Attitudes of Students of Jahrom University of Medical Sciences toward Euthanasia
Introduction: Increased incidence of incurable diseases and technological advancement in recent years have raised new concerns for treatment team members and forced them to deal with many ethical challenges including Euthanasia. The present study aimed to determine attitudes of students of Jahrom University of Medical Sciences toward Euthanasia.
Method: This was an analytic study. The participants were 188 paramedical and medical students studying in Jahrom University of Medical Sciences in 2018. The required data was collected using demographic questionnaire and the Euthanasia Attitude Scale (EAS). The collected data was analyzed using SPSS v.21.
Findings: Mean score of attitudes of students toward Euthanasia was 42.30 ± 13.68 (20
Conclusion: Most of the participants were neutral toward Euthanasia. However, a significant percent of participants were negative toward Euthanasia and only a very small percent of participants were positive toward this issue. It is recommended to investigate effective factors in students' attitude toward Euthanasia in future.
Euthanasia, Medical sciences, Students
Enhanced quality of health care as well as medical and technological advancement in recent years have altered the concept of death  and increased survival of many patients . However, consequent complications and disabilities resulting from incurable diseases have exacerbated suffering of patients who have no hope of recovery. These have also imposed high costs on their families and the health system . The concern for ending life of the patients who have no hope of recovery has increased in recent years. This is noted as one of the ten major ethical challenges in the medicine . Euthanasia or an easy way to end life is one of the most controversial issues in medical ethics [5,6]. Euthanasia refers to an action that helps the patient to die quietly, peacefully and painlessly . In another definition, Euthanasia refers to a deliberate and easy ending of life to escape from an incurable disease with too much pain and no hope of recovery [8,9]. Different results have been obtained in previous studies on Euthanasia targeting different members of the treatment team. Bulut studied attitudes of nursing students toward Euthanasia. The results indicated negative attitudes of most of the students (85.5%) . Bakalls et al. also showed that most of Greek nursing students did not fully understand the concept of Euthanasia and believed that it was contrary to ethical principles . Kamath et al. investigated attitudes of physicians toward Euthanasia in India. The results indicated positive and favorable attitude of physicians toward this issue. The most common reason for consenting to Euthanasia was ending pain and suffering of the patient with an incurable illness and the most common reason for dissenting from Euthanasia was undervaluing the importance of life and misusing Euthanasia by the treatment group . Several studies have also been conducted in Iran on this issue. Naseh et al. indicated negative attitude of medical students and practitioners toward Euthanasia . Sarhadi et al. also showed that most of nurses (66%) were negative toward Euthanasia . Asadi et al. also showed that most of nurses working in oncology and intensive care units were also negative attitude toward this issue and they remembered it as a moral challenge . According to the abovementioned materials, medical students as future physicians should undoubtedly make decisions on Euthanasia to an increasing extent that force them to deal with many ethical challenges. This shows the importance of discussing this issue from viewpoints of these students . Considering different cultural views and beliefs about ethical issues in various societies , it is necessary to recognize attitudes of medical students about this issue in order to make plans for dealing with this ethical challenge. Therefore, the present study aimed to determine attitudes of students of Jahrom University of Medical Sciences toward Euthanasia.
Materials and Methods
This was an analytic study. It was approved by the Ethics Committee of Jahrom University of Medical Sciences and Health Services (IR.JUMS.REC.1397.026). The statistical population consisted of all students of Jahrom University of Medical Sciences studying in paramedicine (nursing, anesthesia, operating room, health and laboratory science) and medicine (externship and internship). The stratified sampling method was used to select the participants. The participants were enrolled in the study with respect to the number of students in each field of study. Inclusion criteria were studying at Jahrom University of Medical Sciences, informed consent to participate in the study, at least two semesters of internship at the hospital. Exclusion criteria were unwillingness to cooperate in the study, incomplete completion of questionnaires, and a psychological disorder or taking medications for a mental illness. An introduction letter was given to the author who met the research unit and gave them necessary explanations about objectives of the study and obtained their written consent. The questionnaires were distributed among the students. A two-part questionnaire was used for data collection. The first part included demographic information and the second part consisted of Euthanasia Attitude Scale. The scale was designed and primarily validated by Tordela and Newton in 1979 . Persian version of the scale was prepared by Aghababaei. Reliability of the scale was confirmed using Cronbach’s alpha (α=0.88). Internal consistency of the scale was also confirmed (0.56) . The scale was used in various studies [5-7]. This scale contained 20 items encompassing four subscales of ethical considerations (items 1-11), practical considerations (items 12-14), valuing life (items 15-18), and naturalistic beliefs (items 19 and 20). There is a clear definition of Euthanasia at beginning of the scale in order to present an overview of Euthanasia for the participants. Then, the participants completed the questionnaire. Their responses were scored based on a five-point Likert scale (completely disagreed=1, completely agreed=5). The higher the score, more positive the attitude will be towards Euthanasia . Fully completed questionnaires were analysed using SPSS v. 21, descriptive and analytical tests (Mann- Whitney and Kruskal-Wallis). Significant levels for all tests were considered as p<0.05.
