Hostname: page-component-76fb5796d-9pm4c Total loading time: 0 Render date: 2024-04-30T02:15:28.024Z Has data issue: false hasContentIssue false
  • English
  • Français

Does voluntary assisted dying cause public stigma for the bereaved? A vignette-based experiment

Published online by Cambridge University Press:  05 January 2021

Sarah Philippkowski Open the ORCID record for Sarah Philippkowski [Opens in a new window] ,
Moira O'Connor ,
Maarten C. Eisma ,
Lindy Willmott ,
Andrew R. Johnson  and
Lauren J. Breen Open the ORCID record for Lauren J. Breen [Opens in a new window]
Sarah Philippkowski
Affiliation:
School of Psychology, Curtin University, Perth, WA6102, Australia
Moira O'Connor*
Affiliation:
School of Psychology, Curtin University, Perth, WA6102, Australia WA Cancer Prevention Research Institute (WACPRU), School of Psychology, Perth, WA6102, Australia
Maarten C. Eisma
Affiliation:
Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, 9701, The Netherlands
Lindy Willmott
Affiliation:
Faculty of Law, Queensland University of Technology, Brisbane, QLD4000, Australia
Andrew R. Johnson
Affiliation:
School of Psychology, Curtin University, Perth, WA6102, Australia
Lauren J. Breen
Affiliation:
School of Psychology, Curtin University, Perth, WA6102, Australia
*
Author for correspondence: Moira O'Connor, School of Psychology, Curtin University, GPO Box U1987 Perth, Western Australia6102, Australia. E-mail: m.oconnor@curtin.edu.au
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Studies in countries where assisted dying is legal show that bereaved people express concern over the potential for social disapproval and social stigma because of the manner of death. There are indications that voluntary assisted dying is judged as less acceptable if the deceased is younger. A vignette-based experiment was used to determine whether public stigma (i.e., negative emotional reactions and desired social distance) and expected grief symptoms are higher for conjugally bereaved people through voluntary assisted dying (vs. long-term illness), when the deceased is a young adult (vs. older adult).

Method

A 2 × 2 randomized factorial design was conducted with 164 Australian adults (130 women, 34 men, Mage = 37.69 years). Each participant was randomized online to read one of four vignettes and completed measures of anger, fear, prosocial emotions, desire for social distance, and expectations of grief symptomatology.

Results

A multivariate analysis of variance (MANOVA) was conducted. Death at a young age (28 years) was significantly associated with stronger negative emotional reactions of fear ($\eta _p^2 = 0.04$, P = 0.048) and anger ($\eta _p^2 = 0.06$, P = 0.010). There were no differences in outcomes associated with the mode of death, nor was there an interaction between mode of death and age group.

Significance of results

Concerns that voluntary assisted dying elicits public stigma appear unfounded. The fact that participants reported significantly higher anger and fear in response to bereaved people experiencing loss at a younger (vs. older) age, irrespective of cause of death, indicates that young people who lose their spouse might benefit from additional support.

