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'Bad law' Polling a tragedy

Judges have a saying: “Hard cases make bad law.” The same could be said of polling, with the Terri Schiavo case a current and wrenching example. As personal autonomy has become an increasingly important value for Americans, attitudes toward end-of-life issues have evolved dramatically. In 1950, Gallup asked, “When a person has a disease that cannot be cured, do you think doctors should be allowed to end the patient’s life by some painless means if the patient requests it.” At that time, only 36 percent favored physician-assisted suicide. By 2003, that number had doubled to 72 percent.

Judges have a saying: “Hard cases make bad law.” The same could be said of polling, with the Terri Schiavo case a current and wrenching example.

As personal autonomy has become an increasingly important value for Americans, attitudes toward end-of-life issues have evolved dramatically. In 1950, Gallup asked, “When a person has a disease that cannot be cured, do you think doctors should be allowed to end the patient’s life by some painless means if the patient requests it.” At that time, only 36 percent favored physician-assisted suicide. By 2003, that number had doubled to 72 percent.

But, like most issues involving complex tradeoffs, answers to questions on this subject vary significantly depending on the question. For example, Pew found an 11-point difference in responses to otherwise identical questions that did and did not use the word “suicide”.

Most poll questions that show substantial support for the right to die have three elements. First, they note a specific request from the patient (or close family member when that is not possible) to have his or her life ended. Second, there is either a direct statement or implication that the patient is terminally ill. Finally, there is often an implication that the patient is in pain or “severe distress.”

Perhaps the most complete inventory of the conditions under which ending life is acceptable was part of the British Social Attitudes Survey. Support for legal euthanasia was nearly unanimous (86 percent) in the case of a patient who suffered from an incurable disease, was on life support and was never expected to regain consciousness and whose relatives requested it.

However, where a patient who is not in much pain and not in danger of death but permanently and completely dependent on others for all physical needs asked to end his or her life, only 51 percent supported legal euthanasia. Only 41 percent supported euthanasia requested by a patient who was suffering from a painful, incurable but nonfatal disease.

The point is that the precise circumstances seem to matter. In principle, people believe that euthanasia is justified when a patient or close relatives of the patient request an end to life, the patient is incurable, natural death is near and the patient is suffering.

Schiavo does not seem to meet the last two criteria, yet 56 to 63 percent favor removing her feeding tube and even more in each poll say they would want the tube to be removed if they were in her condition. Either respondents inaccurately assume that she is suffering and that her death is near, or there is something about this case that is not neatly captured by the scenarios pollsters have presented in survey questions.

Compounding the problem is the source of the request for her life to be ended, a factor that seems critical in most of the polling. Every survey indicates that spouses are preferred to parents as the decisionmaker. In Schiavo’s case, though, the actual status of her husband is complicated. He has been living with another woman for a decade and has children with her.

His suffering has no doubt been immense, and few could judge him harshly for trying to get on with his life. But his efforts to move on may well affect public judgments as to whether he is the appropriate decisionmaker. All but one of the polls asking who should decide in the Schiavo case omits this information. The one poll that conveyed this information, albeit in a somewhat biased form, found only 32 percent in favor of removing her feeding tube.

This very hard case may afford limited insight into public opinion on these very difficult issues.

Mellman is president of The Mellman Group and has worked for Democratic candidates and causes since 1982, including Sen. John Kerry (D-Mass.) last year.