OMEGA, Vol.

49(2) 109-115, 2004

TURKEY’S PHYSICIANS’ ATTITUDES TOWARD

EUTHANASIA: A BRIEF RESEARCH REPORT

ERDEM ÖZKARA, MD MUSTAFA KARAGÖZ, MD

Dokuz Eylül University, Turkey Akdeniz University, Turkey
HAMIT HANCI, MD ATILLA SENIH MAYDA, MD
Abant Izzet Baysal University, Turkey
MURAT CIVANER, MD
SÜLEYMAN GÖREN, MD
Ankara University, Turkey
Dicle University, Turkey
COSKUN YORULMAZ, MD
AHMET NEZIH KÖK, MD
Istanbul University, Turkey
Atatürk University, Turkey

ABSTRACT
Euthanasia and assisted suicide are subject to an ongoing debate and dis-
cussed with various aspects. Because physicians are in a profession closely
related to euthanasia, their attitudes toward this subject are significant.
Thus, research intending to explore their opinions is carried out in many
countries. In this study, opinions of the physicians regarding euthanasia’s
definition, contents, legal aspects, and acceptable conditions for its appli-
cation are addressed. The questionnaire was given to 949 physicians,
more than 1% of the total working in Turkey. Of the physicians who
participated in the study, 49.9% agreed with the opinion that euthanasia
should be legal in certain circumstances. In addition, 19% had come across
a euthanasia request and the majority of physicians (55.9%) believed that
euthanasia is applied secretly in the country despite the prohibitory legis-
lation. In conclusion, the authors infer from the study itself and believe
that euthanasia should be legal in certain circumstances and that the subject,
which is not in the agenda of the Turkish population, should continue to
be examined.

109
! 2004, Baywood Publishing Co., Inc.
110 / ÖZKARA ET AL.

Euthanasia and assisted suicide involve taking deliberate action to end or assist
in ending the life of another person on compassionate grounds. There is con-
siderable disagreement about the acceptability of these acts and about whether
they are ethically distinct from decisions to forgo life-sustaining treatment.
Legal approaches to euthanasia are not identical in every country due to the
different health systems, economical situations, and cultures. For example, though
euthanasia is legally accepted in certain conditions in the Netherlands, it is
forbidden by law in some countries. In some other countries it is forbidden to
practice although it is not defined in law at all (Akabayashi, 2002; Bernheim,
2001; Inceo!lu, 1999; Kelly & Mcloughlin, 2002; Özkara, 2001, Weber, 2001).
There is increasing pressure to resolve the question whether physicians or
other health care professionals should, in certain circumstances, participate in
intentionally bringing about the death of a patient and whether these practices
should be approved by society as a whole. Because the ethical, legal, and public
policy implications of these questions merit careful consideration, numerous
studies have been run to explore the opinions of patients, lawyers, paramedics, and
especially physicians (Akabayashi, 2002; Dickinson, Lancaster, Clark, Ahmedzai,
& Noble, 2002; Dickinson, Lancaster, Sumner, & Cohen, 1997-98; Kaplan &
Bratman, 1999-2000; Kelly & Mcloughlin, 2002; Maltsberger, 2003; Özkara, et
al., 2000; Özkara, Yemi"cigil, & Dalg!#, 2001; Radulovic & Mojsilovic, 1998;
Suarez-Almazor, Newman, Hanson, & Bruera, 2002).
Since the legalization of euthanasia and physician-assisted suicide is an area
where opinions are sharply opposing, research is required to understand the
basis of physicians’ beliefs. This study was designed to examine the extent and
correlation of physicians’ approval of the legalization of euthanasia and assisted
suicide with regard to their specialties, sex, and workplace in the Turkish
healthcare system.

METHODS
Physicians working in seven geographical regions of Turkey were included
in this study. The physicians were randomly chosen specifically from the central
cities of each region. Of the 77,344 physicians working in Turkey (Turkish Health
Statistics, 2000), 1200 were given questionnaires. Of these 1200, 949 responded—
a reasonably acceptable return rate of 79%. The respondents were asked to
complete a multiple-choice questionnaire that measured their awareness and
attitudes regarding euthanasia. Some of the items of the questionnaire were
prepared by the authors according to previous studies (Özkara, Özdemir, et al.,
2000; Özkara et al., 2001). Previously, age, sex, title, and workplace were
analyzed as independent variables, and the definition of euthanasia, the legal
aspect of euthanasia, and witnessing any request for euthanasia, expectations
about euthanasia, and attitude toward euthanasia were treated as dependent
variables. The data obtained was analyzed using SPSS.
 TURKISH PHYSICIANS AND EUTHANASIA / 111

RESULTS
Of the 949 physicians from the central cities of the seven geographical regions
of Turkey who responded, 59.4% were male and 40.6% were female. Average age
was 33.79 years old. The total number of the physicians and the number of the
respondents are shown in Table 1 according to the regional distribution.
Of the respondents, 48.2% are general practitioners and 51.8% are specialists.
Of the specialists, 47.0% are in surgical branches and 53.0% are in medical
branches.
The distribution of physicians according to the institution in which they work
is shown in Figure 1.

