Table 1 Summary of Survey Results
Reference | Type of practice1 | Country | Year of study | Study design | Age range (mean;SD) | Female/Male | Response Rate | Sample Size | Type of predictors investigated (* = sign.) | Intervention | Study Outcome | consent to palliative sedation | consent to (physician-)assisted suicide | consent to withdrawal of active therapy (PE/TW) | consent to active euthanasia | consent to euthanasia | consent to legalisation of EUT/PAS/AE |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
[41] | EUT | Hong Kong | 2021 | cross-sectional survey, anonymous online self-administered 28-item questionnaire | 17–25 | 57.0%/43.0% | N/A | 228 | Age Comparison of two universities Ethnicity Gender* Religion* Year of study | none | Association between attitudes and knowledge Attitudes towards EUT Exposure to EUT Knowledge towards EUT Readiness to assist decision-making on EUT | - | - | - | - | 41.2% | - |
[53] | EUT PAS | Poland | N/A | cross-sectional survey, 18-item questionnaire | 21–41 (24.71 ± 1.81) | 59.26%/40.79% | 94.1% | 659 | Place of residence* | none | Access to palliative care/pain therapy decreases EUT Active participation in EUT/PAS Attitudes towards legalisation Claiming EUT/PAS for oneself Ethical context Knowledge about EUT/PAS Personal arguments for claiming EUT/PAS for oneself Personal arguments for practicing EUT Risk of abuse Teaching Palliative Care Values in contact with patients | - | - | - | - | 25.9% | 34.4% (EUT) |
[64] | PAS | Germany | 2020 | cross-sectional study, self-administered 10-item questionnaire | mean 24.5 (± 3.5) | 62%/38% | 82% | 271 (4th year) | N/A | none | Active participating in PAS Attitudes towards PAS Claiming PAS for oneself Teaching PAS Knowledge regarding legislation | - | 93% | - | - | - | - |
[44] | AE EUT PAS | India | 2020 | cross-sectional survey, self-administered questionnaire | N/A | 61.5%/38.5% | N/A | 400 (1st, 2nd, 3rd and final year) | Gender | none | Attitude towards EUT/PAS Knowledge towards EUT Legalisation of EUT/AE Person controlling EUT/Person deciding over EUT Reasons to support/oppose EUT Risk of abuse | - | 38% | - | - | 72% | 61% (AE) 75% (PE) |
[49] | PAS | New Zealand | 2018 | mixed-methods online survey | 18–40 | 61.8%/38.2% | 28% | 326 (2nd to 5th year) | Ethnicity Gender Religiosity* Year of study* | none | Attitudes towards legalisation of PAS | - | - | - | - | - | 56% (AE) |
[52] | AE | Serbia | 2017 | cross-sectional survey, paper-based 10-item questionnaire | N/A | N/A | N/A | 107 | N/A | none | Acceptance/refusal of AE in hypothetical scenarios Attitudes towards AE Claiming AE for oneself Ethical acceptance of AE Legalisation of AE Personal arguments for claiming AE | - | - | - | 57% | - | 44% (AE) |
[37] | AE PAS PE | Turkey | 2018 - 2019 | cross-sectional survey, paper-based 11-item questionnaire | 18–40 | 57.9%/42.1% | 78.9% | 242 (1st & 6th year) | Gender Year of study* | none | Active participating in EUT Arguments in favour/against EUT Attitudes towards AE/PAS/PE Ethical justification of EUT Legalisation of EUT Risk of abuse | - | 28.9% | 27.3% (PE) | 35.9% | - | 33.4% (EUT) |
[43] | AE EUT PE | Iran | 2016 | cross-sectional study, self-administered questionnaire | 18–28 (mean 22.12 ± 2.35) | 60.5%/39.5% | N/A | 152 | Age* Gender Year of study* | none | Active participating in EUT Attitudes towards AE/PE | - | - | 44.7% (PE) | 30.9% | - | - |
[42] | EUT | India | N/A | cross-sectional study, semi-structured 10-item questionnaire | N/A | N/A | N/A | 96 | N/A | none | Attitudes towards EUT Current legislation on EUT Knowledge about EUT Legalisation on EUT | - | - | - | - | 41.7% | 83.3% (EUT) |
