In a groundbreaking international survey recently published in the Journal of Medical Ethics, researchers have unveiled compelling insights into physicians’ own preferences regarding end-of-life care, particularly when facing severe conditions such as advanced cancer or Alzheimer’s disease. Drawing responses from over a thousand doctors across multiple jurisdictions with differing legal landscapes on assisted dying, the study reveals that over half of these medical professionals would contemplate assisted dying for themselves under such circumstances. This nuanced research sheds light on how legislation surrounding euthanasia and physician-assisted suicide shapes doctors’ personal attitudes and, potentially, their clinical decision-making.
The study intricately probes the complex relationship between national or state laws and physicians’ preferences for managing their own terminal conditions. While earlier research has typically focused on doctors’ views of patient care or outdated perspectives on end-of-life practices, this extensive survey is among the first to directly investigate the doctors’ personal choices. By incorporating two hypothetical scenarios—advanced cancer and Alzheimer’s disease—the research robustly explores how doctors envision their own care pathways, including a spectrum of options from life-sustaining interventions to symptom relief and active measures to hasten death.
Respondents hailed from eight distinct jurisdictions: Belgium, Italy, Canada, and the Australian states of Victoria and Queensland, alongside the U.S. states of Oregon, Wisconsin, and Georgia. These locations present a rich tapestry of legislative contexts. For example, Oregon, pioneering the legalization of physician-assisted suicide since 1997, contrasts starkly with states like Georgia and Wisconsin, where such practices remain illegal. Similarly, Canada and Belgium feature legal frameworks permitting euthanasia and assisted suicide, whereas Italy and Queensland had strict prohibitions at the time of data collection, the latter having only recently passed legislation not yet in force.
The survey’s breadth allowed it to capture views from various medical specialties, notably family physicians, palliative care experts, and specialists such as oncologists, neurologists, and intensive care clinicians—groups intimately familiar with end-of-life care complexities. The inclusion criteria ensured a comprehensive perspective representative of physicians directly involved with terminal patients, providing a granular understanding of attitudes toward each form of intervention including CPR, mechanical ventilation, tube feeding, symptom intensification, palliative sedation, and methods intended to hasten death, such as physician-assisted suicide and euthanasia.
One of the most striking findings is the overwhelming rejection by physicians of life-sustaining measures as desirable options for themselves in both advanced cancer and Alzheimer’s scenarios. For instance, only minuscule fractions rated CPR as a very good choice (0.5% in cancer; 0.2% in Alzheimer’s), paralleled by similarly low approval for mechanical ventilation and tube feeding. Conversely, symptom relief through intensified alleviation was overwhelmingly favored, receiving endorsement from over 90% of respondents. Palliative sedation, often employed to address refractory symptoms, was also considerably accepted, though its endorsement varied significantly based on jurisdictional and cultural contexts.
Geographical and legal differences emerged clearly in attitudes toward euthanasia. In regions where such actions are legally permissible, notably Belgium and Canada, physicians were significantly more inclined to view euthanasia as a good or very good option. Belgium exhibited the highest support, with over 80% favoring euthanasia in the cancer context and nearly 67.5% in the Alzheimer’s scenario. Contrastingly, in Italy and Georgia, where euthanasia remains illegal and cultural attitudes tend to be conservative, support was markedly lower, under 40%. Such disparities suggest not only legal but also social and cultural acceptance deeply influence medical professionals’ comfort with assisted death.
Physician-assisted suicide specifically, characterized by the provision of lethal drugs to patients to self-administer, was considered a viable option by roughly one-third of respondents when contemplating their own end-of-life care. The legal permissibility of this practice again appeared to be a potent determinant, underscoring how familiarity, acceptance, and professional experience in regulated environments can shape deeply personal preferences. The findings imply physicians internalize and are influenced by the normative frameworks within which they practice, possibly reflecting their experiences with patient outcomes and societal narratives around dying with dignity.
An intriguing dimension of the research examined how medical specialty and religious beliefs inform preferences. Palliative care specialists demonstrated a stronger inclination toward palliative sedation and were less likely to favor active euthanasia or physician-assisted suicide compared to general practitioners or other specialists. Meanwhile, doctors without strong religious affiliations were significantly more open to assisted dying options, with preferences for physician-assisted suicide standing at 65% versus 38% among their religious counterparts, and euthanasia preferred by 72% versus 40%. These differences illuminate the complex intersection of professional ethos, medical training, personal belief systems, and ethical considerations in shaping end-of-life attitudes.
Despite the robustness of these findings, the researchers caution that survey-based designs carry inherent limitations, including the potential for selection bias. Doctors with particular interest or predisposition toward assisted dying issues might have been more motivated to participate. Moreover, geographical representation skewed somewhat due to underrepresentation of general practitioners in some regions, such as Canada. Nonetheless, the large sample size and cross-jurisdictional approach contribute valuable and timely insights into a topic of growing global importance, as populations age and debates on assisted death intensify.
The implications of this research extend beyond academic curiosity; they resonate deeply within clinical practice. The observed divergence between doctors’ personal preferences and the frequent use of life-prolonging treatments at the population level calls for critical reflection. Many physicians reportedly experience moral distress regarding the continuation of aggressive life-sustaining interventions for patients nearing death. This incongruence may highlight systemic barriers, such as institutional policies, family expectations, or legal frameworks, that impede alignment between patient care and physician values.
By revealing that legal context and professional exposure shape personal preferences, the study advocates for ongoing dialogue and education on end-of-life options. It suggests that facilitating physician familiarity with assisted dying practices—through legislation, training, and ethical discourse—could normalize these options and reduce moral distress. Furthermore, the research supports calls for patient-centered care models that genuinely incorporate patient and family wishes, informed by doctors who are both knowledgeable and comfortable with the ethical terrain of end-of-life decision-making.
In sum, this landmark international survey offers a compelling lens into the often private contemplations of physicians grappling with their own mortality and treatments at life’s end. It underscores the profound influence of legal, cultural, and individual factors on attitudes towards euthanasia, physician-assisted suicide, and palliative care measures. As societies worldwide reconsider their policies and moral frameworks surrounding death, this evidence underscores the need for sensitive, evidence-based approaches that respect both professional insights and patient autonomy. The researchers’ nuanced findings invite healthcare providers, lawmakers, and ethicists to reflect on how best to honor dignity and alleviate suffering in the final chapters of life.
Subject of Research: People
Article Title: Physicians’ preferences for their own end-of-life: a comparison across North America, Europe, and Australia
News Publication Date: 10-Jun-2025
Web References: 10.1136/jme-2024-110192
Keywords: Euthanasia, Terminal illness
