Conceptions of Medical Assistance in Dying and Euthanasia: A Literature Review on the Role of Religious Affiliation and Religiosity.

Euthanasia and physician-assisted suicide (EAS) constitute a profoundly significant issue of growing relevance in the context of healthcare. As more jurisdictions legalize EAS, its societal impacts continue to grow, and it is important that religious perspectives are understood and thoughtfully considered in public discourse on this topic. A literature review of quantitative studies examining views on EAS based on religious affiliation and religiosity was conducted across four databases. Extracted data included survey questions, year of data collection, geographic location, population subgroups, participants' religiosity and religious affiliation and levels of support for EAS. Mean support proportions were calculated, and group differences were analysed using two-sample t-tests. A total of 104 relevant papers were identified, containing data from 1944 to 2022 relating to 31 countries. Sixty-nine papers examined support for legalizing EAS or its moral acceptability in specific contexts in relation to respondents' religiosity. All studies found that higher religiosity was associated with lower support for EAS. Support for EAS among the general public was 36% (95% CI 31%, 40%) for the highly religious versus 64% (95% CI 57%, 71%) for those with low levels of religiosity (p < 0.00001) and 16% (95% CI 11%, 21%) for highly religious doctors versus 42% (95% CI 34%, 50%) for their least religious counterparts (p < 0.00001). Forty-nine papers explored EAS support based on religious or denominational affiliation. Studied religions included Christianity, Judaism, Islam, Hinduism, Buddhism and Shintoism. With the exception of liberal Christianity and Judaism, affiliation with a religious tradition was consistently associated with markedly lower support for EAS compared to non-religious or atheist individuals. Muslim and evangelical Christians demonstrated the lowest levels of support, both at 27%. In the case of Judaism, relatively higher acceptance of EAS was partly attributed to the influence of secular Jewish respondents. This review confirms that religious affiliation, especially high religiosity, is consistently associated with lower support for EAS across diverse contexts. This persistent religious-secular divide suggests that expectation gaps and worldview-based conflicts over EAS are likely to continue. Acknowledging this divide is important for guiding meaningful discussions and future policy.