Attitudes to some aspects of death and dying, living wills and substituted health care decision-making in South Australia: public opinion survey for a parliamentary select committee

Abstract

This study aimed to provide evidence on community attitudes to certain death and dying issues in South Australia for a state parliamentary committee on the law and practice relating to death and dying. The following areas were studied: truth-telling, pain control, level of treatment, preferred place of death, rights of patients to refuse treatment, opinion about living wills and substituted health care decision making. A representative population survey of 625 households in metropolitan Adelaide and three major rural centres was made in August 1991, using personal interviews administered at home with one adult in each house hold aged over 18 years. A total of 462 (74%) adults completed the interviews. There was strong support for truth-telling by doctors about incurable cancer and impending death, although this was not universal. Fears of potential addiction, habituation, tolerance and impaired cognitive function as a result of analgesia for cancer pain were strongly expressed, particularly amongst those who reported least formal education. Those with experience of a death in the last eight years were most likely to consider the level of treatment offered to patients with incurable cancer to be inadequate, but 53% considered the level to be about right. Nearly 60% of respondents favoured death at home, but there was a trend for older people to favour death in hospital. Despite the existence of the Natural Death Act (1982), only 20% were aware that living wills were legal in South Australia. There was strong support for a medical power of attorney.