Perceptions and attitudes of medical students and doctors on Euthanasia

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Whether euthanasia is performed with the intention of ending suffering that otherwise cannot be helped should truly be supported. The thoughts on this topic- especially of those who work closely with patients who suffer from terminal illnesses- healthcare providers must be analyzed. Their perception and views on legalizing the procedure and their hesitancy or lack thereof to perform such a procedure would give the rest of the world a clearer picture- a better standpoint to understand what to do. This study attempted to quantify and analyze the views of doctors and medical students regarding euthanasia. Methods A cross-sectional survey of 212 doctors and medical students at a private medical college in South India was conducted to determine their attitudes toward euthanasia. Results Most participants (66%) supported the practice of euthanasia. The majority of participants also believed that euthanasia should only be performed with the explicit consent of the patient (71.7%). It was also observed that those who had heard about euthanasia via hearsay mostly agreed that it must only be performed with the explicit consent of the patient. Moreover, the study showed that those who had heard about it from hearsay and news mostly stood for it. Conclusion It has been noted that news and media all around us heavily influence people’s opinions. It is concluded that these opinions have changed from the past, and will likely do so depending on the environment and media around the topic. 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F1000Research 2024, 13 :1009 ( https://doi.org/10.12688/f1000research.153956.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Research Article Perceptions and attitudes of medical students and doctors on Euthanasia [version 1; peer review: 2 not approved] Rohith Motappa https://orcid.org/0000-0002-8939-2850 1 , Ajay Mallya https://orcid.org/0000-0002-2280-3176 2 , Meghna Guleria 3 , [...] Aditi Singhal 3 , Pallavi Nambiar 3 , Vaibhavi Gaiha 3 , Himani Kotian https://orcid.org/0000-0002-1252-507X 2 Rohith Motappa https://orcid.org/0000-0002-8939-2850 1 , Ajay Mallya https://orcid.org/0000-0002-2280-3176 2 , [...] Meghna Guleria 3 , Aditi Singhal 3 , Pallavi Nambiar 3 , Vaibhavi Gaiha 3 , Himani Kotian https://orcid.org/0000-0002-1252-507X 2 PUBLISHED 05 Sep 2024 Author details Author details 1 Department of Community Medicine, Rajajinagar, ESIC Medical College & PGIMSR and Model Hospital, Bangalore, Karnataka, 560010, India 2 Community Medicine, Kasturba Medical College, Mangalore, Karnataka, 575001, India 3 Kasturba Medical College, Mangalore, Karnataka, 575001, India Rohith Motappa Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Ajay Mallya Roles: Conceptualization, Writing – Original Draft Preparation, Writing – Review & Editing Meghna Guleria Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Aditi Singhal Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Software, Supervision, Validation Pallavi Nambiar Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Vaibhavi Gaiha Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Software, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Himani Kotian Roles: Data Curation, Formal Analysis, Validation, Visualization OPEN PEER REVIEW DETAILS REVIEWER STATUS This article is included in the Manipal Academy of Higher Education gateway. Abstract Background The concept of euthanasia has recently come into the spotlight, and cases such as those of Aruna Shanbaug have heavily influenced people’s opinions on the topic. Whether euthanasia is performed with the intention of ending suffering that otherwise cannot be helped should truly be supported. The thoughts on this topic- especially of those who work closely with patients who suffer from terminal illnesses- healthcare providers must be analyzed. Their perception and views on legalizing the procedure and their hesitancy or lack thereof to perform such a procedure would give the rest of the world a clearer picture- a better standpoint to understand what to do. This study attempted to quantify and analyze the views of doctors and medical students regarding euthanasia. Methods A cross-sectional survey of 212 doctors and medical students at a private medical college in South India was conducted to determine their attitudes toward euthanasia. Results Most participants (66%) supported the practice of euthanasia. The majority of participants also believed that euthanasia should only be performed with the explicit consent of the patient (71.7%). It was also observed that those who had heard about euthanasia via hearsay mostly agreed that it must only be performed with the explicit consent of the patient. Moreover, the study showed that those who had heard about it from hearsay and news mostly stood for it. Conclusion It has been noted that news and media all around us heavily influence people’s opinions. It is concluded that these opinions have changed from the past, and will likely do so depending on the environment and media around the topic. READ ALL READ LESS Keywords Euthanasia, legalization, healthcare providers Corresponding Author(s) Ajay Mallya ( [email protected] ) Close Corresponding author: Ajay Mallya Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Motappa R et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Motappa R, Mallya A, Guleria M et al. Perceptions and attitudes of medical students and doctors on Euthanasia [version 1; peer review: 2 not approved] . F1000Research 2024, 13 :1009 ( https://doi.org/10.12688/f1000research.153956.1 ) First published: 05 Sep 2024, 13 :1009 ( https://doi.org/10.12688/f1000research.153956.1 ) Latest published: 31 Mar 2026, 13 :1009 ( https://doi.org/10.12688/f1000research.153956.4 )  There is a newer version of this article available. Suppress this message for one day. Introduction Medical care has advanced several times in the last century, especially in the last few decades. These advances have led to the increased longevity of multiple diseases. On an equal footing, there is an ever-increasing awareness of quality of life. People are becoming cognizant of their right to make decisions not only in their options regarding treatment, but also in their choice to end their lives. Euthanasia is defined as an easy or painless death or intentional ending of the life of a person suffering from an incurable or painful disease at his or her request. 1 It is of two types: active euthanasia, where the physician directly administers a lethal medication and ends a patient’s life, or passive euthanasia, where a patient is allowed to die by witholding life support. 2 It was first legalized in the Netherlands. Subsequently, many countries followed suit, including Belgium, Luxembourg, and Canada. 3 In other countries such as the US, euthanasia is legal in some states only under certain conditions. However, it is still illegal in most countries, and there have been instances in India where euthanasia has been permitted by the courts of India. 4 , 5 Consider, for example, Shanbaug’s case. A nurse, who was assaulted, was left with limited functionality, such as blinking and eating food placed in her mouth. 6 , 7 Even after extensive care was provided by the nursing staff of the hospital she remained in, her quality of life was sub-par. The Supreme Court of India permitted euthanasia to be practiced in her case to end the constant suffering her life had become. Similarly, in the case of P. Rathinam Vs. U.O.I, the Supreme Court decided that the right to life, elaborated upon in Article 21 of the Constitution, includes the right to die. 8 In a subsequent case, Gian Kaur Vs. State of Punjab, the court held that the right to die with dignity is included in Article 21. 4 Clearly, the Supreme Court of India has made its standpoint- in the case of absolute suffering that cannot be helped, if euthanasia helps alleviate said suffering, it may be done. The attitude towards euthanasia has always varied over time. In recent years, there has been an increasing awareness towards the same. Understanding and analyzing the way current and future healthcare providers perceive euthanasia is important, especially in the current world, where debate about legalizing this procedure is ongoing. 9 This study investigates the attitudes and perceptions of medical students and doctors of a private medical college in Karnataka regarding euthanasia and its legislation in India. Objectives 1. To gauge the awareness of Euthanasia in humans among medical students and doctors, 2. To analyse the attitude and perceptions of medical students and doctors on euthanasia Methods Variables: Euthanasia is defined as an easy or painless death or the intentional ending of life of a person suffering from an incurable or painful disease at his or her request. This is also called mercy killing. Study design: Cross-sectional study Study type: Analytical study Study setting: Kasturba Medical College, Mangalore Study population: Medical Undergraduates, Interns and Post-Graduates/Doctors of Kasturba Medical College, Mangalore Inclusion criteria: medical undergraduates, interns, and post-graduuates/doctors who gave their consent. Study duration: 10 th March 2022 to 13 th June 2022 Study sample: 220. 110 Students and 110 Doctors/PGs/interns. Sample size: N=Z α 2 pq/d 2 where Z α = 1.96 for 95% confidence p = proportion of the population which has the attribute in question q = 1-p d = precision The sample size was calculated with the help of a study done by Subba et al., titled “Doctors’ Attitude Towards Euthanasia: A Cross-sectional Study,” conducted in Mangalore, March-April 2010, which found that while 46.8% of doctors justified euthanasia to alleviate suffering. 