Vol. 16 No. 1 | ISSN: 0834-1729
The Impact of Religious Affiliation and Religious Practices on Attitudes Toward Euthanasia

by John Pollard
The mystery of life -- and death -- has intrigued thinkers since time immemorial, and these questions are still with us today. What meaning does our life have -- or our death? This article focuses on decisions we make at the end of our lives, or when we become terminally ill, that relate to our treatment options, but also to our subjectively-felt quality of life and the meaning we attach to our final days. The central question here is how our deepest values and, in particular, our religious affiliations and practices, influence our decisions about life and death. Religion is considered to be an important variable in this research since religious affiliations and practices often play a part in many of the important life transitions that we experience (e.g., births, marriages, and funerals, etc.) and in values that come to be important to us (e.g., moral values of right and wrong, etc.). These affiliations and practices could significantly impact our attitudes toward choices we may have to make if we, or those we are close to, become terminally ill. This research, thus, explores how our deepest beliefs about living inform our practices around dying.
Public Opinion
North American public opinion polls have demonstrated increasing support for euthanasia over the past 50 years. Although the wording of the survey questions has changed over time and sampling procedures have varied from study to study, there is indisputable evidence that the general public is becoming increasingly comfortable with the notion of euthanasia, including active voluntary euthanasia. In 1994, the National Angus Reid Poll found that 74 percent of Canadians believed a medical doctor should be able to legally help a terminally ill patient end their life if this is what they want. Public opinion in favour of euthanasia, including assisted suicide, is not restricted to North America. A national study in Australia in 1995 found 78 percent of respondents agreeing that a doctor should be able to legally give a lethal substance to a patient who was hopelessly ill, in great pain, and who had no chance of a recovery. Nation-wide polls in Britain have also been remarkably consistent over time, showing a strong majority (up to 82 percent in one survey) to be in favour of legalized voluntary euthanasia.

A wide-ranging investigation of attitudes toward euthanasia and assisted suicide was undertaken by a Special Committee set up by the Senate of Canada in 1994. The Committee met with hundreds of groups and individuals, representing a wide range of opinions on this topic. While significant recommendations were put forward in their final report regarding such areas as palliative care, pain control and advance directives, the Committee recommended that no changes be made to Criminal Code subsection 241 which deems it illegal to counsel suicide or to assist in someone else's suicide.

Euthanasia finds its greatest acceptance today in the Netherlands. Most recently, the Dutch government has passed a bill to formally legalize euthanasia and assisted suicide. Heretofore there had been an agreement not to prosecute physicians who help their terminally ill patients commit suicide if they have followed a series of prescribed guidelines. Assisted suicide also became legally sanctioned through the Oregon Death With Dignity Act in October 1997 but recent studies have shown that only a small number of Oregon residents (e.g., 23 individuals in 1998) have received prescriptions for lethal medications under the Act -- and an even smaller number (15 in 1998) have actually chosen to ingest these lethal substances. Though small in scope, these studies suggest that legalizing assisted suicide may not necessarily lead to increased demand nor widespread abuse.
Methods
The survey items measuring attitudes toward euthanasia and assisted suicide that were designed for the current research were included in the Institute for Social Research's Quality of Life survey, which was administered by telephone to a random sample of more than 800 residents of Metropolitan Toronto in 1998. Responses to the questions in this survey are considered to be accurate to within plus or minus 3.4 percentage points, 19 times out of 20. The 1998 Quality of Life study had a response rate of 60 percent which is considered to be good for research studies of a general nature like this one.
Findings
The survey findings, as seen in Table 1, showed that a substantial majority of Torontonians support the notion of euthanasia -- 69 percent of the sample segment who were asked about a scenario depicting passive euthanasia (treatment was withdrawn at the patient's request) reported approving of the doctor's actions and 61 percent of another sample segment who were presented with a case involving active euthanasia (a lethal substance was administered at the patient's request) also said they approved.

Table 1
Attitudes Toward Passive Euthanasia and Active Euthanasia

Level of Approval or Disapproval Passive Euthanasia   Active Euthanasia
Number Percent Number Percent
Strongly approve 125 47 89 33
Somewhat approve 59 22 76 28
Somewhat disapprove 24 9 22 8
Strongly disapprove 25 9 46 17
It depends 11 4 15 6
Don’t know/Refused 25 9 22 8
Total 269 100 270 100

An important methodological approach that was used involved challenging respondents to see how firmly they held their opinions. Those approving of euthanasia, for example, were asked if they would still feel this way if the patient was not in unbearable pain and there was some hope for a longer life, while those disapproving were asked if they would still disapprove if the patient was in unbearable pain and there was no hope for a recovery. A majority of respondents (51 percent) who initially expressed disapproval of euthanasia maintained their disapproving attitude when challenged, whereas a similar majority of survey participants (52 percent) who first expressed approval changed their mind and became disapproving when challenged. These results suggest that approval for euthanasia may be a newly-developing opinion on the part of Torontonians and that attitudes toward this important issue are not yet entrenched. Thus, when challenged, it is possible they retreated to the 'safer' position until they gather more information on this topic. The minority who initially disapproved of euthanasia, however, still disapproved when challenged, suggesting these opinions are firmly held. An important methodological suggestion ensuing from this work, then, is that it may be useful to ask respondents how firmly they hold their opinions when focusing on issues that may be considered controversial or are newly-emergent in the population.

