Acceptability of euthanasia for people with dementia: perspectives of clinicians from six countries

Abstract

Objectives: Euthanasia for people with dementia is controversial and clinicians should decide how to respond to euthanasia requests. The authors aimed to investigate clinicians' perspectives on the acceptability of euthanasia for people with dementia, and differences between countries and personal characteristics potentially associated with acceptability.

Design, Setting, Participants, Measurements: Cross-sectional vignette study as part of the CONT-END studies, in which the authors conducted interviews with clinicians from the Netherlands, Switzerland, Germany, USA, Japan, and Israel online or in-person, and logistic regression analyses to assess associations with acceptability.

Results: Participants included 202 physicians and three nurse specialists who assumed similar medical responsibilities. Acceptability was higher in the Netherlands (66%) than in other countries (23%-44%, OR 0.16-0.41, p = 0.003-0.03). Dutch clinicians were more often willing to perform euthanasia upon request of a person with dementia (58%) than clinicians in other countries (18%-34%, OR 0.16-0.17, p = 0.007-0.03), except for Israel (40%, OR 0.48, p = 0.07). Two coping styles, planning (OR 0.77, 95% CI [0.59, 1.00]) , reli- gious coping (OR 0.71, 95% CI [0.60, 0.84]), were associated with lower accept- ability of euthanasia. Being religious (OR 0.47, 95% CI [0.24, 0.93]), training in palliative care (OR 0.48, 95% CI [0.26, 0.91]) , using emotional social sup- port as coping style (OR 0.77, 95% CI [0.62, 0.95]) were associated with lower willingness to perform euthanasia upon request of a person with dementia. Conclusions: Clinicians' perspectives on the acceptability of euthanasia for people with dementia varied across countries and individuals, with diversity related to coping styles, training in palliative care, and religion.