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Fonseca L, Castro L, Gonçalves A, Monteleone F, Rêgo G, Nunes R. Cross-Cultural Adaptation and Validation of an Attitude about Euthanasia Scale in Portuguese Older Adults with Mixed Anxiety-Depressive Disorder. Healthcare (Basel) 2024; 12:1221. [PMID: 38921334 PMCID: PMC11204183 DOI: 10.3390/healthcare12121221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/14/2024] [Accepted: 06/16/2024] [Indexed: 06/27/2024] Open
Abstract
On 25 May 2023, the Portuguese parliament approved the decriminalisation of euthanasia for incurable illnesses. As the experiences of other countries show us, it will be a matter of time before mental disorders are addressed. Studying the phenomenon, particularly in vulnerable groups, in advance is essential for proper law drafting. Therefore, instruments that allow an objective assessment and comparison between groups must be available. This study aims to explore the validation of Faria's attitude about euthanasia scale in Portuguese older adults with mixed anxiety-depressive disorder. A sample of 114 older adults with mixed anxiety-depressive disorder collected by convenience in the Psychiatry Department of Senhora da Oliveira Hospital in Portugal was included. The pre-final version of the scale was tested in a small group with good results. The validity of the internal structure was analysed using exploratory factorial analysis. The internal consistency study verified reliability. For construct validity, we assessed the correlation with other validated scales measuring attitudes toward euthanasia, cognitive performance, personality and empathy. The attitude about euthanasia scale showed good internal consistency. One factor was retained in the principal component analysis. Significant correlations verified construct validity. The results support the scale's usefulness and validity. This study makes available a unique instrument to assess the overall tendency of the attitudes towards euthanasia from the European-Portuguese perspective, which can be used, for example, to compare Portuguese with Brazilian older adults suffering from the same disorder. Furthermore, the adapted scale paves the way for other cross-cultural translations, adaptations, validations, and comparative analyses.
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Affiliation(s)
- Luís Fonseca
- Bioethics Department, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (G.R.); (R.N.)
- Psychogeriatrics Unity, Psychiatry Department, Senhora da Oliveira Hospital, 4835-044 Guimarães, Portugal; (A.G.); (F.M.)
| | - Luísa Castro
- Department of Community Medicine, Information and Health Decisions Sciences, MEDICIS, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal;
- Centre for Health Technology and Services Research (CINTESIS@RISE), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Andreia Gonçalves
- Psychogeriatrics Unity, Psychiatry Department, Senhora da Oliveira Hospital, 4835-044 Guimarães, Portugal; (A.G.); (F.M.)
| | - Francesco Monteleone
- Psychogeriatrics Unity, Psychiatry Department, Senhora da Oliveira Hospital, 4835-044 Guimarães, Portugal; (A.G.); (F.M.)
| | - Guilhermina Rêgo
- Bioethics Department, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (G.R.); (R.N.)
| | - Rui Nunes
- Bioethics Department, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (G.R.); (R.N.)
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Fonseca L, Castro L, Rêgo G, Nunes R. Multidimensional Study of the Attitude towards Euthanasia of Older Adults with Mixed Anxiety-Depressive Disorder. Healthcare (Basel) 2024; 12:1078. [PMID: 38891153 PMCID: PMC11171529 DOI: 10.3390/healthcare12111078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/18/2024] [Accepted: 05/21/2024] [Indexed: 06/21/2024] Open
Abstract
INTRODUCTION This study aims to verify if older adults with mixed anxiety-depressive disorder are more prone to euthanasia and identify factors that interfere with their satisfaction with health and capacity for well-informed decisions. MATERIAL AND METHODS The study applied a paper questionnaire composed of a sociodemographic section and a battery of scales (to assess depression, anxiety, cognitive performance, suicide risk, therapeutic adhesion, functionality, loneliness, attitude towards euthanasia, decision pattern, personality, empathy, and health status) in the Psychogeriatric Unity of Senhora da Oliveira Hospital in Portugal. The sample was collected by convenience to include patients and controls of the same age. Six months later, a reassessment was performed. Patients and controls were compared using descriptive statistics and a multiple-regression model. RESULTS A total of 114 patients and 25 controls were included. Eighty-one point six percent of patients had four or fewer years of schooling. Contrary to controls, they presented mild depressive and anxiety symptoms, loneliness feelings, worse cognitive performance, a more fragile personality, higher personal distress, and a poorer health state. No statistically significant differences were found between controls and patients regarding their attitudes towards euthanasia. Patients more favourable to euthanasia had higher empathic concern, conscientiousness, and fantasy, and lower personal distress. DISCUSSION AND CONCLUSION When addressing euthanasia in these patients, it is crucial to ensure they are fully self-determinate and that all the necessary treatment and support are available. It may not be the case when the educational level is low and a mild disease persists, significantly affecting their well-being and cognitive performance.
