Attitudes of Flemish secondary school students towards euthanasia and other end-of-life decisions in minors

Background: The aim of the study was to investigate attitudes of secondary school students towards acceptability of requests by minors for end-of-life decisions (ELDs) with a possible life-shortening effect: non-treatment decisions, potentially life-shortening alleviation of pain and symptoms (APS) and euthanasia. Methods: A cross-sectional survey was conducted among second and fourth grades students in 20 secondary schools in Flanders, Belgium. An anonymous structured questionnaire was administered to measure attitudes towards acceptability of requests for euthanasia and other ELDs, towards the right to be informed about terminal prognosis and their own desire to be informed. Results: In total, 1769 students participated. In case of a terminal patient, 61% found a request for euthanasia acceptable, 60% a request for APS and 69% a request for non-treatment decision, compared with 18% (euthanasia) and 50% (APS) in case of a non-terminal patient. Acceptance was highest among: boys, participants older than 14 years and participants from general as opposed to technical and vocational education. Sixty-six per cent said the parents' opinion not being asked was a circumstance that should hold back a physician from administering a lethal drug. Ninety per cent of participants thought a minor has the right to be informed about terminal prognosis of a disease while 78% would like to be informed themselves. Conclusions: Attitudes towards ELD requests varied with case and participant characteristics and type of ELD. The studied adolescents have a clear wish to be informed about terminal prognosis. Physicians and caregivers should adequately involve adolescents in decision making and tailor prognosis-related information to their needs and level of competency