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Longitudinal changes in attitudes of offspring concerning life-sustaining measures for their terminally ill parents
R Cooper-Kazaz1, Y Friedlander, A Steinberg
1Department of Psychiatry, Hadassah Medical Center, Hebrew University-Hadassah, Jerusalem, Israel.
Objectives:
To define longitudinal changes in the attitudes of offspring concerning life-sustaining measures for their older, terminally ill parents and to determine whether experience of a "life event" influences such decisions.
Design:
An attitudinal survey of three groups.
Setting:
The geriatric department of a university-affiliated general hospital.
Participants:
Fifty-one subjects who had been interviewed regarding life-sustaining treatment for their terminally ill parents were reinterviewed 6 years later. In addition, a control group composed of 116 participants was generated from patients visiting hospital outpatient clinics. The control group had no prior experience involving hospitalization of a first-degree relative as a result of a life-threatening situation.
Interventions:
Each subject took part in a personal interview.
Main Outcome Measures:
Attitudes regarding life-sustaining measures were assessed, and the subjects' sociodemographic and religious characteristics were noted.
Results:
The attitudes of offspring in the acute phase situation and after the passage of 6 years were strikingly consistent. Twenty-one percent had requested the initiation of resuscitation in the acute phase ("real time"), and 27.4% said the same 6 years later. The provision of nutrition and medication was requested by approximately 70% of participants both at the acute phase and 6 years later. When comparing each individual's personal views at the interviews with all others, consistency in attitude was found among answers to most questions. When comparing the acute phase group with the control group, a significantly higher percentage of the former requested the initiation of resuscitation (48.3% vs 25%), whereas a smaller percentage preferred that the decision be made by the physician (3.5% vs 21.3%). Active euthanasia was requested by 6.5% of the acute phase group and 12.9% of the control group.
Conclusions:
The decisions made by offspring regarding life-sustaining measures for their terminally ill parent at real time remain unchanged 6 years after the event. Exposure to a life event significantly affects the decision-making of the offspring of a terminally ill parent. However, the subject's attitude toward extreme solutions--opposing active euthanasia and requesting the administration of nutrition and medication--was not influenced by the fact that the subject had undergone a life event.