A majority of the public believes that the terminally ill have the right to choose to die and that all patients should be entitled to animal organ transplants, according to a national survey released Wednesday.
The survey, sponsored by the American Board of Family Practice, polled 1,007 Americans across the country on a variety of health issues, including sex education, smoking restrictions, parental punishment of children and the care and costs of medical service.
Identical questions were asked of 303 certified family practitioners, whose responses on most issues corresponded closely with those of the public. The two groups of respondents differed most markedly in ranking the importance of different health concerns and in answers to questions about the best ways to reduce medical costs.
"The study shows that patients want to have more input about their health care and the direction it should take," said Dr. Paul Brucker, a member of the family practice board and a professor of family medicine at Thomas Jefferson University in Philadelphia. "This indicates that patients don't just want physicians to listen to what's wrong with them. They want to have a say about the whole health care delivery system."
Explains Degrees of Support
By a 58% margin, the public respondents said they believe that the terminally ill or permanently bedridden have the right to have life-support systems diconnected. Half of the physicians polled agreed. Only 2% of the public respondents said that no one should be allowed to die under any circumstances and only 3% cited religious or ethical grounds for opposition.
Brucker said he believes that public support for the concept is greater than that of family practitioners because of physicians' training and concerns about legal consequences.
"In many physicians' minds, death frequently is equated with failure," Brucker said. "There's also concern about the legal aspects, and probably the easiest route to take is to sustain life at all costs."
Both physicians and the public respondents said they believe that patients are entitled to animal organ transplants, with 72% of the physicians and 55% of the general public in favor. But 20% of the public and 4% of the doctors described animal organ transplants as "immoral."
In posing the subject, interviewers used the example of Baby Fae, an infant who lived for 20 days with a baboon heart. The survey found that the more affluent, the younger and the more educated the respondent, the stronger the support for such transplants.
In other areas, the survey found that overwhelming majorities support restrictions on smoking and believe that even "second-hand smoke" is hazardous to health. A sizable 40% of the public believes that smoking should be prohibited in the workplace and more than one-fifth said tobacco use should be banned altogether.
The survey, conducted from Dec. 20 to Jan. 24, identified a shift away from permissive attitudes in child rearing in favor of discipline. By large majorities, both the public and physicians polled said that parents not only have the right but the responsibility to "gently spank" their children.
Only 13% of the public and 10% of the family physicians said that children should be punished solely by scolding. Ten percent of the public said parents have the right to "beat their children."
The survey found that the public disagrees with family physicians over the importance of various health concerns. For example, the public identified drug abuse, the homeless and the hungry, and air, water and land pollution, respectively, as the three most important health issues facing the nation.
Physicians agreed with the public on pollution but rated alcohol and smoking the top two concerns, respectively. The public, by contrast, rated smoking as the least important of eight health issues and placed alcohol consumption in sixth place.
Touching Found Beneficial
Both the public and physicians believe that touching by physicians is beneficial to patients. Two-thirds of the public and nine-tenths of the physicians said a comforting hand promotes the healing process by diminishing patients' fears and apprehension.
But people spend little time shopping around for a good doctor, the survey showed. In fact, respondents said they spend more time choosing a supermarket than in searching for a good physician.
On sex education, an overwhelming majority of the Americans polled said they believe that parents should do the teaching and that the goals should be to stamp out sexually transmitted diseases and to improve family planning. Only 43% of the public said the purpose of such instruction should be to improve sexual relations. By contrast, 76% of the physician cited improved relations as a goal of sex education.
On questions about reducing medical costs, 70% of the public said they support using price controls for hospitals, medical centers and drugs, compared to only 35% support for controls by the physicians. A majority of the public respondents believe that employers should pay a greater share of health insurance costs. Almost half the public respondents said they favored national health care insurance while only 17% of the physicians supported the concept.
More House Calls Wanted
Asked about house calls by doctors, a majority of the public respondents said they want more doctors to visit patients' homes, whereas only a minority of the doctors supported the idea. Both groups said better health care can be achieved by watching or listening to health-related programming on radio and television and reading about health issues in newspapers and magazines.
Most respondents also believe that the children of the aged should be financially responsible for their parents' medical care. Thirty-nine per cent of the public believe that aged parents should be placed in a care home if affordable and 34% said that the elderly should care for themselves until they die. A sizable majority of the public said the elderly should feel free to have sex, but only if they are married.