Table 2 Summary of Qualitative Results

[49]

PAS

New Zealand

2018

mixed-methods online survey

18–40

61.8%/38.2%

28%

326 (2nd to 5th year)

Explore how students view PAS and if their views differ in different stages of medical education

Written responses to open-ended questions

none

Thematic analysis using general inductive approach

Supporting law change: Relieving suffering, Autonomy, dignified death, financial reasons, relief for family

Opposing law change: Potential for misuse, sanctity of life, slippery slope, not the role of doctor, palliative care as an alternative, personal values

Unsure about law change: Potential for misuse, not the role of doctor, general uncertainty, relieving suffering, undermines palliative care, autonomy

Supporting EUT/PAS: Death of family member/friend, experience in rest home, medical teaching, public discussion/personal study, experience in clinical training, death/suffering of family member/friend

Opposing EUT/PAS: medical teaching, discussion with friends/family, death/suffering of family member or friends, discussion with doctors, public discussion/personal study

Unsure about EUT/PAS: medical teaching, public discussion/personal study, experience in rest home, death/suffering of family/friend, discussion with family/friends

[35]

AE

Mexico

2008–2009

paper based survey

17–26

56.1%/43.9%

N/A

444

Explore psychological meaning and positive/negative attitudes toward AE

Sheet with"I think euthanasia is…"and a table in which to write down at least five words that define AE, then rank each word according to how closely it defines the term

none

Semantic networks technique

Psychological meaning of EA (in descending order): choice, respectable, calm, convenient, murder, unethical, help, voluntary, illegal, relief, suffering, controversial, , compassionate and ethical

Attitudes towards EA: positive 52.1%, ambivalent 24.3%, negative 14.9% and neutral 8.7%

[67]

EUT

Sweden

2001/2003

2001: mail survey

2003: paper-based survey

19–40

61.3%/38.7%

44%

165

(1st and 5th year)

Describe students' attitudes and arguments toward EUT

Explorative qualitative study with written responses to open-ended questions, such as:"Do you favour legalisation of euthanasia? Why or why not?"

none

Qualitative content analysis without predetermined categories

34% had a positive opinion towards EUT, 52% a negative and 13% were undetermined

5 categories opposing EUT

2 categories supporting EUT

Person controlling EUT/Participants deciding over EUT

2 categories supporting EUT

(1) Autonomy

(2) Relief of suffering due to: Severe symptoms and diagnosis; reduced integrity and autonomy; Hopelessness; Social factors; Complications of old age

5 categories opposing EUT

(1) Morally wrong

(2) Slippery slope

(3) Guilt and strain

(4) Not a true wish to die

(5) Not a task for health-care system

[66]

EUT

Sweden

2001/2003

2001: mail survey

2003: paper-based survey

19–40

61.3%/38.7%

44%

165

(1st and 5th year)

Explore and describe students' definitions of a dignified death

Explorative qualitative study with written responses to the open-ended question:"What meaning do you ascribe to the term a dignified death?"

none

Qualitative content analysis without predetermined categories

Five categories of death:

(1) Without suffering

(2) With limited medical interventions

(3) With a sense of security

(4) With respect of autonomy

(5) With acceptance

Medical science pursues life at any cost and can prolong the dying process; this could be a reason for promoting euthanasia as a means to a dignified death

[65]

PE

UK

cohort design started 1996

vignette survey

24 mean

N/A

N/A

162 (before year 1)

111 (after year 1)

85 (after year 3)

62 (after year 5)

Examine attitudes and potential behaviour to PE; before/after year 1, after year 3 and 5; analyse reasons and knowledge change during curriculum

Case vignette with patients’ request for PE; responses are consent or refusal, including written personal justification

During medical curriculum/changes through curriculum

Comparing multi-choice responses at the four times

Classifying written justifications with data reduction method into 5 categories (C1 - 5)

C 1: Based on consensus reasoning of experts in the field of medical ethics, legal requirements on practitioners, or on policies issued by relevant professional institutions

C 2: Based on the subject’s personal values/morality

C 3: Influenced by other non-medical/legal value systems

C 4: Although based on moral argument, it is not consistent with the profession’s normative values

C 5: Indeterminate

Answers are consistent with professional consensus opinion pre- and post-curriculum; with progressing curriculum, more responses considered issues of the underlying principle of patient autonomy

[70]

PAS

UK

2024

online survey/written workshop evaluation

N/A

N/A

N/A

40 (1st year)

Investigate perspectives on PAS and its potential legalisation; explore the ethical complexities of PAS

Roleplay (patient and GP) of a case history in a Goldfish bowl with discussion from the students

none

N/A

Reasons for legalisation PAS: autonomy – it’s my choice, fear of future, burden to others, suffering – prolonged dying, able to be open about suicidal ideas, dignity-maintaining a positive perspective of self, avoid travelling to Switzerland, cost, stimulate better healthcare

Reasons against legalisation PAS: irreversible, slippery slope, people and circumstances might change, loss of trust in doctors, depression/mental illness, emotional toll on doctors, vulnerable people at risk-pressure on people with disabilities, coercion, sanctity of life

Before the workshop, 55% supported PAS legalisation, 30% opposed it, and 15% were unsure. After the workshop, 25% reported a change in view, with 10 of 11 students who initially supported PAS shifting toward uncertainty or opposition