Physicians' Attitudes Toward Euthanasia in Türkiye: A Cross-Sectional Survey of Ethical Heterogeneity and...

Background: Physicians play a central role in end-of-life decision-making, yet their attitudes toward euthanasia remain complex and context-dependent. This study aimed to examine physicians' attitudes toward euthanasia in Türkiye, focusing on ethical heterogeneity and decision-making patterns associated with support for its legal permissibility. Methods: A cross-sectional, web-based survey was conducted among 250 actively practicing physicians recruited via convenience sampling through physician-oriented social media platforms between November and December 2024. The primary outcome, support for the legal permissibility of euthanasia (Yes/No/Undecided), was analyzed using multinomial logistic regression. Additional analyses included item-wise ordinal logistic regression, latent class analysis, exploratory factor analysis based on a polychoric correlation matrix, and Firth penalized logistic regression. Results: Agreement with the standard definition of euthanasia was 94.4%. Support for legal permissibility was 44.0%, opposition was 35.2%, and 20.8% were undecided. Physicians who would not personally consider euthanasia had lower relative risk ratios for supporting legalization (RRR = 0.02, 95% CI: 0.01-0.06), and those who were undecided also had lower relative risk ratios (RRR = 0.19, 95% CI: 0.06-0.57). Agreement with euthanasia was 53.2% for terminal conditions and 18.4% for general scenarios. Latent class analysis identified three classes with proportions of 52.4%, 20.3%, and 27.4%. Exploratory factor analysis yielded two factors with eigenvalues of 4.58 and 1.47. In Firth penalized logistic regression, the odds ratio for not personally considering euthanasia was 0.034 (95% CI: 0.011-0.104). Conclusions: In this sample of physicians in Türkiye, attitudes toward euthanasia were heterogeneous and multidimensional. A substantial undecided group and context-dependent differences across clinical scenarios were observed.