瑞典医学生对医师协助死亡的看法：定量与定性分析

BACKGROUND: Physician-assisted dying (PAD) remains prohibited in Sweden despite increasing public and professional support, and ongoing societal debate. Since medical students are future physicians, they constitute a relevant group for studying potential shifting attitudes to PAD. The present study examined Swedish medical students' attitudes toward PAD, explored how ethical reasoning and individual characteristics relate to these attitudes, and assessed whether value-laden terminology influenced responses.

METHODS: A cross-sectional mixed-methods study was conducted among medical students from all semesters and at all seven Swedish medical faculties (2024-2025). Two parallel questionnaires, differing only in terminology ("physician-assisted dying" [PAD] versus "physician-assisted suicide" [PAS]), were electronically distributed. Each defined the practice as a physician prescribing lethal medication for patient self-administration and presented a clinical vignette designed to reflect a typical case under the Oregon Death with Dignity Act, structured questions and free-text response fields. Quantitative data from the questionnaires were analysed using chi-square tests and qualitative data using thematic analysis. In total, 2,107 responses were included (response rate 23%).

RESULTS: Overall, 57% of the participants supported legalisation of the specific form of PAD described in the vignette, 23% opposed it, and 20% were undecided; 53% reported willingness to personally assist if legal, while 68% opposed mandatory participation. No significant differences were observed between questionnaire versions. Prioritisation of autonomy was associated with support for PAD and willingness to assist, whereas prioritisation of non-maleficence and beneficence was associated with opposition or uncertainty (p < .001). Religious belief was associated with more restrictive attitudes (p < .001). Qualitative findings highlighted tensions between ethical principles, professional responsibility, and concerns about societal and clinical consequences.

CONCLUSIONS: The findings suggest that Swedish medical students generally hold favourable attitudes towards the Oregon model of PAD examined in this study, reflecting a possible shift compared with previous studies. Nevertheless, views remained highly polarised, with respondents presenting strongly argued positions on both sides of the debate. Students' attitudes toward PAD were shaped by ethical frameworks and religious beliefs. The results did not indicate that the choice of a potentially value-laden term such as PAS substantially influenced responses.