Knowledge, attitude, and acceptance of euthanasia among medical students and doctors in Pakistan

Globally, euthanasia is a strongly debated and ethically complex issue, with views shaped by cultural, religious, and moral precepts. In conservative cultures like Pakistan, euthanasia discussions are sensitive and occasionally ignored. This study aims to evaluate medical professionals' and students' knowledge, attitudes, and acceptance of euthanasia in Pakistan. From May 16 to June 16, 2025, a cross-sectional survey was conducted involving 10 Pakistani medical institutions. The study utilized convenience sampling to select MBBS first- and final-year students and practicing doctors with a minimum of 1 year of clinical experience. Outcomes were assessed using a modified Attitudes Toward Euthanasia scale and structured knowledge items to evaluate knowledge of euthanasia, attitudes toward it, and the acceptability of its legalization. Descriptive statistics summarized participant characteristics, while one-way analysis of variance and independent-samples t tests were used to assess differences in mean attitude ratings across demographic categories. Chi-square tests analyzed relationships between categorical factors and euthanasia approval, and Spearman rank correlation examined connections between attitude ratings and continuous variables such as age and clinical experience. Statistical significance was set at P < .05. A study involving 506 participants, including first-year and final-year medical students and practicing physicians, found that only 40.1% favored euthanasia. Knowledge and attitude scores averaged 66.4 ± 10.8 and 8.7 ± 2.1, respectively, with a positive correlation between them (ρ = 0.44, P < .01). Practicing physicians showed significantly higher acceptance than students, particularly those with lower religiosity (P < .05). Acceptance of euthanasia is related significantly to religion and religiosity, with non-Muslims and less religious participants more likely to accept it. Gender, occupation, religion, province, and religiosity were independent predictors of attitude scores, while religion and religiosity were the strongest predictors of approval in logistic regression. Pakistani medical students and doctors possess limited knowledge and varied attitudes toward euthanasia, significantly influenced by professional experience, level of training, and religious beliefs. Misconceptions about the legal and ethical aspects emphasize the need for integrating structured bioethics and end-of-life care education in medical training. Targeted educational initiatives can enhance ethically informed decision-making among healthcare professionals.