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Attitudes towards assisted dying are influenced by question wording and order: a survey experiment

by Morten MagelssenMagne SupphellenPer Nortvedt and Lars Johan Materstvedt, BMC Medical Ethics, 2016

The Norwegian researchers conducted an experiment to test whether ‘framing effects’ (question wording, order and context) had an effect on people’s views of euthanasia and assisted suicide.

Their conclusion is that “Stakeholders in the assisted dying debate need to acknowledge potential framing effects, and accordingly should interpret survey results with caution. The same holds for researchers who conduct attitude surveys in the field of bioethics.”

Researchers face particular challenges when performing research with this field, which include the following: First, medical end-of-life decision making is an extraordinarily complex activity. Complexity is further compounded by a great variety in terms, definitions and distinctions used in the clinical, ethical and juridical context as well as within the research itself. Second, the field is normatively charged, and partisans often cham- pion their own preferred set of terms, labels and distinctions. This phenomenon is also seen in AD laws; for instance, Oregon’s PAS law is called the “Death with Dignity Act”, avoiding direct reference to PAS and AD. Nor does the text of the law make use of any of these terms.

Both the complexity and the normative charge some- times cause confusion and misunderstanding among citizens, journalists and politicians, as well as among healthcare professionals. In the literature it is, unfortunately, uncommon for attitude surveys to take these issues sufficiently into account. Instead of stating detailed and unequivocal definitions of key concepts and using normatively balanced questions, questionnaires often employ euphemisms and leave crucial terms undefined.


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