Skip to main content
NCBI home page
Journal of Medical Ethics logoLink to Journal of Medical Ethics
. 2003 Dec;29(6):330–336. doi: 10.1136/jme.29.6.330

When is physician assisted suicide or euthanasia acceptable?

S Frileux 1, C Lelievre 1, S Munoz 1, E Mullet 1, P Sorum 1
PMCID: PMC1733803  PMID: 14662811

Abstract

Objectives: To discover what factors affect lay people's judgments of the acceptability of physician assisted suicide and euthanasia and how these factors interact.

Design: Participants rated the acceptability of either physician assisted suicide or euthanasia for 72 patient vignettes with a five factor design—that is, all combinations of patient's age (three levels); curability of illness (two levels); degree of suffering (two levels); patient's mental status (two levels), and extent of patient's requests for the procedure (three levels).

Participants: Convenience sample of 66 young adults, 62 middle aged adults, and 66 older adults living in western France.

Main measurements: In accordance with the functional theory of cognition of N H Anderson, main effects, and interactions among patient factors and participants' characteristics were investigated by means of both graphs and ANOVA.

Results: Patient requests were the most potent determinant of acceptability. Euthanasia was generally less acceptable than physician assisted suicide, but this difference disappeared when requests were repetitive. As their own age increased, participants placed more weight on patient age as a criterion of acceptability.

Conclusions: People's judgments concur with legislation to require a repetition of patients' requests for a life ending act. Younger people, who frequently are decision makers for elderly relatives, place less emphasis on patient's age itself than do older people.

