Survey: the attitudes of geriatricians in Europe towards euthanasia and assisted suicide
Study Protocol
Title
Attitudes of geriatricians in Europe towards euthanasia and assisted suicide.
Introduction
Euthanasia and assisted suicide are currently legal in four European countries: Belgium, the Netherlands, Luxembourg and Spain. While assisted suicide is also legal in Switzerland, euthanasia is not.
Euthanasia has been defined as “the act of deliberately ending a life to relieve suffering.” 1 Assisted Suicide has been defined as “the act of deliberately assisting or encouraging another person to kill themselves”. 1
There is on-going debate regarding euthanasia and assisted suicide throughout Europe. It has been recognized that physicians’ attitudes towards euthanasia and assisted suicide are authoritative given their direct experience with end-of-life care2 and their inevitable involvement in any program for euthanasia and assisted suicide once/if legalised3. The opinions of geriatricians can be considered particularly relevant in this regard given their involvement with the care of older patients. It is important that the on-going debate regarding legalization of euthanasia and assisted suicide is informed with empirical data regarding the attitudes of geriatricians. There is, however, a dearth of such data in the existing literature.
Participant Information Leaflet & Consent Form_EuGMS
Literature Review
A 2001 postal survey of UK geriatricians found that 80% and 68% respectively believed that euthanasia and assisted suicide were never ethically justified 4. Most of those who were opposed to legalization of euthanasia worried that older people might feel pressurized into ending their lives. The authors noted that, in free text commentary, many respondents expressed the belief that palliative care was an appropriate alternative to euthanasia and assisted suicide.
By contrast, in Belgium, where euthanasia and assisted suicide are legal, a 2011 survey found that 90.4% of physicians were in favor of euthanasia for terminal patients with uncontrollable suffering 5. Furthermore, only 10.1% felt that legalization of euthanasia and assisted suicide impeded the development of palliative care. There is no available data regarding the attitudes of Belgian geriatricians.
In a 2016 survey of Irish physicians3, the attitudes of Irish geriatricians mirrored those of their UK counterparts mentioned above, with 81.25% opposed to euthanasia and 71.87% opposed to assisted suicide.
A survey of Danish geriatricians in 2016 found that 55.8% and 64.2% respectively felt that euthanasia and assisted suicide were never ethically justifiable 6. 62.2% felt legalization of euthanasia and assisted suicide would negatively impact the doctor-patient relationship.
While euthanasia remains illegal in Sweden, there appears to be somewhat less ardent opposition towards euthanasia among geriatricians in that country. Within a wider study of Swedish physicians conducted in 2021, 37% of geriatricians were in favor of euthanasia while only 45% were opposed 7.
No other country-specific data were found and no study comparing and contrasting the views of geriatricians practicing in Europe was found.
Aim
The aim of this study is to analyse the attitudes of geriatricians towards euthanasia and assisted suicide throughout Europe.
Study Design
A descriptive cross-sectional study design will be used.
Study Population
The potential study population will include all geriatrician members of the European Union Geriatric Medicine Society.
Study Measures
A novel electronic questionnaire has been designed. It contains direct questions to ascertain participants’ demographic details and to elicit information regarding participants’ experience with end-of-life care. Likert-type questions are used to assess attitudes towards euthanasia and assisted suicide.
Study Procedures
The study e-questionnaire, together with the participant information leaflet and consent form, will be distributed as a link (Google Forms) by email to all members of the European Union Geriatric Medicine Society. After acquiring their informed consent, potential participants will be invited to complete the questionnaire on-line.
Data Management & Analysis
All responses received will be anonymized. No information that might lead to the identification of a study participant will be used in the statistical analysis or in any published report. Data will be analyzed using statistical analysis software. All responses received shall be destroyed upon completion of the study. Data protection laws and principles will be strictly adhered to.
Sample Size
There are approximately 12,000 members of the European Union Geriatric Medicine Society.
Ethical Approval
Ethical approval for this research study will be sought from the Clinical Research Ethics Committee of the Cork Teaching Hospitals.
References
- Royal College of Physicians of Ireland. Assisted Suicide - Position Paper. Dublin: Royal College of Physicians of Ireland; 2017. Available at:https://www.rcpi.ie/news/publications/topic/assisted-suicide/
- House of Lords Select Committee on the Assisted Dying for the Terminally Ill
Bill. Assisted Dying for the Terminally Ill Bill [HL] Report. London: Stationary Office;2005. 86-I. - Crowley P, Doran K, O’Caoimh R. Euthanasia and Physician-Assisted Suicide: Attitudes of Irish Consultant Physicians. Irish Medical Journal. 2021;114(4):328
- Clark D, Dickinson G, Lancaster C, Noble T, Ahmedai S, Philp I. UK geriatricians’ attitudes towards voluntary active euthanasia and physician-assisted death. Age and Ageing. 2001;30(5):395-8.
- Smets T, Cohen J, Bilsen J, Van Wesemael Y, Rurup M, Deliens L. Attitudes and experience of Belgian physicians regarding euthanasia practice and the euthanasia law. Journal of pain and symptom management. 2011;41(3):580-93.
- Ivemark J, Dahle B, Matzen L. Questionnaire-based survey suggests that the majority of Danish geriatricians are against euthanasia. Danish Medical Journal. 2016;63(2):A5187.
- Lynoe N, Lindblad A, Engstrom I, Sandlund M, Juth N. Trends in Swedish physicians’ attitudes towards physician-assisted suicide: a cross-sectional study. BMC Medical Ethics. 2021;22(1):86.
