personhood and are only there in body. The problem with performing euthanasia on them is that there is the argument of sanctity of life verses quality of life. The sanctity of life is the perspective that all human life is sacred and inviolable. The quality of life is the meaning and value of life from personal perspective (Wallace & Eser, 1981). This theory takes into account personhood, which is what makes a person something other than just a body. In other words it is what makes a person an individual.

There are several important and outstanding court cases in history that exemplify this very argument. The first and most important case is that of Karen Ann Quinlan. Karen Ann was 21 when she was brought home from a party after consuming alcohol and three different drugs. She stopped breathing twice for longer than 15 minutes and slipped into a coma. She was rushed to the hospital where she was diagnosed as being in a persistent vegetative state. Karen slowly deteriorated throughout the next few months when finally her parents decided she needed to be taken off the ventilator. The hospital officials absolutely refused, saying that it was the same as killing her. The family took the case to the Supreme Court of New Jersey and ended up winning their case. Karen was then taken off the ventilator, but was still fed by means of artificial nutrition. Surprisingly, she could breathe without help and she lived nine more years until she died of pneumonia in 1985 (Ulrich, 1999).

Karen Ann Quinlan's case was one of the most important cases of passive euthanasia of someone in a persistent vegetative state in the U.S. It demonstrated that society needs to do what is best for the patient, which is not always what is thought to be morally 'right'. The case of Terri Schiavo was another big case, which was called the Karen Ann Quinlan of the 1990's by several people who witnessed it. Terri Schiavo collapsed one day in her home and suffered from cardiac and respiratory arrest, which resulted in extensive brain damage. She was then diagnosed as being in the persistent vegetative state one year after the incident. After being in this state for several years her husband petitioned to have Terri's feeding tube taken out. He petitioned the court to act as Terri and to decide what she would want if she were able to decide herself. Before they could make a decision, Terri's family stepped in and argued that she was still conscious and would not want to go through death by dehydration, although research suggests that this is a very peaceful way to die given the right medications. After hearing Terri's wish to not be kept on life support with no hope of improvement from several people, they found it to be credible and her feeding tube was removed on March 18, 2005. She died on March 31. (Leming & Dickinson, 2007).

Both of these cases helped society see a different side of euthanasia. It is not somebody killing a patient just because they think they should be put out of their misery, but rather it is ending a person's suffering when they are terminally ill or in a completely unresponsive state.

Aside from euthanasia, there is physician-assisted suicide, which is defined as 'a physician 'giving advice' to a patient about taking her or his life and /or prescribing a lethal dosage of medication whereby the individual can take her or his own life' (Leming & Dickinson, 2007). It is sometimes also referred to as physician-assisted death. This is very similar to active voluntary euthanasia except the difference is that in physician-assisted suicide the patient takes their own life in the end, whereas in active voluntary euthanasia the doctor does it for them under their request. Some problems with physician-assisted suicide include family members or insurance agencies pressuring the patient to get it done, patients will give up all hope too soon knowing that they can just end it now, improvements in palliative care will end, people will begin to build up a fear of hospitals and medical staff, and it could cause the prohibition on killing to be weakened or start down the slippery-slope (Dieterle, 2007). These are the main reasons that physician-assisted suicide has not been legalized in most places. Oregon is the only state that has legalized physician-assisted suicide along with the Netherlands and Belgium, but there are several other places that are considering it such as California and Washington (Gramlich, 2008 and Welch, 2007).

At the center of physician-assisted suicide is Dr. Jack Kevorkian. Dr. Jack Kevorkian has been nicknamed 'Dr. Death' since he has helped over 100 people commit suicide (Morganthau, 1993 and Leming & Dickinson, 2007). The process was that the patients would sit in a chair (known as the suicide machine) built by Dr. Kevorkian, be hooked up to an IV, and if they pressed a button it would inject in them a narcotic followed by a lethal dose of potassium chloride. Therefore, Dr. Kevorkian never 'killed' anyone, he just helped them die. This is why he was charged three times for murder, and each time the case was thrown out of court. In 1991 Kevorkian had his medical license suspended and he could no longer obtain prescription drugs. When this happened, he turned to carbon monoxide. The way that it worked was that the patient pulled a clip, inhaled the gas, fell unconscious, and soon after died. He argued that he was just helping end their suffering. All of Dr. Kevorkian's patients were unique in some way, although the most common illnesses that they had were cancer and multiple sclerosis (Morganthau, 1993). Dr. Kevorkian is now serving time in prison for assisting those who asked him to assist in their suicides (Leming & Dickinson, 2007).