Full Text

The Full Text of this article is available as a PDF (315.2 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aranda S., O'Conner M. Euthanasia, nursing and care of the dying: rethinking Kuhse and Singer. Aust Nurs J. 1995 Aug;3(2):18–21. [PubMed] [Google Scholar]
  2. Asai A., Ohnishi M., Nagata S. K., Tanida N., Yamazaki Y. Doctors' and nurses' attitudes towards and experiences of voluntary euthanasia: survey of members of the Japanese Association of Palliative Medicine. J Med Ethics. 2001 Oct;27(5):324–330. doi: 10.1136/jme.27.5.324. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Baume P., O'Malley E. Euthanasia: attitudes and practices of medical practitioners. Med J Aust. 1994 Jul 18;161(2):137, 140, 142-4. [PubMed] [Google Scholar]
  4. Berger J. T., Majerovitz D. Stability of preferences for treatment among nursing home residents. Gerontologist. 1998 Apr;38(2):217–223. doi: 10.1093/geront/38.2.217. [DOI] [PubMed] [Google Scholar]
  5. Blank K., Robison J., Doherty E., Prigerson H., Duffy J., Schwartz H. I. Life-sustaining treatment and assisted death choices in depressed older patients. J Am Geriatr Soc. 2001 Feb;49(2):153–161. doi: 10.1046/j.1532-5415.2001.49036.x. [DOI] [PubMed] [Google Scholar]
  6. Blank K., Robison J., Prigerson H., Schwartz H. I. Instability of attitudes about euthanasia and physician assisted suicide in depressed older hospitalized patients. Gen Hosp Psychiatry. 2001 Nov-Dec;23(6):326–332. doi: 10.1016/s0163-8343(01)00160-8. [DOI] [PubMed] [Google Scholar]
  7. Blendon R. J., Szalay U. S., Knox R. A. Should physicians aid their patients in dying? The public perspective. JAMA. 1992 May 20;267(19):2658–2662. [PubMed] [Google Scholar]
  8. Bonnin-Scaon Sylvie, Lafon Peggy, Chasseigne Gérard, Mullet Etienne, Sorum Paul Clay. Learning the relationship between smoking, drinking alcohol and the risk of esophageal cancer. Health Educ Res. 2002 Aug;17(4):415–424. doi: 10.1093/her/17.4.415. [DOI] [PubMed] [Google Scholar]
  9. Braun K. L., Tanji V. M., Heck R. Support for physician-assisted suicide: exploring the impact of ethnicity and attitudes toward planning for death. Gerontologist. 2001 Feb;41(1):51–60. doi: 10.1093/geront/41.1.51. [DOI] [PubMed] [Google Scholar]
  10. Caddell D. P., Newton R. R. Euthanasia: American attitudes toward the physician's role. Soc Sci Med. 1995 Jun;40(12):1671–1681. doi: 10.1016/0277-9536(94)00287-4. [DOI] [PubMed] [Google Scholar]
  11. Callahan D. Death and the research imperative. N Engl J Med. 2000 Mar 2;342(9):654–656. doi: 10.1056/NEJM200003023420910. [DOI] [PubMed] [Google Scholar]
  12. Caplan A. L., Snyder L., Faber-Langendoen K. The role of guidelines in the practice of physician-assisted suicide. University of Pennsylvania Center for Bioethics Assisted Suicide Consensus Panel. Ann Intern Med. 2000 Mar 21;132(6):476–481. doi: 10.7326/0003-4819-132-6-200003210-00009. [DOI] [PubMed] [Google Scholar]
  13. Cicirelli V. G. Personality and demographic factors in older adults' fear of death. Gerontologist. 1999 Oct;39(5):569–579. doi: 10.1093/geront/39.5.569. [DOI] [PubMed] [Google Scholar]
  14. Cohen J. S., Fihn S. D., Boyko E. J., Jonsen A. R., Wood R. W. Attitudes toward assisted suicide and euthanasia among physicians in Washington State. N Engl J Med. 1994 Jul 14;331(2):89–94. doi: 10.1056/NEJM199407143310206. [DOI] [PubMed] [Google Scholar]
  15. Coppola K. M., Bookwala J., Ditto P. H., Lockhart L. K., Danks J. H., Smucker W. D. Elderly adults' preferences for life-sustaining treatments: the role of impairment, prognosis, and pain. Death Stud. 1999 Oct-Nov;23(7):617–634. doi: 10.1080/074811899200803. [DOI] [PubMed] [Google Scholar]
  16. Cuperus-Bosma J. M., van der Wal G., Looman C. W., van der Maas P. J. Assessment of physician-assisted death by members of the public prosecution in The Netherlands. J Med Ethics. 1999 Feb;25(1):8–15. doi: 10.1136/jme.25.1.8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Dickinson George E., Lancaster Carol J., Sumner Edward D., Cohen Jonathan S. Attitudes toward assisted suicide and euthanasia among physicians in South Carolina and Washington. Omega (Westport) 1997;36(3):201–218. doi: 10.2190/cjwl-ab7g-hyx4-dbjh. [DOI] [PubMed] [Google Scholar]
