Mroz S, Dierickx S, Chambaere K, et al
Physicians’ preferences for their own end of life: a comparison across North America, Europe, and Australia
Journal of Medical Ethics Published Online First: 10 June 2025. doi: 10.1136/jme-2024-110192
Abstract
Objective To study physicians’ personal preferences for end-of-life practices, including life-sustaining and life-shortening practices, and the factors that influence preferences.
Design A cross-sectional survey (May 2022–February 2023).
Setting Eight jurisdictions: Belgium, Italy, Canada, USA (Oregon, Wisconsin, and Georgia), Australia (Victoria and Queensland).
Participants Three physician types: general practitioners, palliative care physicians, and other medical specialists.
Main outcome measures Percentage of physicians who preferred various end-of-life practices and provided information about influence on preferences and demographics.
Results 1157 survey responses were analysed. Physicians rarely considered life-sustaining practices a (very) good option (in cancer and Alzheimer’s respectively: cardiopulmonary resuscitation, 0.5% and 0.2%; mechanical ventilation, 0.8% and 0.3%; tube feeding, 3.5% and 3.8%). About half of physicians considered euthanasia a (very) good option (respectively, 54.2% and 51.5%). The proportion of physicians considering euthanasia a (very) good option ranged from 37.9% in Italy to 80.8% in Belgium (cancer scenario), and 37.4% in Georgia, USA to 67.4% in Belgium (Alzheimer’s scenario). Physicians practising in a jurisdiction with a legal option for both euthanasia and physician-assisted suicide were more likely to consider euthanasia a (very) good option for both cancer (OR 3.1, 95% CI 2.2 to 4.4) and Alzheimer’s (OR 1.9, 95% CI 1.4 to 2.6).
Conclusion Physicians largely prefer to intensify alleviation of symptoms at the end of life and avoid life-sustaining techniques. In a scenario of advanced cancer or Alzheimer’s disease, over half of physicians prefer assisted dying. Considerable preference variation exists across jurisdictions, and preferences for assisted dying seem to be impacted by the legalisation of assisted dying within jurisdictions.
Data availability statement
Data are available upon reasonable request. The datasets are available upon request. Requests may be addressed to the first author. Every request will be evaluated on an individual basis and the ethics committee of the Vrije Universiteit Brussels will be contacted for approval before any sharing of participant-level data.
https://jme.bmj.com/content/early/2025/06/05/jme-2024-110192