Dr. Kevorkian's story is very controversial because it is easily confused with murder, since they are drugs he obtained and it was his machinery. His story plays a big role in peoples' opinions on the issue of physician-assisted suicide and even active voluntary euthanasia since they are so similar.

Topics such as euthanasia, physician-assisted suicide, and murder are so controversial because of the conflicting beliefs that society holds. These beliefs could stem from a number of things such as religion, gender, age, being terminally ill versus not, personal experiences with the death of someone close, or even one's personality characteristics. Regardless of what it is, society is influenced to believe one way or another. With such a controversial subject, not many people are on the fence.

There are many different reasons that patients or families would choose euthanasia or physician-assisted suicide to end the patient's life early and there are several pieces of research that explain some of these reasons. First, Pearlman, Hsu, Starks, Back, Gordon, & Bharucha (2005) conducted a longitudinal study on patients and families that actively pursued Physician-assisted suicide to gain a medical and ethical understanding of end-of-life care. The data collection consisted of interviews with 60 participants who were either the patient or the patient's family member. The interviews were made up of open-ended questions over many topics including, but not limited to, the patient's illness, reasons for the pursuit of physician-assisted suicide, other factors that may have influenced this decision, etc. The end result showed three main sets of issues relating to the patient's pursuit of physician-assisted suicide. They included effects of the patient's illness, sense of self being lost, and fears about the patient's future. The biggest out of these three factors that makes patient's feel like they need to end their life early is the loss of sense of self. They are afraid to lose control when the disease takes over. Although pain has been a factor that has motivated patients in other research, it was not found as much in this particular study. The reason this study did not find some of the same data as other studies have on the same topic is because their group was self-selected through an advocacy organization. This is a huge limitation to this study.

Research over similar points that renders somewhat different results from the aforementioned research is that by Wilson, Chochinov, McPherson, Skirko, Allard, & Chary (2007). Their research was over the desire for euthanasia or physician-assisted suicide in patients receiving palliative cancer care. A survey titled 'The Canadian National Palliative Care Survey' interviewed patients who met all five of the criteria: '(a) the patient's medical diagnosis was cancer and he or she had been informed that it was incurable, (b) the clinician considered the patient to be cognitively lucid and able to provide a valid interview, (c) the clinician estimated the survival duration to be under six months, (d) the patient was medically stable enough to attempt an interview, and (e) the patient was able to converse in either English or French' (Wilson, Chochinov, et. Al., 2007). The interview examined demographics, religious practices, attitudes toward the two different end-of-life processes, the diagnostic assessment of depression and anxiety disorders, and questions on a range of common physical, social, and existential symptoms and concerns. Also included were social variables (number of children, relatives, and friends) and religiosity (self-perception, attendance at organized services, and frequency of private prayer).

A majority of patients (62%) endorsed the legalization of euthanasia or physician-assisted suicide. Close to half of patients (40%) could envision future circumstances where they might request a quickened death. Some patients claimed they would feel more comfortable knowing that euthanasia and physician-assisted suicide were available in case their illness did get worse although most would not exercise the right to partake in such events. The study also found that if euthanasia and physician-assisted suicide were legally available, 5.8% of participants would have taken the action required to end their life. The 22 patients who indicated desire for one of the end-of-life processes differed from the other patients in a couple ways. They had lower religiosity and were less likely to be Roman Catholic. This means it is likely that they had no moral obligations on the basis of religion. They also had a greater number of symptoms and concerns, but did not have a lower life expectancy.

Results also indicated that 40% of participants with a desire for euthanasia or physician-assisted suicide met criteria for major depression. This finding could say something for the relationship between people with major depression and the desire to commit suicide. Furthermore, following the legalization of euthanasia and/or physician-assisted suicide, terminally ill patients may tend to lean towards these processes as escape routes from a depressed life.

