Data-Driven Learning Guide

Goal & Concept

Goal

The goal of this exercise is to explore attitude consistency and the ideological dimensions of attitudes about euthanasia. Frequency distributions and crosstabulations will be used.

Concept

Social scientists and policy makers have long been interested in understanding the factors that shape public attitudes about a given policy issue. Logically, citizens should adopt policy preferences that further their private interests. However a vast body of research shows that self-interest is not strongly related to people's policy preferences. Instead what does appear to shape public attitudes is what social scientists call "symbolic predispositions--stable affective preferences (such as racial prejudice, ideology, nationalism, religion, or party identification) acquired through conditioning in pre-adult years.

Researchers hypothesize that some issues touch on symbols that influence public attitudes through cognitive consistency--the idea that people strive to maintain consistency between beliefs, values and attitudes; attitudes and behavior; and among different attitudes. In other words, an attitude does not exist in isolation. It is related to other attitudes that are likely to be consistent with each other as well as with the specific values, cognitions, beliefs, and behaviors that accompany them. If this is correct, then people ought to display attitudes that fit into ideologically coherent patterns.

Euthanasia--"the act of bringing about the death of a hopelessly ill and suffering person in a relatively quick and painless way for reasons of mercy" (American Medical Association)-- is a policy issue that presents a valuable opportunity for social scientists to explore the ideological dimensions of our attitudes. Euthanasia can be classified as either active or passive and as either voluntary or involuntary. In active euthanasia, specific steps are taken to cause the patient's death, such as injecting her with poison, or giving her an overdose of pain-killers. In contrast passive euthanasia refers to the withdrawal of medical treatment or the withholding of food and fluids with the deliberate intention of causing the patient's death. Voluntary euthanasia is when the patient requests that action be taken to end her life, or that life-saving treatment be stopped. Involuntary euthanasia is when a patient's life is ended without the patient's knowledge and consent, usually because she is unconscious, or too weak to communicate. Euthanasia differs from assisted suicide, where a physician provides lethal medications but the patient decides whether and when to ingest them.

Examples of research questions about [concept]:

How does self-interest influence support for euthanasia?
Do people who say they would consider euthanasia if they were terminally ill also support euthanasia for other terminally ill patients?
How do attitudes about euthanasia vary by age, gender, and race?
Does the form of euthanasia (active/passive/voluntary/involuntary) affect people's attitudes toward euthanasia?
Are people's attitudes about euthanasia consistent with their religious views?
What symbolic predispositions have the strongest influence on attitudes about euthanasia?
Since, in the case of euthanasia, one person might consider euthanasia in her interest while another might not, how would a researcher explore the possible relationship between self-interest and attitudes about euthanasia?

Dataset

This exercise will use the Detroit Area Study, 1999: Life and Death Decision Making, Mail/Web Survey. For this survey, 795 respondents from three counties in the Detroit, Michigan, area were queried about their health, satisfaction with their health care, end of life decisions, policies about life and death decisions, and experiences with life and death decisions. They were also asked whether they trust the health care provider's judgment on medical decisions and whether they felt that a doctor or family members would follow the respondent's instructions for life sustaining procedures. Another set of questions sought respondents' opinions on terminating a patient's life support in a variety of different situations, including the treatment of critically ill infants. The survey also asked whether respondents or their families had ever experienced an end-of-life decision, whether they have discussed end-of-life decisions, and what types of methods they would consider. Respondents were also asked about their attitudes on the death penalty, abortion in certain situations, physician assisted suicide, and the 1998 proposal to legalize physician assisted suicide. Background information includes marital status, employment, political orientation, and income.

Variables

This exercise will use the following variables:

Remove from life support (Q74)
Give an injection (Q76)
Religious preference (Q111)
Political views (Q108)
Adults should be allowed to do what they please without interference from the government (Q81)
Active euthanasia (Q67)
Injection to hasten patient's death (Q55)
Family objects to patient being taken off the respirator (Q54)
Man in coma from stroke (Q53)
Woman with permanent brain damage (Q56)
Man diagnosed with AIDS (Q59)
A/B Version indicator (Q14)

For ease of interpretation, recoding variables is sometimes necessary or helpful. (Note: the online analysis package used here requires recoding variables for the sole reason of modifying or adding labels.) The following variables were recoded:

Application

This guide will examine attitudinal consistency in relation to respondents' personal choices about euthanasia and along the ideological lines of religion, political affiliation, and views about the role of government. Because the survey did not include questions about passive voluntary euthanasia, this particular form of euthanasia will not be addressed in the exercise.