Table 1. Regional Distribution of the Respondents and Total Number

of the Physicians in Turkey
Sum:
No. of No. of No. of No. of Total MDs/
Region specialists respondents practitioners respondents respondents

Marmara-!stanbul 12,225 123 11,537 117 23,762/240

Ege-!zmir 5,277 61 7,044 77 12,321/138
Akdeniz.-Antalya 3,286 62 4,638 70 7,924/132
Int. Anatolia-Ankara 7,901 127 9,708 86 17,609/213
Black Sea-Düzce 2,216 47 3,982 40 6,198/87
East Anatolia Erzurum 1,157 32 2,678 37 3,835/69
Southeast Anatolia
Diyarbakir 960 40 2,049 30 3,009/70

Figure 1. The distribution of physicians according to the

institutions (n = 927).
112 / ÖZKARA ET AL.

The item asking if every individual has a right to terminate his/her own life was
positively replied by 83.8% and negatively by 13.6% of the physicians, while
2.6% replied that “they don’t know” and 15 of the respondents did not reply.
Physicians differed in their definition of euthanasia. A large majority (91.8%)
defined euthanasia as “the performance of death upon the request of a patient,
who has a progressive, unbearable and fatal disease after a long and painful
period with no hope of recovery in today’s medicine, with the assistance of a
physician, in better conditions and without pain”; 5.6% of the respondents defined
it as “the performance of death upon the request of a patient who doesn’t have a
fatal or unbearable disease but is very old, bed-ridden and dependent; and who
cannot continue an active social life and does not desire to wait for the conditions
to deteriorate and give pain to him or the people near him”; and 1.8% defined it
as “an individual’s own decision with free will to end his life and the assistance
of the physician in such a condition.”
A majority of the respondents approved the practice of euthanasia in patients
“very old and dependent to bed” but do not approve of the practice of euthanasia
for “those without a fatal disease.” The physicians’ definitions include notions
of “with no hope for recovery,” “fatal and unbearable disease,” “and request of
the patients,” and “assistance of the physicians.” The response to the question
asking who should decide on using euthanasia when it is considered for an adult
who is unconscious and has a fatal and painful disease is shown in Table 2.
In response to the question asking if legal options should be given to the patient
who has a progressive, unbearable, and fatal disease to request assistance for his
death at the requested time and conditions, of the 935 respondents, 49.9% replied
positively, 38.7% replied negatively, and 11.4% replied as having no opinion.
When asked if they are against the practice of euthanasia or not, 39% (n = 366)
replied that they are not against euthanasia, 61% (n = 583) replied that they are
against the practice for various reasons (Figure 2).
The arguments of the physicians (n = 583) against euthanasia are shown in
Table 3.

Table 2. Who Should Decide for Euthanasia When It is Considered for

for an Adult Who is Unconscious and has a Fatal and Painful Disease

n Percent

No other one 465 51.8

Family + physician 349 38.9
Family 45 5.1
Physician 38 4.2
Total 897 100.0
 TURKISH PHYSICIANS AND EUTHANASIA / 113

Figure 2. Are you against the practice of euthanasia? (n = 949).

Table 3. Arguments Against Euthanasia (n = 583)

n Percent

Probable abuse 360 41.6

Ethically incorrect 216 24.9
Religious 162 18.7
Illegal 97 11.2
Other 31 3.6
Total (more than one option can be chosen) 866 100.0

In response to the question asking if euthanasia practice should be punished,

69.8% (n = 662) replied in favor of no punishment and 30.2% (n = 287) replied
in favor of punishment. The definitions of the crime proposed by those against
euthanasia are shown in Table 4.
Of the physicians, 19% had encountered a request for euthanasia and 81% had
not (n = 903). A majority of the physicians (55.9%) believed that euthanasia,
though illegal, is practiced secretly and 44.1% (n = 897) did not believe that
euthanasia is practiced (Figure 3).
A large majority (84.8%) of the physicians think that it is worthwhile to
publicly debate euthanasia in Turkey.

