Social Inequalities in Euthanasia Knowledge and Trends in Potential use Two Years Post-Legalization: A Population-Based Study in Basque Country, Spain

Euthanasia was legalized in Spain in 2021 through the Organic Law of Euthanasia Regulation. However, legal recognition does not guarantee equal access as axes of inequality may influence both awareness of the law and attitudes toward its potential use. This study analyzes social inequalities in knowledge about euthanasia legalization and hypothetical behaviors in situations covered by the regulation. A cross-sectional survey was conducted among a representative sample of adults living in the Basque Country, including those who were not born there ( n = 5858). The prevalence of knowledge and willingness to request euthanasia were estimated by social position, and adjusted prevalence ratios were calculated using multivariate Poisson regression models with robust variance. Awareness of the legal right to request euthanasia decreased with lower education and social class and was also lower among older adults, young men, and individuals born in lower-income countries. Willingness to apply for euthanasia showed similar social gradients; however, men were more predisposed overall, and significant age differences appeared mainly among older adults and people not originally from the Basque Country. These findings reveal structural inequities that may constrain effective access to euthanasia despite its legalization, underscoring the need to integrate equity considerations into policies that guarantee an equitable application of the right.