Attitudes towards self-determination in health care: A general population survey in northern Sweden

Background: Today, patient self-determination has become an issue in many western countries due to the widespread availability and use of technology, which makes it possible to prolong life often in spite of severe disability and poor quality of life. Many people fear an overzealous use of modern life-saving procedures which merely serve to prolong the dying process. As a first step towards autonomy and increasing self-determination, advance directives (living wills) have been introduced in some countries. Methods: To survey a general population's attitudes towards advance directives and self-determination a questionnaire was mailed to a representative sample of 600 citizens in northern Sweden. Issues regarding importance of control, concerns about own health care, treatment preferences and support for and use of advance directives were addressed. Results: There was a response rate of 80% and the great majority of respondents reported that it was extremely or very important to have a say in decisions about their health care (79.5%). A significant number of subjects were concerned about either being treated too aggressively or not aggressively enough. There was a variability in treatment preferences, depending on the reversibility of the condition. Conclusions: The results demonstrate a vital interest among the Swedish general public for greater self-determination in health care, which is also reflected by their support of advance directives.