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Objective: This research examines attitudes of the Austrian population toward various forms of end-of-life (EOL) decisions, including active euthanasia, as intentional and active hastening or induction of death, assisted suicide, as providing a person, upon their voluntary and competent request, with the means and information to end their own life, withholding or withdrawal of life-sustaining treatments, and palliative sedation, as pain-relieving treatment accepting an unintended shortening of life. We aimed to analyze public attitudes toward EOL decisions, including perceptions of legal and ethical regulations, while exploring influencing factors. Understanding these attitudes and determinants can help inform the development of medical curricula, particularly in fostering ethical decision-making in end-of-life care.

Methods: A total of 1,000 individuals from the Austrian general population aged 18 years and older participated in the survey (700 online and 300 via telephone interviews). Using hypothetical vignettes and a questionnaire, the study assesses the acceptance of EOL practices and analyzes differences based on gender, age, and other factors. The structured interviews included questions about ethical considerations, and the evaluation of different EOL options. Data analysis involved qualitative techniques, as well as factor and cluster analyses.

Results: The findings present a nuanced picture. Pain relief through medication, even if it may accelerate the end of life, received broad approval. Factor analysis identified eight key dimensions, including autonomy, risk of abuse, medical-ethical aspects, and the role of family and healthcare professionals. Cluster analysis revealed a polarized stance on active euthanasia, whereas treatment withdrawal and palliative sedation, as well as assisted suicide, found broader acceptance. Differences were particularly evident concerning age, gender, religious activity, and professional involvement in the healthcare sector.

Discussion: The study highlights the complexity of attitudes toward EOL decisions and their significance for medical education. Notably, active euthanasia provokes strong polarization, and there are marked differences between personal and external perspectives. Many respondents believed that the decision regarding EOL decisions should rest with the affected individual, indicating a strong need for autonomy in this sensitive area. This underscores the intricate balance between ethical principles, medical frameworks, and the desire for self-determination. Additionally, a clear association was observed: those advocating for self-determination at the end of life were more likely to support active euthanasia. The findings emphasize the necessity of integrating ethical decision-making processes into the training of healthcare professionals. Case-based, practice-oriented examples could be beneficial in fostering ethical reflection among medical practitioners.