First Advisor

Matthew J. Carlson

Date of Publication

Spring 6-3-2013

Document Type


Degree Name

Doctor of Philosophy (Ph.D.) in Sociology






Death -- Planning -- Social conditions, Death -- Planning -- Religious aspects, Advance directives (Medical care) -- Moral and ethical aspects



Physical Description

1 online resource (ix, 145 pages)


Individuals who are facing death today are doing so in an environment that is significantly different than it was in the past. Medical technology is increasingly able to keep people alive even with multiple complex chronic conditions. While these advances in medicine are beneficial to many, it can also unnecessarily prolong inevitable deaths. Concerns over the ability to have a death that is in alignment with personal values has increased the interest in the use of formal end-of-life planning including writing an advance instructional directive and assigning a durable power of attorney for health care. Although research has indicated that the use of these formal planning strategies is beneficial, not everyone completes them. Using a current nationally representative sample, the three specific aims of this study were to examine whether there are racial and ethnic differences in formal end-of-life planning done by older African American, Hispanic, and White adults; to examine socioeconomic factors including education and income in formal end-of-life planning as well as assess the contribution of these factors in explaining racial and ethnic differences in formal end-of-life planning; and to examine the role of religiosity in formal end-of-life planning and to assess its influence on racial and ethnic differences in explaining formal end-of-life planning.

Logistic regression was run on data from the Health and Retirement Study (HRS) in order to analyze the completion of formal end-of-life plans by African American, Hispanic, and White decedents. Exit interviews conducted with knowledgeable proxies in 2008 or 2010 were combined with data from earlier waves of the HRS survey in order to analyze the completion of formal end-of-life plans, race and ethnicity, socioeconomic status, and religion.

Both Blacks and Hispanics were less likely to complete a written advance directive, assign a proxy, or complete both forms of formal planning than were Whites. Group differences remained after controlling for region of death and cause of death. Both Blacks and Hispanics were less likely to complete any form of formal planning than Whites. Group differences remained after additionally controlling for gender, age, marital status, whether the decedent had children, income, education, religious preference, importance of religion, and frequency of attending religious services. Higher levels of income and education both increased the odds that formal advance planning would take place. Religious preference was not significant, but decedents who had stated that religion was very important were less likely to plan while those that attended services frequently were more likely to plan.

I speculate that the role of cultural capital may partially explain the persistent racial and ethnic disparities and the importance of income and education. Additionally the dominant religious doctrines of Christianity may have a greater influence than the different religious teachings of Protestant and Catholics around end-of-life medical care. Contrary to expected findings, reference groups of those who attend religious services frequently may assist in formal planning. These finding may help guide interventions that can diminish disparities in the end-of-life experience. Understanding who are completing formal plans can help ensure end-of-life care that is in alignment with personal beliefs and values.


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