Personal choices

Let's begin by examining respondents' personal choices regarding end-of-life decisions, measured by the variables NOSUPPORT and INJECTION. These variables show whether respondents would consider passive euthanasia (the removal of life support) and active euthanasia (asking for an injection intended to end their life) respectively.

Take a look at the frequency distributions of NOSUPPORT and INJECTION. What percentage of respondents indicated that they would consider passive euthanasia (the removal of life support)? What percentage said they would consider active euthanasia (asking for an injection to end their life)? How would you explain the difference?

To see whether there is a relationship between people's personal choices regarding end-of-life decisions and their attitudes about euthanasia in general, we created a series of crosstabs. The first one, with ACTVOL and NOSUPPORT, looks at attitudes about active voluntary euthanasia. The second one, with ACTINVOL and NOSUPPORT, focuses on active involuntary euthanasia. Finally the crosstab of PASSINVOL and NOSUPPORT, asks about passive involuntary euthanasia. Let's examine the results of these analyses.

What percentage of those who said they would consider euthanasia for themselves also support active voluntary euthanasia? How did the respondents who indicated that they would not consider euthanasia for themselves feel about this? Scrolling down to the second results table, among which group is support for active involuntary euthanasia the highest? Now considering the third results table, would you say that the majority of respondents is for, or against, passive involuntary euthanasia? Compare the results of these three analyses: do people's attitudes about euthanasia appear to be consistent? Which groups show the most/the least consistent attitudes?

A technique sometimes used in survey research is to present respondents with slightly different versions of the same questions. Respondents are randomly selected to receive one version or the other. This allows researchers to see the effects of variations in question wording for example or, as is the case here, to explore factors that may influence respondents' attitudes.

In this survey, an example would be Q53--"A 70-year-old (A: Caucasian/B: African American) man recently suffered a stroke leaving him in a coma and unable to breathe without a respirator. His doctors say he will never regain consciousness. He has left no instructions about his own wishes in such a situation. The doctors have asked the man's family whether he should be taken off the respirator, and the family has given its consent to do so. In your opinion, would it be right to take this man off the respirator?"--where half the sample got version A (a 70-year-old Caucasian man), and the other half got version B (a 70-year-old African American man). Consider the results of the crosstab of Q53 and NOSUPPORT, controlling for version (Q14). For which group does race appear to make the most difference?

Question Q56 presented respondents with another scenario: "(A: A 23/B: An 87)-year-old woman had a heart attack that caused permanent brain damage. She is now in a coma. Her doctors say she will never regain consciousness. If you were a close relative and the doctors asked you whether this woman should be taken off the respirator, would you tell them to do so?" Again we created a crosstab with Q56 and NOSUPPORT, controlling for version (Q14).

What percentage of those who said they would never consider ending their own life under any circumstance responded that the young woman should be taken off the respirator? What percentage of the same group thought the old woman should be taken off the respirator? Are their answers consistent with those of the other two groups? (Generally speaking, do people seem more or less likely to support euthanasia in cases where the person is old?)

A third scenario (Q59) was described as follows: "A 50-year-old man was diagnosed with AIDS that he acquired from (A: a blood transfusion he received in a hospital several years ago/B: intravenous heroin use). He has been hospitalized several times in the past, and his medical care, covered by insurance, has cost more than one million dollars. Recently he was hospitalized with a serious form of pneumonia that occurs as a complication of AIDS. He is having trouble breathing and must be placed on a respirator in order to survive this episode. Should he be placed on a respirator?" Notice that while the other questions asked whether the patient should be taken off life support, in this scenario the question is whether the patient should be placed on life support.

Examine the results of the crosstab of Q59 and NOSUPPORT (using Q14 as a version control). How does the manner in which the patient contracted AIDS affect respondents' attitudes about whether he should be placed on life support?

