A medicolegal evaluation of attitudes toward euthanasia: psychometric validation of the ATE scale in Türkiye

Abstract Background Euthanasia remains a complex ethical, legal, and medical issue. Although euthanasia is not legally permitted in Türkiye, understanding medical students’ attitudes toward euthanasia is important for medical education, bioethical debate, and future policy discussions. This study aimed to adapt the Attitudes Toward Euthanasia scale into Turkish, evaluate its psychometric properties among medical students, and interpret the resulting factor structure within a medicolegal context. Methods The final analytical sample comprised 967 medical faculty students. Although law faculty students were initially included in the study design, their low representation precluded meaningful psychometric evaluation; therefore, all analyses were conducted only with medical students. Linguistic equivalence was established through forward–backward translation, expert review, and pilot testing. Because previous cross-cultural adaptations had reported different factor structures, the dataset was randomly divided into two independent subsamples for exploratory factor analysis and confirmatory factor analysis. Analyses were based on the polychoric correlation matrix. Principal axis factoring was used for the exploratory phase, and the unweighted least squares with mean and variance adjustment estimator was used for the confirmatory phase. Reliability was evaluated using McDonald’s omega and stratified alpha. Results Exploratory factor analysis identified a two-factor structure, which was confirmed in the independent confirmatory subsample. The two factors were labeled Patient Request and Doctor’s Authority. The model showed adequate fit: comparative fit index = 0.977, Tucker–Lewis index = 0.970, root mean square error of approximation = 0.079, and standardized root mean square residual = 0.029. The two-factor solution differed from the original four-factor conceptual structure and suggested that patient request was interpreted together with severe suffering in this medical student sample. McDonald’s omega was 0.926 for Patient Request and 0.931 for Doctor’s Authority, and stratified alpha was 0.927 for the total scale. Item discrimination was statistically significant for all items. Conclusions The Turkish version of the Attitudes Toward Euthanasia scale appears to be a valid and reliable instrument for assessing euthanasia-related attitudes among Turkish medical students. Its two-factor structure, centered on Patient Request and Doctor’s Authority, supports its use in medical education, bioethics research, and cross-cultural comparisons. The findings also suggest that some ATE items may carry context-dependent meanings and should be further examined in future content-validity studies.