[30] | PAS | Canada | 2016 - 2017 | cross-sectional survey, self-administered, anonymous online 47-item questionnaire | 18–30 + | N/A | 12% | 1210 | Age Birthplace* Frequency of religious attendance* Gender Parental education Educational background Province of Canada* Religion* Urban/rural upbringing Year of study | none | Active participating in PAS | - | 71% | - | - | - | - |
[59] | AE TW PS | UK | N/A | cohort study, paper-based, self-completion questionnaire with 5 scenarios | 18–44 (mean 22.7) | 59.8%/ 40.2% | 79% | 400 (1st and final year) | Age* Gender Graduate status* Personal belief* Religious background* Year of study* | none | Active participation in AE Attitudes towards AE/TW/PS | - | 28% | 58% | 16% | - | - |
[47] | EUT PAS | South Africa | 2016 - 2017 | semi-quantitative survey, modified [57] paper-based 16-item questionnaire | N/A | N/A | 69.3% | 277 (3rd, 4th and 5th year) | Religion | none | Acceptance/refusal of EUT/PAS in hypothetical scenarios Active participating in EUT/PAS Attitudes towards EUT/PAS Personal arguments in favour and against EUT/PAS | - | 35% | - | - | 47.7% | 52.7% (EUT/PAS) |
[29] | AE PE | Mexico | N/A | cross-sectional survey, modified [34, 77] 9-item questionnaire | 17–30 | 54.7%/43.3% | N/A | 1319 | Age Gender* Importance of religiosity and spirituality* Religion* Year of Study | none | Arguments in favour/against AE/PE Attitudes towards PE/AE Claiming AE for oneself Legalisation of AE/PE | - | - | 52.1% (PE) | 44.4% | - | - |
[38] | EUT2 | Turkey | 2017 | cross-sectional survey, 13-item online questionnaire | N/A | N/A | N/A | 125 | N/A | none | Arguments in favour/against EUT Attitudes towards (paediatric) EUT Conditions under which paediatric EUT is acceptable Level of agreement with legalisation Person controlling EUT/Person deciding over EUT Risk of abuse | - | - | - | - | 32% | - |
[48] | EUT PAS TW | South Africa | 2016 | cross-sectional study, adapted [78] 12-item questionnaire | 17–25 | 58.7%/41.3% | 71.6% | 481 | Comparison of preclinical (1st and 2nd year) vs. clinical (3rd, 4th and 5th year) students | none | Active participating in PAS Attitudes towards EUT/PAS Claiming PAS for oneself Legalisation of PAS Person controlling PAS/Person deciding over PAS | - | 36.2% | 69.8% | - | 30.1% | 43.0% (AS) |
[28] | AE EUT PAS | Canada | 2015 | exploratory cross-sectional survey, self-administered, 16-item questionnaire | N/A | 57.3%/42.7% | 87.1% | 405 | Gender Spirituality Year of study | none | Acceptance/refusal of EUT/PAS in hypothetical scenarios Active participating in PAS/AE Arguments in favour/against PAS Legalisation of PAS Person controlling/practicing PAS | - | 61% | - | 38% | - | 88% (AS) |
[50] | EUT PAS PE | Germany | N/A | case vignette study | mean 24 (± 2.8) | 68.5%/31.5% | 80% | 241 (4th year) | Age Gender | none | Assumed permissibility for PS/PAS/AE Attitudes towards PS/PAS/AE Comparison physical vs. emotional suffering Ethical acceptability of PS/PAS/AE Knowledge about legal norms Rates of consent to different types of practice | 83.8% | 51.2% | - | - | 19.2% | - |
[60] | EUT PS | Belgium | 2012 | cross-sectional study, self-administered 22-item questionnaire | N/A | N/A | 45.1% | 335 | Gender Philosophy of life* | none | Arguments accepting/supporting EUT Attitudes towards EUT Attitudes towards EUT law Claiming EUT/PS for oneself Knowledge about EUT/PS Personal experience with EUT/PS | - | - | - | - | 31.8% | 95.9% (EUT) |
