Wishes regarding the use of life-sustaining treatments among elderly persons in Israel: an explanatory model.

This study investigates the wishes of Israeli elderly concerning the use of life-sustaining treatments (LST) at the end of life, and suggests an explanatory causal model for these wishes. The data include 1138 Israeli elderly (70+) respondents. The results indicate that most of the elderly want to prolong their life in mild health conditions, including having cancer with a relatively good prognosis, while only a small percentage want LST in severe illness. Structural equation analysis (LISREL) of wishes for LST in severe illness conditions revealed that personal experience with other people's illnesses is the single most powerful explanatory factor affecting choice regarding LST directly and indirectly, channeled through fear of death and fear of dying. The results of such experiences whether positive or negative affect wishes for LST in the same direction; however, since they are mostly negative, past experience mostly weakens the will to prolong life by LST. Beliefs and feelings regarding life and death, such as fear of death, fear of dying, the will to live and religiosity, are also good predictors of wishes for LST. Those who fear death, have a strong will to live, and those who are more religious are more likely than others to want to prolong their life by LST, while those who fear dying want it less. Religiosity affects these wishes directly and indirectly through fear of death, fear of dying, and the will to live. Health status and social support have only a minor effect on wishes for LST: the higher the present quality of life, the more likely are the elderly to want LST. Most of the socio-demographic characteristics have no significant effect on elderly persons' wishes for LST. Only gender has a minor direct and indirect effect, channeled through the fear of dying and the will to live. Women in comparison to men want less LST because they fear dying more and have a weaker will to live. The results of this study shed some light on the explanatory factors of wishes for LST in severe illness conditions. More research is needed in order to promote social understanding of the concerns and wishes of the most relevant parties regarding the use of LST. This is a necessary condition for the formulation of new societal guidelines for general policy and daily behavior.