In an effort to examine respondents' attitudes toward euthanasia within a larger civil libertarian context (respondents were asked about their support of the right to choose, including the right to die, versus the sanctity of human life), it was shown that a majority of survey participants (58 percent) supported the right to choose. And finally, shifting respondents out of the philosophical realm and into the political, they were asked whether or not they supported a free vote in the House of Commons on the legalization of euthanasia and, again, a substantial majority (65 percent) said they favoured a free vote on this topic.

An exploration of the impact of respondents' background characteristics on their attitudes toward these issues was undertaken, with a particular focus on the importance of religious affiliation and attendance at religious services. Looking first at religion, it was found that religious affiliation impacted respondents' answers to a number of the issues under examination, particularly to the 'right to life' versus the 'right to choose' item (see Table 2) and the question concerning a free vote. Statistically significant differences were seen, particularly between the group categorized as 'other' (comprised of Muslims, Hindus and smaller groups not categorized elsewhere) and the 'none' group who said they had no religious affiliation. For example, 73 percent of those reporting no religious affiliation supported the right to choose whereas only 31 percent of those categorized as 'other' did so. Seventy-nine percent of those with no religious affiliation supported a free vote on euthanasia in the House of Commons but just 50 percent of the 'other' group felt this way. These findings suggest that those with few or no religious affiliations are more supportive of euthanasia and those with strong religious affiliations of a traditional nature are less supportive of euthanasia.

Table 2
Right-to-Choose’ Versus ‘Right-to-Life’ by Religious Affiliation

Religious Affiliation Right to
Choose		 Right to
Life		 Ambiva-
lent		  Total
No. % No. % No. % No. %
Catholic 150 55 99 36 24 9 273 34
Jewish 23 62 8 22 6 16 37 5
Protestant 173 64 70 26 27 10 270 33
Other 29 31 46 50 17 19 92 11
None 98 73 25 19 11 8 134 17
Total 473 59 248 31 85 11 806 100

Religiosity, as measured by the frequency of attendance at religious services, had an even greater impact on responses. Statistically significant differences were found in almost every survey question on the basis of religiosity, with those attending religious services most frequently responding most 'conservatively' to the survey questions, and those attending least frequently responding most 'liberally.' These findings suggest that those who regularly attend religious services are less supportive of euthanasia and that respondents who rarely or never attend these services are more supportive (see Figure 1).

Figure 1:
Attitudes Toward Passive Euthanasia by Attendance at Religious Services

The item measuring ethnocultural background, replicated from recent Statistics Canada surveys, allowed survey participants to categorize themselves in a variety of ways. The groups self-identified as white and 'other' (this category was re-coded from a number of smaller groups not categorized elsewhere) tended to respond 'liberally' to most of the survey questions, and the black and Asian groups (the Asian group was re-coded from a number of groups with Asian ethnicity) tended to respond 'conservatively,' with the most divergent responses being between the white group and the black group. Multiple regression analysis was undertaken to explore the relative impact of what appeared to be the most important influences on the survey participants' responses, and it was shown that attendance at religious services and, to a lesser degree, ethnicity were the strongest predictors of attitudes toward euthanasia.
Conclusion
The findings in this research have shown that there is substantial support for euthanasia in the City of Toronto, but that when the surface of this support is scratched, it appears to be somewhat equivocal. Perhaps this is a newly-developing interest among this population rather than long-held belief. Support for euthanasia was also related to people's religious practices, with most support coming from those who were least involved in attending religious services. This finding seems to be congruent with the rising secularism and increasing individualism seen in society today. Those who appear to be supportive of autonomy and self-determination, however, are still being challenged by institutional forces which seek to hold the status quo in check. It seems, therefore, that we are still struggling with the tension between public support of euthanasia and the legal prohibition against it, not to mention the ethical dilemmas and difficult decisions facing those caught between these opposing positions.

Perhaps the time is ripe to re-open the debate on the decriminalization of euthanasia and assisted suicide. Other important aspects to consider while pondering possible alternatives to euthanasia and assisted suicide, such as improved pain management and the welcoming environment of hospice, may take on greater importance at this juncture as well. A number of years ago, Sue Rodriguez, in a videotaped message to a parliamentary committee in Ottawa which was meeting to discuss euthanasia and assisted suicide, asked her now-famous question: "I want to ask you, gentlemen, if I cannot give consent to my own death, then whose body is this? Who owns my life?" Perhaps this will be a defining question as we continue to explore the complex intersection of religious affiliations and practices, new approaches to the concept of conscious dying, and individual desire versus the public good, in the coming decades.
John Pollard is a Project Manager at the Institute for Social Research and he edits ISR's Newsletter.
The author would like to thank Professor Toyomasa Fusé, Supervisor of his MA Committee, and Professor Thelma McCormack, Committee Member, for their generous and very gifted guidance of his thesis work, from which this article is drawn.
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