10 so considering 46.8% as the prevalence of 46.8% was the prevalence of doctors who justified euthanasia and considering 10% relative precision and 95% confidence, the sample size was calculated to be 200. After adding a 10% non-responsive error, the final sample size was calculated to be 220. Sampling strategy: Convenience sampling (non-probability sampling) Tools for data collection: A questionnaire was prepared after extensive review of the literature. Therefore, a semi-structured questionnaire consists of two sections. Section A consists of two parts: demographic details and awareness. Section B consists of Part 1: ATE Scale and Part 2: Perceptions. Scoring and Interpretation: Here, we used the ATE scale to interpret the attitudes of medical undergraduates, interns, and PGs/doctors towards euthanasia based on the Likert Scale. 11 , 12 1 = strongly disagree, 2 = disagree, 3 = neutral, 4 = agree, and 5 = Strongly Agree. Data collection methodology : The study protocol was approved by the Institutional Ethics Committee (IEC) of Kasturba Medical College, Mangalore. After obtaining approval from the Ethics Committee, permission was obtained from the Dean of Kasturba Medical College, Mangalore, and the data were collected after obtaining informed consent from the participants. All methods were performed in accordance with the relevant guidelines and regulations. The questionnaire was sent to the students in the form of a Google link to WhatsApp, e-mail, and Telegram. Online informed consent was obtained from all the participants. Only after consent is given can the Google link for the questionnaire be opened. Data analysis: Data were entered and analyzed using Statistical Software Statistical Package for Social Sciences (SPSS) version 25.0. Descriptive statistics such as mean (standard deviation) and proportion were used to express the results. The various factors associated with attitudes towards euthanasia were analyzed using the chi-square, independent t-test, and linear regression analysis. Ethical consideration: This was a questionnaire-based study of medical undergraduates, interns, and doctors of Kasturba Medical College, Mangalore. The study did not pose any risk to the participants. Interpersonal data will be kept confidential and protected. The records maintained will only be used for research purposes. Entering the research study was voluntary. The participants had the right to stop at any time and did not need to provide any reason for the same. Ethical Approval: was taken from the institutional ethics committee of Kasturba Medical College, Mangalore. On 17-03-2022 (DHR Reg. No. EC/NEW/INST/2020/742) Consent: Informed consent was obtained through a Google Form. The initial section of the questionnaire asked participants whether they consented to participate in the study. Those who selected ‘yes’ were allowed to proceed with the remainder of the questionnaire, while those who selected ‘no’ were not asked any further questions. This procedure was approved by the ethical committee. Results Our results indicated that a significant majority (86.3%) were aware of what euthanasia was, although only 47.2% possessed knowledge of the different types of euthanasia, and even fewer (44.3%) were aware of the legalities of its practice in India. Furthermore, only 30.2% of respondents were familiar with the guidelines used to perform euthanasia. Regarding the sources of their information, 29.2% first learned about euthanasia through news, followed by hearsay and work at 25.9%, and personal research at 18.9%. The majority opinion (71.7%) was that the final decision to administer euthanasia should lie with the patient themselves, while 11.8% believed it should be a family member’s decision, 9% thought it should be the court of law, and 7.5% placed this responsibility on the treating physician. Regarding the stance on euthanasia, 66% of the respondents were in favor, whereas 34% were against it ( Table 1 ). Table 1. Distribution of participants based on opinions about various aspects of euthanasia. Sl. No. Particulars Frequency (n) Percentage (%) 1. Awareness of people on Euthanasia • Aware 183 86.3 • Not aware 29 13.7 2. Knowledge of the types of euthanasia • Aware 100 47.2 • Not aware 112 52.8 3. Legalities concerning the practice of euthanasia in India • Aware 94 44.3 • Not aware 118 55.7 4. Awareness of the guidelines that are used to perform euthanasia • Aware 64 30.2 • Not aware 148 69.8 5. Source of information about euthanasia for the first time • Hearsay 55 25.9 • News 62 29.2 • Personal research 40 18.9 • Work 55 25.9 6. Final proxy to administer euthanasia should lie with • Court of law 19 9 • Patient themselves 152 71.7 • Family member 25 11.8 • Treating physician 16 7.5 7. I am for/against euthanasia • For 140 66 • Against 72 34 A significant majority (86.3%) were aware of what euthanasia was, although only 47.2% possessed knowledge of the different types of euthanasia, and even fewer (44.3%) were aware of the legalities of its practice in India. Furthermore, only 30.2% of respondents were familiar with the guidelines used to perform euthanasia. Regarding the sources of their information, 29.2% first learned about euthanasia through news, followed by hearsay and work at 25.9%, and personal research at 18.9%. The majority opinion (71.7%) was that the final decision to administer euthanasia should lie with the patient themselves, while 11.8% believed it should be a family member’s decision, 9% thought it should be the court of law, and 7.5% placed this responsibility on the treating physician. Regarding the stance on euthanasia, 66% of the respondents were in favor, whereas 34% were against it. Among the reasons for supporting the legalization of euthanasia in India, 110 respondents cited relief of suffering, 91 mentioned valuing patient autonomy, 63 highlighted minimizing financial burden, 48 emphasized better utilization of resources, and 20 had other reasons. Reasons for opposing legalization included potential misuse for criminal reasons (38 respondents), the belief that medicine is meant to preserve life (33 respondents), the view that palliative care is sufficient (23 respondents), violation of medical ethics (23 respondents), religious beliefs (8 respondents), and other reasons (8 respondents) ( Table 2 ). Table 2. Distribution of participants for and against euthanasia based on their justification for their opinion. Sl. No. Particulars Frequency (n) 1. Reason for legalisation of euthanasia in India • Better Utilization of resources 48 • Minimise financial burden 63 • Patient autonomy is valued 91 • To relieve suffering 110 • Others 20 2. Reasons to choose against the legalization of euthanasia in India • Violation of medical ethics 23 • Might be misused for criminal reasons 38 • Palliative care is enough 23 • Religious beliefs 8 • Medicine is to preserve life not end it 33 • Others 8 On further analysis, the source of acquiring information about euthanasia for the first time has a significant bearing on who the participants feel should be the final proxy for administering euthanasia to patients. Further statistical analysis of the variable regarding the source of euthanasia and attitude towards euthanasia was found to be significant ( Table 3 ). Table 3. Associations between variables and attitudes toward Euthanasia. Variable Against For Chi-Square P value Gender Female 44 (61.1%) 84 (60.0%) 0.025 0.876 Male 28 (38.9%) 56 (40.0%) Age >30 years 25 (34.7%) 44 (31.4%) 0.363 18-24 years 43 (59.7%) 86 (61.4%) 25-30 years 4 (5.6%) 10 (7.1%) Year of Study 1 st year 18 (25.0%) 23 (16.4%) 3.275 0.513 2 nd year 18 (25.0%) 42 (30.0%) 3 rd year 1 (1.4%) 4 (2.9%) 4 th year 4 (5.6%) 5 (3.6%) Intern/PG/doctor 31 (43.1%) 66 (47.1%) I heard about Euthanasia for the first time from Hearsay 9 (12.5%) 46 (32.9%) 10.885 0.012 News 26 (36.1%) 36 (25.7%) Personal Research 14 (19.4%) 26 (18.6%) Work 23 (31.9%) 32 (22.9%) We can infer that respondents’ opinions on the legalization of euthanasia in India are highly influenced by the source of acquiring information about euthanasia for the first time, and this was found to be statistically significant ( Table 4 ). Table 4. Association between the source where the participants first heard about euthanasia and who they feel should be the final proxy of euthanasia. I feel the final proxy of the patient should be Hearsay News Personal research Work Chi square value P value Court of law 1 7 2 9 22.303 .008 Euthanasia should only be done with the explicit consent and will of the patient 51 43 26 32 Family member 3 7 7 8 Treating physician 0 5 5 6 Discussion This study analyzed the attitudes and perceptions of healthcare workers towards Euthanasia. The present study was conducted at Kasturba Medical College, Mangalore. The composition of the study participants varied and ranged from doctors, post-graduates, interns, to medical students, although there were more medical students and interns than doctors and post-graduates. The participants were restricted to the students and staff of Kasturba Medical College, Mangalore. Statistical Package for the Social Sciences (SPSS) was used to analyze the data. In the present study, 86.3% of the respondents were aware of the concept of euthanasia. Similar results were obtained in a study conducted in 2013, wherein the majority of selected professionals in New Delhi were aware of the concept of euthanasia. 7 In this study, it was found that the majority of respondents who first encountered euthanasia via news or hearsay were of the opinion that euthanasia should only be practiced with the explicit consent of the patient. 66 Of the respondents, 66% were euthanized, and 34% were against it. Moreover, the majority of people who stood for euthanasia also first encountered euthanasia via news or hearsay. Thus, this study suggests that society and mass media heavily influence controversial topics, such as euthanasia. A systematic review of studies conducted in the UK to assess the attitudes of doctors towards euthanasia was conducted in 2012. This review revealed that the doctors mostly opposed the introduction of physician-assisted suicide (PAS) and Active Voluntary Euthanasia (AVE). Religious reasons were part of why doctors opposed euthanasia. 