Keywords

EuthanasiaGriefPhysician-assisted suicideStigmaVoluntary assisted dying
Type
Original Article
Information
Palliative & Supportive Care , Volume 19 , Issue 5 , October 2021 , pp. 558 - 562
Check for updates
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Aoun, SM, Breen, LJ, Howting, DA, et al. (2015) Who needs bereavement support? A populated based survey of bereavement risk and support need. PLoS ONE 10, 1–14. doi:10.1371/journal.poneCrossRefGoogle Scholar
Aoun, SM, Breen, LJ, White, I, et al. (2018) What sources of bereavement support do bereaved people perceive to be helpful and why? Empirical evidence for the compassionate communities approach. Palliative Medicine 32, 1378–1388. doi:10.1177/0269216318774995CrossRefGoogle Scholar
Australian Bureau of Statistics. (2017). Australians pursuing higher education in record numbers. Available at: https://www.abs.gov.au/AUSSTATS/abs@.nsf/mediareleasesbyReleaseDate/1533FE5A8541D66CCA2581BF00362D1DGoogle Scholar
Bevacqua, F and Kurpius, SER (2013) Counseling students’ personal values and attitudes toward euthanasia. Journal of Mental Health Counseling 35(2), 172–188.CrossRefGoogle Scholar
Blendon, RJ, Szalay, US and Knox, RA (1992) Should physicians aid their patients in dying?: The public perspective. JAMA 267(19), 2658–2662. doi:10.1001/jama.1992.03480190102042CrossRefGoogle ScholarPubMed
Cohen, J (2013) Statistical Power Analysis for the Behavioral Sciences. New York, NY: Academic Press.10.4324/9780203771587CrossRefGoogle Scholar
Corrigan, P (2004) How stigma interferes with mental health care. American Psychologist 59(7), 614–625. doi:10.1037/0003-066X.59.7.614CrossRefGoogle ScholarPubMed
Cryer, REM, Calear, AL, Batterham, PJ, et al. (2018) Suicide, mental, and physical health condition stigma in medical students. Death Studies, 1–7. doi:10.1080/07481187.2018.1539049Google ScholarPubMed
De Ruddere, L, Bosmans, M, Crombez, G, et al. (2016) Patients are socially excluded when their pain has no medical explanation. Journal of Pain 17(9), 1028–1035. doi:10.1016/j.jpain.2016.06.005CrossRefGoogle ScholarPubMed
Downie, J and Oliver, K (2016) Medical certificates of death: First principles and established practices provide answers to new questions. Canadian Medical Association Journal 188(1), 49–52.CrossRefGoogle ScholarPubMed
Eisma, MC (2018) Public stigma of prolonged grief disorder: An experimental study. Psychiatry Research 261, 173–177. doi:10.1016/j.psychres.2017.12.064CrossRefGoogle ScholarPubMed
Eisma, MC, te Riele, B, Overgaauw, M, et al. (2019) Does prolonged grief or suicide bereavement cause public stigma? A vignette-based experiment. Psychiatry Research 272, 784–789. doi:10.1016/j.psychres.2018.12.122CrossRefGoogle ScholarPubMed
Faul, F, Erdfelder, E, Lang, AG, et al. (2007) Statistical power analyses using G*Power 3.1: Tests for correlation and regression analyses. Behaviour Research Methods 41, 1149–1160. doi:10.3758/BRM.41.4.1149CrossRefGoogle Scholar
Frileux, S, Lelièvre, C, Muñoz Sastre, MT, et al. (2003) When is physician assisted suicide or euthanasia acceptable? Journal of Medical Ethics 29(6), 330. doi:10.1136/jme.29.6.330CrossRefGoogle ScholarPubMed
Gamondi, C, Pott, M, Forbes, K, et al. (2015) Exploring the experiences of bereaved families involved in assisted suicide in southern Switzerland: A qualitative study. BMJ Supportive & Palliative Care 5(2), 146. doi:10.1136/bmjspcare-2013-000483CrossRefGoogle ScholarPubMed
Gamondi, C, Pott, M, Preston, N, et al. (2018) Family caregivers’ reflections on experiences of assisted suicide in Switzerland: A qualitative interview study. Journal of Pain and Symptom Management 55(4), 1085–1094. doi:10.1016/j.jpainsymman.2017.12.482CrossRefGoogle ScholarPubMed
Goffman, E (1968) Stigma: Notes on the Management of Spoiled Identity. Harmondsworth: Penguin.Google Scholar
