Attitudes towards Euthanasia: A Longitudinal Analysis of the Role of Economic, Cultural, and Health-related Factors.

Inglehart, Ronald C; Nash, Ryan; Hassan, Quais; Schwartzbaum, Judith

CONTEXT It is crucial that physicians understand differing attitudes towards euthanasia and which factors to consider when discussing end-of-life decisions with patients and families from diverse backgrounds. OBJECTIVES To investigate how attitudes towards euthanasia differ among countries, how they change, and how economic, religious, and health-related factors affect these attitudes. METHODS We analyzed attitudes towards euthanasia and economic, religious, and health-related indicators using longitudinal (1981-2018) World Values Survey (WVS) data. They included 62 countries with at least a 15-year, three-wave, time series (total n=389,243 participants). Each national survey interviewed representative samples of adults (mean=1,405). RESULTS In the latest wave, The Netherlands had the most favorable views of euthanasia (10-point scale with 1=least justifiable: Mean=7.47) and Jordan the least (Mean=1.50). Residents of 23 of 24 high-income countries came to view euthanasia as more justifiable, while residents of 12 of 38 middle- and low-income countries came to view it as less justifiable over time. The higher GDP per-capita at the time of survey, the more euthanasia was accepted (r=0.703; p<0.0001); the more important respondents viewed religion as being, the less euthanasia was accepted (r= -0.834; p<0.0001); the higher life expectancy and the lower infant mortality were, the more euthanasia was accepted (r=0.669; p<0.0001/r=-0.716; p<0.0001). CONCLUSION Euthanasia-related attitudes differ widely depending on the cultural context; changes over time varied in both directions; euthanasia-related attitudes were associated with economic, religious and health-related factors. With globalization increasing cultural diversity, these findings can inform physicians' communication about end-of-life decisions with patients and families from diverse backgrounds.