Original Article

Euthanasia and physician-assisted suicide: a systematic review of medical students’ attitudes in the last 10 years


This study aimed at examining the approval rate of the medical students’ regarding active euthanasia, passive euthanasia, and physician-assisted-suicide over the last ten years. To do so, the arguments and variables affecting students’ choices were examined and a systematic review was conducted, using PubMed and Web of Science databases, including articles from January 2009 to December 2018.
From 135 identified articles, 13 met the inclusion criteria. The highest acceptance rates for euthanasia and physician-assisted suicide were from European countries. The most common arguments supporting euthanasia and physician-assisted suicide were the followings: (i) patient’s autonomy (n = 6), (ii) relief of suffering (n = 4), and (ii) the thought that terminally-ill patients are additional burden (n = 2). The most common arguments against euthanasia were as follows: (i) religious and personal beliefs (n = 4), (ii) the “slippery slope” argument and the risk of abuse (n = 4), and (iii) the physician’s role in preserving life (n = 2). Religion (n = 7), religiosity (n = 5), and the attributes of the medical school of origin (n = 3) were the most significant variables to influence the students’ attitude. However, age, previous academic experience, family income, and place of residence had no significant impact.
Medical students' opinions on euthanasia and physician-assisted suicide should be appropriately addressed and evaluated because their moral compass, under the influence of such opinions, will guide them in solving future ethical and therapeutic dilemmas in the medical field.

Vizcarrondondo FE. Euthanasia and assisted suicide: the physician’s role. Linacre Q. 2013; 80(2): 99-102.

Garrard E, Wilkinson S. Passive euthanasia. J Med Ethics. 2005; 31(2): 64-8.

Materstvedt LJ, Clark D, Ellershaw J, et al. Euthanasia and physician-assisted suicide: a view from an EAPC ethics task force. Palliat Med. 2003; 17(2): 97-101.

Anonymous. Chapter 5: Opinions on caring for patients at the end of life. [Cited on August 2020]. Available from: https://www.ama-assn.org/system/files/2019-06/code-of-medical-ethics-chapter-5.pdf

Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009; 6(7): e1000097.

Gutierrez-Castillo A, Gutierrez-Castillo J. Active and passive euthanasia: current opinion of Mexican medical students. Cureus. 2018; 10(7): e3047.

Jakobs RK, Hendricks M. Medical students' perspectives on euthanasia and physician-assisted suicide and their views on legalising these practices in South Africa. The South African Medical Journal. 2018; 108(6): 484-9.

Bator EX, Philpott B, Costa AP. This moral coil: a cross-sectional survey of Canadian medical student attitudes toward medical assistance in dying. BMC Med Ethics. 2017; 18: 58.

Marais C, Smouse J, Poortier G, Fair A, Joubert G, Steinberg WJ. End-of-life practices: The opinions of undergraduate medical students at a South African university. South African Journal of Bioethics and Law. 2017; 10(2): 96.

Anneser J, Jox RJ, Thurn T, Borasio GD. Physician-assisted suicide, euthanasia and palliative sedation: attitudes and knowledge of medical students. GMS J Med Educ. 2016; 33(1): Doc11.

Roelands M, Van den Block L, Geurts S, Deliens L, Cohen J. Attitudes of belgian students of medicine, philosophy, and law toward euthanasia and the conditions for its acceptance. Death Stud. 2015; 39(1-5): 139-50.

Lucchetti G, de Oliveira LR, Leite JR, Lucchetti ALG, SBRAME Collaborators. Medical students and controversial ethical issues: results from the multicenter study SBRAME. BMC Med Ethics. 2014; 15: 85.

Leppert W, Majkowicz M, Forycka M. Attitudes of Polish physicians and medical students toward breaking bad news, euthanasia and morphine administration in cancer patients. J Cancer Educ. 2013; 28(4): 603-10.

Loria A, Villarreal-Garza C, Sifuentes E, Lisker R. Physician-assisted death. opinions of Mexican medical students and residents. Arch Med Res. 2013; 44(6): 475-8.

Hassan W, Ahmad F, Malik A, Ali S. Knowledge and attitude regarding euthanasia among medical students in the public and private medical schools of Karachi. J Pak Med Assoc. 2013; 63(2): 295-9.

Leppert W, Gottwald L, Majkowicz M, et al. A comparison of attitudes toward euthanasia among medical students at two Polish universities. J Cancer Educ. 2013; 28(2): 384-91.

Stronegger WJ, Schmölzer C, Rásky E, Freidl W. Changing attitudes towards euthanasia among medical students in Austria. J Med Ethics. 2011; 37(4): 227-9.

Kontaxakis VP, Paplos KG, Havaki-Kontaxaki BJ, et al. Attitudes on euthanasia and physician-assisted suicide among medical students in Athens. Psychiatriki. 2009; 20(4): 305-11.

Lee W, Price A, Rayner L, Hotopf M. Survey of doctors’ opinions of the legalisation of physician assisted suicide. BMC Med Ethics. 2009; 10: 2.

Hernandez-Arriaga JL, Morales-Estrada A, Cortes-Gallo G. [Survey of physicians’ attitudes to terminal patients]. Rev Invest Clin. 1997; 49(6): 497-500.

Julesz M. [Active euthanasia in Colombia and assisted suicide in California]. Orv Hetil. 2016; 157(5): 174-9.

Van Ness PH, Towle VR, O’Leary JR, Fried TR. Religion, risk, and medical decision making at the end of life. J Aging Health. 2008; 20(5): 545-59.

Sprung CL, Maia P, Bulow HH, et al. The importance of religious affiliation and culture on end-of-life decisions in European intensive care units. Intensive Care Med. 2007; 33(10): 1732-9.

Gula RM. Euthanasia: a Catholic perspective. Health Prog. 1987; 68(10): 28-34, 42.

Ayuba MA. Euthanasia: a Muslim’s perspective. Scriptura. 2016; 115(1): 1-13.

Daly B, Gokhale S, Ramos-Estebanez C. Clinical and ethical judgment: a profound dilemma. Neurology. 2014; 83(15): 1369-71.

Sjöstrand M, Helgesson G, Eriksson S, Juth N. Autonomy-based arguments against physician-assisted suicide and euthanasia: a critique. Med Health Care Philos. 2013; 16(2): 225-230.

Schmidt U. Euthanasia, autonomy and beneficence. Studia Theologica. 2002; 56(2): 132-51.

Anonymous. Stanford encyclopedia of philosophy: the principle of beneficence in applied ethics. [Cited on August 2020]; Available from: https://plato.stanford.edu/entries/principle-beneficence/

Pereira J. Legalizing euthanasia or assisted suicide: the illusion of safeguards and controls. Curr Oncol. 2011; 18(2): e38-e45.

Benatar D. A legal right to die: responding to slippery slope and abuse arguments. Curr Oncol. 2011; 18(5): 206-7.

Kumar A. Hippocratic oath, 21st Century. Indian J Surg. 2010; 72(2): 171–5.

Eyigor S. Fifth-year medical students' knowledge of palliative care and their views on the subject. J Palliat Med. 2013; 16(8): 941-6.

IssueVol 13 (2020) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/jmehm.v13i22.4864
Euthanasia; Medical students; Medical ethics; Physician-assisted Suicide; Religion.

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How to Cite
Gutierrez-Castillo A, Gutierrez-Castillo J, Guadarrama-Conzuelo F, Jimenez-Ruiz A, Ruiz-Sandoval JL. Euthanasia and physician-assisted suicide: a systematic review of medical students’ attitudes in the last 10 years. J Med Ethics Hist Med. 2020;13.