Table 4. The Proposed Definition of the Crime Committed

by the Physician

Crime n Percent

Assisted suicide 133 46.3

A less severe crime 81 28.2
Homicide 73 25.5
Total 287 100.0
114 / ÖZKARA ET AL.

Figure 3. “Do you believe that euthanasia is practiced,

though illegal, in TURKEY?” (n = 897).

CONCLUSIONS

Currently, euthanasia is not in the agenda of public debate in Turkey. But it

is clear that, in a country where 19% of the physicians were requested to perform
euthanasia and where 55.9% believed that it is practiced secretly, this subject must
be discussed among scientific circles. The opinions of those holding professions
concerning euthanasia and the patients they serve must be evaluated. As a matter
of fact, the respondent physicians suggest that an open and public debate will be
useful in this issue. Furthermore, in the dawn of legal arrangements about
euthanasia, not only the physicians but also the suggestions of the public and the
concerned professionals must be taken into account when seeking the most
appropriate course regarding euthanasia for Turkey.

REFERENCES

Akabayashi, A. (2002). Euthanasia, assisted suicide, and cessation of life support:

Japan’s policy, law, and an analysis of whistle blowing in two recent mercy killing cases.
Social Science & Medicine, 55, 517-527.
Bernheim, J. L. (2001). Euthanasia in Europe. Lancet, 357, 1038.
Dickinson, G. E., Lancaster, C. F., Clark, D., Ahmedzai, S. H., & Noble, W. (2002).
U.K. physicians toward active voluntary euthanasia and physician-assisted suicide. Death
Studies, 26, 479-490.
Dickinson, G. E., Lancaster, C. F., Sumner, E. D., & Cohen, J. S. (1997-1998).
Attitudes toward assisted suicide and euthanasia among physicians in South Carolina and
Washington. Omega, 36(3), 201-218.
$nceo!lu, S. (1999). Right to die—Euthanasia (Ölme Hakk!-Ötanazi) (1st ed.,
pp. 135-254). Istanbul: Ayr!nt! Yay!nlar!. (in Turkish)
Kaplan, J. K., & Bratman, E. (1999-2000). Gender, pain, and doctor involvement:
High school student attitudes toward doctor-assisted suicide. Omega, 40(1), 27-41.
Kelly, B. D., & Mcloughlin, D. M. (2002). Euthanasia, assisted suicide and psychiatry:
A Pandora’s box. British Journal of Psychiatry, 181, 278-279.
 TURKISH PHYSICIANS AND EUTHANASIA / 115

Maltsberger, J. T. (2003). The case against assisted suicide: For the right to end-of-life
care. Journal of Nervous & Mental Disease, 191(1), 62-64.
Özkara, E. (2001). Basic concepts and current discussions about euthanasia
(Ötanazide Temel Kavramlar ve Güncel Tart!"malar) (1st ed., pp. 11-46). Ankara: Seçkin
Press. (in Turkish)
Özkara, E., Özdemir, M. H., Dalg!ç, M., Karaku", A., Salaçin, S., & Yemi"cigil, A.
(2000). Physicians approach towards euthanasia (Hekimlerin ötanaziye yakla"!m!). This
study presented as oral presentation IV. Forensic Sciences Congress—$stanbul, Abstract
Book, p. 8. (in Turkish)
Özkara, E., Yemi"cigil, A., & Dalg!ç, M. (2001). The opinions of law school students
on the issue of euthanasia (Hukuk Fakültesi Ö!rencilerinin Ötanaziye Bak!"!). Journal
of Forensic Medicine (Turkey), 15, 46-52. (in Turkish)
Radulovic, S., & Mojsilovic, S. (1998). Attitudes of oncologists, family doctors,
medical students and lawyers to euthanasia. Support Care Cancer, 6, 410-415.
Suarez-Almazor, M. E., Newman, C., Hanson, J., & Bruera, E. (2002). Attitudes
of terminally ill cancer patients about euthanasia and assisted suicide: Predominance of
psychosocial determinants and beliefs over symptom distress and subsequent survival.
Journal of Clinical Oncology, 20(8), 2134-2141.
Turkish Health Statistics (Türkiye Sa!l!k $statistikleri). (2000). Ankara: Turkish
Medical Association Press, pp. 3-68. (in Turkish)
Weber, W. (2001). Netherlands Legalize to Euthanasia. Lancet, 357, 1189.

Direct reprint requests to:

Asst. Prof. Erdem Özkara
Dokuz Eylül University
School of Medicine
Dept. of Forensic Medicine
35300 $zmir-Turkey
e-mail: erdem.ozkara@deu.edu.tr

View publication stats