When it comes to euthanasia and physician-assisted suicide, the argument sometimes is centered on whether it is right to induce death and/or let die. Research by Achille & Ogloff (1997) delves further into this exact topic. They hypothesized that passive euthanasia would be judged more acceptable than active euthanasia and that the acceptability of euthanasia might differ as a function of the identity of the patient. After administering a mailed questionnaire to 810 participants (44% women and 55% men) results indicated that 'in the eyes of the public, ending life by means of a lethal injection is significantly less acceptable than withdrawing life-support, regardless of who is requesting such a procedure' (Achille & Ogloff, 1997). The five most important considerations in judging the acceptability of a request for euthanasia were chance for recovery, mental alertness, considerations for alternative treatments, and pain-relieving treatment, psychological suffering, and stability over time of the patient's request for euthanasia. Concerning the differences between groups that support the right-to-die movement versus those who do not, there have been a couple of interesting studies conducted. Hemlock Society members were surveyed to determine demographics of those who support the right-to-die movement. According to Wilson, Fox, & Kamakahi (1998), the Hemlock Society's main goal is to 'provide a climate of public opinion which is tolerant of the rights of people who are terminally ill to end their lives in a planned manner.' These right-to-die supporters utilize their financial status to support legislative referendums allowing for physician-assisted aid in dying. When the 6,399 members of this society were surveyed, it was found that the majority were older, white, wealthy, highly educated, and economically and politically active women. This research is limited though since there are 25,000 members in this group and there were only 6,399 people who responded to the survey. Nonetheless, the findings suggest that women are the leading powerhouse in the right-to-die movement.

Another study conducted that is similar to the last explored the comparisons of pro- and anti-euthanasia groups (Holden, 1993). The pro-euthanasia group, again, was the Hemlock Society since they are the most well-known group of their kind and the anti-euthanasia group was the California Pro-Life Council (CPLC). The purpose was to determine whether the two groups differed in demographics. There were 785 questionnaires completed by members of the Hemlock Society and 161 questionnaires completed by members of the CPLC. Results on demographics indicated that CPLC respondents were younger, more often Latino, lower income, blue-collar workers, Republican and conservative, Roman Catholic, and currently married. Hemlock respondents were more often retired, more highly educated, non-Christian, and divorced or widowed. Based off the data collected, it is safe to say that the demographics differ significantly between the two opposing groups, with the majority of the Hemlock Society not having ties to anything in their lives (religion, spouse, job, etc.).

An interesting area of research over euthanasia and physician-assisted suicide suggests that the type of doctor involved in the treatment may play a role in peoples' opinions on the topic. This is such in 'Attitudes Toward Physician-Assisted Suicide: Effects of Physician Background, Patient Prognosis and Patient Mental Health Status' (Peacock, Heath, & Grannemann, 2001). The results of the study provided evidence that the physician's background can influence decisions regarding a criminal case over physician-assisted suicide. The physician whose background includes a preoccupation with death is more likely to be found guilty than one without the same background. It is speculated in the study that a physician with a background including a preoccupation with death may have a questionable motive and a community may not be as willing to allow this type of person to help a patient terminate his or her life.

Another piece of research (Peretti-Watel, Bendian, Pegliasco, Lapiana, Favre, & Galinier, 2003) assesses French doctors' opinions toward euthanasia and compares them with their specialty (general practitioners, oncologists, and neurologists) via a telephone interview. There were 917 doctors who agreed to participate in the study. Oncologists were less likely to feel uncomfortable with terminally ill patients since they treated more of them than the other two groups. It was found that the legalization of euthanasia was more common among general practitioners and neurologists than among oncologists. This finding seemed a bit odd since oncologists were more experienced in end of life care, more frequently trained in palliative care, and showed greater comfort and better communication with terminally ill patients. The argument for euthanasia is that it is a continuation of end of life care and that doctors should respect patients' autonomy including their wish to die. This makes the fact that oncologists did not support euthanasia as much as the other two groups a somewhat puzzling finding.

A different end-of-life process that is deserving of discussion is capital punishment, or the death penalty. Although there is not a lot of research available on the topic, there have been some unique findings related to the topic. First, there was a survey administered to 272 students who were in introduction to psychology, introduction to sociology, or introduction to social science. Personality traits were measured along with attitudes toward the death penalty. The findings expressed that extroversion and neuroticism were related to pro-death penalty attitudes and that there was a positive relationship between conscientiousness and attitudes toward the death penalty (Robbers, n.d.).

