Influence of physicians’ life-stance on attitudes towards end-of-life decisions and actual end-of-life decision-making in six countries

Joachim Cohen, Johannes Van Delden, Freddy Mortier, Rurik Löfmark, M. Norup, Colleen Cartwright, K. Faisst, C. Canova, Bregje Onwuteaka-Philipsen, Johan Bilsen

Research output: Contribution to journalArticlepeer-review


Aim: To examine how physicians life stances affect their attitudes to end-of-life decisions and their actual end-of-life decision-making.

Methods: Practising physicians from various specialties involved in the care of dying patients in Belgium, Denmark, The Netherlands, Sweden, Switzerland and Australia received structured questionnaires on end-of-life care, which included questions about their life stance. Response rates ranged from 53% in Australia to 68% in Denmark. General attitudes, intended behaviour with respect to two hypothetical patients, and actual behaviour were compared between all large life-stance groups in each country.

Results: Only small differences in life stance were found in all countries in general attitudes and intended and actual behaviour with regard to various end-of-life decisions. However, with regard to the administration of drugs explicitly intended to hasten the patient s death (PAD), physicians with specific religious affiliations had significantly less accepting attitudes, and less willingness to perform it, than non-religious physicians. They had also actually performed PAD less often. However, in most countries, both Catholics (up to 15.7% in The Netherlands) and Protestants (up to 20.4% in The Netherlands) reported ever having made such a decision.

Discussion: The results suggest that religious teachings influence to some extent end-of-life decision-making, but are certainly not blankly accepted by physicians, especially when dealing with real patients and circumstances. Physicians seem to embrace religious belief in a non-imperative way, allowing adaptation to particular situations.
Original languageEnglish
Pages (from-to)247-253
Number of pages7
JournalJournal of Medical Ethics
Issue number34
Publication statusPublished - 2008


  • religion
  • end of life decisions


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