10 The present study showed majority of the people who were for euthanasia gave the reason “To relieve suffering.” A similar cross-sectional study was conducted in South India in 2011 to assess the attitudes of doctors towards euthanasia, wherein a majority of the respondents (69.3%) supported the concept of euthanasia, giving “relief from unbearable pain and suffering” as the most cited reason for the same. 13 Another study conducted in Sri Lanka in 2021 to analyze attitudes toward euthanasia among medical students showed that 47.1% of the participants favored legalizing euthanasia, whereas 25.9% directly opposed it. 27% were undecided. Participants who came under the undecided category were more likely to have unfavorable ATE. 11 Thus, several studies have shown how the attitudes and perceptions of euthanasia vary among medical practitioners. In conclusion, the attitudes and perceptions of medical practitioners towards euthanasia are varied and heavily influenced by how euthanasia is portrayed in mass media. There has been a gradual shift in people’s general opinions that seem to favor euthanasia, but concerns about its misuse continue to remain. This study was conducted to analyze the attitudes and perceptions of healthcare practitioners towards euthanasia, and has effectively shown how the opinions and views of people shift due to mass media, society, and personal beliefs. It is important to consider the thoughts of medical professionals towards euthanasia - those who work closely with patients - to analyze and understand the highly subjective topic of whether life must be qualitatively viewed or quantitatively. Conclusion In conclusion, euthanasia has been a topic of much debate since the ages and is still illegal in India; however, there is a change in the opinions of people, especially physicians and future caregivers, as is also evident in this study. Physicians’ views on this topic are also influenced by a multitude of factors such as where they first came to know about euthanasia. In this study, we found that the majority of the respondents who first came across euthanasia via news or hearsay were of the opinion that euthanasia should only be practiced with the explicit consent of the patient. 14 Furthermore majority of the people who stand for euthanasia as a practice also first encountered euthanasia via news or hearsay. It would therefore appear that when it comes to such sensitive issues as euthanasia, the people’s opinions are influenced by the society they live in and how euthanasia is being portrayed in that society by means of mass media such as stories, news, articles, television, etc. There is indeed an evident shift in people’s opinions about euthanasia, since the majority of the respondents supported euthanasia and its legalization in this study. However, there are still lingering concerns regarding their possible misuse. Ethics and consent The study protocol was approved by the Institutional Ethics Committee (IEC) of Kasturba Medical College, Mangalore. After obtaining approval from the Ethics Committee, permission was obtained from the Dean of Kasturba Medical College, Mangalore, and the data were collected after obtaining informed consent from the participants. Data availability Underlying data Figshare: Perceptions and Attitudes of Medical Students and Doctors on Euthanasia, https://doi.org/10.6084/m9.figshare.26200124.v2 . 15 This project contains the following underlying data: 1. Data Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Extended data Figshare: Perceptions and Attitudes of Medical Students and Doctors on Euthanasia. https://doi.org/10.6084/m9.figshare.26501110.v2 16 This project contains the following underlying data: 1. Questionnaire - Perceptions and Attitudes of Medical Students and Doctors on Euthanasia Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). References 1. NCI dictionary of Cancer Terms. National Cancer Institute; 2011 [cited 2022 Jul3]. Reference Source 2. Sinha VK, Basu S, Sarkhel S: Euthanasia: An Indian perspective. Indian J. Psychiatry. 2012 Apr; 54 (2): 177–183. PubMed Abstract | Publisher Full Text | Free Full Text 3. Patil YD: Euthanasia and Death with Dignity. JKIMSU. 2016 Jul-Sep; 5 (3): 142–144. Reference Source 4. Mudur G: Indian court says it may sanction euthanasia in the future. BMJ. 2011 [cited 2022 Jul 3]; 342 (mar11 2): d1628. PubMed Abstract | Publisher Full Text Reference Source 5. Kranidiotis G, Ropa J, Mprianas J, et al. : Attitudes towards euthanasia among Greek intensive care unit physicians and nurses. Heart Lung. 2015; 44 (3): 260–263. PubMed Abstract | Publisher Full Text Reference Source 6. Singh N: India is now among select group of nations where passive euthanasia is legal. ThePrint. 2018 [cited 2022 Jul 3]. Reference Source 7. Kamath S, Bhate P, Mathew G, et al. : Attitudes Toward Euthanasia Among Doctors in a Tertiary Care Hospital in South India: A Cross Sectional study. Indian J. Palliat. Care. 2011 Sep [cited 2023 Mar 31]; 17 (3): 197–201. PubMed Abstract | Publisher Full Text | Free Full Text Reference Source 8. Bandewar SV, Chaudhuri L, Duggal L, et al. : The Supreme Court of India on euthanasia: Too little, too late. Indian J Med Ethics. 2018 Apr-Jun; 3 (2): 91–94. PubMed Abstract | Publisher Full Text 9. Mani RK: Constitutional and Legal Protection for Life Support Limitation in India. Indian J. Palliat. Care. 2015 Sep-Dec; 21 (3): 258–261. PubMed Abstract | Publisher Full Text | Free Full Text 10. Subba SH, Khullar V, Latafat Y, et al. : Doctors’ Attitude Towards Euthanasia: A Cross-sectional Study Experience. Japi. 2016; 63. Reference Source 11. Herath HMMTB, Wijayawardhana KWSM, Wickramarachchi UI, et al. : Attitudes on euthanasia among medical students and doctors in Sri Lanka: a cross sectional study. BMC Med. Ethics. 2021 Dec 7; 22 (1): 162. PubMed Abstract | Publisher Full Text | Free Full Text Reference Source 12. Wasserman J, Clair JM, Ritchey FJ: A scale to assess attitudes toward euthanasia. Omega (Westport). 2005; 51 (3): 229–237. PubMed Abstract | Publisher Full Text Reference Source 13. McCormack R, Clifford M, Conroy M: Attitudes of UK doctors towards euthanasia and physician-assisted suicide: a systematic literature review. Palliat. Med. 2012 Jan; 26 (1): 23–33. Erratum in: Palliat Med. 2012 Jul;26(5):770. PubMed Abstract | Publisher Full Text Reference Source 14. Dees MK, Vernooij-Dassen MJ, Dekkers WJ, et al. : Perspectives of decision-making in requests for euthanasia: a qualitative research among patients, relatives and treating physicians in the Netherlands. Palliat. Med. 2013; 27 (1): 27–37. PubMed Abstract | Publisher Full Text 15. Mallya A, Motappa R: Data - Perceptions and Attitudes of Medical Students and Doctors on Euthanasia.xlsx. figshare. 2024 [cited 2024Aug20]. Reference Source 16. Mallya A, Motappa R: Questionnaire - Perceptions and Attitudes of Medical Students and Doctors on Euthanasia. figshare. 2024 [cited 2024Aug20]. Reference Source Comments on this article Comments (0) Version 4 VERSION 4 PUBLISHED 05 Sep 2024 ADD YOUR COMMENT Comment Author details Author details 1 Department of Community Medicine, Rajajinagar, ESIC Medical College & PGIMSR and Model Hospital, Bangalore, Karnataka, 560010, India 2 Community Medicine, Kasturba Medical College, Mangalore, Karnataka, 575001, India 3 Kasturba Medical College, Mangalore, Karnataka, 575001, India Rohith Motappa Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Ajay Mallya Roles: Conceptualization, Writing – Original Draft Preparation, Writing – Review & Editing Meghna Guleria Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Project Administration, Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Aditi Singhal Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Software, Supervision, Validation Pallavi Nambiar Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Vaibhavi Gaiha Roles: Conceptualization, Data Curation, Formal Analysis, Investigation, Methodology, Software, Validation, Writing – Original Draft Preparation, Writing – Review & Editing Himani Kotian Roles: Data Curation, Formal Analysis, Validation, Visualization Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (4) version 4 Revised Published: 31 Mar 2026, 13:1009 https://doi.org/10.12688/f1000research.153956.4 version 3 Revised Published: 05 Sep 2025, 13:1009 https://doi.org/10.12688/f1000research.153956.3 version 2 Revised Published: 30 Jul 2025, 13:1009 https://doi.org/10.12688/f1000research.153956.2 version 1 Published: 05 Sep 2024, 13:1009 https://doi.org/10.12688/f1000research.153956.1 Copyright © 2024 Motappa R et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Motappa R, Mallya A, Guleria M et al. Perceptions and attitudes of medical students and doctors on Euthanasia [version 1; peer review: 2 not approved] . F1000Research 2024, 13 :1009 ( https://doi.org/10.12688/f1000research.153956.