Intergenerational Differences and Similarities in Life-Sustaining Treatment Attitudes and Decision Factors.

A cross-sectional sample of members of 3-generation families was used to evaluate life-sustaining medical treatment attitudes and decision factors for oneself and for parents. Results show that the older generation (G1) perceived mental capacity, family burden, and pain as the most important considerations. Among the middle generation (G2), family burden was not an important factor, but the type of life-sustaining treatment was important. The youngest generation (G3) was similar to the other two generations in that mental capacity and pain were important, but a smaller percentage of the G3s considered this important. Key Words: family, decision making, intergenerational relationships, medical treatment, quality of life. In recent years, there has been growing interest and increased attention paid to legal documents that allow individuals the opportunity to designate their preferences for medical care or to designate proxies to make decisions for care in the event a patient is unable to communicate these wishes in the future. Advance directives and the durable power of attorney for health care are two such legal instruments that enhance individuals' rights while also protecting surrogate decision makers from legal liability for health care decisions at the end of life (Hopp, 2000). Furthermore, medical societies, health care organizations, and the public have identified improved end-of-life care as a high national priority (Steinhauser et al., 2000). Despite emphasis on the rights of patient and surrogate decision makers, the focal point of discussions about life-sustaining medical treatment is commonly based on the perception and judgment about what is an acceptable "quality of life." Implicitly, this issue also addresses concerns about the "quality of death." The subjective and personal nature of the meaning of "quality" makes it even more challenging to formulate a judgment or opinion about the use of life-sustaining treatments. For example, what is perceived as quality to one person may be perceived as anguish and suffering to another. In this regard, lifesustaining treatment that some would gladly accept, others would disapprove as too arduous or unseemly (Coupon, 1990; Steinhauser et al., 2000). At least two competing ideologies are related to the use of life-sustaining medical treatments. Many people believe that life is a precious gift and, whatever the quality, life is to be maintained at all cost. This outlook suggests that any possibility of sustaining life warrants and mandates the use of all potentially effective means. Other people believe that the expectation of continuing a quality life is a fundamental requirement in decisions about whether to apply life-sustaining treatments. These competing ideologies can be expressed as medical treatments that "prolong life" versus treatments that "prolong death" (see Cicirelli, 2001; Coulton, 1990). The goal of this study was to identify factors associated with life-sustaining medical treatment attitudes and decisions. Specifically, our research examines whether generational position within families influences the basis for decision making and, if so, to identify the salient issues for each generation. Conceptual Framework Social theorists have considered the role of the family in maintaining continuity in social ideologies over time (e.g., Chodorow, 1978; Engels, 1967; Parsons & Baltes, 1955). Research on intergenerational transmission of attitudes has shown that parents' attitudes are significant predictors of adult children's attitudes (Glass, Bengtson, & Dunham, 1986). Attitude similarity between generations can be viewed as the outcome of successful parental socialization of beliefs and values (Glass et al.). Yet, family research and studies of group decision making also have acknowledged the diversity of influences on the decision making process. For example, social change is a constant force that shapes parent-child relationships, contributing to the complexity of the context of family relationships (Bengtson & Allen, 1993; Peterson, Madden-Derdich, & Leonard, 2000). …