The next piece of research to be examined (Betancourt, Dolmage, Johnson, Leach, Menchaca, Montero, &Wood, 2001) was based off of published public opinion polls. It was found that the American public's attitude toward the death penalty changes yearly. Furthermore, support for the death penalty has increased and is continuing to increase since 1953, with homicides remaining fairly consistent over the past 20 years. It is speculated that the constant increase is due to the brutal descriptions of crimes by the media.

All of this research leads to the same question in the beginning: what causes the difference in the general public's opinions on end-of-life processes? There have been a few studies (Bluck, Dirk, Hux, & Mackay, 2008, Newsome, & Dickinson, 2000, and Sternberg, 1998) that examined peoples' opinions on these topics when they have experienced deaths throughout their life. The first study (Bluck, Dirk, & Mackay, 2008) examined the effects of varying levels of life experience with dying individuals on attitudes. Participants were recruited from three hospice organizations. They included 12 men and 40 women, which is representative of hospice volunteer groups. The recruited were divided into 2 groups: an experienced group, which was composed of active volunteers who had experienced at least one death of an assigned patient and the novice group, which included people that worked in roles that do not involve patient contact. A survey was administered to all participants. The most significant finding was that experienced volunteers reported having less death anxiety and this was especially lower related to the higher number of deaths they had experienced than did the novice group.

Another study revolving around death experiences in relation to death attitudes was based off of the perceptions of college students. The primary purpose of the study was to 'determine the experiences of undergraduate students regarding death, their knowledge about and involvement with hospice, and the focus on differences by gender, if any' (Newsome & Dickinson, 2000). A survey, containing open-ended and closed-ended questions, was given to 122 Biology majors (80 women and 42 men). Results indicated that 91% of respondents had seen a dead body at a wake or funeral, 33% had witnessed a death, and 67% of men and 83% of women were familiar with hospice. Overwhelmingly, the group preferred to die at home and to bring their parents and relatives home to die as well. This research has a limitation of only being administered to Biology majors, as they are more familiar with medical issues in today's world than is the average student. Therefore, this research cannot be generalized to the whole college community.

In a dissertation titled 'Perceptions of Death Anxiety & Empathy & Euthanasia Attitude, Female Mental Health Professionals' (Sternberg, 1998), the relations among death anxiety, empathy, and euthanasia attitudes were studied. Participants included 241 female mental health professionals who were all in graduate school or early into their careers. Findings indicated that attitudes of euthanasia were positively related to fantasy and to anxiety about dying. However, euthanasia attitudes were not related to anxiety about death.

The inclusion of certain personality characteristics may be another signifier of a person's opinions on end-of-life processes. Again, there is not much research available in this aspect, but self-consciousness and empathy have been studied. In the study on the relationship between self-consciousness and attitudes on death (Kemmelmeier, 2001), there was found to be a strong association between value orientations and attitudes among individuals high in private self-consciousness but only a weak association between those variables among individuals with low private self-consciousness. On the other hand, the research on empathy (Van Lange, 2008) was mainly to examine the interpersonal motivations that might be triggered by empathy. The researcher hypothesized that empathy would activate altruistic motivation and the findings were consistent with the hypothesis. It is important to note that empathy may activate altruistic motivation and this could be an explanation as to why people support euthanasia and physician-assisted suicide. As an empathetic person, they may be thinking more about how their illness will hurt everyone around them and, in turn, support the end-of-life processes.

The question of what causes the difference in society's views of euthanasia, physician-assisted suicide, and the death penalty is still not completely answered based off of all the research that is available. The current study serves the purpose of determining if gender, personality, and/or a person's experiences with death influence their views of the end-of-life processes. Hypotheses include (a) Women are more nurturing than men; (b) Women support euthanasia, physician-assisted suicide and the death penalty more than men do; (c) People who do support end-of-life processes are more conscientious, caring, nurturing, and empathetic than those who do not support them; and (d) People who have experienced the death of someone close (relative or friend) will favor euthanasia, physician-assisted suicide, and the death penalty.