[58] | EUT PAS | Norway | 2012 | cross-sectional study, paper-based questionnaire | N/A | 65.5%/34.5% | 59% | 531 (5th and 6th year) | Gender Religion | none | Active participating in EUT Attitudes towards EUT/PAS Legalisation of EUT/PAS | - | - | - | - | - | 19.4% (EUT) 31.2% (PAS) |
[32] | EUT TW | Brazil | 2010 - 2011 | cross-sectional survey, adapted [79,80,81] 43-item questionnaire | mean 22.5 (± 4.6) | 53.8%/46.2% | 61.0% | 3630 | Age Believe in soul* Gender Income* Location of the university (urban vs. rural)* Number of medical students* Religion* Religious affiliation* Religious attendance* Year of school foundation* | none | Attitude towards EUT/TW | - | - | 45.7% | - | 41.4% | - |
[34] | AE PAS TW | Mexico | 2007 | cross-sectional survey, adapted [77] 9-item questionnaire | 18–25 | 54%/46% | N/A | 99 (3rd and 4th year) | Age Comparison of religiously and lay-administered medical schools* Gender Importance of religion Religion | none | Acceptance/refusal of PAS in hypothetical scenarios Attitudes towards AE/PAS/TW Claiming PAS for oneself Legalisation of PAS | - | 52% | 61% | - | - | - |
[56] | EUT PAS | Poland | 2008 - 2009 | cross-sectional survey intervention study, anonymous self-administered 12-item questionnaire | mean 24.44 (± 1.13) | 67.35%/32.65% | 90.5% | 588 (5th and 6th year) | Age Comparison of 2 universities* Gender* Intervention Place of residence Religion* | palliative medicine course with symptom management, psychological, social and spiritual support | Attitudes towards EUT/PAS Attitudes towards EUT/PAS law Claiming EUT/PAS for family member or friends Claiming EUT/PAS for oneself Knowledge towards EUT/PAS Legalisation of EUT Personal arguments in favour EUT practice Risk of abuse | - | - | - | - | 11.7% | 29.6% (EUT/AS) |
[57] | EUT PAS | Poland | 2001 - 2002 | cross-sectional survey, anonymous 13-item questionnaire | mean 23.1 (± 2.2) | 72%/28% | N/A | 401 (3rd year) | Comparison of physicians and medical students* | none | Active participating in EUT Attitudes towards EUT Claiming EUT/PAS for family member or friends Claiming EUT/PAS for oneself Legalisation of EUT/PAS Personal definitions of EUT | - | 12% | - | - | 12% | 26% (EUT) |
[55] | EUT PAS | Poland | N/A | cross-sectional intervention study, anonymous 28-item questionnaire | N/A | 32.8%/67.2% | N/A | 320 (final year) | Comparison of medical and nursing students* Effect of training program* | Effect of pilot training program within paediatric-palliative care (PPC) | Attitudes towards EUT Evaluation of satisfaction from educational program Knowledge towards PPC Legalisation of EUT Opinions on special problems of EUT | - | - | - | - | 11.5% (BI) 9.5% (AI) | 2.5% (BF) 3.5% (AF) |
[40] | AE EUT | Pakistan | 2011 - 2012 | N/A | "3:1" | N/A | 493 | Comparison of two universities (private and public) Gender* Religion* Year of study* | none | Active participation in EUT Attitude towards AE Knowledge about EUT Legalisation of AE/EUT | - | - | - | 32.9% | - | 27% (EUT) | |
[63] | AE | Austria | 2001 (I) 2003/04 (II) 2008/09 (III) | repetitive cross-sectional study, questionnaire | 25.4 (I) 25.6 (II) 27.5 (III) | 60.8%/39.2% (I) 62.2%/37.8% (II) 63.6%/36.4% (III) | 91.7% | 694 | Survey phases* | none | Active participation in AE Attitude towards AE Personal motivation regarding acceptance/objection | - | - | - | 30.8% | - | - |
[54] | EUT PAS TW PS | Greece | N/A | cross-sectional survey, self-administered, anonymous paper-based 20-item questionnaire | mean 24.7 (± 1.8) | 44.6%/55.4% | 94.4% | 251 (final year) | Gender* | none | Attitudes towards EUT/PAS/TW/PS Claiming PAS for family member or friends Claiming PAS for oneself Factors influencing attitudes towards PAS Factors influencing deciding EUT/PAS Legalisation of EUT/PAS Request for PAS is evidence of a mental disorder Requirements to be fulfilled for PAS Risk for medical practice | 53.3% | 69.7% | 79.2% | - | 52.0% | - |
