Race, Ethnicity, and Attitudes Toward Physician-Assisted Death in the United States: A Narrative Review

Physician-assisted death (PAD) is a controversial practice, legal in mostly wealthy European countries and U.S. states with a lower-than-average proportion of Black residents. Although studies report lower support for PAD among Black Americans, a comprehensive review of the association between PAD attitudes and race and ethnicity is lacking. This narrative review sought to clarify the association between race and/or ethnicity and attitudes toward PAD, while exploring possible explanatory factors.

A comprehensive search of PubMed, Web of Science Core Collection, and PsycINFO databases through December 2024, supplemented by citation follow-up and manual searches.

The search yielded 64 eligible studies. These studies varied in sampling method, populations, studied, survey questions, and timing. To account for quality, studies were grouped into those employing random (38) versus nonrandom (26) sampling. Across both categories, White respondents consistently demonstrated higher support for PAD than racial and ethnic minority groups, particularly Black Americans, in both unadjusted and adjusted analyses. Although some studies show adding religion variables eliminates this association, the largest and most methodologically rigorous studies still show that race and ethnicity retain an independent association with PAD attitudes. Notably, there was a paucity of studies examining trust in the health care system as a potential factor.

Overall, the evidence suggests lower support for PAD among racial and ethnic minority groups that may reflect, in part, distinct sociocultural factors extending beyond religion or socioeconomic status. This review highlights the need for more research on trust in health care and nuanced understanding to guide discussions on PAD policy and practice in diverse populations.