A systematic review of older adults’ request for or attitude toward euthanasia or assisted-suicide

Abstract

Objectives: Prevalence rates of death by euthanasia (EUT) and physician-assisted suicide (PAS) have considerably increased in older adults, and public debates on these practices are still taking place. In this context, it seemed important to conduct a systematic review of the predictors (demographic, physical, psychological, social, quality of life, religious or existential) associated with attitudes toward, wishes and requests for, as well as death by EUT/PAS among individuals aged 60 years and over. Method: The search for quantitative studies in PsycINFO and MEDLINE databases was conducted three times until April 2018. Articles of probable relevance (n = 327) were assessed for eligibility. Studies that only presented descriptive data (n = 306) were excluded. Results: The review identified 21 studies with predictive analyses, but in only 4 did older adults face actual end-of-life decision making. Most studies (17) investigated attitudes toward EUT/PAS (9 through various hypothetical scenarios). Younger age, lower religiosity, higher education and socioeconomic status, were the most consistent predictors of endorsement of EUT/PAS. Findings were heterogeneous with regard to physical, psychological and social factors. Findings were difficult to compare across studies because of the large variety of outcomes measures and sample characteristics. Conclusion: Future studies should adopt common and explicit definitions of these concepts, as well as mixed longitudinal research designs that would allow for better consideration of various personal and social factors, and their interplays, on the decisionmaking process with regard to EUT/PAS.

The views of Aotearoa/New Zealand adults over 60 years regarding the End of Life Choice Act 2019

“…Analysis of responses of 1066 individuals in the US General Social Survey found that religiosity, belief in the afterlife and heaven, and religious denomination were significantly associated with opposition to euthanasia (Sabriseilabi & Williams, 2020). Finally, a review of the literature by Castelli Dransart et al (2019) reported that religious affiliation was not associated with support for euthanasia or physician-assisted suicide in Switzerland or Connecticut, and Indiana in the USA.…”

The Impact of Infectious Disease-Related Public Health Emergencies on Suicide, Suicidal Behavior, and Suicidal Thoughts

“…Among these constructs are several established risk factors for suicide-related outcomes, including depression, anxiety, posttraumatic stress disorder (PTSD), hopelessness, fear, unresolved anger, guilt, worthlessness, sleep problems, self-stigmatization, feelings of entrapment and burdensomeness, substance misuse, loneliness, social isolation, disconnectedness, disruption of everyday routines, unemployment, financial strain/insecurity, domestic violence, and child neglect/abuse (Cullen et al, 2020;Dong & Bouey, 2020;James et al, 2019;Jeste et al, 2020;Oyesanya et al, 2015;Reger et al, 2020). Since many of these factors are also associated with accessing medical assistance in dying (MAID; Castelli Dransart et al, 2019) it remains to be seen whether epidemics led to increases in MAID as well. Exploration of the psychiatric and neuropsychiatric presentations associated with severe coronavirus infections (Rogers et al, 2020;Tucci et al, 2017) highlights the frequent occurrence of delirium/confusion in the acute phase, and higher levels of depression, fatigue, insomnia, anxiety, and PTSD in the postacute phase.…”

Perception of Medical Assistance in Dying Among Asian Buddhists Living in Montreal, Canada

“…With EU, the physician administers lethal medications to patients in order to relieve their suffering by bringing about their death; while with PAS, the physician usually provides the lethal substances, but the patients have to end their own life (Gerson et al, 2020). EU and PAS are legally practiced in 15 regions of the world, mostly in Western countries like Canada (Castelli Dransart et al, 2019). Issues, such as grievous incurable illnesses, or advanced state of irreversible decline (Beuthin, 2018), which cause unbearable physical and psychological suffering, were common justifications for their legalization in these countries (Castro et al, 2016).…”

“…Many factors influence the position towards EU and PAS. Younger age, being divorced or widowed, living alone, and higher education and income, were associated with a favorable attitude towards EU or PAS in older adults (Castelli Dransart et al, 2019). Ageist societal discourse about the increasing burden and cost of the elderly population, as well as the perception to be no longer a useful or valuable member of the society increase the likelihood that older adults would choose a hastened death in a hypothetical terminal illness situation (Castelli Dransart et al, 2019).…”

“…Official religious doctrinal viewpoints usually consider MAiD morally wrong due to its adherence to the principle of sanctity of life (Cohen et al, 2014), and individuals who give more importance to their religious beliefs in daily life were more likely to disagree with EU or PAS (Castelli Dransart et al, 2019;Lapierre et al, 2018). In Europe, being unaffiliated to a religion or Protestant predicted acceptance of EU or PAS as an EoL care option (Cohen et al, 2014).…”