Attitudes of older adults toward active euthanasia in advanced Alzheimer's disease

Background: Active euthanasia by physicians involves administering a substance that directly causes a patient's death. In Alzheimer's disease, progressive cognitive decline and increasing dependence raise complex ethical and emotional dilemmas. Although legalized in some countries, active euthanasia remains controversial, with public attitudes shaped by multiple factors, particularly in advanced disease stages. Objective: This study examined older adults’ attitudes toward active euthanasia in advanced Alzheimer's disease from three perspectives: toward themselves, a family member, and an unknown individual. It also explored associations between sociodemographic and psychosocial variables and these attitudes. Methods: A quantitative study was conducted with 501 individuals aged 75+, recruited through day centers and snowball sampling. Attitudes were measured using hypothetical cases involving euthanasia decisions for oneself, a family member, and an unknown individual. Variables included self-efficacy, will to live, desire to prolong life, life satisfaction, fear of death, social support, and sociodemographic characteristics. Analyses employed mean comparisons and hierarchical linear regression models. Results: Participants reported the most favorable attitudes toward euthanasia when considering themselves (M = 3.61), followed by a family member (M = 3.22), with the least favorable attitudes expressed toward an unknown individual (M = 2.86). Lower desire to prolong life and higher self-efficacy predicted more positive attitudes across all cases, while lower will to live was positively associated only in personal and familial contexts. Female gender, higher education, and lower religiosity were linked to more favorable attitudes across all contexts. Conclusions: Sociodemographic and personality characteristics should be considered when developing strategies aimed at increasing public awareness of active euthanasia, especially among older adults.