  18. Emanuel E. J., Fairclough D., Clarridge B. C., Blum D., Bruera E., Penley W. C., Schnipper L. E., Mayer R. J. Attitudes and practices of U.S. oncologists regarding euthanasia and physician-assisted suicide. Ann Intern Med. 2000 Oct 3;133(7):527–532. doi: 10.7326/0003-4819-133-7-200010030-00011. [DOI] [PubMed] [Google Scholar]
  19. Fouquereau Evelyne, Fernandez Anne, Mullet Etienne, Sorum Paul Clay. Stress and the urge to drink. Addict Behav. 2003 Jun;28(4):669–685. doi: 10.1016/s0306-4603(01)00276-3. [DOI] [PubMed] [Google Scholar]
  20. Genuis S. J., Genuis S. K., Chang W. C. Public attitudes toward the right to die. CMAJ. 1994 Mar 1;150(5):701–708. [PMC free article] [PubMed] [Google Scholar]
  21. Hanlon T. R., Weiss M. C., Rees J. British community pharmacists' views of physician-assisted suicide (PAS). J Med Ethics. 2000 Oct;26(5):363–369. doi: 10.1136/jme.26.5.363. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Ho Robert. Assessing attitudes toward euthanasia: an analysis of the subcategorical approach to right to die issues. Pers Individ Dif. 1998 Oct;25(4):719–734. doi: 10.1016/s0191-8869(98)00108-1. [DOI] [PubMed] [Google Scholar]
  23. Kitchener B., Jorm A. F. Conditions required for a law on active voluntary euthanasia: a survey of nurses' opinions in the Australian Capital Territory. J Med Ethics. 1999 Feb;25(1):25–30. doi: 10.1136/jme.25.1.25. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Koenig H. G., Wildman-Hanlon D., Schmader K. Attitudes of elderly patients and their families toward physician-assisted suicide. Arch Intern Med. 1996 Oct 28;156(19):2240–2248. [PubMed] [Google Scholar]
  25. Kuhse H., Singer P. Doctors' practices and attitudes regarding voluntary euthanasia. Med J Aust. 1988 Jun 20;148(12):623–627. doi: 10.5694/j.1326-5377.1988.tb116334.x. [DOI] [PubMed] [Google Scholar]
  26. Kuhse H., Singer P. Euthanasia: a survey of nurses' attitudes and practices. Aust Nurses J. 1992 Mar;21(8):21–22. [PubMed] [Google Scholar]
  27. Kuhse H., Singer P. Voluntary euthanasia and the nurse: an Australian survey. Int J Nurs Stud. 1993 Aug;30(4):311–322. doi: 10.1016/0020-7489(93)90103-2. [DOI] [PubMed] [Google Scholar]
  28. Meier D. E., Emmons C. A., Wallenstein S., Quill T., Morrison R. S., Cassel C. K. A national survey of physician-assisted suicide and euthanasia in the United States. N Engl J Med. 1998 Apr 23;338(17):1193–1201. doi: 10.1056/NEJM199804233381706. [DOI] [PubMed] [Google Scholar]
  29. Michelson C., Mulvihill M., Hsu M. A., Olson E. Eliciting medical care preferences from nursing home residents. Gerontologist. 1991 Jun;31(3):358–363. doi: 10.1093/geront/31.3.358. [DOI] [PubMed] [Google Scholar]
  30. Muñoz Sastre M. T., Mullet E., Sorum P. C. Self-assessment of inebriation from external indices. Addict Behav. 2000 Sep-Oct;25(5):663–681. doi: 10.1016/s0306-4603(00)00073-3. [DOI] [PubMed] [Google Scholar]
  31. O'Brien L. A., Siegert E. A., Grisso J. A., Maislin G. M., LaPann K., Evans L. K., Krotki K. P. Tube feeding preferences among nursing home residents. J Gen Intern Med. 1997 Jun;12(6):364–371. doi: 10.1046/j.1525-1497.1997.00061.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Quill T. E., Cassel C. K., Meier D. E. Care of the hopelessly ill. Proposed clinical criteria for physician-assisted suicide. N Engl J Med. 1992 Nov 5;327(19):1380–1384. doi: 10.1056/NEJM199211053271911. [DOI] [PubMed] [Google Scholar]
  33. Richardson D. S. Oncology nurses' attitudes toward the legalization of voluntary active euthanasia. Cancer Nurs. 1994 Aug;17(4):348–354. [PubMed] [Google Scholar]
  34. Rogers J. R. Assessing right to die attitudes: a conceptually guided measurement model. J Soc Issues. 1996 Summer;52(2):63–84. doi: 10.1111/j.1540-4560.1996.tb01568.x. [DOI] [PubMed] [Google Scholar]
  35. Sastre M. T., Mullet E., Sorum P. C. Relationship between cigarette dose and perceived risk of lung cancer. Prev Med. 1999 Jun;28(6):566–571. doi: 10.1006/pmed.1999.0482. [DOI] [PubMed] [Google Scholar]
  36. Sears S. R., Stanton A. L. Physician-assisted dying: review of issues and roles for health psychologists. Health Psychol. 2001 Jul;20(4):302–310. doi: 10.1037//0278-6133.20.4.302. [DOI] [PubMed] [Google Scholar]
  37. Seidlitz L., Duberstein P. R., Cox C., Conwell Y. Attitudes of older people toward suicide and assisted suicide: an analysis of Gallup Poll findings. J Am Geriatr Soc. 1995 Sep;43(9):993–998. doi: 10.1111/j.1532-5415.1995.tb05563.x. [DOI] [PubMed] [Google Scholar]