In terms of demographic characteristics, most of the participants (54.3%) were from 21 to 25 years old, females (57.4%) and married (84%). Considering the field of study, 11.2% of students were studying medicine, 25% nursing, 16.5% laboratory science, 17.6% anesthesia, 10.1% health, and 19.7% operating room. Regarding the economic status, most of the participants (63.3%) were middle. Considering religious status, 96.8% of the students were Shia and 45.7% were moderately religious. These findings are presented in Table 1.
|Age (in terms of years)||<20||76||40.4|
|21 to 25||102||54.3|
|25 to 30||10||5.3|
|Field of study||Medicine||21||11.2|
|Relationship with religion||Poor||23||12.2|
Table 1: Frequency distribution of demographic variables regarding research units
The findings showed that overall mean score of attitude toward Euthanasia was 42.30 ± 13.68. The highest score belonged to practical considerations with a mean score of 46.36 ± 19.87 and the lowest score belonged to valuing life with a mean score of 39.22 ± 16.99. Contents of Table 2 show that the mean of all variables is significantly different (p<0.01) from the tested value (mean score=50). Since calculated t-values for variables of attitude toward Euthanasia and its dimensions are negative (less than observed mean score=50), mean score of students’ attitudes toward Euthanasia and its dimensions was significantly lower than expected mean score.
|Variables||Mean||Standard deviation||Tested value=50|
|Attitude toward Euthanasia||42.3||13.68||-7.716||187||0.000|
Table 2: Mean and standard deviation of variables of attitude toward Euthanasia and its dimensions in students of Jahrom University of Medical Sciences
For qualitative description of level of attitude toward Euthanasia and its dimensions, the range of values of these variables was divided into five equal categories namely very negative, negative, neutral, positive and very positive. Accordingly, most of respondents (60.6%) were neutral toward Euthanasia, 36.7% were negative and very negative and only 2.6% were positive and very positive (Table 3).
|Level of attitude toward Euthanasia (total)||Very negative||15||8|
Table 3: Qualitative description of level of attitude of students of Jahrom University of Medical sciences toward Euthanasia
Mann-Whitney and Kruskal-Wallis tests were used to test the difference between level of students’ attitudes toward Euthanasia and demographic variable. The results showed that women were significantly more positive toward Euthanasia than men (p<0.05). There was also a significant and positive relationship between relationship with religion and attitude toward Euthanasia (p<0.05). However, there were no significant difference between attitude toward Euthanasia and other demographic variables (p>0.05) (Table 4).
|Field of study||8.321||0.080|
Table 4: Mean score of attitude toward Euthanasia in terms of demographic variables in students of Jahrom University of medical sciences
Attitude toward Euthanasia was studied in students of Jahrom University Medical Sciences. Most of participants in this study (60.6%) were neutral toward Euthanasia. However, Leppert et al. determined attitude of Polish physicians toward Euthanasia with regard to cancer patients. They showed that 90% of physicians disagreed with Euthanasia . McCormack et al. also showed negative attitude of most of English physicians toward Euthanasia . The results of another study in Italy showed that a small percentage of physicians (33%) agreed with Euthanasia . Few studies were conducted on attitudes of students of medical sciences toward Euthanasia in Iran. Sarhadi et al., Asadi et al., Taghaddosinejad et al., Vakili et al. and Tavoosiyan et al. studied attitudes of physicians and nurses toward Euthanasia. The results of these studies showed that most of them were negative toward Euthanasia [12,13,19-21]. The results of studies on attitudes toward Euthanasia in Iran and foreign countries showed that the results of this study differ from the results of previous studies. In this study, most of students were neutral toward Euthanasia. This difference may be due to lack of clinical experience on patient care and lack of knowledge on Euthanasia rules among the students. Attitude of medical students toward Euthanasia was also investigated with regard to demographic variables. The result showed that attitude toward Euthanasia was significantly different in the two genders. There was also a significant difference between attitude toward Euthanasia and relationship with religion. No significant difference was found between attitude toward Euthanasia and other demographic variables. The results of this study are inconsistent with the results of studies by Gielen et al. , Vakili et al.  and Ay et al. , who found out a significant relationship between gender and tendency to Euthanasia. However, Aghababei et al.  and Naseh et al.  found no significant relationship between gender and attitude toward Euthanasia, which is in agreement with the results of this study. This might be due to different statistical population in these studies. The findings of the present study also indicated a significant and positive difference between relationship with religion and attitude toward Euthanasia. On the contrary, Naseh et al. showed a significant and negative correlation between relationship with religion and attitude toward Euthanasia . Sprung et al. also found out that religion has a positive influence on attitudes toward end-of-life decision making in 11 European countries .
The results of this study showed that a high percentage of students were neutral toward Euthanasia. Attitude toward Euthanasia was generally investigated in this study and various types of Euthanasia were not studied in details. Therefore, it is suggested that various types of Euthanasia be studied in future. The role of effective factors in consenting or dissenting from Euthanasia was not also investigated in this study. Therefore, it is suggested that the role of effective factors in attitudes toward Euthanasia be studied in future.
