Confusion between Euthanasia and Other End-of-Life Decisions: Influences on Public Opinion Poll Results

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ABSTRACT

Background: Public opinion polls indicate that a majority of Canadians are in favour of euthanasia. However, there have been many criticisms of the validity of these findings. The objective of this study was to assess public opinion towards euthanasia while controlling for possible threats to validity indicated in the literature review.

Methods: A telephone public opinion poll was conducted in 2002 with a representative sample of the general population of Quebec (n=991; response rate=49.8%). Respondents were asked about their support for euthanasia and treatment withdrawal and, for comparison, were asked a previously used question on euthanasia (Gallup) which has been criticized for methodological problems. Respondents were also asked to distinguish between euthanasia and other end-of-life decisions in hypothetical scenarios.

Results: Eleven percent more people supported euthanasia with the Gallup question than the question developed in this study. Support for euthanasia (69.6%) was less prevalent than for treatment withdrawal (85.8%). Respondents who failed to distinguish between euthanasia and treatment withdrawal or withholding treatment in hypothetical scenarios were more likely to support euthanasia in public opinion poll questions. Furthermore, there is a significant relationship between opinions about the acceptability of euthanasia and inaccurate knowledge of the nature of euthanasia.

Interpretation: Public opinion polls on euthanasia must be interpreted in the light of the wording of the question. Education of the population concerning euthanasia and other end-of-life decisions may be considered to be an important prerequisite to engage in public debate concerning the legalization of euthanasia.

MeSH terms: Euthanasia; public opinion; withdrawing treatment; knowledge; problem formulation

Debates concerning euthanasia have become more frequent during the past two decades. Euthanasia was legalized in the Netherlands (2000) and Belgium (2002), and the US state of Oregon legalized physician-assisted suicide (1997). The fact that polls show strong public support has been used in legislative debates to justify why euthanasia should be legalized.1 In fact, in Canada,2 as in Australia,3 Great Britain,4 USA,5 and the Netherlands,6 the majority of the general population support legalizing euthanasia. However, critics have questioned the validity of these polls.

Although the word "euthanasia" is derived from the ancient Greek eu (good) and thanatos (death), there is a general consensus in research,7 legislation and in the medical field8-12 to adopt a definition similar to the one used in the Netherlands: "Euthanasia is defined as the administration of drugs with the explicit intention of ending the patient's life at his/her explicit request".13 However, some authors suggested avoiding the use of "euthanasia" because of possible ambiguity1,14-17 and since this term can be emotionally charged.18 In addition, answers given to questions on euthanasia may be influenced by the wording of the question.19

Another concern is the fact that people may not be well informed about end-oflife practices.1,20 Within the context of a public information day, Gallagher21 found that almost half of people thought that treatment withdrawal was euthanasia and an Oregon study revealed much confusion in patients about their end-of-life options.15 For some,22-25 such confusion may be understandable because they believe that there is no moral distinction between acts or omissions that result in death. They contend that "passive" and "active" euthanasia are morally equivalent. However, legislation as well as medical practice8-12,26,27 invariably distinguish between these practices. For example, in Canadian law, active euthanasia is treated as homicide, while treatment refusal, treatment withdrawal and the "double effect" (providing medications to alleviate pain which may hasten death), which some call "passive euthanasia," are legal. …