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. 2025 May 2;25(1):642.
doi: 10.1186/s12909-025-07077-y.

Attitudes of undergraduate medical students towards end-of-life decisions: a systematic review of influencing factors

Julia S Grundnig  1 , Marlen A Roehe  2 , Carmen Trost  2 , Anahit Anvari-Pirsch  2 , Anita Holzinger  2
Affiliations

Attitudes of undergraduate medical students towards end-of-life decisions: a systematic review of influencing factors

Julia S Grundnig et al. BMC Med Educ. .

Abstract

Background: Medical end-of-life decisions, including voluntary active euthanasia (lethal injection), (physician-)assisted dying (prescribing lethal substances), passive euthanasia (refraining from or ceasing life-sustaining treatments), palliative sedation (administering sedatives to alleviate suffering, possibly leading to unintended life-shortening), and treatment withdrawal/withholding, have become prevalent in modern medical practice.

Aim: This systematic review aims to analyse international data on undergraduate medical students' attitudes towards (physician-) assisted dying, palliative sedation, treatment withdrawal/withholding, active and passive euthanasia. The objectives are to assess approval rates over the past 24 years and to identify factors influencing these attitudes.

Design: In accordance with PRISMA guidelines, a systematic search of six electronic databases (MEDLINE, CINAHL, EMBASE, ERIC, PsycINFO, and Web of Science) was conducted. The review encompasses studies from 2000-2024.

Results: Forty-nine studies met the inclusion criteria (43 surveys, 6 qualitative studies, 1 mixed-method study). The studies were globally distributed: Europe (27), Asia (10), America (8), Africa (3), and Australia (1). Predictors such as age, clinical vs. pre-clinical status, religious aspects, sex, and ethnicity were investigated. Age and gender had limited influence, whereas religion was a significant factor. Compared with pre-clinical students, clinical students showed more support for end-of-life practices. Geographic locations and socioeconomic status also affect attitudes.

Conclusion: Medical students' attitudes towards end-of-life decisions are influenced by clinical experience, religious beliefs, and geographic location. The acceptance rates for euthanasia and (physician-)assisted dying vary significantly across regions, reflecting diverse cultural and educational backgrounds.

Keywords: Assisted dying; Assisted suicide; End-of-life decisions; Ethical principles; Euthanasia; Medical students; Palliative sedation; Systematic review; Terminal sedation.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The Ethics Committee of the Medical University of Vienna waived a formal vote for this study, as it did not involve any procedures or interventions that necessitate ethical review according to the institution's guidelines. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

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PRISMA flowchart
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