  38. Sherbourne C. D., Keeler E., Unützer J., Lenert L., Wells K. B. Relationship between age and patients' current health state preferences. Gerontologist. 1999 Jun;39(3):271–278. doi: 10.1093/geront/39.3.271. [DOI] [PubMed] [Google Scholar]
  39. Shuman C. R., Fournet G. P., Zelhart P. F., Roland B. C., Estes R. E. Attitudes of registered nurses toward euthanasia. Death Stud. 1992 Jan-Feb;16(1):1–15. doi: 10.1080/07481189208252553. [DOI] [PubMed] [Google Scholar]
  40. Singer P. A., Choudhry S., Armstrong J., Meslin E. M., Lowy F. H. Public opinion regarding end-of-life decisions: influence of prognosis, practice and process. Soc Sci Med. 1995 Dec;41(11):1517–1521. doi: 10.1016/0277-9536(95)00057-e. [DOI] [PubMed] [Google Scholar]
  41. Sorum P. C., Muñoz Sastre M. T., Mullet E., Gamelin A. Eliciting patient disutilities for the adverse outcomes of cardiopulmonary resuscitation. Resuscitation. 2001 Mar;48(3):265–273. doi: 10.1016/s0300-9572(00)00260-4. [DOI] [PubMed] [Google Scholar]
  42. Steinberg M. A., Najman J. M., Cartwright C. M., MacDonald S. M., Williams G. M. End-of-life decision-making: community and medical practitioners' perspectives. Med J Aust. 1997 Feb 3;166(3):131–135. doi: 10.5694/j.1326-5377.1997.tb140042.x. [DOI] [PubMed] [Google Scholar]
  43. Stevens C. A., Hassan R. Nurses and the management of death, dying and euthanasia. Med Law. 1994;13(5-6):541–554. [PubMed] [Google Scholar]
  44. Suarez-Almazor M. E., Belzile M., Bruera E. Euthanasia and physician-assisted suicide: a comparative survey of physicians, terminally ill cancer patients, and the general population. J Clin Oncol. 1997 Feb;15(2):418–427. doi: 10.1200/JCO.1997.15.2.418. [DOI] [PubMed] [Google Scholar]
  45. Tsevat J., Dawson N. V., Wu A. W., Lynn J., Soukup J. R., Cook E. F., Vidaillet H., Phillips R. S. Health values of hospitalized patients 80 years or older. HELP Investigators. Hospitalized Elderly Longitudinal Project. JAMA. 1998 Feb 4;279(5):371–375. doi: 10.1001/jama.279.5.371. [DOI] [PubMed] [Google Scholar]
  46. Vincent J. L. Forgoing life support in western European intensive care units: the results of an ethical questionnaire. Crit Care Med. 1999 Aug;27(8):1626–1633. doi: 10.1097/00003246-199908000-00042. [DOI] [PubMed] [Google Scholar]
  47. Ward R. A. Age and acceptance of euthanasia. J Gerontol. 1980 May;35(3):421–431. doi: 10.1093/geronj/35.3.421. [DOI] [PubMed] [Google Scholar]
  48. Watts D. T., Howell T., Priefer B. A. Geriatricians' attitudes toward assisting suicide of dementia patients. J Am Geriatr Soc. 1992 Sep;40(9):878–885. doi: 10.1111/j.1532-5415.1992.tb01983.x. [DOI] [PubMed] [Google Scholar]
  49. Whitney S. N., Brown B. W., Jr, Brody H., Alcser K. H., Bachman J. G., Greely H. T. Views of United States physicians and members of the American Medical Association House of Delegates on physician-assisted suicide. J Gen Intern Med. 2001 May;16(5):290–296. doi: 10.1046/j.1525-1497.2001.04159.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  50. Willems D. L., Daniels E. R., van der Wal G., van der Maas P. J., Emanuel E. J. Attitudes and practices concerning the end of life: a comparison between physicians from the United States and from The Netherlands. Arch Intern Med. 2000 Jan 10;160(1):63–68. doi: 10.1001/archinte.160.1.63. [DOI] [PubMed] [Google Scholar]
  51. Wilson K. G., Scott J. F., Graham I. D., Kozak J. F., Chater S., Viola R. A., de Faye B. J., Weaver L. A., Curran D. Attitudes of terminally ill patients toward euthanasia and physician-assisted suicide. Arch Intern Med. 2000 Sep 11;160(16):2454–2460. doi: 10.1001/archinte.160.16.2454. [DOI] [PubMed] [Google Scholar]
  52. van Holsteyn J., Trappenburg M. Citizens' opinions on new forms of euthanasia. A report from the Netherlands. Patient Educ Couns. 1998 Sep;35(1):63–73. doi: 10.1016/s0738-3991(98)00084-6. [DOI] [PubMed] [Google Scholar]
  53. van der Maas P. J., Pijnenborg L., van Delden J. J. Changes in Dutch opinions on active euthanasia, 1966 through 1991. JAMA. 1995 May 10;273(18):1411–1414. doi: 10.1001/jama.273.18.1411. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Medical Ethics are provided here courtesy of BMJ Publishing Group

RESOURCES