We would like to thank the Clinical Research Development Unit of Peymanieh Educational and Research and Therapeutic Center of Jahrom University of Medical Sciences for providing facilities to this work. This project was approved by the Jahrom University of Medical Sciences with a code of ethics (IR.JUMS.REC. 1397.026).
Ethical issues were completely observed by the authors.
Conflict of Interest
The authors declare that there is no conflict of interest regarding the publication of this manuscript.
- Levin K, Bradley G, Duffy A. Attitude toward Euthanasia for patients who suffer from physical or mental illness. Omega-J Death Dying 2018.
- Alborzi J, Sabeti F, Baraz SH, et al. Investigating of moral distress and attitude to Euthanasia in the intensive care unit nurses. Int J Pediatr 2018; 6:8475-82.
- Bulut A. The opinions about Euthanasia among students in elderly care department of vocational school of health services at Bingol University. Med-Science Int Med J 2017.
- Hossienzadeh K, Rafiei H. Nursing student attitude toward Euthanasia: A cross-sectional study. Nurs Ethics 2017; 1-8
- Naseh L, Heidari M. The attitudes of nursing students to Euthanasia. Indian J Med Ethics 2017; 28: 1-6.
- Aghababaei N. Assessing attitudes toward Euthanasia. Iran J Med Ethics Hist Med 2011; 5:59-70.
- Naseh L, Shirani A, Taghavi LT, et al. Medical specialties’ and medical students’ vantage points on Euthanasia. J Educ Ethics Nurs 2017; 6:1-8.
- Inghelbrecht E, Bilsen J, Mortier F, et al. Attitude of nurses towards Euthanasia and towards their role in Euthanasia: A nationwide study in Flanders, Belgium. Int J Nurs Stud 2009; 46:1209-18.
- Rahimi R, Rahmani A, Pakpour V, et al. Nurses opinion about Euthanasia in East Azarbaijan province, Iran. JJHR 2015; 6:1-6.
- Bakalls N, Filippia N, Maria N, et al. The attitude of Greek student nurses toward Euthanasia. J Nurs Educ Pract 2014; 4:237-24.
- Kamath S, Bhate P, Mathew G, et al. Attitude toward Euthanasia among doctors in a teriary care hospital in south India: A cross sectional study. Indian J Palliat Care 2011; 17:197-201.
- Sarhadi M, Abdollahyar A, Sahadi R. Attitudes of nurses toward Euthanasia in the hospitals of Zahedan, Iran, 2014. J Sabzevar Uni Med Sci 2017; 23:910-6.
- Asadi N, Rooyani Z, Hidari M, et al. Attitudes of ICU and oncology nurses towards Euthanasia. Prev Care Nurs Midwifery J 2014; 4:74-80.
- 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; 28:384-91.
- Gielen J, Branden S, Broeckaert B. Religion and nurses’ attitudes to Euthanasia and physician assisted suicide. Nurs Ethics 2009; 16:304-18.
- Tordella MA, Neutens JJ. An instrument to appraise attitudes of college students toward euthanasia. J School Health 1979; 49:351-2.
- McCormack R, Clifford M, Conroy M. Attitude of UK doctors toward Euthanasia and physician assisted suicide: A sysytemic literature review. Pall Dedicin 2012; 26:23-33.
- Smets T, Cohen J, Bilsen J. Attitude and experiences of Belgian physicians regarding Euthanasia practice and the Euthanasia law. J Pain Symptom Manage 2011; 41:580-93.
- Taghaddosinejad F, Okazi A, Mogharehzadeh IM, et al. Comparison Of attitude of physicians and patients about Euthanasia In Tehran’s university of medical sciences hospitals in 2012-2013. Sci J Forensic Med 2014; 19:377-84.
- Vakili M, Delavar S, Karimian Z, et al. Survey of the attitudes of nurses and physicians in the intensive care units about Euthanasia in the university hospitals of Yazd-2012. Community Ment Health J 2012; 7:1-9.
- Tavoosiyan A, Sedaghat M, Aramesh K. Euthanasia: Assesment of medical students’ perspective. Iranian J Med Ethics 2009; 3:43-52.
- Ay MA, Oz F. Nurses attitude towards death, dying patients and Euthanasia: A descriptive study. Nurs Ethics 2018.
- Aghababei N, Hatami J, Rostami R. The role of individual characteristics and judgment pattern in attitude towards Euthanasia. Iranian J Crit Nurses 2011; 4:23-32.
- 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; 33:1732-9.
2Department of Anesthesiology, Critical Care and Pain Management Research Center, Jahrom University of Medical Sciences, Jahrom, Iran
3Department of Emergency Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
4Department of Health Services Management, Jahrom University of Medical Sciences, Jahrom, Iran
5Department of Emergency Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
Citation: Fatemeh Golestan, Hasan Zabetian, Mohamad Javad Zarei, Fatemeh Honarmand Jahromy, Navid Kalani, Samaneh Abiri*, Attitudes of students of Jahrom university of medical sciences toward Euthanasia, J Res Med Dent Sci, 2019, 7(1): 201-205.
Received Date: Jan 24, 2019 / Accepted Date: Feb 20, 2019 /