Chinese views of euthanasia: A population-based study from Hong Kong to inform policy

Background

Medically-assisted death (MAD), which includes active euthanasia and physician-assisted suicide, is currently prohibited in all countries in Asia. Despite calls for greater public dialogue there are no large-scale studies on the acceptability of MAD to inform health policy.

Objectives

As Hong Kong has one of the oldest populations in the world, this study sought to examine the cultural acceptability of MAD among Chinese adults and factors associated with support/opposition.

Methods

An anonymous, random telephone and internet survey on Hong Kong Chinese adults (age > =35 years) was conducted in May-December 2024 (n = 3100). Respondents were asked their views of legalizing MAD across 7 clinical scenarios and their reasons. Multivariable analysis was conducted to assess correlates of support/opposition to MAD.

Results

The proportion who supported legalization of MAD for the following clinical scenarios varied considerably: terminally ill patients in severe pain (88.8%), non-terminal patients with an irreversible condition and severe pain (84.2%), vegetative patients with advance directives (77.6%), patients with severe disability (60.3%), severe dementia patients with advance directives (46.8%), very old people who wish to discontinue living (31.1%), and patients with unremitting mental illness (20.5%). While 80% accepted MAD for at least 3 clinical scenarios only 5.7% rejected all MAD. Nearly half of the respondents said that they would consider seeking MAD overseas if faced with an intolerable disease. Multivariable models revealed that support for MAD was significantly associated with younger age, belief in afterlife, poor health status, low levels of filial piety, high income, poor perception of health services, and low perception of MAD harms (OR: 1.37-3.53).

Conclusions

There is sufficient public support for MAD in Hong Kong for greater policy discussion. Rapidly aging countries in the East Asia region should explore cultural acceptability of MAD.

Key messages

• There is high levels of support for medically assisted death among urban Chinese in high-income regions. Attitudes may be similar for ethnic Chinese living in western countries.

• Perceptions of health care accessibility, quality and affordability influence support for medically-assisted death.