Religious views

Religious views may also shape people's attitudes about euthanasia. The following analyses will use the variable Q111, "Religious preference," which divides the sample among five groups: Protestants, Catholics, Jews, Muslims, and "other." Note the very small number of respondents who identified as "Jewish" or "Muslim"--too few to be representative of Jews and Muslims in the general population. While we decided to include them in our analyses, we cannot draw any solid conclusion from these groups' answers.

First we will explore how the different religious groups view active voluntary euthanasia (ACTVOL), active involuntary euthanasia (ACTINVOL), and passive involuntary euthanasia (PASSINVOL). Looking at the first crosstab, among which religious group is support for active voluntary euthanasia the highest? The lowest? Scroll down to the results of the second analysis. What percentage of Protestants indicated support for active involuntary euthanasia? How about Catholics? Now considering the results of the third crosstab, look at the "Row total" column: what percentage of the sample supports passive involuntary euthanasia? Compare the results of these three analyses: do people's attitudes about euthanasia appear to be consistent? Which groups show the most/the least consistent attitudes?

Recall the three scenarios used in the previous section: the 70-year-old (A: Caucasian/B: African American) man who suffered a stroke; the (A: 23/B: 87)-year-old woman with permanent brain damage; and the 50-year-old man diagnosed with AIDS that he acquired from (A: a blood transfusion he received in a hospital several years ago/B: intravenous heroin use)--questions Q53, Q56, and Q59 respectively.

Let's see how the different religious groups reacted to the first scenario (crosstab of Q53 and Q111, controlling for version, Q14). Does the patient's race appear to make a large difference in people's attitudes about whether he should be taken off the respirator?

To examine whether the patient's age affected respondents' attitudes, we used the second scenario (Q56) in a crosstab with Q111 (Religious preference), controlling for version (Q14). According to the results of this analysis, do people appear more, less, or equally as likely to support euthanasia in cases where the person is old?

Finally, examine the results of the crosstab of Q59 and Q111 (using Q14 as a version control). How does the manner in which the patient contracted AIDS affect respondents' attitudes about whether he should be placed on life support?

Political views

Political views are measured with the variable POLVIEWS. As we did in the previous two sections, let's first explore how the different political groups view active voluntary euthanasia (ACTVOL), active involuntary euthanasia (ACTINVOL), and passive involuntary euthanasia (PASSINVOL). Looking at the first crosstab, among which political group is support for active voluntary euthanasia the highest? The lowest? Scroll down to the results of the second analysis. What percentage of Conservatives indicated support for active involuntary euthanasia? How about Liberals? Now considering the results of the third crosstab, look at the "Row total" column: what percentage of the sample supports passive involuntary euthanasia? Compare the results of these three analyses: do people's attitudes about euthanasia appear to be consistent? Which groups show the most/the least consistent attitudes?

Recall the three scenarios used in the earlier sections: the 70-year-old (A: Caucasian/B: African American) man who suffered a stroke; the (A: 23/B: 87)-year-old woman with permanent brain damage; and the 50-year-old man diagnosed with AIDS that he acquired from (A: a blood transfusion he received in a hospital several years ago/B: intravenous heroin use)--questions Q53, Q56, and Q59 respectively.

Look at the results of the crosstab of Q53 and POLVIEWS. Does the patient's race appear to make a large difference in people's attitudes about whether he should be taken off the respirator?

According to the results of the crosstab of Q56 and POLVIEWS, do people appear more, less, or equally as likely to support euthanasia in cases where the person is old?

Finally, would you say that the manner in which the patient contracted AIDS affected respondents' attitudes about whether he should be placed on life support? How so?

Views about the role of government

Debates over euthanasia often involve arguments about whether an individual should have the right to choose when and how to end her life, or whether the government should legislate such decisions. Therefore another ideological dimension that may affect people's attitudes about euthanasia is their views about the role of government, measured by the variable FREEDOM ("I should be allowed to do as I please without government intervention").