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 05 Sep 2024 Views 0 Cite How to cite this report: Buterin T. Reviewer Report For: Perceptions and attitudes of medical students and doctors on Euthanasia [version 1; peer review: 2 not approved] . F1000Research 2024, 13 :1009 ( https://doi.org/10.5256/f1000research.168923.r363347 ) The direct URL for this report is: https://f1000research.com/articles/13-1009/v1#referee-response-363347 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 19 Feb 2025 Toni Buterin , University of Rijeka, Rijeka, Croatia; University of Rijeka Faculty of Health Studies (Ringgold ID: 611977), Rijeka, Primorje-Gorski Kotar County, Croatia Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.168923.r363347 The introduction of the paper effectively introduces the topic of euthanasia, but it contains several weaknesses that reduce its clarity and precision. In such a complex research field, euthanasia should not be narrowed to a classical definition, but instead, it ... Continue reading READ ALL The introduction of the paper effectively introduces the topic of euthanasia, but it contains several weaknesses that reduce its clarity and precision. In such a complex research field, euthanasia should not be narrowed to a classical definition, but instead, it should be expanded and argued as it goes beyond the scope of (only) medicine. Euthanasia involves perspectives from various fields such as philosophy, sociology, law, and theology. Before focusing on India, the introduction should provide a broader overview of global trends in the regulation (and attitudes) toward euthanasia. Many countries adopt varying approaches, from full legalization to strict prohibition, depending on the type and with different exceptions under different conditions. Understanding these variations is crucial for comparison with the Indian legal framework and the consequential attitudes – in this case, of doctors and medical students. The introduction would be clearer and stronger if the global perspective were analyzed first, followed by a more detailed discussion of the Indian case. More precise formulations and better arguments would improve the quality of the paper. The objectives need to be formulated more precisely to be clearer and more strongly justified. The current formulations are incomplete and unclear. This is especially evident when reading the conclusion, where it is difficult to determine if the research objectives have been achieved. The methodology requires a more detailed description. The aim and purpose of the research are unclear. The limitations of the study need to be highlighted, as the choice of participants could lead to bias and limit the representativeness of the population. Participants are from one 'pool' (Kasturba Medical College), which means the results may not be applicable to the broader population of (future) medical professionals in India. The results are brief and need to be expanded. The first two paragraphs are duplicated. In Table 2, it is unclear how the total sample can exceed 100% for female respondents (61.1% for, 60% against). For male respondents, the total is less than 100% (38.9% for, 40% against). Is this an error, or am I misinterpreting it? In the discussion , it is highlighted that attitudes towards euthanasia are highly diverse, but there is a lack of detailed discussion about contradictions within the results themselves (a lot of the content repeats again), as well as the influence of specific sociocultural factors in the context of India and possible causes. Additionally, the potential bias of the sample is not considered, given that the sample is limited to a single medical school. The discussion deviates from the standard academic approach. A more detailed analysis of the causes and broader implications of respondents' attitudes toward euthanasia is needed, with more concrete references to existing works, stronger argumentation, and the presentation of facts derived from research on similar topics. The discussion should also address methods for reducing bias in future research. There is no analysis of trends or a more specific comparison with previous studies. The conclusion is based more on speculation than on the real outcomes of the objectives. In fact, it is unclear from the conclusion whether the stated objectives have been justified. The focus has shifted from assessing awareness and analyzing the attitudes of doctors and students to the influence of the media. How the media (and the way euthanasia is reported) succeeded in steering respondents toward positive attitudes and a significant correlation remains an open question. Since the role of the media in shaping views is already addressed in the discussion and conclusion, it should have been introduced earlier, particularly in relation to its influence on reporting contemporary medico-ethical controversial issues. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? No Competing Interests: No competing interests were disclosed. Reviewer Expertise: Medical ethics, Bioethics, Public health, History of Medicine I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Buterin T. Reviewer Report For: Perceptions and attitudes of medical students and doctors on Euthanasia [version 1; peer review: 2 not approved] . F1000Research 2024, 13 :1009 ( https://doi.org/10.5256/f1000research.168923.r363347 ) The direct URL for this report is: https://f1000research.com/articles/13-1009/v1#referee-response-363347 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 09 Aug 2025 Ajay Mallya , Community Medicine, Kasturba Medical College, Mangalore, 575001, India 09 Aug 2025 Author Response Dear Reviewer Thank you for your insightful feedback. We’ve revised the manuscript to address your comments, improving clarity. Competing Interests: No competing interests were disclosed. Dear Reviewer Thank you for your insightful feedback. We’ve revised the manuscript to address your comments, improving clarity. Dear Reviewer Thank you for your insightful feedback. We’ve revised the manuscript to address your comments, improving clarity. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 09 Aug 2025 Ajay Mallya , Community Medicine, Kasturba Medical College, Mangalore, 575001, India 09 Aug 2025 Author Response Dear Reviewer Thank you for your insightful feedback. We’ve revised the manuscript to address your comments, improving clarity. Competing Interests: No competing interests were disclosed. Dear Reviewer Thank you for your insightful feedback. We’ve revised the manuscript to address your comments, improving clarity. Dear Reviewer Thank you for your insightful feedback. We’ve revised the manuscript to address your comments, improving clarity. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Picón Jaimes YA. Reviewer Report For: Perceptions and attitudes of medical students and doctors on Euthanasia [version 1; peer review: 2 not approved] . F1000Research 2024, 13 :1009 ( https://doi.org/10.5256/f1000research.168923.r360955 ) The direct URL for this report is: https://f1000research.com/articles/13-1009/v1#referee-response-360955 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 29 Jan 2025 Yelson Alejandro Picón Jaimes , Univ Ramon Llul, Barcelona, Spain Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.168923.r360955 Introduction The definition of euthanasia is generally correct, but it could be made more precise by clearly differentiating between active euthanasia, assisted suicide, passive euthanasia, dysthanasia, and orthothanasia. As it stands, the current definition blends technical and common terms, ... Continue reading READ ALL Introduction The definition of euthanasia is generally correct, but it could be made more precise by clearly differentiating between active euthanasia, assisted suicide, passive euthanasia, dysthanasia, and orthothanasia. As it stands, the current definition blends technical and common terms, which may lead to confusion. To enhance global context, more specific data should be included, such as: In the Netherlands, euthanasia was legalised in 2002 under strict criteria. Canada legalised it in 2016 under the term "Medical Assistance in Dying" (MAiD). Providing such details adds precision and context to the information. Additionally, it would be useful to explain how the Gian Kaur judgment laid the foundation for recognising the "right to die with dignity" within the framework of Article 21 of the Indian Constitution. However, it is essential to clarify that this right does not extend to assisted suicide. Methods Definition of Euthanasia in Variables: The definition of euthanasia in the "Variables" section is repetitive (already mentioned in the introduction) and overly general for the methods section. Study Design: The study is referred to as both cross-sectional and analytical, which creates confusion. If the study is cross-sectional, it is typically descriptive rather than analytical. This should be clarified. The word "post-graduuates" in the inclusion criteria contains a typographical error. Sampling Justification: The use of convenience sampling should be justified, and its limitations acknowledged. For example: "Convenience sampling was employed due to the accessibility of participants in an academic setting. While this method may introduce biases, it was suitable for an exploratory, single-centre study." Additionally, if convenience sampling was used (a non-probabilistic method), it should be clarified why a probabilistic sample size calculation was performed. Description of the Questionnaire: The description of the data collection tool (questionnaire) is too short. It does not specify how the questionnaire was validated or whether a pilot study was conducted before its implementation. Data Analysis: The data analysis section is too brief and lacks clarity on the dependent and independent variables. It should also specify the measures of central tendency (e.g., mean, median) and dispersion (e.g., standard deviation) used. Moreover, it should detail which statistical tests were employed to examine associations (e.g., chi-square, t-tests). Ethical Considerations: The ethical considerations section should explain the data protection measures implemented, particularly since the questionnaires were administered virtually. For instance: "All virtual questionnaires were anonymised, and responses were securely stored to ensure data confidentiality. Access to the data was restricted to authorised personnel only." Results The first and second paragraphs of the results section are redundant and repeat the same ideas. This should be streamlined for clarity. The results are purely descriptive, which is inconsistent with the stated study design of an "analytical study." This discrepancy reinforces the idea that the study is descriptive rather than analytical. The results do not adequately address the second study objective: "To analyse the attitude and perceptions of medical students and doctors on euthanasia." A more focused analysis is needed to examine attitudes and perceptions. Statistical tests (e.g., chi-square or regression analysis) could be employed to identify significant factors influencing attitudes. