Social Science & Medicine 63 (2006) 743–756 European public acceptance of euthanasia: Socio-demographic and cultural factors associated with the acceptance of euthanasia in 33 European countries Joachim Cohen a,Ã , Isabelle Marcoux b,c , Johan Bilsen a,d , Patrick Deboosere e , Gerrit van der Wal c , Luc Deliens a,c a End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium b Centre for Research and Intervention on Suicide and Euthanasia, University of Quebec at Montreal, Montreal, Canada c VU University Medical Center, Department of Public and Occupational Health, EMGO Institute, Amsterdam, The Netherlands d Centre for Environmental Philosophy and Bioethics, Ghent University, Ghent, Belgium e Faculty of Economic, Social and Political Sciences, Department of Social Research, Interface Demography, Vrije Universiteit Brussel, Brussels, Belgium Available online 14 March 2006 Abstract In many European countries, the last decade has been marked by an increasing debate about the acceptability and regulation of euthanasia and other end-of-life decisions in medical practice. Growing public sensibility to a ‘right to die’ for terminally ill patients has been one of the main constituents of these debates. Within this context, we sought to describe and compare acceptance of euthanasia among the general public in 33 European countries. We used the European Values Study data of 1999–2000 with a total of 41 125 respondents (63% response rate) in 33 European countries. The main outcome measure concerned the acceptance of euthanasia (defined as ‘terminating the life of the incurably sick’, rated on a scale from 1 to 10). Results showed that the acceptance of euthanasia tended to be high in some countries (e.g. the Netherlands, Denmark, France, Sweden), while a markedly low acceptance was found in others (e.g. Romania, Malta and Turkey). A multivariate ordinal regression showed that weaker religious belief was the most important factor associated with a higher acceptance; however, there were also socio-demographic differences: younger cohorts, people from non-manual social classes, and people with a higher educational level tended to have a higher acceptance of euthanasia. While religious belief, socio- demographic factors, and also moral values (i.e. the belief in the right to self-determination) could largely explain the differences between countries, our findings suggest that perceptions regarding euthanasia are probably also influenced by national traditions and history (e.g. Germany). Thus, we demonstrated clear cross-national differences with regard to the acceptance of euthanasia, which can serve as an important basis for further debate and research in the specific countries. r 2006 Elsevier Ltd. All rights reserved. Keywords: Europe; Euthanasia; Attitudes of general public; Empirical study; European values; Cross-national research ARTICLE IN PRESS www.elsevier.com/locate/socscimed 0277-9536/$ - see front matter r 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.socscimed.2006.01.026 Ã Corresponding author. Tel.: +32 2 477 47 14; fax: +32 2 477 47 11. E-mail addresses: jcohen@vub.ac.be (J. Cohen), marcoux.isabelle@uqam.ca (I. Marcoux), johan.bilsen@vub.ac.be (J. Bilsen), patrick.deboosere@vub.ac.be (P. Deboosere), g.vanderwal@vumc.nl (G. van der Wal), luc.deliens@vub.ac.be (L. Deliens).