Attitudes Toward Medical Assistance in Dying Among Swedish Palliative Care Professionals

Background: The debate over legalizing medical assistance in dying (assisted dying) is ongoing, also in Nordic countries such as Sweden where assisted dying is illegal. A 2020 survey by the Swedish Medical Association highlighted varied perspectives, with 41% of physicians supporting and 34% opposing legalization. Professionals in palliative care were more negative toward it. 

Objective: To assess attitudes toward the legalization of, and the need for education about, assisted dying among Swedish palliative care professionals. 

Study Design: A survey with 19 closed- and 2 open-ended questions was administered to the participants of the 2023 Swedish National Conference on Palliative Care (including physicians, nurses, assistant nurses, administrators, and researchers). 

Results: Of the 866 conference participants who were invited, 444 (51%) participated. Predominantly, the cohort comprised women (89%); 60% were nurses and 17% physicians. The results showed that 38% opposed euthanasia, 36% supported it, and 26% remained undecided, with similar findings regarding physician-assisted suicide. There was a significant trend of increasingly negative attitudes with age and experience in palliative care (p < 0.01). Physicians emerged as the group most opposed to euthanasia (80%), whereas assistant nurses were the most positive, with 13% opposing legalization, and 33% of the nurses opposed euthanasia. The open-ended questions revealed thoughts regarding the complexity of the issue and the need for further discussion and education. 

Conclusion: In Sweden, where euthanasia and physician-assisted suicide is illegal, more than one-third of palliative care professionals were in favor of legalizing these practices while one-fourth were undecided, these proportions differed markedly between professions. Further, we uncovered a significant need for further discussion and education.