Reasoning for these hypotheses include that since women may be more nurturing than men, they would support end-of-life processes because they would not want the person to suffer. In contrast, men would not support the end-of-life processes since they may be less nurturing. People who do support end-of-life processes seem to be more likely to be conscientious because they think things through and let what they believe to be right and wrong guide their lives, caring because they care about the person suffering, nurturing because of the reasons mentioned above, and empathetic because they may be able to put them self in the person's place and see that ending their life is the best thing for them. Lastly, people who have experienced the death of someone close will favor end-of-life processes because they may have seen them have to suffer and would not wish that for any other person.

In the current study, nurturance is measured by self-report of how nurturing each person believes they are. Support of end-of-life processes (euthanasia, physician-assisted suicide, and the death penalty) is evaluated using situational questions as well as questions asking about belief in legalization. Measures of personality are taken from an adapted version of Eyesenck's personality survey, where the participants choose the four characteristics that best describe themselves. Finally, experiences of the death of someone close is measured by asking if the participant has experienced different types of ways of dying with someone close to them (ex. Has someone close to you ever committed suicide?).

Method

Participants

The participants for the current study were chosen by a convenience sample, but were all attending a small Midwestern university. They were selected if their class was at a convenient time for the researcher to administer the survey. No surveys were administered outside the classroom setting. There were 120 participants, 56.7% female and 43.3% male ranging from age 18 to 50, with the mean age being 21.74. The majority of participants were working towards a psychology or sociology degree. The group of participants was mostly Caucasian (87.5%) followed by African American (6.7%), Indian (1.7%), Asian (0.8%), Hispanic (0.8%), and other (2.5%). A large majority of participants were either single (49.2%) or in a relationship (40.8%). Participants were mostly either affiliated with the Democratic Party (30.8%) or did not affiliate with any party (31.7%) when it came to politics. The remaining 37.5% were either affiliated with the Republican Party (22.5%), Independent Party (9.2%) or marked other (5%). This went with the 41.7% of participants that were neutral, 44.2% that leaned towards more of a liberal view, and the 14.7% that were conservative.

Materials

The researcher developed a survey made up of 39 closed-ended questions including moral dilemma questions, demographic questions, personality questions, and questions about past experiences with death. There was no need for counterbalancing since the types of questions did not call for it. Constancy was used throughout the survey; all questions went in the same direction (from negative view to positive view) and none needed to be recoded. There appeared to be no yea or nay saying in any of the surveys. The return rate for the survey was 100%. Therefore, there is no non-response bias. Before the survey was distributed, the researcher told every participant that they were not obligated to complete the survey. Also, each participant read and initialed an informed consent page.

Procedure

The researcher first created a survey (See Appendix) to test how personality, gender, and experiences with death affected peoples' views of end-of-life processes such as euthanasia, physician-assisted suicide, and the death penalty. It was then field tested with an Experimental Psychology class, revised according to the class' feedback, and was sent through the expedited Institutional Review Board process to make sure it was ethical and met research standards. After receiving IRB approval, the survey was administered over a four day period of time. Survey answers were entered into SPSS and the results were analyzed using bivariate correlations and one-way ANOVAs.

Results

To test the hypothesis that women are more nurturing than men (based on a self-report), a one-way Analysis of Variance (ANOVA) was performed. Results indicated a significant difference in gender and nurturance: F (1,118) = 19.435, p = .0001. Refer to Figure 1 for the means plot. Figure 1 goes from males at a 4.96 level of nurturance to females at a 5.81 level of nurturance. Therefore, the first hypothesis is supported in that women are more nurturing than men.

Figure 1: Means plot for gender and self-reported nurturance

A one-way ANOVA was used to test whether or not women were more supportive of euthanasia, physician-assisted suicide, and the death penalty than men. Results did not indicate a significant difference in gender and support in these end-of-life processes: F (1,117) = 1.807, p = 0.181. In looking at the means plot (See Figure 2), one can see that data was in the exact opposite direction as predicted. Men supported euthanasia, physician-assisted suicide, and the death penalty more than women, although not at a significant level. Therefore, the second hypothesis was not supported.

Figure 2: Means plot for gender and belief in euthanasia, physician-assisted suicide, and the death penalty.