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Affiliation(s)
- Luís Fonseca
- Bioethics Department, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (G.R.); (R.N.)
- Psychogeriatrics Unity, Psychiatry Department, Senhora da Oliveira Hospital Guimarães, 4835-044 Guimarães, Portugal
| | - Luísa Castro
- Department of Community Medicine, Information and Health Decisions Sciences, MEDICIS, Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal;
- Centre for Health Technology and Services Research (CINTESIS@RISE), Faculty of Medicine, University of Porto, 4200-450 Porto, Portugal
| | - Guilhermina Rêgo
- Bioethics Department, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (G.R.); (R.N.)
| | - Rui Nunes
- Bioethics Department, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (G.R.); (R.N.)
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Ristic I, Ignjatovic-Ristic D, Gazibara T. Personality traits and attitude towards euthanasia among medical students in Serbia. Int J Psychiatry Med 2024; 59:232-247. [PMID: 37503904 DOI: 10.1177/00912174231191963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
OBJECTIVE Various factors may influence the attitudes of medical students towards euthanasia, including personal values, beliefs, and personality traits. The objective of this study was to examine the attitudes of 2nd and 5th year medical students about euthanasia and the relationship between these attitudes and students' personality traits. METHODS Medical students from the Universities of Kragujevac and Belgrade, Serbia, participated in this study. A questionnaire was administered assessing attitudes toward euthanasia and student personality traits (honesty-humility, emotionality, extraversion, agreeableness, conscientiousness, and openness using the HEXACO-60). RESULTS More than 50% of students in the second year and 60% of students in the fifth year were supportive of euthanasia. Students in the 5th year were 2.5 times more likely to express a concern that euthanasia needs to be clearly regulated by law compared to students in the second year. Adjusted analyses indicated that lower levels of honesty-humility and emotionality were positively correlated with students' belief that euthanasia should be legalized. CONCLUSION Many medical students in Serbia have a positive attitude towards euthanasia. It is important to consider the possible influences of culture, religion, and the law on attitudes towards euthanasia. Undergraduate medical training should include more hours dedicated to palliative care and end-of-life topics to raise awareness of patients' preferences in this regard.
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Affiliation(s)
- Ivan Ristic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Tatjana Gazibara
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Khosravi M. The impact of openness to experience personality trait on attitudes of medical students toward euthanasia: the moderating role of spiritual intelligence. Eur J Transl Myol 2023; 33:11845. [PMID: 37817649 PMCID: PMC10811635 DOI: 10.4081/ejtm.2023.11845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/03/2023] [Indexed: 10/12/2023] Open
Abstract
Euthanasia is the most important ethical challenges in the entire field of medicine. Various factors may influence the medical students' attitudes toward euthanasia, including personal beliefs, values, and personality traits. This research aimed at examining spiritual intelligence as a moderator of the relationship between openness to experience and attitude toward euthanasia. In this cross-sectional study, a total of 219 medical students (85 men and 134 women) in Zahedan, Iran, in 2022, were selected by convenience sampling method and evaluated using the socio-demographic information form (including age, gender, and medical education level), Spiritual Intelligence Self-Report Inventory, 24-item Brief HEXACO Inventory, and Euthanasia Attitude Scale, followed by using SPSS v25 for data analysis. The study results showed that openness to experience positively and spiritual intelligence negatively associated with attitude toward euthanasia. Also, the regression analysis revealed that spiritual intelligence had a moderating role in the relationship between openness to experience and attitude toward euthanasia. It seems that paying attention to personality differences and spiritual intelligence training among medical students can play an important role in changing their attitudes toward euthanasia.
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Affiliation(s)
- Mohsen Khosravi
- Department of Psychiatry, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran; Health Promotion Research Center, Zahedan University of Medical Sciences, Zahedan, Iran, Zahedan University of Medical Sciences, Zahedan.
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The Attitude of Iranian Critical Care Nurses Toward Euthanasia: A Multicenter Cross-sectional Study. Crit Care Nurs Q 2021; 45:62-73. [PMID: 34818299 DOI: 10.1097/cnq.0000000000000389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Today, one of the major ethical challenges facing the world's health care system, and in particular nurses in the intensive care unit, is euthanasia or death out of pity. The aim of this study was to investigate the attitude of Iranian nurses in the intensive care unit toward euthanasia. This was an analytical cross-sectional study using census sampling. The data collection tool was the Euthanasia Attitude Scale. A total of 206 nurses working in the intensive care unit in 4 hospitals in the Mazandaran province of Iran were included in this study. The mean of total Euthanasia Attitude Scale score in intensive care unit nurses was 2.96. The mean euthanasia dimensions were ethical consideration, practical considerations, treasuring life, and naturalistic beliefs, 3.03, 2.92, 2.98, and 2.99, respectively. There was significant but low negative correlation between age and total Euthanasia Attitude Scale score, ethical considerations, and practical considerations. Male nurses exhibited significantly higher Euthanasia Attitude Scale scores, specifically in regard to ethical and practical considerations compared with female nurses. The most Iranian nurses in the intensive care unit had a negative attitude toward euthanasia for patients in the later stages of the disease. However, this opposition was less than similar studies in Iran in the past.
