A team of researchers from the University of Otago Medical School’s Dunedin School of Medicine has undertaken the first review of research focusing on New Zealanders’ attitudes to euthanasia and assisted dying (EAD). Their aim was not to enter the ethical debate on EAD but to understand the current landscape and identify areas in which more research is needed.
Spanning a 20-year period, the researchers identified and reviewed 21 quantitative and five qualitative studies involving a total of 36,304 people.
The questions employed typically asked respondents whether doctors should be allowed to assist a patient to die, at that patient’s request, when the patient’s condition is terminal or incurable and/or they are in pain.
All public attitude studies reported that the majority (an average of 68.3%) of respondents support EAD, 14.9% oppose it, and 15.7% are neutral or unsure. These findings are consistent with international research.
One of the review’s key findings is that public attitude to EAD has remained relatively stable over the two decades analysed.
“This was surprising,” says lead researcher Jessica Young, who cites a perception that “the more an issue is talked about, the more acceptable it becomes”.
The researchers were also surprised how few statistically significant demographic associations there were with attitudes toward EAD.
“We thought there would be clearer relationships between age and income, but the results were mixed across different surveys,” says Young. “There isn’t one typical supporter or opponent.”
Exceptions include religiosity, some ethnic groups (support was lowest among Asians) and educational attainment. Study participants with a bachelor’s degree or higher were less likely to support euthanasia.
Young says the qualitative research reviewed by the team paints a more nuanced picture of public attitude to EAD.
“You can dig into the details more and look at the reasons behind the opinions.
“It’s the ‘why’ that is important to understand.”
While it is challenging to summarise the criteria under which people feel EAD should be accessible, Young says suffering and loss of dignity were key factors cited.
The theme of being a burden was the top concern across qualitative research involving healthy participants of advanced age. Participants believed they could be an encumbrance on others if their death was protracted, and some did not want to rely on others for care. Respondents also expressed that they did not want family members to watch them suffer. Some relayed concerns about no longer contributing to society in a meaningful way, and about the cost of care and the desire to leave an inheritance.
Across health professional specialities, the review found significant variations, with those who work exclusively with the dying being most opposed to EAD. Nurses are most closely aligned with public opinion (67%), while GP support sits at around 50% and palliative care specialists at 7-9%.
Among palliative care specialists there was slightly higher support for assisted dying (when a doctor provides a prescription for lethal medicine at the voluntary request of a competent patient) than euthanasia (when a lethal injection is administered by a doctor or a nurse practitioner at the voluntary request of a competent patient).
Very few palliative care specialists were willing to participate in euthanasia (2%) or assisted dying (4.5%). Young and her team calculated (and confirmed with authors) that of the total sample of NZ doctors who were surveyed, 34.5% would be willing to prescribe the lethal medication, and 28.5% would administer the medication if it was legal to do so.
While the team concluded from the quantitative research that a majority of New Zealanders are open to legislative change, they say “the qualitative research reveals the complexity of the issue and indicates a need for careful consideration of any proposed law changes”.
“Specific research is needed to understand the views of potentially vulnerable populations, such as people with disabilities, and to evaluate which conditions and safeguards New Zealanders believe should be available.”
As part of her doctorate research, Young has interviewed people who are approaching the end of their lives due to life-limiting illnesses, about EAD.
“This is a big gap in the research,” she says. “Theirs is a significant voice that’s missing.
“I’m keen to bring their views into the debate.”
The full research paper is freely available here: https://www.tandfonline.com/doi/full/10.1080/1177083X.2018.1532915