The hypothesis that people who do support end-of-life processes are more conscientious, caring, nurturing, and empathetic than those who do not support them was tested using another one-way ANOVA. Results did not indicate a significant difference: F (6,112) = 0.996, p = 0.432. According to Figure 3, it almost went in the complete opposite direction, with people having one of the four personality characteristics having the highest belief in the end-of-life processes and people having three of the four having the lowest belief. This result could stem from the fact that there were several people with none or one of the personality characteristics, but very few with three of the four.

Figure 3: Means plot for belief in end-of-life processes based off of how many of the personality characteristics (conscientious, caring, nurturing, and/or empathetic) participants reported having.

The final hypothesis that people who have experienced the death of someone close, such as a family member or friend, will favor euthanasia, physician-assisted suicide, and the death penalty was analyzed using a one-way ANOVA. Results indicated a significant difference: F (3,115) = 3.753, p = 0.013. The means plot (See Figure 4) expresses this relationship. Participants having reported never witnessing a death of someone close show extremely low support of end-of-life processes as compared to those who have experienced several different deaths of people close to them.

Figure 4: Means plot for participants' belief in euthanasia, physician-assisted suicide, and the death penalty in relation to their experiences with death.

Aside from the five hypotheses, the data collected also yielded other interesting results. First, when comparing party affiliation with participants' belief in euthanasia, physician-assisted suicide, and the death penalty, people that stated they had other political designations had significantly higher support of end-of-life processes than did those that reported being democratic, republican, or independent: F (4,113) = 3.315, p = 0.013. Next, when analyzing the relationship between liberals and conservatives and their beliefs, a bivariate correlation was used. Results indicated a significant correlation: r = -.255, p = .005, with liberals having higher support. A one-way ANOVA was performed to see if religion caused a difference in participants' support of end-of-life processes. Results here also indicated a significant difference: F (11,107) = 2.181, p = .021. The means plot (See Figure 5) shows which religions had higher support of end-of-life processes and which had a lower belief. It is clear that participants with no religion had the lowest belief, closely followed by Catholics and the Islam participant had the highest belief.

Figure 5: Means plot for different religions and their support of euthanasia, physician-assisted suicide, and the death penalty.

The last finding gathered is on whether gender made a difference in the acceptability of the premise of a father killing a man who kidnapped and raped his daughter. A one-way ANOVA was performed and yielded significant results: F (1,118) = 13.822, p = .0001. Males found the father's behavior significantly more acceptable (M = 4.981, SD= 1.995) than women did (M = 3.735, SD= 1.672).

Discussion

This study shows a few of the factors that may and a few that may not contribute to society's views of euthanasia, physician-assisted suicide, and the death penalty. Religion, whether one is conservative or liberal, and experiences with death are aspects that may very well contribute to peoples' support of these end-of-life processes, although more research should be conducted to verify these results. Gender and certain personality characteristics (empathy, nurturance, conscientiousness, and caring) did not have a major effect on peoples' beliefs of end-of-life processes in the study. Had the researcher obtained a much larger and diverse sample that was more representative of society as a whole, some of the results may have been significant. This is a big limitation to the study since it is difficult to take research conducted on a very small sample at a college and generalize it to anything other than that specific group of people. Therefore, the results in this study can only be said to be representative of the college community. Another limitation is the fact that it was a convenience sample and not a random sample. Results may have also differed if the sample were completely random.

If the researcher was to conduct the same research again, they would definitely obtain a much larger random sample. This would embody more of the characteristics of society than a small convenience sample. The researcher would also look at the differing views between passive and active euthanasia as this survey did not contain enough questions on the two different kinds to be able to differentiate between them. Since there has been some research done in this specific area, it would be interesting to find out more on this topic.

Finding out that there are certain factors that play a role in peoples' beliefs on these controversial issues only makes more research on these topics pertinent. If researchers could find what shapes peoples' views and opinions on these end-of-life processes, it could help down the road when/if families are in these types of situations themselves. Also, researching society's views on these processes, especially euthanasia and physician-assisted suicide would provide support for more legislation. Oregon is the only state that currently has legalized physician-assisted suicide, but if it turned out that the vast majority of people in the United States approved of physician-assisted suicide, other states may consider legalizing it as well.

