Introduction

Most physicians in most countries are against active euthanasia, defined as a measure taken with the definite intention to end life at the patient's explicit request due to refractory suffering (further, we will use the term ‘euthanasia’ to refer to voluntary active euthanasia).1 ,2 There is, however, notable variation in the percentage of physicians supporting euthanasia. On the one hand, and not unexpectedly, the support has been high in both Belgium (78%–90%)3 ,4 and the Netherlands (59%–77%).5 ,3 On the other hand, euthanasia has had little support among, for example, American oncologists (6.5%),6 German palliative care physicians (9.6%),7 general practitioners in Northern Ireland (13%)8 and physicians in Mexico (14.3%).9

This variation is partly due to real differences in opinion. There are, however, several methodological issues that can explain part of the variation. First, the distinction between withholding or withdrawing life-saving therapy and deliberately terminating the life of the patient has not always been made explicit in studies. Second, some studies have focused on the ethical acceptance of the practice, while others have addressed its legalisation. Third, some studies have used questionnaires, while others have presented case vignettes.

If the willingness to practice euthanasia was addressed in a study, it was usually significantly lower than the general acceptance rate of euthanasia. According to a qualitative study in Belgium, for example, most general practitioners support euthanasia but are not willing to practice it.10

Although numerous surveys have addressed physicians’ attitudes towards euthanasia, we found only two follow-up studies in which the attitudes of physicians had been surveyed across time.11 ,12 In the Alberta survey, the follow-up time was 3 years (1991–1994), during which support for the practice and legalisation of active euthanasia decreased considerably.12 According to the Finnish study, there were no major changes in the attitudes during the decade 1993–2003.11

Euthanasia as a concept is not mentioned in the Criminal Code of Finland. However, it was extensively discussed in the preparatory work for the revision of the Code in 1969, which retained the old enactment concerning ‘killing by request’. This was to carry a more lenient sentence than murder.13 ,14 The 1995 revision of the Criminal Code did not mention ‘killing by request’ anymore because it was not considered applicable to medical situations.13 ,14

The current Criminal Code contains three categories of homicide: manslaughter, murder and killing. Killing is described as follows: ‘If the manslaughter, in view of the exceptional circumstances of the offence, the motives of the offender or other related circumstances, when assessed as a whole, is to be deemed committed under mitigating circumstances, the offender shall be sentenced for killing to imprisonment for at least four and at most ten years’.15

Along the lines of the World Medical Association, The Finnish Medical Association has repeatedly and clearly rejected active euthanasia in its statements, most recently in 2013.16

The practice of euthanasia in the Netherlands and Belgium has received wide attention in the Finnish media. According to some surveys, the public opinion seems to support active euthanasia. To find out possible changes in the attitudes of Finnish physicians, we repeated the earlier survey performed in 1993 and 2003 after another decade. A follow-up of 20 years is unique in this area of research.