Attitudes of nurses towards euthanasia and towards their role in euthanasia: a nationwide study in Flanders, Belgium

Nurses have an important role in caring for terminally ill patients. They are also often involved in euthanasia. However, little is known about their attitudes towards it.

To investigate on a nationwide level nurses' attitudes towards euthanasia and towards their role in euthanasia, and the possible relation with their socio-demographic and work-related characteristics.

A cross-sectional design was used. In 2007, a questionnaire was mailed to a random sample of 6000 of the registered nurses in Flanders, Belgium. Response rate was 62.5% and after exclusion of nurses who had no experiences in patient care, a sample of 3321 nurses remained.

Attitudes were attained by means of statements. Logistic regression models were fitted for each statement to determine the relation between socio-demographic and work-related characteristics and nurses' attitudes.

Ninety-two percent of nurses accepted euthanasia for terminally ill patients with extreme uncontrollable pain or other distress, 57% accepted using lethal drugs for patients who suffer unbearably and are not capable of making decisions. Seventy percent believed that euthanasia requests would be avoided by the use of optimal palliative care. Ninety percent of nurses thought nurses should be involved in euthanasia decision-making. Although 61% did not agree that administering lethal drugs could be a task nurses are allowed to perform, 43% would be prepared to do so. Religious nurses were less accepting of euthanasia than non-religious nurses. Older nurses believed more in palliative care preventing euthanasia requests and in putting the patient into a coma until death as an alternative to euthanasia. Female and home care nurses were less inclined than male and hospital and nursing home nurses to administer lethal drugs.

There is broad support among nurses for euthanasia for terminally ill patients and for their involvement in consultancy in case of euthanasia requests. There is, however, uncertainty about their role in the performance of euthanasia. Guidelines could help to make their role more transparent, taking into account the differences between health care settings.