From left to right: Robert N. Mayer of the Nathan Cummings Foundation; Charles Willis of the Fetzer Institute; George Gallup Jr.; and Laurence J. O'Connell of the Park Ridge Center.

After several decades of bearing witness to the indignities sometimes associated with high-tech death, Americans have begun to insist that dying is more than a clinical event. "The American people want to reclaim and reassert the spiritual dimensions of dying," said George H. Gallup, Jr., chairman of the George H. Gallup International Institute, of his organization's recent national survey, Spiritual Beliefs and the Dying Process. The Park Ridge Center hosted the first of three national gatherings to discuss key findings of the survey, which was commissioned by the Nathan Cummings Foundation and the Fetzer Institute.

The survey, based on telephone interviews with 1200 adults 18 and older, explored three clusters of attitudes and behaviors: 1) how people find comfort in their dying days; 2) things that worry people when they think about their own death; and 3) how people plan for disability or death, including the possibility of physician-assisted suicide. The study also considered factors that might account for variations in these attitudes and behaviors, namely, life situations, demographic characteristics, and spiritual beliefs.

The survey emphasized the importance of human contact as a source of both spiritual and emotional support at the time of death. People look to family (81%) or close friends (61%) to provide this support. A minority of Americans sees the clergy as capable of providing broad spiritual support. Only 36% believe members of the clergy could effectively comfort them. This statistic gives credibility to a recent statement by Charles Halpern, president of the Nathan Cummings Foundation: "Seminaries and major religious groups need to acknowledge the needs of the dying, and then find ways to devote more theological and practical training to spiritual needs at the end of life."

George Gallup, during his visit to the Center, was even more direct. The survey, he said, "is a wake-up call for the clergy."

The Gallup study listed 24 different matters that might worry respondents as they think about their own deaths. Although medical concerns— such as suffering great pain or living in a vegetative state—are prominent among all age groups, specifically spiritual concerns were most pronounced among younger adults. For example, 72% of the 18 to 24 year-olds worried about not being forgiven by God, and 63% of them feared dying cut off from God or a higher power. One might surmise that younger people are still struggling with the shape of their personal spirituality and thus feel less confident about facing ultimate questions.

The question of physician-assisted suicide continues to elicit divided opinions. For example, 33% support making it legal under a wide variety of conditions, while 32% support making it legal in a few cases and 31% oppose making it legal for any reason. Minorities and those over 55 are more likely to oppose physician-assisted suicide. Those who identify closely with a particular faith are most likely to oppose it.

But Americans split down the middle on the question of whether they can envision a situation in which they would request physician-assisted suicide for themselves. Fifty percent said they would, and 47% said they would not. Younger people were more likely to support physician-assisted suicide and to see it as a personal option.

When asked if they would consider very painful treatment if given a 50/50 chance of survival, a majority of Americans said they would opt for the treatment. When the odds became one in four, 70% chose easing pain rather than extending life. One might expect those with the strongest religious faith to be more willing to accept death. But those who said that their religious faith was the most important thing in their lives and that their lives belonged to God were more likely to choose extending them, even at the cost of significant pain and with greatly reduced odds. Does religious faith somehow engender a deeper appreciation of life's value? Does it sometimes bestow a sense of stewardship that celebrates the preciousness of every moment of life no matter how diminished or painful?

Only 28% of Americans have signed any type of legal document that either appoints someone to make medical decisions for them or describes the type of care they would want. Those most likely to have signed such documents are the elderly (40% of those over 65), college graduates (36%), and the widowed (50%). And of those who have signed such documents, 82% have told a family member, but only 15% have informed a lawyer or medical professional.

This national survey comes at a time when the public and the media seem more receptive than ever to frank discussion of the way we die in America. The findings deserve wide dissemination and serious attention.