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Appendix

Survey including Informed Consent and Debriefing

Informed Consent

'I have read the statement below and have been fully advised of the procedures to be used in this project. I have been given sufficient opportunity to ask any questions I had concerning the procedures and possible risks involved. I understand the potential risks involved and I assume them voluntarily.'

Participant Initials Date

Tear Here

The McKendree University Psychology Department supports the practice of protection for human participants participating in research and related activities. The following information is provided so that you can decide whether you wish to participate in the present study. Your participation in this study is completely voluntary. You should be aware that even if you agree to participate, you are free to withdraw at any time, and that if you do withdraw from the study, your grade in this class will not be affected in any way. This survey is being conducted to assist the researcher in fulfilling a partial requirement for Psych 496 W and HON 402.

You must be over 18 years of age to participate in the survey. It should not take more than 10 minutes for you to complete and will be completely anonymous and confidential. If you should have any other questions, don't hesitate to contact me, Chelsea Hettenhausen at cnhettenhausen@mckendree.edu, or Dr. Bosse, 618-537-6882 or at mbosse@mckendree.edu. Some of the questions in the survey may confront sensitive topics. If answering any of these questions causes you problems or concerns, please contact one of our campus psychologists, Bob Clipper or Amy Champion, at 537-6503.

1. What is your gender?

Male Female

2. What is your age?

3. What is your major?

4. What is your current marital status?

Single In a relationship Married Divorced Widowed

5. Which party do you most identify with?

Democratic Republican Independent None Other

6. Which one best describes you?

African American Asian Caucasian Hispanic Indian Native American Other

7. Which one religion do you most identify with?

Catholic Mormon Baptist Evangelical Pentecostal Lutheran

Jewish Buddhism Hinduism Islam Presbyterian Methodist

Atheist Agnostic Other___________________ Nondenominational No Religion

8. On average, how often do you attend a religious gathering?

Twice or more a week Once a week Once-3 times a month Once every 2-3 months

Twice a year Never Other____________________

9. I consider myself a religious person.

1 2 3 4 5 6 7

Not Somewhat Strong

At All Belief

10. Please circle the four personality characteristics that best describe you.

Caring Open-minded Controlled

Aggressive Sociable Responsive

Pessimistic Optimistic Careful

Thoughtful Impulsive Adaptable

Conscientious Nurturing Unsociable

Empathetic Reliable Likeable

Rigid Calm Passive

(Adapted from Eyesenck's personality survey)

11. I consider myself

1 2 3 4 5 6 7

Liberal Neutral Conservative

(Belief in individual freedom) (Belief in maintaining existing views or institutions)

12. I am a nurturing person

1 2 3 4 5 6 7 Strongly Somewhat Strongly

Disagree Agree

13. Have you heard of Euthanasia before this survey?

Yes No Maybe

14. Have you heard of Physician-Assisted Suicide before this survey?

Yes No Maybe

Physician-assisted suicide is defined as 'a physician 'giving advice' to a patient about taking her or his life and/or prescribing a lethal dosage of medication whereby the individual can take her or his own life' (Leming & Dickinson, Pg. 305).

15. Do you understand the difference between Euthanasia and Physician-Assisted Suicide?

1 2 3 4 5 6 7

Not Somewhat Completely

At All Understand

16. Based on the definition above, I believe that active euthanasia should be legalized in the U.S.

1 2 3 4 5 6 7

Not Somewhat Strong

At All Belief

17. Based on the definition above, I believe that passive euthanasia should be legalized in the U.S.

1 2 3 4 5 6 7

Not Somewhat Strong

At All Belief

18. Based on the definition above, I believe Physician-Assisted Suicide should be legalized in the U.S.

1 2 3 4 5 6 7

Not Somewhat Strong

At All Belief

19. I believe that suicide should be illegal in the U.S.

1 2 3 4 5 6 7

Not Somewhat Strong

At All Belief

20. I believe that the death penalty is a proper punishment for crime under certain circumstances.

1 2 3 4 5 6 7

Not Somewhat Strong

At All Belief

How acceptable would each of the following situations be? Please circle the best number that represents your belief.

21. A family member was involved in a car accident and has been in a coma for one year and the doctors say the odds are against her. Her mother wants to remove all life support.

1 2 3 4 5 6 7

Not Somewhat Completely