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Complexity of attitudes towards death and euthanasia

Public examination of a doctoral dissertation in the field of Nursing Science

Doctoral candidate: MHSc Anja Terkamo-Moisio

Date and venue: 23.9.2016 at 12 noon, Medistudia, MS300, Kuopio Campus

Language of the dissertation and the public examination: English

The studies this thesis are based upon had the following objectives. First, to reveal and describe attitudes towards death and euthanasia among the general public and nurses in Finland. Then, to explore the factors related to the attitudes and analyse connections between individuals’ death- and euthanasia-related attitudes in both target groups. Finally, to construct an empirical model of factors associated with individuals’ attitudes towards euthanasia.

These objectives were addressed in a qualitative interview-based study and a quantitative web-based survey. Interviewees in the first study were 17 registered nurses who worked in two primary care hospitals in southern Finland. The collected data were analysed with inductive content analysis. Participants in the survey were representatives of the general public (n=2796) and nurses (n=1003), who were recruited via social media and the Finnish Nurses Association members’ bulletin. Data were collected online with a designed electronic questionnaire then analysed using statistical methods and Bayesian network modelling.

Participating nurses and members of the general public in Finland generally had neutral attitudes towards death. The level of fear of death was low in both groups. Furthermore, participants in both groups reported low levels of death avoidance, and more of both groups believed that death could provide welcome escape from a life filled with suffering than in a happy afterlife. Both groups expressed attitudes indicating general approval of euthanasia. Most of the nurses (74.4%) and members of the general public (85.2%) expressed their acceptance of euthanasia as part of Finnish health care. In addition, more than half of the participants in both groups (62.1 and 67.0% respectively) thought that Finland would benefit from a law permitting euthanasia. However, the interviews revealed that nurses had concerns about possible misuse of euthanasia, and that a nurses’ right of conscientious objection to participation in euthanasia was crucial. The empirical model of factors associated with individuals’ attitudes towards euthanasia revealed that profession, religiosity and attitudes towards death were predictors of individuals’ attitudes towards euthanasia. However, religiosity was only a predictor when its component dimensions were separately assessed.

The studies have provided new knowledge about attitudes towards death and euthanasia of nurses and the general public in Finland, and presented a new empirical model that could be employed in future research and education. The studies have several implications. An open dialogue about death and euthanasia at all levels of Finnish society is crucial. More information and death-related education is needed in the nursing profession to improve the quality of end-of-life care. Additional research is needed for further characterization of attitudes towards death and euthanasia.

The doctoral dissertation of Anja Terkamo-Moisio, Master of Health Sciences, entitled Complexity of attitudes towards death and euthanasia will be examined at the Faculty of Health Sciences. The Opponent in the public examination will be Professor Chris Gastmans of KU Leuven, Belgium, and the Custos will be Professor Anna-Maija Pietilä of the University of Eastern Finland.

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