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: Clinical and applied bioethics in the experimental field. Research methodology. Epidemiology and public health I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Picón Jaimes YA. Reviewer Report For: Perceptions and attitudes of medical students and doctors on Euthanasia [version 1; peer review: 2 not approved] . F1000Research 2024, 13 :1009 ( https://doi.org/10.5256/f1000research.168923.r360955 ) The direct URL for this report is: https://f1000research.com/articles/13-1009/v1#referee-response-360955 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Author Response 09 Aug 2025 Ajay Mallya , Community Medicine, Kasturba Medical College, Mangalore, 575001, India 09 Aug 2025 Author Response Dear Reviewer Thank you for your insightful feedback. We’ve revised the manuscript to address your comments, improving clarity. Competing Interests: No competing interests were disclosed. Dear Reviewer Thank you for your insightful feedback. We’ve revised the manuscript to address your comments, improving clarity. Dear Reviewer Thank you for your insightful feedback. We’ve revised the manuscript to address your comments, improving clarity. Competing Interests: No competing interests were disclosed. Close Report a concern Respond or Comment COMMENTS ON THIS REPORT Author Response 09 Aug 2025 Ajay Mallya , Community Medicine, Kasturba Medical College, Mangalore, 575001, India 09 Aug 2025 Author Response Dear Reviewer Thank you for your insightful feedback. We’ve revised the manuscript to address your comments, improving clarity. Competing Interests: No competing interests were disclosed. Dear Reviewer Thank you for your insightful feedback. We’ve revised the manuscript to address your comments, improving clarity. Dear Reviewer Thank you for your insightful feedback. We’ve revised the manuscript to address your comments, improving clarity. Competing Interests: No competing interests were disclosed. Close Report a concern COMMENT ON THIS REPORT Comments on this article Comments (0) Version 4 VERSION 4 PUBLISHED 05 Sep 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 4 5 6 7 Version 4 (revision) 31 Mar 26 Version 3 (revision) 05 Sep 25 read read read read Version 2 (revision) 30 Jul 25 read Version 1 05 Sep 24 read read Yelson Alejandro Picón Jaimes , Univ Ramon Llul, Barcelona, Spain Toni Buterin , University of Rijeka, Rijeka, Croatia; University of Rijeka Faculty of Health Studies (Ringgold ID: 611977), Rijeka, Croatia Dennis Demedts , Vrije Universiteit Brussel, Brussels, Belgium Luis Espericueta , Universidad de Granada, Granada, Spain Janine Penfield Winters , University of Otago, Dunedin, New Zealand Merri Iddrisu , University of Ghana, Accra, Ghana Sofia Salas , Universidad del Desarrollo, Santiago, Chile Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2026 Salas S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 29 Dec 2025 | for Version 3 Sofia Salas , Universidad del Desarrollo, Santiago, Chile 0 Views copyright © 2026 Salas S. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Comments to the authors: Thanks to the authors for giving me the opportunity to review their study that explores the perceptions and attitudes of medical students and physicians from a private medical college in South India toward euthanasia. I agree with them that euthanasia has profound ethical and legal issues. I have some observations and need clarification on some paragraphs. Abstract: Sample size was 212, distributed among medical students and doctors. Please provide more information in this section regarding how many students and doctors participated in the study, and a little more information related to how they were recruited and which year were the students, and the specialty of the doctors. At least from the abstract, there is no data to support this: “The study highlights evolving attitudes toward euthanasia”. Please clarify. Introduction: the authors mention that, worldwide, there are diverse cultural, ethical, and legal perspectives towards euthanasia. Considering this, it should be interesting to give the rationale of exploring the views of medical students and medical doctors at Kasturba Medical College, Mangalore, Karnataka, India. Does this region represent a particular view or cultural context or a particular region within India? Why they choose to do the study at this hospital and not in another one? Or it was for convenience (they work there)? Please clarify. Methods : how was validated the semi-structured questionnaire developed through literature review? Please clarify. Was there any intention to have adequate sampling of participants in different years? It is surprising that there were only 5 and 9 students from years 3 & 4, respectively. Maybe it could be more interesting to have medical students, interns and medical doctors (assuming that residents already are graduated from medical school) as three categories. Results: In India, “interns” are already medical doctors, or are still students? If interns are not yet doctors, maybe it should be better to have a different category (medical students, interns, and doctors). This is important, since they mention that only 39% of the participants are older than 25 y (6.3% were in the 25–30 years age group, and 32.7% were above 30 years). There are some minor inconsistencies regarding the number of participants: in methods they say “110 students, 110 doctors/interns/post-graduates”; in results section, there are 115 students and 97 participants in the other categories. Likewise, they say “out of the 212 people…”, but “Responses to the Attitudes Toward Euthanasia (ATE) Scale showed distinct patterns across the 208 participants”. I assume that there are missing responses, but that should be clear. Table 1 shows the distribution of participants opinions regarding euthanasia. However, if they asked questions to be answered with “aware”, “not aware”, it is very difficult to verify that knowledge. For example: “Legalities concerning the practice of euthanasia in India”, they could answer “fully aware”, but their actual knowledge be wrong. Please clarify. With respect to Table 4, it is rather confusing the way data is presented. I am particularly concerned with the analysis done when there are so few cases (for example, only 5 students in 3 rd year). Please review with an expert if the way you are presenting the data is correct. For example, in table 4, 65% of female participants (84 out of 128) and 66% of males (56 out of 84) favor euthanasia; in other words, there is no gender difference. But the authors calculated the % in the other way. Discussion: Regarding the data provided in this study, it is not clear how they can suggest that there is an evolving regional perspectives post- Shanbaug . There is a huge time lapse between references 10 & 11, so differences cannot be attributed to regional perspectives after a particular case. Conclusion: Data presented in the study do not support that there is “a growing acceptance” of euthanasia in India. Results should not be generalized to a whole country. References: if possible, please include more updated studies. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Yes Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise MD, with expertise in medical education and bioethics. I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (0) Salas S. Peer Review Report For: Perceptions and attitudes of medical students and doctors on Euthanasia [version 1; peer review: 2 not approved] . F1000Research 2024, 13 :1009 ( https://doi.org/10.5256/f1000research.187552.r438853) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-1009/v3#referee-response-438853 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Iddrisu M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 26 Dec 2025 | for Version 3 Merri Iddrisu , University of Ghana, Accra, Ghana 0 Views copyright © 2025 Iddrisu M. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Comments Abstract Clarity -There is a need for more clarity of purpose and methodology in the abstract. It should indicate what was measured in the study. Introduction Context: The legal context of euthanasia is well discussed in the introduction (covering many nations), but some broader discussion of attitudes to and laws on euthanasia worldwide would be beneficial. Definition: Definitions of euthanasia and physician-assisted suicide (PAS) could be clearer, specifically distinguishing between active and passive euthanasia. Literature References: Add such references on modern literature discussing world views of euthanasia and possible consequences. Methods Design: It is essential to clarify the design of the study (cross-sectional and analytical). Consistency in wording should be used throughout the paper. Sample Size Calculation: Please state the rationale for selecting a convenience sampling and clearly indicate its limitations in the methods section. Validation of the questionnaire: A more extensive description of how the questionnaire was developed and validated would strengthen the methodological quality. Results Presentation of Data: The authors should ensure that all tables are clear and presentable. The numbers in Table 2 do not appear to sum correctly; confirm the accuracy of the data. Descriptive vs. Analytical: Both descriptive and analytical statistics are used to meet study objectives. Discussion Role of media: The media's role in influencing public perceptions of euthanasia could be explained with examples and references. Culture: A more nuanced exploration of cultural and religious considerations would have deepened the analysis of perceptions about euthanasia. Comparative analysis: Discussion and comparison of the outcomes qualitatively and quantitatively with other studies conducted in diverse settings. Conclusion Guesswork: Desist from anything that reads like conjecture. Keep conclusions to those that are based purely on the data collected. Implications : Discuss broader policy and practice implications for medical education regarding euthanasia. General Comments Limitations: The authors should clearly present the study's limitations and future research directions. Is the work clearly and accurately presented and does it cite the current literature? Yes Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Psychosocial oncology, women's health, palliative care, and spiritual and ethical issues in healthcare I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Iddrisu M. Peer Review Report For: Perceptions and attitudes of medical students and doctors on Euthanasia [version 1; peer review: 2 not approved] . F1000Research 2024, 13 :1009 ( https://doi.org/10.5256/f1000research.187552.r430565) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-1009/v3#referee-response-430565 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Winters J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 24 Dec 2025 | for Version 3 Janine Penfield Winters , University of Otago, Dunedin, New Zealand 0 Views copyright © 2025 Winters J. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions A nice idea for a study but the execution is unsophisticated and cluncky. Two areas are particularly concerning. The PAS scale is quite an old instrument, and strong arguments can be made that as language has shifted in this field, the work to standardize this as a metric is no longer valid. Terms: I am an expert in this area (terms about end-of-life decisions, palliative care, life-prolonging care, withholding and withdrawing no longer helpful technology, euthanasia, and assisted dying). This field is very difficult in that the meaning of terms is disputed and inconsistent. Because the participants in this study are medical pre-professionals, I strongly recommend using 21 st century medical terminology for euthanasia and assisted dying (EAD). The authors use the term “euthanasia” inconsistently. Particularly noticeable, is the use of the term (incorrectly) in the abstract in variance with the better accepted definition in sentence 2 of the introduction. The term euthanasia has come to mean, as the authors report "Euthanasia entails the deliberate ending of a patient’s life by a healthcare professional, typically through lethal medication, at the patient’s explicit request." While the term "passive euthanasia", was used in the Indian court decision of 2011 is medically outdated and no longer used by medical professionals working with patients and families about the use of technology during the death process. Particularly, the term “passive euthanasia” is avoided by end-of-life specialists and intensive care staff due to confusion with involuntary active euthanasia. Use of the term passive euthanasia signals a philosophy or social sciences perspective rather than the vocabulary used by medical professionals working with patients in settings equipped with advanced life-prolonging technology. In countries with access to modern ICU care, the withdrawal of life-prolonging treatment that does not meet the patients goals of care is described as “forgoing no longer helpful intervention”. Well-known examples of this vocabulary are in the American Academy of Pediatrics statements on forgoing medically provided nutrition and hydration (Diekema Foregoing mediclly provided nutrition and hydration in children, 2009 https://doi-org.ezproxy.otago.ac.nz/10.1542/peds.2009-1299 ) Consider the terms "withholding and withdrawing life-sustaining treatment" and consideration of the modern term "managed withdrawal of life-sustaining medical therapy (MWLSMT)". I recommend considering this term (or citing literature about this term) Because most deaths of young people in modern, well-funded Intensive Care Units occur after withdrawal of life-prolonging technology, medical literature considering paediatric ICU death uses the term ​​​"​​​​managed withdrawal of life-sustaining medical therapy (MWLSMT)" This usually done because the goal of care cannot be met. I recommend these two articles that document this: Sands et al. “Characteristics of deaths in paediatric intensive care: a 10 year study. (2009) Methodology- Please describe how you got 212 respondants out of 220. This is so incredible a response rate that it could appear falsified to some without explanation of how you did this. I am not an expert in methadology so I cannot peer review the remaining parts of this section. Other: I am unsure why the word euthanasia is capitalized in the title. Suggest updating terms. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? No Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Bioethics and Palliative Medicine. Specific research foci: euthanasia, assisted dying, palliative medicine, paediatric palliative care, withholding life-prolonging treatments. I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (0) Winters JP. Peer Review Report For: Perceptions and attitudes of medical students and doctors on Euthanasia [version 1; peer review: 2 not approved] . F1000Research 2024, 13 :1009 ( https://doi.org/10.5256/f1000research.187552.r430867) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-1009/v3#referee-response-430867 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Espericueta L. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 12 Nov 2025 | for Version 3 Luis Espericueta , Universidad de Granada, Granada, Spain 0 Views copyright © 2025 Espericueta L. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Introduction In the definition of euthanasia, the authors state: “typically through lethal medication.” I question the pertinence of typically. What other legally recognized means of performing euthanasia exist? This point should also be reviewed in the definition of PAS. The authors write that “Globally, regulatory approaches differ significantly” and mention the Netherlands, Canada, Belgium, and Luxembourg. However, it is not clear in what sense these frameworks differ significantly . On the contrary, the Benelux countries share many regulatory characteristics concerning assisted dying, and Canada’s legislation is not far from these models. If the goal is to illustrate broader diversity, it would be useful to include Colombia—where euthanasia was decriminalized judicially despite the absence of a specific law—or certain U.S. jurisdictions where only PAS is legal and restricted to terminal illness. Throughout the article, the terms euthanasia and active euthanasia are used. As another reviewer has noted, the most recent literature no longer distinguishes between active and passive euthanasia. Results In the Results section, the authors write: “Of 140 supporters of euthanasia legalization, relief of suffering (110) and patient autonomy (91) were the main reasons, highlighting humanitarian priorities.” Labeling these motivations as humanitarian seems inadequate, as the term is ambiguous. A more precise alternative would be to refer to the bioethical principles of beneficence and respect for autonomy. In any case, this interpretation seems more appropriate for the Discussion section. Discussion In this section, the authors state: “These findings are similar to a study in New Delhi, where 80% of healthcare professionals were aware of euthanasia, but only 50% supported legalization under strict conditions.” However, unless I am mistaken, the cited study does not include such findings. The authors should verify their source. The manuscript also reads: “Religious diversity and collectivist family norms in India also appear to influence opposition: 34% of participants opposed euthanasia, often citing potential misuse (n = 38) or ethical concerns (n = 23).13 These findings align with evidence that religious and cultural values are major determinants of euthanasia attitudes worldwide.” Yet, the data presented do not clearly support that religious diversity influenced opposition, given that religion appeared only eight times in Table 3. Nor is the connection with family norms evident when the two main reasons for opposing euthanasia were its potential misuse and its contradiction with medical deontology. The authors further claim: “These findings align with evidence that religious and cultural values are major determinants of euthanasia attitudes worldwide.” However, neither of the two sources cited identifies religious or cultural values as major determinants worldwide . In fact, one of those studies focuses exclusively on India. While these papers discuss religion and cultural aspects, they are not empirical studies capable of substantiating such a broad claim. A similar issue arises with the statement: “In our study, 71.7% of participants emphasized patient consent, reflecting global trends where patient autonomy is central to legalized euthanasia frameworks.” The cited references—Dutch legislation and a UK-based study—do not justify framing this as a global trend. Overall, the discussion would benefit from deeper engagement with specialized bioethical literature and a more detailed analysis of the study’s results and variables. Conclusions The conclusions are brief—most of the section focuses on limitations. Furthermore, the statement “The findings underscore the tension between ethical principles like autonomy and cultural factors such as religious diversity, shaping diverse perspectives among healthcare providers” is not entirely supported by the data, since, as mentioned above, the results do not indicate religion as a predominant factor. Is the work clearly and accurately presented and does it cite the current literature? No Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? No Competing Interests No competing interests were disclosed. Reviewer Expertise Healthcare policy, bioethics, medical ethics. I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (0) Espericueta L. Peer Review Report For: Perceptions and attitudes of medical students and doctors on Euthanasia [version 1; peer review: 2 not approved] . F1000Research 2024, 13 :1009 ( https://doi.org/10.5256/f1000research.187552.r428352) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-1009/v3#referee-response-428352 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Demedts D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 18 Aug 2025 | for Version 2 Dennis Demedts , Vrije Universiteit Brussel, Brussels, Brussels, Belgium 0 Views copyright © 2025 Demedts D. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Thank you for the opportunity to review your paper: 'Perceptions and attitudes of medical students and doctors on Euthanasia'. Euthanasia is a topic that raises many questions, not least among healthcare students and workers. Please find my comments below: TITLE * Please change 'doctor' to 'physician'. This clarifies that the survey was conducted with MDs, not PhDs. ABSTRACT Background * The concept of euthanasia has recently come into the spotlight... Is this specific to India? Please clarify. * Whether euthanasia is performed with the intention of ending suffering that otherwise cannot be helped should truly be supported... This sentence is a personal statement. It is not appropriate in a scientific presentation of a study. It would be more suitable in an opinion piece. * Please change 'doctor' to 'physician'. This clarifies that the survey was conducted with MDs, not PhDs. * According to the title the aim was to research the perceptions and attitudes instead of the views. Methods * Please also state which questionnaire was used. Indicate the time frame, and confirm whether approval was obtained from a medical ethics committee. Results * Where does the statement “explicit consent of the patient” come from? This cannot be found in the results. Conclusion * The conclusion cannot be derived from the results. Furthermore, it is written in colloquial language. Keywords * Include medical students and physicians as well. INTRODUCTION * These definitions are outdated. Euthanasia is the termination of life by someone other than the person concerned, carried out at their explicit request. Physician-assisted suicide involves obtaining a prescription for lethal substances from a physician with the intention of ending one's own life. Together, these constitute medical assistance in dying. * In the Netherlands and Belgium, assisted dying is also possible for non-terminal suffering, as well as for minors (but only in cases of terminal suffering). METHODS * Please change 'doctor' to 'physician'. This clarifies that the survey was conducted with MDs, not PhDs. RESULTS * Indicate the percentage of respondents in the 18-24 age group. * Please change 'doctor' to 'physician'. This clarifies that the survey was conducted with MDs, not PhDs. * Be careful not to make any interpretations in the results section. This is something for the discussion. * The method indicates that the ATE scale was used. However, the results of this scale cannot be found anywhere. DISCUSSION * You state that 66% of participants support euthanasia. Wouldn't it be better to use the ATE scale, which enables you to calculate an average and indicate whether participants have a positive or negative attitude towards euthanasia? * It is correct to state that the media can play a role. However, you should elaborate on this by explaining how the media can play a role and substantiating your argument with literature. * Same for religious diversity in India and collectivist family norms. * It is correct to suggest that medical curricula should integrate evidence-based euthanasia education. However, this needs to be elaborated further. There are studies on nursing students and euthanasia, as well as a study on simulation education and euthanasia. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Yes Are sufficient details of methods and analysis provided to allow replication by others? Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? No References 1. Demedts D, Magerman J, Goossens E, Tricas-Sauras S, et al.: Using simulation to teach nursing students how to deal with a euthanasia request. PLOS ONE . 2024; 19 (3). Publisher Full Text 2. Demedts D, Fobelets M, Tricas-Sauras S, Bilsen J: Nursing students’ view on their future role and skills regarding euthanasia due to unbearable mental suffering: A mixed-method Study. Nurse Education in Practice . 2023; 71 . Publisher Full Text 3. Radulović D: Euthanasia – A Legal or Medical Issue: A Narrative Review. Iranian Journal of Public Health . 2025. Publisher Full Text 4. Usanos, R. A., Massé García, M. C., Lorenzo Izquierdo, D., & Esquerda Aresté, M. (2025). Euthanasia and the Media in Spain (2019-2021). Eutanasia y Medios de Comunicación en EspaÑa (2019–2021). Cuadernos de bioetica : revista oficial de la Asociacion Espanola de Bioetica y Etica Medica, 36(116), 59–68. https://doi.org/10.30444/CB.185. 5. Grove G, Lovell M, Hughes I, Maehler E, et al.: Voluntary-assisted dying, euthanasia and physician-assisted suicide: global perspectives—systematic review. BMJ Supportive & Palliative Care . 2025; 15 (4): 423-435 Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise Nursing, euthanasia, evidence-based practice, healthcare education, simulation I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (1) Author Response 11 Sep 2025 Ajay Mallya, Community Medicine, Kasturba Medical College, Mangalore, 575001, India Comment: Please change 'doctor' to 'physician'. This clarifies that the survey was conducted with MDs, not PhDs. Response with Action taken: The Authors Agree with the comment and we have changed the title as per the review suggestions Comment: The concept of euthanasia has recently come into the spotlight... Is this specific to India? Please clarify. Response with Action taken: The Authors agree and the Abstract has been revised accordingly Comment: Whether euthanasia is performed with the intention of ending suffering that otherwise cannot be helped should truly be supported... This sentence is a personal statement. It is not appropriate in a scientific presentation of a study. It would be more suitable in an opinion piece. Response with Action taken: The Authors agree and the Abstract has been revised accordingly Comment: Please change 'doctor' to 'physician'. This clarifies that the survey was conducted with MDs, not PhDs. Response with Action taken: The Authors agree and the Abstract has been revised accordingly Comment: According to the title the aim was to research the perceptions and attitudes instead of the views. Response with Action taken: The Authors agree and the Abstract has been revised accordingly Comment: Please also state which questionnaire was used. Indicate the time frame, and confirm whether approval was obtained from a medical ethics committee. Response with Action taken: The authors agree and the abstract has been revised accordingly Comment: Where does the statement “explicit consent of the patient” come from? This cannot be found in the results. Response with Action taken: The authors agree and the abstract has been revised accordingly Comment: The conclusion cannot be derived from the results. Furthermore, it is written in colloquial language. Response with Action taken: The authors agree and the abstract has been revised accordingly Comment: Include medical students and physicians as well. Response with Action taken: we have included the recommended keywords Comment: These definitions are outdated. Euthanasia is the termination of life by someone other than the person concerned, carried out at their explicit request. Physician-assisted suicide involves obtaining a prescription for lethal substances from a physician with the intention of ending one's own life. Together, these constitute medical assistance in dying. Response with Action taken: The authors agree and the introduction section has been revised accordingly. Comment: Please change 'doctor' to 'physician'. This clarifies that the survey was conducted with MDs, not PhDs. Response with Action taken: The authors agree and the manuscript has been revised accordingly Comment: Indicate the percentage of respondents in the 18-24 age group. Done Response with Action taken: The authors agree and the manuscript has been revised accordingly Comment: Please change 'doctor' to 'physician'. This clarifies that the survey was conducted with MDs, not PhDs. Response with Action taken: The authors agree and the manuscript has been revised accordingly Comment: Be careful not to make any interpretations in the results section. This is something for the discussion. Response with Action taken: The authors agree and the manuscript has been revised accordingly Comment: The method indicates that the ATE scale was used. However, the results of this scale cannot be found anywhere. Response with Action taken: The authors had missed this table whie drafting the manuscript. we now have added the same in the results section Comment: * You state that 66% of participants support euthanasia. Wouldn't it be better to use the ATE scale, which enables you to calculate an average and indicate whether participants have a positive or negative attitude towards euthanasia? * It is correct to state that the media can play a role. However, you should elaborate on this by explaining how the media can play a role and substantiating your argument with literature. * Same for religious diversity in India and collectivist family norms. * It is correct to suggest that medical curricula should integrate evidence-based euthanasia education. However, this needs to be elaborated further. There are studies on nursing students and euthanasia, as well as a study on simulation education and euthanasia. Response with Action taken: The authors agree and the manuscript has been revised accordingly View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Demedts D. Peer Review Report For: Perceptions and attitudes of medical students and doctors on Euthanasia [version 1; peer review: 2 not approved] . F1000Research 2024, 13 :1009 ( https://doi.org/10.5256/f1000research.184704.r404173) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-1009/v2#referee-response-404173 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Buterin T. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 19 Feb 2025 | for Version 1 Toni Buterin , University of Rijeka, Rijeka, Croatia; University of Rijeka Faculty of Health Studies (Ringgold ID: 611977), Rijeka, Primorje-Gorski Kotar County, Croatia 0 Views copyright © 2025 Buterin T. