AN ABSTRACT OF THE THESIS OF Donna A Champeau for the degree of Doctor of Philosophy in Public Health presented on November 23, 1994. Title: Factors Influencing Individual Attitudes Toward Voluntary Active Euthanasia and Physician Assisted Suicide. Redacted for privacy Abstract approved: Rebecca J. Donate lle Issues of right to life, as well as death have surfaced as topics of hot debate. In particular, questions about when and if individuals have the right to end their own lives have emerged and gained considerable attention as health policy issues having the potential to affect all Americans.. The purpose of this study was to identify the factors that are most likely to influence an individual's decision to support or not support voluntary active euthanasia (VAE) and physician assisted suicide (PAS) in specific medical situations. This study also examined the differences in medical vignettes by various demographic and attitudinal factors. Data were collected from a sample of classified staff members at two institutions of higher learning in Oregon. A survey was used to collect all data. Paired sample T- tests, stepwise multiple regression analysis and repeated measures multiple analysis of variance (MANOVA) were used to analyze the data. Based on survey results, there were significant differences in attitudes toward PAS and VAE for each medical vignette. Religious beliefs, fear of dependency, and fear of death were the most powerful predictors of individual support for PAS in each medical situation. In the case of VAE, there were differences in support on each medical situation in terms of the most powerful predictors: fear of dependency and religious beliefs for the cancer vignette, fear of dependency, religious beliefs, and age for the ALS vignette, and religious beliefs and fear of dependency for the paralysis vignette. The repeated measures MANOVA revealed that in general, the older the individual was, the less likely they were to support PAS or VAE. However, women over age 66 in this study were more likely to support VAE than were the males age 66 and over. Males in the 51-65 year old category were more supportive of VAE than females in this age category. Also, those who were more fearful of death were more likely to have a higher level of support for VAE. In all three vignettes (Cancer, Amyotrophic lateral sclerosis (ALS), and paralysis) for both PAS and VAE, there was a significantly different level of support measured on a seven point Likert scale. FACTORS INFLUENCING INDIVIDUAL ATTITUDES TOWARD VOLUNTARY ACTIVE EUTHANASIA AND PHYSICIAN ASSISTED SUICIDE by Donna A. Champeau A THESIS submitted to Oregon State University in partial fulfillment of the requirements for the degree of Doctor of Philosophy Completed November 23, 1994 Commencement June 1995 Doctor of Philosophy thesis of Donna A. Champeau presented on November 23, 1994 APPROVED: Redacted for privacy Major Professor, r presenting Health Education Redacted for privacy Chair of Department of Public Health Redacted for privacy Dean of Graduate pool I understand that my thesis will become part of the permanent collection of Oregon State University libraries. My signature below authorizes release of my thesis to any reader upon request. Redacted for privacy Donna A. Champeau, Author ACKNOWLEDGMENTS I wish to extend my gratitude to all the classified staff members that participated in this study. Their willingness to take the time to answer the questionnaire was greatly appreciated and made the completion of this study possible. For providing partial financial assistance I would like to acknowledge the College of Health and Human Performance at Oregon State University. This assistance was extremely helpful. Thanks are also given to my colleagues, and friends at Oregon State University for their encouragement and support throughout the final preparation of this thesis. A special thanks is given to my dear friend and associate graduate student, Jessica Hendersen for the encouragement and support that she so unselfishly gave during this entire process. For statistical assistance I would like to thank Laura Bond at Boise State University and Cheryl Kelber at the University of Milwaukee Wisconsin for their advice and suggestions in the analysis of data collected. A very special thanks to Laura for her willingness to provide many suggestions and much advise. I sincerely thank the members of my graduate committee, Drs. Rebecca Donatelle, Jan Hare, Anna Harding, Ray Tricker, and Jeff McCubben, for their valuable input and interest in this study. I am especially appreciative of the contributions of Dr. Jan Hare, my co-chair on this project, who gave generously of her time and counsel. Her expertise and understanding throughout this project have been invaluable to me. I would also like to extend the biggest thanks to my major professor, Dr. Rebecca Donate lle, who has given an incredible amount of her time and expertise not only on the completion of this final project