Polarization in public attitudes toward end-of-life decisions in Israel – A cross-sectional study

Abstract

Objectives End-of-life (EoL) processes are a complex socio-normative and ethical phenomenon. This study aimed to generate a database of public opinion in Israel concerning EoL processes and decisions and to identify differences in attitudes across subgroups in the population, particularly based on experience as a family caregiver of a dying patient. Methods This cross-sectional study was performed in late March 2022. The study utilized an online sample of 605 adults over the age of 50 including those who accompanied a loved one to their death in the last 3 years. Participants were requested to provide their opinions and attitudes on several aspects of EoL decisions, including truth-telling, medically assisted dying, EoL procedures, pre-death actions, and family caregivers’ engagement. Results While only 27% and ∼30% of participants support artificial respiration or feeding (respectively) of terminally ill patients, 66% support analgesic treatment, even at the risk of shortening life. The data show an association between religiosity and agreement with life-extending procedures. For example, while 83% of seculars support medically assisted dying, only 59% and 26% of traditional and religious respondents support it. However, no statistically significant differences were observed in support of family involvement in EoL process in any sociodemographic variable. Significance of results The results of this study suggest that the Israeli public is relatively polarized on several issues about EoL processes, specifically patient autonomy and medically assisted dying. Yet, at the same time, there is a consensus among the Israeli public about certain EoL elements, particularly the importance of family caregivers in the EoL decision-making process.

The Complex Dynamics of Decision-Making at the End of Life in the Intensive Care Unit: A Systematic Review of Stakeholders' Views and Influential Factors

“…After removing 1572 duplicates, 7841 unique records were obtained and screened. We reviewed 167 full-text studies, of which 33 studies were finally included [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59].…”

“…Most of them were conducted at a national level, with the exception of 10 multinational ones [9,[12][13][14]44,45,48,49,57,59]. The individual national studies included four studies from France [5,17,19,50], three studies from the USA [10,16,56], two studies each from Turkey [8,43], China [46,47], and Brazil [42,53], as well as one study each from Israel [51], Croatia [11], South Africa [15], India [58], Italy [54], Portugal [52], Spain [7], Greece [6], Sweden [18], and Canada [55]. Four out of 10 multinational studies were conducted in Europe [9,44,48,49], one in Asia [57], one in Australia and New Zealand [12], one in the Middle East [59], one in both the US and Europe [45], and two on a global scale [13,14].…”

“…Three national studies [18,50,51] assessed the attitudes of the general public (Table 1). Overall, participants from the French [50], Israeli [51], and Swedish [18] public supported family involvement in decision-making (Tables 2, 7).…”

“…Three national studies [18,50,51] assessed the attitudes of the general public (Table 1). Overall, participants from the French [50], Israeli [51], and Swedish [18] public supported family involvement in decision-making (Tables 2, 7). Notably, in a competent patient scenario, half of the respondents (50%) from the Swedish public wanted physicians to be excluded from the decision-making process [18].…”

Public Attitudes Toward Ethics and Practices in End-of-Life Decision-Making for Neonates

“…Study participants with prior personal involvement did not reveal attitudes that were fundamentally different from those expressed by the general public. Furthermore, we were surprised by the low-magnitude associations between sociodemographic variables and attitudes toward euthanasia and withdrawal of life-prolonging treatment, in contrast to findings in other studies that have shown associations with variables such as age, educational level, sex, income level, religiosity, or health-related factors with certain attitudes toward euthanasia, withdrawal of life-prolonging treatment, and end-of-life decision-making . We assumed that, in a culturally diverse society, personal views become less determined by sociodemographic variables than in the past.…”