Conscientious objection to medical aid in dying: Knowledge, attitudes, and practices in primary care

The Euthanasia Regulation Law includes the right to conscientious objection (CO). However, there is hardly any information available on its exercise or the grounds for objection. The objective of this study was to identify knowledge, attitudes, and practices (KAP) regarding CO to the provision of medical aid in dying (MAID) in primary care, which is the level of care where most provisions occur.

Cross-sectional KAP model study. A total of 434 active General Practitioners (GPs) working in health centres across Spain were surveyed through self-administered questionnaires on knowledge, attitudes, and practices related to CO. A descriptive analysis of the responses in each domain was performed, followed by multivariate analyses to determine the factors related to having objected or considering doing so.

Of the GPs surveyed, 46.3% practised in Madrid. 75.2% were women, with an average age of 47. 84.8% had received training in bioethics. 54.9% reported knowing the law, only 29% correctly answered questions about CO in end-of-life practices. 35% had objected or considered objecting. Higher rates of objection were observed among those practising in Madrid (aOR = 2.98; 95% CI 1.16-5.34), those with religious beliefs (aOR = 5.23; 95% CI 2.78-9.80), and those opposed to MAID (aOR = 12.63; 95% CI 5.80-27.50).

The main reasons for objecting are moral and emotional, although other contextual factors also emerge. Given the high level of ignorance of the practices to which one can object, improvements in training and institutional involvement are needed for responsible practice and to guarantee the MAID.