Activists and delegators: elderly patients' preferences about control at the end of life

The views of elderly patients concerning control over the dying process are explored in this paper. Thirty-eight hospitalized elderly patients were interviewed about their attitudes, both general and personal, toward exerting control over end-of-life decisions. A majority (27) of the participants could be categorized as 'activists', that is, they preferred to have a voice in decision-making at the end of life. There were also a number of 'delegators' (11) in the study. They preferred to delegate the decision-making to their physicians, to God, or to fate. Activists were better educated, had held more professional and managerial jobs and tended more often to be middle class rather than lower class. Their advanced sophistication about consumer rights and their general knowledge of health issues is reflected in their greater interest in patient control over dying. Most activists rejected the idea of euthanasia or assisted suicide for themselves, but favoured the withholding and withdrawing of treatment. It is possible that these ideal types of 'activists' and 'delegators' could anchor a continuum that is measurable. Such a scale could facilitate the differentiation of the elderly on this issue and thereby prove useful in the development of appropriate policy.