Attitudes of undergraduate medical students towards end-of-life decisions: a systematic review of influencing factors
Abstract Background Medical end-of-life decisions, including voluntary active euthanasia (lethal injection), (physician-)assisted dying (prescribing lethal substances), passive euthanasia (refraining from or ceasing life-sustaining treatments), palliative sedation (administering sedatives to allevia...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-05-01
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| Series: | BMC Medical Education |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12909-025-07077-y |
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| Summary: | Abstract Background Medical end-of-life decisions, including voluntary active euthanasia (lethal injection), (physician-)assisted dying (prescribing lethal substances), passive euthanasia (refraining from or ceasing life-sustaining treatments), palliative sedation (administering sedatives to alleviate suffering, possibly leading to unintended life-shortening), and treatment withdrawal/withholding, have become prevalent in modern medical practice. Aim This systematic review aims to analyse international data on undergraduate medical students' attitudes towards (physician-) assisted dying, palliative sedation, treatment withdrawal/withholding, active and passive euthanasia. The objectives are to assess approval rates over the past 24 years and to identify factors influencing these attitudes. Design In accordance with PRISMA guidelines, a systematic search of six electronic databases (MEDLINE, CINAHL, EMBASE, ERIC, PsycINFO, and Web of Science) was conducted. The review encompasses studies from 2000–2024. Results Forty-nine studies met the inclusion criteria (43 surveys, 6 qualitative studies, 1 mixed-method study). The studies were globally distributed: Europe (27), Asia (10), America (8), Africa (3), and Australia (1). Predictors such as age, clinical vs. pre-clinical status, religious aspects, sex, and ethnicity were investigated. Age and gender had limited influence, whereas religion was a significant factor. Compared with pre-clinical students, clinical students showed more support for end-of-life practices. Geographic locations and socioeconomic status also affect attitudes. Conclusion Medical students’ attitudes towards end-of-life decisions are influenced by clinical experience, religious beliefs, and geographic location. The acceptance rates for euthanasia and (physician-)assisted dying vary significantly across regions, reflecting diverse cultural and educational backgrounds. |
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| ISSN: | 1472-6920 |