Government of the State of Victoria (2017) Parliament of Victoria voluntary assisted dying act 2017. No 61 of 2017. Available at: http://www.legislation.vic.gov.au/Domino/Web_Notes/LDMS/PubStatbook.nsf/f932b66241ecf1b7ca256e92000e23be/B320E209775D253CCA2581ED00114C60/$FILE/17-061aa%20authorised.pdfGoogle Scholar
Hirooka, K, Fukahori, H, Ozawa, M, et al. (2017) Differences in posttraumatic growth and grief reactions among adolescents by relationship with the deceased. Journal of Advanced Nursing 73(4), 955–965. doi:10.1111/jan.13196CrossRefGoogle ScholarPubMed
Hummert, ML (1990) Multiple stereotypes of elderly and young adults: A comparison of structure and evaluations. Psychology and Aging 5(2), 182–193. doi:10.1037/0882-7974.5.2.182CrossRefGoogle Scholar
Kane, JV and Barabas, J (2019) No harm in checking: Using factual manipulation checks to assess attentiveness in experiments. American Journal of Political Science 63(1), 234–249. doi:10.1111/ajps.12396CrossRefGoogle Scholar
Lamers, CPT and Williams, RR (2016) Older people's discourses about euthanasia and assisted suicide: A foucauldian exploration. The Gerontologist 56(6), 1072–1081. doi:10.1093/geront/gnv102CrossRefGoogle ScholarPubMed
Link, BG and Phelan, JC (2006) Stigma and its public health implications. The Lancet 367(9509), 528–529. doi:10.1016/S0140-6736(06)68184-1CrossRefGoogle ScholarPubMed
Link, BG, Cullen, FT, Frank, J, et al. (1987) The social rejection of former mental patients: Understanding why labels matter. American Journal of Sociology 92(6), 1461–1500.10.1086/228672CrossRefGoogle Scholar
Logan, EL, Thornton, JA and Breen, LJ (2018a) What determines supportive behaviors following bereavement? A systematic review and call to action. Death Studies 42, 104–114. doi:10.1080/07481187.2017.1329760CrossRefGoogle Scholar
Logan, EL, Thornton, JA, Kane, RT, et al. (2018b) Social support following bereavement: The role of beliefs, expectations, and support intentions. Death Studies 42(8), 471–482. doi:10.1080/07481187.2017.1382610CrossRefGoogle Scholar
Penman, EL, Breen, LJ, Hewitt, LY, et al. (2014) Public attitudes about normal and pathological grief. Death Studies 38(8), 510–516. doi:10.1080/07481187.2013.873839CrossRefGoogle ScholarPubMed
Price, V and Neijens, P (1998) Deliberative polls: Toward improved measures of “informed” public opinion? International Journal of Public Opinion Research 10(2), 145–176. doi:10.1093/ijpor/10.2.145CrossRefGoogle Scholar
Srinivasan, EG (2019) Bereavement and the oregon death with dignity Act: How does assisted death impact grief? Death Studies 43(10), 647–655. doi:10.1080/07481187.2018.1511636CrossRefGoogle ScholarPubMed
Stolz, E, Burkert, N, Großschädl, F, et al. (2015) Determinants of public attitudes towards euthanasia in adults and physician-assisted death in neonates in Austria: A national survey. PLoS ONE 10(4). doi:10.1371/journal.pone.0124320CrossRefGoogle ScholarPubMed
Tabachnick, BG and Fidell, LS (2013) Using Multivariate Statistics, 6th ed. New York, NY: Pearson/Allyn & Bacon.Google Scholar
The Federal Assembly the Swiss Confederation (2018). Swiss criminal code. Available at: https://www.admin.ch/opc/en/classified-compilation/19370083/201803010000/311.0.pdfGoogle Scholar
Wagner, B, Keller, V, Knaevelsrud, C, et al. (2012) Social acknowledgement as a predictor of post-traumatic stress and complicated grief after witnessing assisted suicide. International Journal of Social Psychiatry 58(4), 381–385. doi:10.1177/0020764011400791CrossRefGoogle ScholarPubMed
White, B and Willmott, L (2018) Future of assisted dying reform in Australia. Australian Health Review 42(6), 616–620. doi:10.1071/AH18199CrossRefGoogle ScholarPubMed
Widrick, RM and Raskin, JD (2010) Age-related stigma and the golden section hypothesis. Aging & Mental Health 14(4), 375–385. doi:10.1080/13607860903167846CrossRefGoogle ScholarPubMed