[39] | AE TW | China | N/A | cross-sectional survey, online & paper based, modified [84] 19-item questionnaire | mean 21.2 (SD 1.0) | 61.2%/37.8% | 62.9% | 312 (1st, 2nd, 3th and 5th year) | Comparison medical vs. non-medical students Gender Religion Year of study* | none | Acceptance/refusal of AE/TW in hypothetical scenarios Attitudes towards AE/TW Participants deciding over AE/TW Person controlling EUT | - | - | 56% | 44% | - | - |
[51] | AE PAS PE PS | Germany | N/A | cross-sectional survey, anonymous mail survey, self-administered 13-item questionnaire | 22–31 (25.0 ± 2.4) | 69.9%/30.1% | 25% | 113 (2nd & 6th year) | Age Comparison of two universities Gender Religion Year of study* | none | Access to palliative care/pain therapy decreases AE Active participation in EA Anxiety in caring for non-curable patients Arguments for claiming AE Arguments for practicing AE Attitudes towards AE Claiming AE for oneself Knowledge about AE/PAS/PE/PS Knowledge about legal norms AE/PAS/PE/PS Legalisation of AE Medical education is preparation for carrying the dying Risk of abuse | - | - | - | 29.2% | - | 32.7% (AE) |
[62] | EUT PAS TW | Croatia | 2003 / 2004 | cross-sectional intervention study, 20-item questionnaire | mean 19 | 61%/39% | 97% (2003) 93% (2004) | 115 (1st year) | Age Gender High school education Influence of educational course* Parental education Religious belief* Residence* | Medical ethics and Bioethics course: lectures with religious and cultural aspects of dying, sociology of death, definitions and classification of death and dying, and hospice and palliative care | Attitudes towards EUT/PAS/TW Legalisation of EUT/AE | - | 85.2% | 83.5% | - | - | 80% (EUT) |
[61] | PAS | Germany | 2002 - 2003 | cross-sectional study, self-administered, paper-based questionnaire | mean 25.5 | 60.0%/37.6% | 83.3% | 85 (5th year) | Age Gender Religion | none | Claiming PAS for oneself Ethical perspectives on PAS Knowledge about PAS Legalisation of PAS Personal experience with PAS | - | 24.7% | - | - | - | 36.5% (AS) |
[33] | EUT PAS PS | Puerto Rico | 2004 | cross-sectional study, self-administered, paper-based 17-item questionnaire | N/A | N/A | N/A | 152 | Comparison between students, residents and members of medical faculties* Gender* Religious affiliation | none | Active participation/engagement in PAS Attitudes towards PAS/EUT Legalisation of PAS Oppose engaging others in PAS | 76.3% | 13.2% | - | - | 27.6% | 46.1% (PAS) |
[69] | EUT | Poland | N/A | cross-sectional, self-administered 5-item questionnaire | N/A | N/A | N/A | 50 | Comparison of medical students, law students and general public | none | Acceptance/refusal of EUT Active participation in EUT Attitudes towards EUT law Claiming EUT for family member Claiming EUT for oneself | - | - | - | - | 36% | - |
[68] | AE EUT PAS | Switzerland | 2005 | cross-sectional study, anonymous questionnaire | N/A | N/A | 100% | 140 (1st and 2nd year) | Comparison of oncology clinicians, palliative care specialists and medical students | none | Active participating in AE/PAS Attitudes towards AE/EUT/PAS Claiming AE/PAS for oneself Legalisation of AE/PAS Person controlling EUT/Person deciding over EUT | - | 64% | - | 55% | - | 70% (AE) 77% (PAS) |
