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Systematic review
Voluntary-assisted dying, euthanasia and physician-assisted suicide: global perspectives—systematic review
  1. Graham Llewellyn Grove1,2,
  2. Melanie R Lovell3,4,
  3. Ian Hughes5,
  4. Elise Maehler1 and
  5. Megan Best6
  1. 1Specialist Palliative Care, Gold Coast Hospital, Southport, Queensland, Australia
  2. 2The University of Sydney, Sydney, New South Wales, Australia
  3. 3Palliative and Supportive Care, HammondCare, Greenwich Hospital, Greenwich, New South Wales, Australia
  4. 4Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  5. 5Research Office, Gold Coast University Hospital, Southport, Queensland, Australia
  6. 6Institute of Ethics and Society, Sydney Campus, The University of Notre Dame Australia, Chippendale, New South Wales, Australia
  1. Correspondence to Dr Graham Llewellyn Grove; graham.grove{at}health.qld.gov.au

Abstract

Background Discussions about euthanasia and physician-assisted suicide (EAS) involve various stakeholders, including patients, healthcare professionals and the general public. This review examines perspectives across different population subgroups to contribute to a broader understanding of EAS attitudes.

Methods A systematic review of literature published prior to July 2023 with quantitative data about EAS views was undertaken. Details extracted from eligible papers included data year, geography, demographic features of population subgroups and levels of support for EAS under various circumstances. Proportions in support for EAS were calculated based on these factors. Meta-analyses were conducted to estimate changes in the proportion of support for euthanasia dependent on the presence or absence of pain or terminal illness in patients.

Results The search identified 521 relevant studies. There were 1863 relevant survey questions with 1 945 945 individual responses, spanning years 1936 to 2023.

478 studies explored whether EAS should be allowed, 134 examined clinician willingness to practise EAS and 78 investigated which persons might seek EAS. Clinician views were surveyed in 266 studies, public opinion in 139 and patient beliefs in 54.

Support for EAS across studies and subpopulations varied widely. Mean support for EAS was lower in doctors than in the general public (25% compared with 55%). Support varied depending on access criteria to EAS with 54% support for patients in pain vs 36% for those without and 53% for terminally ill patients vs 29% for those without a terminal illness. Public support for EAS was lower in religious people, females, older people and African Americans.

Conclusions Support for EAS varies widely across studies, with numerous demographic and situational factors associated with differing levels of support. This indicates a complex interplay of elements is involved in the formation of EAS beliefs. Understanding these factors is valuable for facilitating meaningful discussions among clinicians and the community and informing policy debates and decisions.

  • Palliative Care
  • Ethics
  • Advance Care Planning
  • Cultural issues

Data availability statement

Data are available upon reasonable request. Much of the key relevant data is include in the supplementary information. Additional data is available from the authors upon reasonable request.

https://doi.org/10.1136/spcare-2024-005116

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    Data availability statement

    Data are available upon reasonable request. Much of the key relevant data is include in the supplementary information. Additional data is available from the authors upon reasonable request.

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    Footnotes

    • Contributors GG led study design, paper search, screening, data extraction, synthesis and statistical analysis, reporting and paper writing. MB and ML were involved in study design, synthesis, reporting and paper editing. IH was involved in statistical analysis, reporting and paper editing. EM was involved in screening and paper editing. GG is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Map disclaimer The inclusion of any map (including the depiction of any boundaries therein), or of any geographic or locational reference, does not imply the expression of any opinion whatsoever on the part of BMJ concerning the legal status of any country, territory, jurisdiction or area or of its authorities. Any such expression remains solely that of the relevant source and is not endorsed by BMJ. Maps are provided without any warranty of any kind, either express or implied.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.