Two-thirds of Americans now say there are some circumstances in which doctors and nurses should allow a seriously ill patient to die, despite a growing minority who believe medical professionals must do everything possible to save a patient’s life in every circumstance, according to new findings published by Pew Research.

When asked about end of life decisions for other people, 66 percent said there are at least some situations in which a patient should be allowed to die. However, 31 percent said medical professionals should do everything possible to save a patient’s life in every circumstance.

“Over the last quarter-century, the balance of opinion has moved modestly away from the majority position on this issue. While still a minority, the share of the public that says doctors and nurses should do everything possible to save a patient’s life has gone up 9 percentage points since 2005 and 16 points since 1990,” the researchers wrote in “Views on End-of-Life Medical Treatments.” Nearly two thousand Americans from across the U.S. were surveyed by phone (both cell and landline) from March to April 2013.

Lead researcher Cary Funk told Life Matters Media the growing minority of adults who believe doctors should always do everything do keep a patient alive reflect multiple demographics. “You are seeing a change amongst a number of different groups. It is a little more pronounced among younger adults than among older adults, and you are seeing some change even among those 65 and older, but you are seeing a more pronounced change among younger adults. And you see a more pronounced change with those with lesser education, those with a high school degree or less,” she said. “It seems to be a broad-based change among adults, but I do see some groups changing a little more than others.”

A majority of adults also said there are at least some situations in which they, personally, would wish to be allowed to die– 57 percent said they would tell their doctors to stop treatments if they had a disease with no hope of improvement and were suffering a great deal of pain. Similarly, more than half of Americans said they would ask their physicians to stop treatments if they had an incurable disease and were completely dependent on someone else for their care. But 35 percent said they would want their doctors to do everything possible to keep them alive, even in “dire” circumstances– slightly more than those who said others should be kept alive in all circumstances.

When questions were framed with a moral imperative, some 60 percent said that a person suffering a great deal of pain and with no hope of improvement has a moral right to commit suicide, up from 55 percent in 1990. However, Americans remain sharply divided over the question of physician-assisted suicide, also known as “Death with Dignity.” Forty-seven percent approve and 49 percent disapprove of laws allowing a physician to prescribe lethal doses of drugs to terminally ill patients who would use them to commit suicide (in 2005 46 percent approved and 45 percent disapproved).

Religion and the End Of Life

Preferences about end of life treatments are still strongly related to religious affiliation as well as race and ethnicity. While most white mainline Protestants (72 percent), white Catholics (65) and white evangelical Protestants (62) said they would stop their medical treatments if they had an incurable disease and were suffering a great deal of pain, most black Protestants (61) and 57 percent of Hispanic Catholics said they would tell their doctors to do everything possible to save their lives in the same circumstances. Overall, blacks and Hispanics are less likely than whites to say they would stop aggressive medical treatments in any circumstance.

Craig M. Klugman, a bioethicist and medical anthropologist who currently serves as chair of the department of health sciences at DePaul University, said the Tuskegee syphilis experiments on African-Americans between 1932 to 1972 and the history of minorities receiving less care than whites are two realities behind these statistics. “There is a lot of mistrust, lots of myths among minorities,” Klugman said. “Sometimes they may feel like they are marked for death by physicians or feel that physicians do not work as hard for them.”

Nearly half of white evangelical Protestants and black Protestants said they reject the idea that a person has a moral right to suicide, but the religiously unaffiliated were much more likely to say there is a moral right to suicide. Eighty-five percent of unaffiliated Americans said that if an individual is in a great deal of pain with no hope of improvement, there is a moral right to suicide. Members of all Christian traditions, however, were least supportive of a right to suicide if an individual was simply a burden to his or her family.

Organ donation specialist Eric Price, who also served as a trauma and pediatric intensive care chaplain at the University of Chicago Medical Center, said the findings show more work to educate religious Americans is needed. “The myth about what science and medicine can do still seems to be winning the day,” Price said. “We don’t always need to treat just because we can. There is a moral and ethical imperative on the part of the health care provider to sometimes just say no, or the very least demand advance directives as part of admission to a hospital when a patient is decisional.”

Klugman said the research shows more Americans now have an opinion about their end of life preferences than ever before. “More of us have seen people die difficult deaths, prolonged deaths, because medical technology now allows people to be sustained longer,” he said. “And people want choice, either way. They want more control over how they die.”

Only about one-third of adults said their end of life wishes are written down somewhere- whether informally or in a formal document, such as a living will or advance health care directive. That percentage is a significant increase; in 1990, only 16 percent had end of life care preferences documented in some way. Sixty percent of adults said they have talked with someone about their wishes for end of life medical treatments.

Funk said there is still a sizable minority- 27 percent- of adults who have given no thought to their end of life plans. The number remains sizeable among adults 75 and older; a quarter of those elderly reported having not considered their end of life plans. “It correlates quite strongly with whether you’ve written down your wishes or talked about your wishes,” Funk said. “About 22 percent of adults 75 and older have neither written down or talked about their wishes.”