Let's explore how views about the role of government affect attitudes about active voluntary euthanasia (ACTVOL), active involuntary euthanasia (ACTINVOL), and passive involuntary euthanasia (PASSINVOL). Looking at the first crosstab, what percentage of those who support freedom from government intervention also supports active voluntary euthanasia? Scroll down to the results of the second analysis. What percentage of this same group indicated support for active involuntary euthanasia? Now considering the results of the third crosstab, look at the "Row total" column: what percentage of the sample supports passive involuntary euthanasia? Compare the results of these three analyses: do people's attitudes about euthanasia appear to be consistent? Which groups show the most/the least consistent attitudes?

We turn again to the three scenarios used in the earlier sections: the 70-year-old (A: Caucasian/B: African American) man who suffered a stroke; the (A: 23/B: 87)-year-old woman with permanent brain damage; and the 50-year-old man diagnosed with AIDS that he acquired from (A: a blood transfusion he received in a hospital several years ago/B: intravenous heroin use)--questions Q53, Q56, and Q59 respectively.

Look at the results of the crosstab of Q53 and FREEDOM. Does the patient's race appear to make a large difference in people's attitudes about whether he should be taken off the respirator?

According to the results of the crosstab of Q56 and FREEDOM, do people appear more, less, or equally as likely to support euthanasia in cases where the person is old?

Finally, would you say that the manner in which the patient contracted AIDS affected respondents' attitudes about whether he should be placed on life support? How so?

Interpretation & Summary

Think about your answers to the application questions before you click through to the interpretation guide for help in answering them.

Personal choices regarding end-of-life decisions

What percentage of respondents indicated that they would consider passive euthanasia (the removal of life support)? What percentage said they would consider active euthanasia (asking for an injection to end their life)? How would you explain the difference?
What percentage of those who said they would consider euthanasia for themselves also support active voluntary euthanasia? How did the respondents who indicated that they would not consider euthanasia for themselves feel about this? Scrolling down to the second results table, among which group is support for active involuntary euthanasia the highest? Now considering the third results table, would you say that the majority of respondents is for, or against, passive involuntary euthanasia? Compare the results of these three analyses: do people's attitudes about euthanasia appear to be consistent? Which groups show the most/the least consistent attitudes?
For which group does race appear to make the most difference?
What percentage of those who said they would never consider ending their own life under any circumstance responded that the young woman should be taken off the respirator? What percentage of the same group thought the old woman should be taken off the respirator? Are their answers consistent with those of the other two groups? (Generally speaking, do people seem more or less likely to support euthanasia in cases where the person is old?)
How does the manner in which the patient contracted AIDS affect respondents' attitudes about whether he should be placed on life support?

Religious views

Among which religious group is support for active voluntary euthanasia the highest? The lowest? What percentage of Protestants indicated support for active involuntary euthanasia? How about Catholics? What percentage of the sample supports passive involuntary euthanasia? Compare the results of these three analyses: do people's attitudes about euthanasia appear to be consistent? Which groups show the most/the least consistent attitudes?
Does the patient's race appear to make a large difference in people's attitudes about whether he should be taken off the respirator?
Do people appear more, less, or equally as likely to support euthanasia in cases where the person is old?
How does the manner in which the patient contracted AIDS affect respondents' attitudes about whether he should be placed on life support? How so?

Political views

Among which political group is support for active voluntary euthanasia the highest? The lowest? What percentage of Conservatives indicated support for active involuntary euthanasia? How about Liberals? What percentage of the sample supports passive involuntary euthanasia? Compare the results of these three analyses: do people's attitudes about euthanasia appear to be consistent? Which groups show the most/the least consistent attitudes?
Does the patient's race appear to make a large difference in people's attitudes about whether he should be taken off the respirator?
Do people appear more, less, or equally as likely to support euthanasia in cases where the person is old?
Would you say that the manner in which the patient contracted AIDS affected respondents' attitudes about whether he should be placed on life support? How so?

Views about the role of government

What percentage of those who support freedom from government intervention also supports active voluntary euthanasia? What percentage of this same group indicated support for active involuntary euthanasia? What percentage of the sample supports passive involuntary euthanasia? Compare the results of these three analyses: do people's attitudes about euthanasia appear to be consistent? Which groups show the most/the least consistent attitudes?
Does the patient's race appear to make a large difference in people's attitudes about whether he should be taken off the respirator?
Do people appear more, less, or equally as likely to support euthanasia in cases where the person is old?
Finally, would you say that the manner in which the patient contracted AIDS affected respondents' attitudes about whether he should be placed on life support? How so?

