Associations of end-of-life preferences and trust in institutions with public support for assisted suicide evidence from nationally representative survey data of older adults in Switzerland

Abstract

The legality of euthanasia and assisted suicide (AS) and nature of regulations of these practices remain controversial and the subject of lively debate among experts and the general public. Our study investigates attitudes and behaviours towards AS among older adults in Switzerland where the practice of AS has a relatively long history and remains rather unregulated. We aim to explore how individuals' preferences regarding their end of life, as well as individuals' trust in institutions involved in the practice or control of AS are associated with attitudes and behaviours towards AS. We analyse nationally representative data of adults aged 55 and over from wave 6 (2015) of the Survey of Health, Ageing and Retirement in Europe (SHARE) in Switzerland (n = 2,145). While large majorities supported current legal arrangements around AS in Switzerland (81.7%) and stated that they could consider AS for themselves under certain circumstances (61.0%), only a minority either was a member of a right-to-die organisation already (4.9%) or stated they were likely to become a member of such an organisation (28.2%). Stated preferences for control over the end of life and for maintaining essential capabilities at the end of life showed a positive association with AS-related attitudes and behaviours, whereas preferences for feeling socially and spiritually connected, as well as for not being a burden displayed a negative association with our outcomes. Higher levels of trust in one's relative were positively associated with both support for the legality of AS and potential use of AS. A positive association was also found between trust in the Swiss legal system and support for the legality of AS. By contrast, trust in religious institutions displayed a negative association with all five AS-related attitudes and behaviours. Similarly, trust in healthcare insurance companies was negatively associated with potential use of AS. Taken together, older adults were generally supportive towards current practices regarding AS. This approval appears to be closely related to individuals' preferences and, at different extends, to trust in social and public institutions with regard to end-of-life issues, which is relatively high in Switzerland.

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

“…Supporters also reported assisted dying as a possible means of contributing to the quality of death by respecting the person's wishes, relieving potential suffering, and preserving dignity. A national survey by Vilpert et al (2020) in Switzerland (where assisted suicide is legal) found that control over the end of life and the ability to maintain essential capabilities at the end of life were positively associated with support for assisted suicide.…”

Assisted suicide: Perception of nursing students about professional performance on this topic

“…Thus, this principle points to the need to encourage patients to choose according to the information transmitted by health professionals, whether agreeing or rejecting any proposed measure even if such a choice results in negative consequences for their health 17 . This happens due to the influence of the increase in medicalization in the therapeutic process because, in some cases, it can harm the quality of life of patients who are in the final moments of life 18 . It is also necessary to create definitions with the objective of implementing the application of euthanasia and assisted suicide in situations that are really appropriate, in order to ensure the legal exercise of these procedures.…”

Determinants of suicidal history before assisted versus self-initiated suicide late in life: an observational study

“…Women's vulnerability is also illustrated by the fact that most women who had experienced the loss of a child or a loved one from violent death, had broken off relationships with their families, suffered from chronic pain or had a caregiver experience. However, experience as a healthcare proxy has been proven to increase positive assisted suicide attitudes and behaviour [12].…”