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. 2025 May 9;26(1):60.
doi: 10.1186/s12910-025-01219-z.

Attitudes of physicians, nurses, and the general public toward End-of-Life (EoL) decisions in European countries: an umbrella review

Pietro Refolo  1   2   3 , Costanza Raimondi  4   5 , Salvatore Simone Masilla  4   5 , Antonina Argo  6 , Emma Capulli  7 , Silvia Ceruti  8 , Silvia Gonella  9 , Francesca Ingravallo  7 , Guido Miccinesi  9 , Mario Picozzi  8 , Pietro Redaelli  8 , Antonio Gioacchino Spagnolo  4   5
Affiliations

Attitudes of physicians, nurses, and the general public toward End-of-Life (EoL) decisions in European countries: an umbrella review

Pietro Refolo et al. BMC Med Ethics. .

Abstract

Background: End-of-life (EoL) decisions represent some of the most ethically complex and emotionally charged aspects of healthcare. Understanding the attitudes of physicians, nurses, and the public toward EoL decisions is crucial for aligning care provided with the personal values and preferences of patients.

Aim: To explore the attitudes of physicians, nurses, and the general public toward EoL decisions, including the withdrawal or withholding of life-sustaining treatments, euthanasia, physician-assisted suicide (PAS), palliative sedation, and advance care planning (ACP) within European countries.

Design: An umbrella review was conducted, covering the period from January 2010 to June 2024. The search strategy included Medline, CINAHL, and PsycINFO, supplemented by manual searches of reference lists of all included studies to identify additional relevant studies.

Results: The search identified 587 papers, 11 of which were included in the synthesis. Of these, six addressed euthanasia and PAS, three focused on ACP, one on the withdrawal of life-sustaining treatments, and one on palliative sedation. In Europe, the general public expressed the highest level of support for EoL practices such as euthanasia and PAS, followed by nurses, while physicians often held a more cautious perspective. For withdrawal of treatment, palliative sedation, and ACP, a critical recurring theme was the need to improve communication between patients and healthcare professionals.

Conclusions: The divergence underscores the intricate complexity of navigating ethical, cultural, and professional considerations in EoL care. Effective communication serves as a cornerstone for respecting patient autonomy and ensuring that healthcare decisions align with individual values, goals and preferences.

Keywords: Advance care planning (ACP); Attitude; End-of-life (EoL) decision; Euthanasia; Palliative sedation; Physician-assisted suicide (PAS); Withdrawal of treatment.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Prisma flow diagram – Identification of relevant studies
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