Many Older Adults Choose Life Over Death No Matter The Quality

May 01, 1997

WEST LAFAYETTE, Ind. -- Faced with terminal illness or a chronic health condition, a majority of older adults would choose to live, but one-third would let someone else decide their fate, according to a Purdue University study of end-of-life decisions.

"Given the changing attitudes toward euthanasia and assisted suicide, we wondered how many older adults would consider those options for themselves and how those choices related to other factors," says Victor G. Cicirelli, professor of developmental/aging psychology.

About 10 percent of the study respondents favored ending their lives if faced with a terminal illness or other health condition that resulted in a low quality of life.

In studies by other researchers, 40 percent to 50 percent of people report that assisted suicide and voluntary euthanasia are morally acceptable and should be legalized. "The implication seems to be that although many older adults favor having such options available, fewer feel that they themselves would actually decide to end their lives," Cicirelli says.

About one-third of the respondents said they would defer end-of-life decisions in such instances to someone else, such as a family member, close friend or physician. "This might be partly due to the tendency of older adults to procrastinate in formalizing their wishes on how to handle various medical situations, and their willingness to let others make decisions for them," Cicirelli says.

"Many older adults were socialized to regard physicians as authority figures. Thus they see themselves as having little autonomy on health matters and are willing to allow physicians to make end-of-life decisions as well."

In Cicirelli's study, 388 adults ages 60 to 100 filled out questionnaires regarding 17 different situations depicting either terminal or very low quality-of-life conditions. Slightly more than half of the respondents, on average, said they would strive to continue living even when facing terminal illness, immobility, extreme dependency, pain or loss of mental faculties.

The purpose of the study was to determine how end-of-life decisions were related to personality and demographic factors. Those who favored maintaining life no matter how dire the circumstances tended to be black, to place greater importance on religion, to place a lower value on quality of life, to have lower socioeconomic status, and to have less fear of the dying process.

Cicirelli speculates that for blacks, choosing to live may be related to their past history of struggle for survival and their greater religiosity compared to whites.

The finding that so many older adults would not choose to end their lives is encouraging, Cicirelli says. "It attests to a strong need to survive as well as inhibitions against self-destruction."

Cicirelli says decisions to end one's life because of health concerns were not significantly related to other reasons for taking one's life. "Depression, low self-esteem and loneliness are factors frequently related to suicide, but in our study they were not significant indicators," he says.

The study also found no particular preference among participants as to how life should be ended, be it suicide, assisted suicide or voluntary euthanasia.

Cicirelli says suicide is more frequent among older persons than any other age group, and the rate continues to rise. "The people filling out our questionnaires were for the most part psychologically sound and healthy. Certainly some would make different decisions in real-life situations," he says.

Questionnaires were given to volunteer participants from a wide range of socioeconomic levels at 20 senior centers in Indiana. Sixteen were in a large urban area, the other four in a medium-sized city.

The respondents could pick one of seven options as a result of the scenarios presented: Take own life; perform assisted suicide; ask others to end life; let someone else decide; let doctor decide; strive to live; and stop medical treatments.

Cicirelli's study was sponsored by the Andrus Foundation of the American Association for Retired Persons. It was reported in the March issue of Psychology and Aging, published by the American Psychological Association.


Source: Victor G. Cicirelli, 765-494-6925; home: 765-743-9771; e-mail,
Purdue News Service: 765-494-2096; e-mail,

NOTE TO JOURNALISTS: A copy of the journal article is available from Beth Forbes, 765-494-9723.

Purdue University

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