UMS-euthanasia and nursing students' attitudes

Published: 27 April 2022| Version 1 | DOI: 10.17632/4y3txnhg8z.1
Dennis Demedts


Nursing Students’ Attitudes Regarding Euthanasia Due to Unbearable Mental Suffering: A cross-sectional Study Abstract Background: There is an increasing debate on euthanasia worldwide (e.g. Portugal), with some countries, such as Belgium, altering the legal framework. The euthanasia legislation in certain countries notes that 'unbearable suffering' of a mental nature may also be considered grounds for euthanasia. If such legislation becomes standard practice in the field, the consequences for healthcare workers would be significant. Since nursing students are the nurses of the future, it is important to examine their attitudes towards euthanasia due to unbearable mental suffering (UMS-euthanasia). Objective: The current study introduces the adaptation of the validated Euthanasia Attitude Scale (EAS) with a focus on UMS-euthanasia in the Flemish (Belgium) setting, as well as final year nursing students’ attitudes towards UMS-euthanasia. Design: Cross-sectional survey. Setting/ participants: A sample of final-year baccalaureate nursing students (n=273) from eight of the eleven Flemish university colleges that agreed to participate. Methods: Explorative, descriptive cross-sectional study conducted using an e-mail survey. The actual questionnaire contains 21 questions and was developed based on a consensus reached following independent translations by a native English speaker, a health education expert, and an end-of-life specialist. The psychometric properties of the EAS were assessed, including reliability and validity. Independent-Samples T Test was used to investigate relation between demographic and education-related data, and domain and total score of the UMS-EAS-NL. This study received ethical approval from the Ethical Committee of the University Hospital Brussels. This study was not registered. Results: McDonald's Omega was 0.838 for the total EAS scores, supporting the validity of the questionnaire. There is a statistically significant difference in total questionnaire score between those who have been involved in euthanasia and those who have not (95% CI 0.031–0.511), as well as for ‘ethical considerations’ (95% CI 0.064–0.545). There are clinically important results for ‘Treasuring Life’ and ‘Naturalistic beliefs’. Conclusions: This study’s sample is representative of the concerned population. McDonald's Omega quantifies the reliability allowing for some sub-domains. However, in order to compare with similar studies, the Cronbach's alpha was also calculated, and it is similar to previous studies (α=.812). Most of the final-year nursing students supported the availability of UMS-euthanasia. In order to monitor adequate care, it is necessary to prepare nursing students adequately for this complex matter.


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A total of eleven Belgian Dutch-speaking university colleges offering nursing studies exist in Belgium. All final-year bachelor nursing students at these university colleges were invited by the researchers to participate in this study that took place between October 2020 and March 2021. Eight university colleges were willing to distribute the link to the questionnaire of this study to their 670 final-year students by e-mail. The other three university colleges refused to participate in the study. For two of these universities, no reason was stated; in the third one, the students were already involved in other research studies, and the management declined participation. All participants gave their informed consent before participating in the study. This study ensured total anonymity of the participants by using an anonymous survey link to the online questionnaire in the mail (Qualtrics). Three reminders to participate in this questionnaire were sent to all students (after 1 week, after 2 weeks and after 4 weeks). The students who had already participated were thanked for their participation and could ignore the reminders.


Vrije Universiteit Brussel


Nursing, Attitude, Euthanasia