Influence of Dark Triad Personality on Attitudes Toward Brain Death, Organ Donation, and Futile Therapy

BACKGROUND The Dark Triad Scale (DTS) encompasses 3 personality traits: narcissism, psychopathy, and Machiavellianism. While numerous studies have explored the structure and social, medical, and behavioral implications of Dark Triad personality, its association with attitudes toward brain death, organ donation, and futile therapy has not been previously examined. The aim of this study was to assess how DTS traits influence perceptions of these end-of-life issues. MATERIAL AND METHODS This cross-sectional study used the DTS and an original questionnaire. Participants included Polish paramedic and midwifery students (n=48) and non-medically educated (NM) individuals recruited via Facebook (n=88). Due to underrepresentation of males in the NM group, only female respondents (n=75) from this group were included in cluster analysis. RESULTS Students of both genders were significantly more willing to become organ donors after death than were NM participants (mean score 3.92±1.3 vs 3.33±1.4 on a 1-5 scale; P=0.014). Among male and female students, higher Machiavellianism was associated with the belief that futile therapy is unethical. In NM females, psychopathy was correlated with denial of the existence of brain death, while Machiavellianism correlated with acceptance of withdrawing futile therapy. Cluster analysis identified 3 subgroups of NM females. Individuals with the highest levels of Dark Triad traits showed the greatest acceptance of withdrawing futile therapy, whereas those tending to deny brain death had moderate levels of these traits. CONCLUSIONS DTS traits are associated with attitudes toward futile therapy and brain death. Higher Machiavellianism is linked to greater acceptance of withdrawing futile therapy, while denial of brain death among females is associated with intermediate Dark Triad traits and higher psychopathy.