Knowledge and perception of end-of-life bioethics among medical students. A comparative study between the University of Verona (Italy) and the University of Halle (Germany)

BACKGROUND: End-of-life care raises complex ethical and legal questions shaped by national frameworks, cultural contexts, and personal beliefs. This comparative study explores how fifth-year medical students in Verona (Italy) and in Halle (Germany) understand and evaluate key end-of-life practices, including advance directives, withholding or withdrawing life-sustaining treatment, palliative care, medically assisted suicide, and life termination through drugs. The study also examines whether religiosity influences ethical orientations. METHODS: A structured questionnaire consisting of 16 closed-ended items and one open question was administered to fifth-year medical students at the University of Verona and the University of Halle during the 2024-2025 academic year. Items assessed knowledge of legal frameworks, ethical attitudes, personal experiences with dying patients, and perceived educational preparedness. Descriptive statistics, cross-tabulations, and chi-square tests were used to compare cohorts, with statistical significance set at p < 0.05. RESULTS: A total of 259 valid responses were analyzed. Students in both countries showed strong consensus regarding the legitimacy and clinical usefulness of advance directives and the central role of palliative care. Acceptance of withholding or withdrawing treatment was high in both cohorts, though slightly higher in Germany. Marked differences emerged regarding life termination through drugs, with Italian students expressing more permissive and polarized positions and German students showing more moderate and cautious responses. Attitudes toward medically assisted suicide were broadly permissive in both groups, with religiosity emerging as a consistent predictor of more restrictive positions, particularly in Italy. CONCLUSIONS: While future physicians in both countries share core commitments to patient autonomy and palliative care, significant differences persist in their evaluation of practices intended to hasten death. These findings suggest that ethical orientations at the end of life are shaped not only by shared professional principles but also by national cultural environments and personal belief systems. Comparative research among medical students offers valuable insight into how medico-legal contexts and education influence emerging professional ethics.