Over the past fifty years, life expectancy has increased significantly, resulting in a growing number of people with chronic diseases, and therefore increasing the demand for high-quality end-of-life care. Physicians often serve as central decision-makers and frequently assist patients in making difficult decisions about whether to decline life-sustaining interventions or pursue options that may hasten death. A physician’s personal beliefs about end-of-life care can influence how these conversations unfold. A recently published multinational study explored physician preferences when faced with end-of-life scenarios and important differences across contexts, locations, specialties, and legal frameworks.
The data were collected through an online cross-sectional survey designed in the Qualtrics program and distributed from May 2022 to February 2023, from physicians’ home or office settings. The survey included physicians from eight jurisdictions (Canada, Oregon, Georgia, Wisconsin (USA), Belgium (Flanders), Italy, Australia (Victoria and Queensland) which differ in the legal status regarding assisted dying. The survey targeted general practitioners, palliative care specialists, and any clinician who may have experience caring for a terminally ill patient. In each jurisdiction, at least 150 physicians were contacted, with efforts made to ensure diversity in roles and backgrounds.
Physicians were presented with hypothetical end-of-life scenarios involving patients with advanced cancer or Alzheimer’s disease, presented with a Likert Scale, based on treatments they considered (e.g., Cardiopulmonary resuscitation [CPR], ventilation, palliative sedation, physician-assisted suicide [PAS], euthanasia). The survey also collected demographic and professional information about the respondents.
From 1408 surveys, 1157 valid responses were analysed. Most respondents were White/European (74%) and identified as either Christian (39%) or non-religious (43%). Most physicians expressed a strong preference for comfort-focused care: >90% supported intensified symptom relief with medication, whereas fewer than 5% supported interventions like CPR, life-support ventilation, or tube feeding. Acceptance of palliative sedation in the cancer scenario was 43-82%, and in the dementia/Alzheimer’s scenario was 39-66%. The support for euthanasia ranged from Italy at 38% to Belgium at 81% acceptance, and the support for physician-assisted suicide ranged from Belgium at 25% to Oregon at 71%. Interestingly, one-third of physicians said they would consider using life-ending medication on themselves.
The legal statutory context played a significant role in shaping physician responses. Physicians practicing in jurisdictions where euthanasia or PAS is legal (e.g., Belgium, Victoria) showed higher levels of support for these practices. In Oregon, physician-assisted suicide gained the most positive support, with 71.2%. However, palliative care physicians were more likely to support palliative sedation, while GPs and other specialists were more likely to support euthanasia and assisted suicide. Non-religious doctors were always more supportive of life-ending options than some for their religious beliefs. Physician age, gender, and ethnicity were not noted to be significant.
Despite legal restrictions, a substantial proportion of physicians are committed personally, despite the law, to assisted dying. This represents a potential disconnect between legal forms and medical opinion. However, palliative care physicians were less likely to support euthanasia and PAS, possibly due to their ethical training, which emphasizes symptom management over the active hastening of death. Religious beliefs were found to play a pivotal role in physicians’ responses. More religious physicians were less likely to support physician-assisted dying, aligning with longstanding ethical principles that emphasize preserving life wherever possible.
There is also a profound emotional dimension to the healthcare professional’s experience when offering care (or not) that rewards their life. These decisions pose significant ethical challenges. Physicians in countries like the UK, Australia, and Canada prefer symptom relief and do not accept aggressive life-prolonging treatments for themselves. These responses are dispassionately dependent on legal, professional, and religious beliefs. There is a need to develop and deliver ethically driven policies and training programs that respect physicians’ conscience while upholding patient autonomy. Such initiatives are essential to ensure equitable and compassionate care at one of life’s most critical junctures.
References: Mroz S, Dierickx S, Chambaere K, et al. Physicians’ preferences for their own end of life: a comparison across North America, Europe, and Australia. J Med Ethics. s 2025:1–9. doi:10.1136/jme-2024-110192