but also throughout my entire doctoral study. Her mentoring and guidance provided me with experiences that were extremely helpful in my development as a health professional. Finally, I would like to thank my family for their unceasing encouragement, love, and understanding. I am especially thankful to my parents and my brother Ryan who have always stood behind me and have been a continual source of inspiration to me. TABLE OF CONTENTS Page CHAPTER I 1 INTRODUCTION 1 Statement of the Problem 6 Purpose of the Study 6 Research Questions 7 Significance of the Study 8 Delimitations 9 Limitations 9 Definition of Terms 10 CHAPTER II 11 REVIEW OF THE LITERATURE 11 Euthanasia: A Historical Overview 12 Types of Euthanasia 19 Arguments in Support of Euthanasia 22 Arguments Against Euthanasia 23 Factors Contributing to the Support or Lack of Support for Physician Assisted Suicide and Voluntary Active Euthanasia 25 Psychological Factors 25 TABLE OF CONTENTS (continued) Page Religious Beliefs. 25 Fear of Death 26 Fear of Dependency 27 Demographic Variables 27 Age 28 Gender 28 Education 28 Summary 29 CHAPTER III 31 RESEARCH DESIGN AND METHODS 31 Subject Selection 31 Instrumentation 32 Procedure 33 Data Analysis 33 Research Question #1-#4 33 Research Questions #5, #6, #7, #8 34 Research Questions #9 and #10 35 CHAPTER IV 36 RESULTS 36 Sample 36 Research Question 1 41 Research Question 2 42 TABLE OF CONTENTS (continued) Page Research Question 3 43 Research Question 4 44 Research Question 5 45 Research Question 6 48 Research Question 7 49 Research Question 8 51 Research Question 9 53 Research Question 10 55 CHAPTER V 57 DISCUSSION, CONCLUSIONS, AND RECOMMENDATIONS 57 Discussion 57 Support for physician Assisted Suicide and Voluntary Active Euthanasia 57 Factors Most Predictive of Support for each Medical Vignette (PAS) 58 Factors Most Predictive of Support for each Medical Vignette (VAE) 60 Differences in vignettes by Demographic variables 61 Conclusions .62 Recommendations 64 REFERENCES 66 APPENDICES 73 TABLE OF CONTENTS (continued) Page Appendix A Survey Cover Letter 74 Appendix B Euthanasia Survey 75 LIST OF TABLES Table Page 1. Level of Support for the Right to Request PAS and VAE (Cancer Vignette) 37 2. Level of Support for the Right to Request PAS and VAE (ALS Vignette) 38 3. Level of Support for the Right to Request PAS and VAE (Paralysis Vignette) 39 4. Level of Support for the Likelihood to choose for themselves PAS and VAE (Cancer Vignette) 39 5. Level of Support for the Likelihood to choose for Themselves PAS and VAE (ALS Vignette) 40 6. Level of Support for the Likelihood to Choose for themselves PAS and VAE (Paralysis Vignette) 41 7. Paired t-test for differences between the Right to Request Physician Suicide and the Right to Request Voluntary Active Euthanasia for each Medical Vignette 42 8. Support for the Right to Request PAS versus the Right to Request VAE 42 9. Paired t-tests for differences between the likelihood to request physician assisted suicide and the likelihood to request voluntary active euthanasia for each medical vignette 43 10. Likelihood to Request PAS Versus Likelihood to Request VAE 43 11. Paired t-test for differences between Respondent's support for PAS and their likelihood of requesting PAS for each medical vignette 44 LIST OF TABLES (continued) Table Page 12. Support for the Right to Request PAS versus Respondent's Likelihood to Request PAS 44 13. Paired t-tests for differences between the support for and the likelihood to request voluntary active euthanasia for each medical vignette 45 14. Support for the Right to Request VAE versus Respondent's Likelihood to Request VAE 45 15. Multivariate Tests of Significance for the Main Effect of Vignette on Demographic Variables (PAS) 46 16. Means, Standard Deviations for three Vignettes for PAS by Demographic Variables of Gender and age 46 17. Multivariate Tests of Significance for Vignette by age Effect (PAS) 47 18. Multivariate Tests of Significance for Vignette by Gender Effect (PAS) 47 19. Multivariate Tests of Significance for The Main Effect of Vignette on Demographic Variables (VAE) 48 20. Means, Standard Deviations for three Vignettes for VAE by Demographic Variables of Gender and age 49 21. Multivariate Tests of Significance for The Main Effect of Vignette by Psychological Variables (PAS) 50 22. Means, Standard Deviations for three Vignettes for PAS by Psychological Variables of Fear of Death, Fear of Dependency, and Religious Beliefs 50 23. Multivariate Tests of Significance for The Main Effect of Vignette by Psychological Variables (VAE) 51 24. Means, Standard Deviations for three Vignettes for VAE by Psychological Variables of Fear of Death, Fear of Dependency, and Religious Beliefs 52 LIST OF TABLES (continued) Table Page 25. Multivariate Tests of Significance for the Interaction effect Vignette by Fear of Death 52 26. Multivariate Tests of significance for the three-way interaction effect Vignette by Fear of Death and Fear of Dependency (VAE) 53 27.