Euthanasia in Syria: an examination of medical student attitudes and predictors in a conflict zone

Euthanasia remains a contentious issue globally, with attitudes significantly shaped by cultural, religious, and societal factors. In Syria, over a decade of conflict has devastated the healthcare system and created unique ethical challenges for future physicians. This study aimed to assess the attitudes of Syrian medical students toward euthanasia and identify the key predictors influencing their views in a conflict, resource-deprived setting. A cross-sectional study was conducted among 1,509 medical students from four major Syrian universities using an online survey. The questionnaire included socio-demographic questions, the Toronto Empathy Questionnaire, and five clinical scenarios depicting passive euthanasia, active euthanasia, orthothanasia, dysthanasia, and sedation. Data were analyzed using Chi-Square tests and binary logistic regression to identify predictors of agreement with different forms of euthanasia. A majority of students expressed disagreement with most forms of euthanasia, particularly passive euthanasia (78.3% disagreement) and active euthanasia (45.3% disagreement). Strikingly, 60.4% of students agreed with dysthanasia (futile, aggressive treatment). Binary logistic regression revealed that being male, identifying as atheist or Christian (compared to Muslim), and having lower religious commitment were significant predictors of agreement with euthanasia. Higher empathy scores were paradoxically associated with opposition to euthanasia but with support for dysthanasia. Age was a significant predictor only for dysthanasia, with younger students showing more agreement. Syrian medical students’ attitudes toward euthanasia are predominantly conservative, driven strongly by religious beliefs. The widespread support for dysthanasia and the paradoxical role of empathy highlight significant gaps in palliative and end-of-life care education. The unique pressures of the Syrian context, including systemic collapse and pervasive trauma, appear to foster moral distress that shapes these ethical viewpoints. Medical education in Syria must be reformed to include integrated palliative care training and psychological support to prepare students for the complex ethical realities of conflict medical practice.