View Interpretation Guide

Interpretation

Things to think about in interpreting the results:

The numbers in each cell of the crosstabulation tables show the percentage of the people who fall into the overlapping categories, followed by the actual number of people that represents in this sample. The coloring in the tables demonstrates how the observed numbers in each cell compares to the expected number if there were no association between the two variables. The accompanying bar charts display the patterns visually as well.

Weights (mathematical formulas) are often used to adjust the sample proportions, usually by race, sex, or age, to more closely match those of the general population. The analyses in this guide used weights to increase the generalizability of the findings, so the resulting tables are meant to reflect the relationships we would expect to see in the general population.

Reading the results:

Personal choices regarding end-of-life decisions

Religious views

Support for active voluntary euthanasia is highest among Jews (76.7%) and Catholics (62.4%), and lowest among Muslims (38.6%). Protestants and respondents who said "Other" are almost evenly divided in their support for this form of euthanasia. 39.2% of Protestants, and 46.3% of Catholics expressed support for active involuntary euthanasia (a drop of about 16 percentage points for each of these two groups compared to the first analysis). Only 14.7% of the sample supports passive involuntary euthanasia. Once again, it appears that active voluntary euthanasia is viewed the most favorably, while passive involuntary euthanasia is viewed the least favorably. Muslims seem the most consistent in their opposition to euthanasia, but as we pointed out earlier, the very small number of Muslims in the sample means that these results may not be representative of the larger Muslim population.
Neither the race nor the age of the patient appears to make much difference in respondents' views about whether s/he should be taken off life support. With the exception of Jews, respondents were more likely to say that the patient should not be placed on life support when they were told that he acquired AIDS from drug use versus a blood transfusion.

Political views

Two thirds of Liberals (67.8%), but slightly less than half of Conservatives (48.1%) support active voluntary euthanasia. These numbers drop to 58.9% and 35.5%, respectively, for active involuntary euthanasia. Only 14.4% of the sample supports passive involuntary euthanasia. As we saw before, active voluntary euthanasia is viewed the most favorably, while passive involuntary euthanasia is viewed the least favorably. All three political groups show attitudinal inconsistency here.
Only Liberals appear more likely to say that it would be right to take the patient off of life support when the patient is African American as opposed to when he's White (95.1% versus 87.6%). All three political groups appear more likely to support euthanasia in cases where the patient is old, and all three political groups were more likely to say that the patient should not be placed on life support when they were told that he acquired AIDS from drug use versus a blood transfusion.

Views about the role of government

Almost three quarters (73.2%) of those who support freedom from government intervention also support active voluntary euthanasia (compared to 33.6% of those who don't support freedom from government intervention). 57% of them support active involuntary euthanasia. Only 16.8% of the sample supports passive involuntary euthanasia. Once again, active voluntary euthanasia is viewed the most favorably, while passive involuntary euthanasia is viewed the least favorably. The differences in attitudes toward the different forms of euthanasia are most pronounced among those who support freedom from government intervention.
The race of the patient seems to make no difference in the two groups' attitudes about whether he should be taken off of life support. Both groups are more likely to support euthanasia in cases where the patient is old, as well as when they are told that the patient acquired AIDS from drug use.

Summary

The goal of this exercise was to explore attitude consistency and the ideological dimensions of attitudes about euthanasia. Taken together, results show that personal choices about end-of-life decisions, religious and political views, as well as views about the role of government all affect attitudes about euthanasia. But results also indicate that, perhaps more than ideology, attitudes about euthanasia are related to the type of euthanasia under consideration: in this survey, respondents consistently viewed active voluntary euthanasia the most favorably, and passive involuntary euthanasia the least favorably (except when it came to their own end-of-life decisions, where the results show the opposite). They were also more likely to support euthanasia in cases where the patient is old, and when they were told that he acquired AIDS from drug use. Our findings suggest that attitudes about euthanasia may be shaped by moral, as well as ideological considerations.

Further research might explore how moral evaluations affect attitudes about euthanasia.