Introduction Medical care at the end-of-life can be an emotionally and economically demanding experience. About 10-20% of the total health care budget and over a quarter of the Medicare budget in the United States are spent on end-of-life care. Of these Medicare funds, 40% is spent for care given in the last 30 days of life and 50% for treatment in the last 60 days.1,2 Apart from monetary expenses, there is the emotional toll on patients and their families. Although every human being will experience death eventually, not all individuals view death or respond to it in the same way. These difference are now becoming more apparent as recent advances in medical technology made it possible to maintain many patients who are terminally ill alive without necessarily improving their quality of life. Several studies have reported on the factors likely to influence the attitudes of patients,3,4,5,6 the public in general,7,8,9 and healthcare providers10,11,12,13,14 toward euthanasia, assisted suicide, advance directives and various end-of-life issues. Apart from one study that surveyed the attitudes of medical students, house staff and faculty physicians toward euthanasia and termination of life-sustaining treatment,15 the attitudes of young adults toward end-of-life issues were not examined. Healthcare providers are encouraged to discuss end of life issues with their patients while they are still healthy and functional rather than in the context of a terminal illness. Therefore, it is not surprising that an increasing number of young healthy adults are being asked to complete advance directives. This study examines the attitudes of a younger population, undergraduate students, toward DNR orders. Methods In this cross-sectional study, the attitudes of undergraduate students toward DNR orders were surveyed using a structured questionnaire.16,17 The questionnaire started with a paragraph explaining the concept of DNR, followed by a series of questions on whether the respondent would favor writing a DNR order for 7 hypothetical patients who differ in age and degree of illness severity. The last section included questions related to respondents' gender, study major, ethnic background and religious beliefs. Questionnaires were distributed to undergraduate students at the University of Rochester in the spring of 1997. Potential respondents were identified from two sources: students attending three different classes (a history of medicine class, and two medical sociology classes) and from a random sample obtained using a random number generator to produce numbers between 271,000 and 277,000 which is the range of the undergraduate students' mail box numbers. Students' participation was voluntary and anonymous.Results were reported as a mean (± SD) unless specified otherwise. General descriptive statistics were used to define groups. The Chi-square test was used to compare dichotomous data. The two-sample t-test was used to compare groups' means. Significance was defined as p<0.05. Statistical analysis was performed using the statistical package Statistica for Windows (Statsoft, Inc., Tulsa, OK 1998). This study was funded by the Barth-Crapsey Award for Research in the Social Sciences and Humanities. Results One hundred and three students from the history of medicine class and 110 students from the sociology classes completed the questionnaire, with a response rate of 100%. Of the 233 mailed questionnaires, 38 were returned with a response rate of 16.3%. Three of these were incomplete and were excluded from the analysis. Table 1 describes the characteristics of all participants (n=248). Of the total study population (n=248), 36% were males, 57% were Whites, 36% were Catholic, 33% Protestant, 11% were Jewish and 14% Atheist. Forty percent, 29%, 12%, and 3% chose a social science, natural science, humanities, or nursing as their major, respectively.
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