[46] | EUT | Sudan | 2002 | cross-sectional survey, paper-based questionnaire | 23–27 | 43.5%/58.6% | 83.5% | 152 (final year) | Gender Religiosity | none | Active participation in EUT Arguments in favour and against EUT Attitude towards EUT Ethical justification of EUT Knowledge about EUT Legalisation of EUT Teaching EUT | - | - | - | - | 23.4% | 23.4% (EUT) |
[31] | PAS | Canada | 2004 | cross-sectional survey, paper-based, 13-item questionnaire | 20–29 + | 56.2%/43.8% | 53% | 124 (1st & 4th year) | Age Gender* Year of study* | none | Active participation in PAS Attitudes towards PAS Claiming PAS for oneself Factors influencing decision-making regarding PAS Level of agreement with legalisation | - | 37% | - | - | - | 39% (PAS) |
[36] | AE EUT PE | Malaysia | 1998 - 1999 | cross-sectional design, self-administered 12-items questionnaire | N/A | N/A | 100% | 400 | Comparison of pre-clinical vs. clinical students Ethnic background | none | Active participating in EUT Arguments in favour and against PE/AE Attitudes towards PS/AE Claiming EUT for oneself Knowledge about EUT Legalisation of EUT Person controlling EUT Reasons against PE/AE Risk of abuse | - | - | 52% (PE) | 27% | - | 33% (EUT) |
[71] | EUT AS | Poland | N/A | cross-sectional survey, anonymous online self-administered 22-item questionnaire | 19–33 (22.49 ± 2.56) | 68.5%/30.6% | N/A | 108 (1st to 4th year) | Age Gender Religion* Place of residence | none | Attitudes towards EUT/AS Claiming EUT/AS for oneself Knowledge about EUT/AS Knowledge about EUT/AS Legalisation of EUT/AS Personal experience Readiness to assist decision-making on EUT/AS | - | - | - | - | 68.7% (EUT) 38% (AS) | |
[72] | PAS | Ireland | 2023 | cross-sectional survey, online 13-item questionnaire | 18–26 + | 62%/37% | 20.9% | 200 | Gender* Religion Year of study | none | Acceptance/refusal of PAS Attitude towards PAS Arguments in favour and against PAS Attitude towards legalisation Factors influencing attitudes towards PAS Teaching PAS Personal arguments in favour and against Readiness to assist in decision-making on PAS | - | 59.5% | - | - | - | - |
[74] | EUT | Poland | 2018 | cross-sectional survey, anonymous 35-item questionnaire | 18–24 | 65.5%/34.5% | 77.6% | 281 1st year | Age Gender Grandparents living with the family Number of siblings* Place of residence Religious engagement* | None | Attitude towards EUTS Attitude towards legalisation Risk of abuse | - | - | - | - | 18.2% | 27.6% (EUT) |
[73] | EUT | Poland | N/A | cross-sectional survey, anonymous 35-item questionnaire | N/A | N/A | N/A | 280 | Comparison of psychology, economic-technical and medical students* | None | Attitude towards EUT Acceptance/Refusal of EUT Risk of abuse | - | - | - | - | 18.2% | - |
[45] | EUT PAS | Pakistan | 2023 | cross-sectional survey | 17–26 | N/A | N/A | 316 | Religion* Gender Year of study* | None | Attitude towards EUT/PAS Attitudes towards legalisation Risk of abuse | - | 21.5% | - | - | 19.2% | - |
[75] | EUT | Serbia | 2017 | cross-sectional survey, 10-item questionnaire | N/A | 64.4%/ 35.4% | 94.4% 97.6% | 551 (2nd & 5th year) | Comparison of two universities Gender Parental education level Socio-economic status Year of study | None | Attitude towards EUT Attitude towards legalisation Person deciding over EUT Risk of abuse | - | - | - | - | - | 57.9% (EUT) |
[76] | AS | Germany | 2021—2022 | online evaluation | N/A | N/A | 66.1% | 37 | N/A | Elective course on AS in palliative care with theoretical knowledge and practical simulations with standardised patients to improve communication, knowledge and compassionate care | Attitude towards AS Teaching palliative Care | - | 68% | - | - | - | - |