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Bodas M, Velan B, Kaplan G, Ziv A, Rubin C, Peleg K. Assisted life termination and truth telling to terminally ill patients - a cross-sectional study of public opinions in Israel. Isr J Health Policy Res 2020; 9:57. [PMID: 33106184 PMCID: PMC7586668 DOI: 10.1186/s13584-020-00419-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND End-of-life decisions are highly complex socio-normative and ethical phenomena. The goal of this study was to provide an assessment of public opinions in Israel concerning aspects of end-of-life decisions. METHODS An online cross sectional study was performed in February 2020. The primary tool including items pertaining to death assistance and truth telling to patients. A sample of 515 participants representative of the adult Israeli population was obtained. RESULTS The majority of participants (71%) supports telling the entire truth to patients even in harsh conditions. Support for truth telling decreases with affiliation to religion, with as little as 40% support among ultra-orthodox. People with vocational education are the least supportive of truth telling. Concerning doctor assisted death, almost half (49%) of the sample were supportive. Opposition is positively associated with religiosity, with 90% of ultra-orthodox and 58% of religious participants opposing doctor-assisted death, compared to only 18% among seculars. Non-Jews were 3.35 times (95%CI: 1.90, 5.91) more likely to oppose doctor assisted death than Jews (p < .0001). An Interrelationship analysis crossing between attitudes revealed that the largest group (39%) was comprised of participants who support both ("autonomists"). CONCLUSIONS Israelis are overwhelmingly supportive of truth telling to patients. In contrast, Israeli public opinions on doctor assisted death are divided. For both attitudes, religiousness plays a crucial role as a catalyst for conservatism and opposition to change. Almost a half of the public is also supportive of an autonomist approach that would allow patients to decide on ending their own lives.
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Affiliation(s)
- Moran Bodas
- Israel National Center for Trauma & Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 5265601, Ramat-Gan, Israel. .,The Department of Emergency Management & Disaster Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.
| | - Baruch Velan
- Israel National Center for Trauma & Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 5265601, Ramat-Gan, Israel
| | - Giora Kaplan
- Israel National Center for Trauma & Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 5265601, Ramat-Gan, Israel
| | - Arnona Ziv
- Israel National Center for Trauma & Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 5265601, Ramat-Gan, Israel
| | - Carmit Rubin
- Israel National Center for Trauma & Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 5265601, Ramat-Gan, Israel
| | - Kobi Peleg
- Israel National Center for Trauma & Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel Hashomer, 5265601, Ramat-Gan, Israel.,The Department of Emergency Management & Disaster Medicine, School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
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Fernández-Martínez E, Fernández-Muñoz JJ, Romero-Blanco C, Parra-Fernández ML, Onieva-Zafra MD. Spanish Version of the Attitude Towards Euthanasia Scale. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113855. [PMID: 32485846 PMCID: PMC7312573 DOI: 10.3390/ijerph17113855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 11/16/2022]
Abstract
Euthanasia is undoubtedly the protagonist of many of the debates around the end of life both among health staff and in the general population. Considering that nurses provide care for terminally ill patients and support families and patients in their final days, it is essential to know their attitudes towards euthanasia. The aims of the study were to adapt and validate the Attitude Towards Euthanasia scale to a Spanish context, to test the dimensionality and to estimate the reliability of the scale. A cross-sectional study was conducted with a non-probabilistic sample of Spanish health-workers of 201 in a University Hospital in Ciudad Real. A self-reported socio-demographic questionnaire and the Euthanasia Attitude Scale were used for data collection. The psychometric properties of the scale were assessed, including reliability and validity using an exploratory and confirmatory factor analysis. Cronbach's alpha of the Attitude Towards Euthanasia scale was α = 0.827 and McDonald's Omega = 0.903. The range of items of homogeneity was from 0.205 to 0.685. For the different exploratory factor analyses carried out, the Bartlett's test of sphericity was p < 0.001 and the sample index value of Kaiser-Meyer-Olkin was over 0.802. in all cases. We present the factorial weights for three models: The first one assumes a unidimensional solution, the second model was composed by three factors and the third model was composed by four factors. In the confirmatory factor analysis, the three models presented an acceptable fit index. The Attitude Towards Euthanasia scale adaptation to a sample of Spanish health workers has shown, with some limitations, appropriate psychometric properties. There have been several differences between the original factorial solution. It would be necessary to replicate the study to reinforce the findings about the number of factors of the scale.