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The introduction of the paper effectively introduces the topic of euthanasia, but it contains several weaknesses that reduce its clarity and precision. In such a complex research field, euthanasia should not be narrowed to a classical definition, but instead, it should be expanded and argued as it goes beyond the scope of (only) medicine. Euthanasia involves perspectives from various fields such as philosophy, sociology, law, and theology. Before focusing on India, the introduction should provide a broader overview of global trends in the regulation (and attitudes) toward euthanasia. Many countries adopt varying approaches, from full legalization to strict prohibition, depending on the type and with different exceptions under different conditions. Understanding these variations is crucial for comparison with the Indian legal framework and the consequential attitudes – in this case, of doctors and medical students. The introduction would be clearer and stronger if the global perspective were analyzed first, followed by a more detailed discussion of the Indian case. More precise formulations and better arguments would improve the quality of the paper. The objectives need to be formulated more precisely to be clearer and more strongly justified. The current formulations are incomplete and unclear. This is especially evident when reading the conclusion, where it is difficult to determine if the research objectives have been achieved. The methodology requires a more detailed description. The aim and purpose of the research are unclear. The limitations of the study need to be highlighted, as the choice of participants could lead to bias and limit the representativeness of the population. Participants are from one 'pool' (Kasturba Medical College), which means the results may not be applicable to the broader population of (future) medical professionals in India. The results are brief and need to be expanded. The first two paragraphs are duplicated. In Table 2, it is unclear how the total sample can exceed 100% for female respondents (61.1% for, 60% against). For male respondents, the total is less than 100% (38.9% for, 40% against). Is this an error, or am I misinterpreting it? In the discussion , it is highlighted that attitudes towards euthanasia are highly diverse, but there is a lack of detailed discussion about contradictions within the results themselves (a lot of the content repeats again), as well as the influence of specific sociocultural factors in the context of India and possible causes. Additionally, the potential bias of the sample is not considered, given that the sample is limited to a single medical school. The discussion deviates from the standard academic approach. A more detailed analysis of the causes and broader implications of respondents' attitudes toward euthanasia is needed, with more concrete references to existing works, stronger argumentation, and the presentation of facts derived from research on similar topics. The discussion should also address methods for reducing bias in future research. There is no analysis of trends or a more specific comparison with previous studies. The conclusion is based more on speculation than on the real outcomes of the objectives. In fact, it is unclear from the conclusion whether the stated objectives have been justified. The focus has shifted from assessing awareness and analyzing the attitudes of doctors and students to the influence of the media. How the media (and the way euthanasia is reported) succeeded in steering respondents toward positive attitudes and a significant correlation remains an open question. Since the role of the media in shaping views is already addressed in the discussion and conclusion, it should have been introduced earlier, particularly in relation to its influence on reporting contemporary medico-ethical controversial issues. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate? I cannot comment. A qualified statistician is required. Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? No Competing Interests No competing interests were disclosed. Reviewer Expertise Medical ethics, Bioethics, Public health, History of Medicine I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (1) Author Response 09 Aug 2025 Ajay Mallya, Community Medicine, Kasturba Medical College, Mangalore, 575001, India Dear Reviewer Thank you for your insightful feedback. We’ve revised the manuscript to address your comments, improving clarity. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Buterin T. Peer Review Report For: Perceptions and attitudes of medical students and doctors on Euthanasia [version 1; peer review: 2 not approved] . F1000Research 2024, 13 :1009 ( https://doi.org/10.5256/f1000research.168923.r363347) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-1009/v1#referee-response-363347 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Picón Jaimes Y. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 29 Jan 2025 | for Version 1 Yelson Alejandro Picón Jaimes , Univ Ramon Llul, Barcelona, Spain 0 Views copyright © 2025 Picón Jaimes Y. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (1) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Introduction The definition of euthanasia is generally correct, but it could be made more precise by clearly differentiating between active euthanasia, assisted suicide, passive euthanasia, dysthanasia, and orthothanasia. As it stands, the current definition blends technical and common terms, which may lead to confusion. To enhance global context, more specific data should be included, such as: In the Netherlands, euthanasia was legalised in 2002 under strict criteria. Canada legalised it in 2016 under the term "Medical Assistance in Dying" (MAiD). Providing such details adds precision and context to the information. Additionally, it would be useful to explain how the Gian Kaur judgment laid the foundation for recognising the "right to die with dignity" within the framework of Article 21 of the Indian Constitution. However, it is essential to clarify that this right does not extend to assisted suicide. Methods Definition of Euthanasia in Variables: The definition of euthanasia in the "Variables" section is repetitive (already mentioned in the introduction) and overly general for the methods section. Study Design: The study is referred to as both cross-sectional and analytical, which creates confusion. If the study is cross-sectional, it is typically descriptive rather than analytical. This should be clarified. The word "post-graduuates" in the inclusion criteria contains a typographical error. Sampling Justification: The use of convenience sampling should be justified, and its limitations acknowledged. For example: "Convenience sampling was employed due to the accessibility of participants in an academic setting. While this method may introduce biases, it was suitable for an exploratory, single-centre study." Additionally, if convenience sampling was used (a non-probabilistic method), it should be clarified why a probabilistic sample size calculation was performed. Description of the Questionnaire: The description of the data collection tool (questionnaire) is too short. It does not specify how the questionnaire was validated or whether a pilot study was conducted before its implementation. Data Analysis: The data analysis section is too brief and lacks clarity on the dependent and independent variables. It should also specify the measures of central tendency (e.g., mean, median) and dispersion (e.g., standard deviation) used. Moreover, it should detail which statistical tests were employed to examine associations (e.g., chi-square, t-tests). Ethical Considerations: The ethical considerations section should explain the data protection measures implemented, particularly since the questionnaires were administered virtually. For instance: "All virtual questionnaires were anonymised, and responses were securely stored to ensure data confidentiality. Access to the data was restricted to authorised personnel only." Results The first and second paragraphs of the results section are redundant and repeat the same ideas. This should be streamlined for clarity. The results are purely descriptive, which is inconsistent with the stated study design of an "analytical study." This discrepancy reinforces the idea that the study is descriptive rather than analytical. The results do not adequately address the second study objective: "To analyse the attitude and perceptions of medical students and doctors on euthanasia." A more focused analysis is needed to examine attitudes and perceptions. Statistical tests (e.g., chi-square or regression analysis) could be employed to identify significant factors influencing attitudes. Is the work clearly and accurately presented and does it cite the current literature? Partly Is the study design appropriate and is the work technically sound? Partly Are sufficient details of methods and analysis provided to allow replication by others? No If applicable, is the statistical analysis and its interpretation appropriate? Partly Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results? Partly Competing Interests No competing interests were disclosed. Reviewer Expertise Clinical and applied bioethics in the experimental field. Research methodology. Epidemiology and public health I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (1) Author Response 09 Aug 2025 Ajay Mallya, Community Medicine, Kasturba Medical College, Mangalore, 575001, India Dear Reviewer Thank you for your insightful feedback. We’ve revised the manuscript to address your comments, improving clarity. View more View less Competing Interests No competing interests were disclosed. reply Respond Report a concern Picón Jaimes YA. Peer Review Report For: Perceptions and attitudes of medical students and doctors on Euthanasia [version 1; peer review: 2 not approved] . F1000Research 2024, 13 :1009 ( https://doi.org/10.5256/f1000research.168923.r360955) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-1009/v1#referee-response-360955 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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