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Affiliation(s)
| | | | - Cristina Romero-Blanco
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla-La-Mancha, Ciudad Real, 13071 Ciudad Real, Spain; (C.R.-B.); (M.D.O.-Z.)
| | - María Laura Parra-Fernández
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla-La-Mancha, Ciudad Real, 13071 Ciudad Real, Spain; (C.R.-B.); (M.D.O.-Z.)
- Correspondence:
| | - María Dolores Onieva-Zafra
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla-La-Mancha, Ciudad Real, 13071 Ciudad Real, Spain; (C.R.-B.); (M.D.O.-Z.)
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Memaryan N, Ghaempanah Z, Aghababaei N, Koenig HG. Integration of Spiritual Care in Hospital Care System in Iran. JOURNAL OF RELIGION AND HEALTH 2020; 59:82-95. [PMID: 31227979 DOI: 10.1007/s10943-019-00864-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
There is a growing body of evidence on the positive effects of religion and spirituality on recovery from cancer and the ability to cope with it. Most spiritual interventions carried out in Iranian research are based on care and support models that have been developed in the West. With the unique cultural and religious features of the Iranian context, a more refined look at spiritual care in the hospital care system of Iran is called for. This paper examines how to implement the spiritual care of cancer patients in hospitals and oncology wards in Iran. A consensus panel of experts was used to develop guidelines for spiritually integrated care consisting of 18 primary areas, which are described in detail in this report. Health care policy makers and managers of health care in Iran and possibly other areas of the Middle East should consider implementing these guidelines. Using indigenous models and programs specific to the religion and the cultural of a region should be considered when providing spiritual care for cancer patients.
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Affiliation(s)
- Nadereh Memaryan
- Spiritual Health Research Center, Mental Health Department, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Zeinab Ghaempanah
- Spiritual Health Research Center, Iran University of Medical Sciences, Shahid Mansouri Street, Niyayesh Street, Satarkhan Avenue, Tehran, 1445613111, Iran.
- Office of Islamic Studies in Mental Health, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran.
| | - Naser Aghababaei
- Department of Behavioral Sciences, The Institute for Research and Development in the Humanities (SAMT), Tehran, Iran
| | - Harold G Koenig
- Center for Spirituality, Theology and Health Duke University Medical Center, Durham, NC, USA
- Department of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Ningxia Medical University, Yinchuan, People's Republic of China
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Malary M, Moosazadeh M, Moghaddasifar I, Imeni M, Faghani Aghoozi M, Sabetghadam S, Amerian M. Attitude of the Nursing and Midwifery Students of Mazandaran University of Medical Sciences towards Euthanasia. PREVENTIVE CARE IN NURSING AND MIDWIFERY JOURNAL 2019. [DOI: 10.29252/pcnm.8.4.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Levin K, Bradley GL, Duffy A. Attitudes Toward Euthanasia for Patients Who Suffer From Physical or Mental Illness. OMEGA-JOURNAL OF DEATH AND DYING 2018; 80:592-614. [DOI: 10.1177/0030222818754667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
This study examined whether attitudes toward euthanasia vary with type of illness and with the source of the desire to end the patient’s life. The study used a 3 (illness type: cancer, schizophrenia, depression) × 2 (euthanasia type: patient-initiated, family-initiated) between-groups experimental design. An online questionnaire was administered to 324 employees and students from a Australian public university following random assignment of participants to one of the six vignette-based conditions. Attitudes toward euthanasia were more positive for patients with a physical illness than a mental illness. For a patient with cancer or depression, but not schizophrenia, approval was greater for patient-, than, family-, initiated euthanasia. Relationships between illness type and attitudes were mediated by perceptions of patient autonomy and illness controllability. Findings have implications for debate, practices, and legislation regarding euthanasia.
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Affiliation(s)
- Kfir Levin
- School of Applied Psychology, Griffith University, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, QLD, Australia
| | - Graham L. Bradley
- School of Applied Psychology, Griffith University, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, QLD, Australia
| | - Amanda Duffy
- School of Applied Psychology, Griffith University, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, QLD, Australia
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Bulmer M, Bӧhnke JR, Lewis GJ. Predicting moral sentiment towards physician-assisted suicide: The role of religion, conservatism, authoritarianism, and Big Five personality. PERSONALITY AND INDIVIDUAL DIFFERENCES 2017. [DOI: 10.1016/j.paid.2016.09.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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