What Determines End-of-Life Attitudes? Revisiting the Dutch Experience
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What Determines End‑of‑Life Attitudes? Revisiting the Dutch Experience Damon Proulx1 · David A. Savage1 Accepted: 19 August 2020 © Springer Nature B.V. 2020
Abstract Societal attitudes and behaviours of suicide and euthanasia often cannot be compared leaving policy makers without informative understanding of how social indicators such as social norms, attitudes, behaviours, identity and culture shape the relationships held to socio-demographic indicators of pro end-of-life attitudes. Applying social indicator principals from behavioural economic theory, we assess attitudes to suicide and euthanasia using the Netherlands as a quasi-experiment. We analysed data extracted from the European Values Study (EVS) from 1981 to 2008 in the Netherlands. This timeframe encompasses the Supreme Court ruling: ‘The Right to Die—1984’ and the ‘Termination of Life on Request and Assisted Suicide (Review Procedures) Act of 2002’. Adopting a pooled ordered logit cross-sectional analysis, we assessed indicators of attitude change towards suicide and euthanasia as a quasi-experimental difference-in-differences estimation across socio-demographic indicators through 1981–1990 and 1999–2008. We find through these periods, only employment status and religiosity remain consistent and significant indicators for suicide. Whereas age, employment status, marital status and having a religious denomination remain consistent and significant indicators for euthanasia throughout both periods. Our findings provide a revised socio-demographic indicator model and extend psycho-social indicator factors from behavioural economics to approach research of end-of-life attitudes of suicide and euthanasia. Keywords Economics · Behavioural · Attitudes · Socio-demographics · Suicide · Euthanasia
* Damon Proulx [email protected] David A. Savage [email protected] 1
Faculty of Business and Law, Newcastle Business School, University of Newcastle, 409 Hunter Street, Newcastle, NSW 2300, Australia
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D. Proulx, D. A. Savage
1 Introduction If economics is to take psychology seriously, it must address the most fundamental aspect of human life, its finitude, and how people deal with it. Models of rational behavior may prove to be inadequate, inviting us to learn from psychology and thanatology (Slemrod 2003, p. 374) While life and death are the two fundamental constants of human existence, the amalgamation of our perceptions determine how we choose to live but also the way in which we choose to die. The WHO (2019) estimates that each year over 800,000 individuals commit suicide, and that 79% of those deaths occur in low to middle income economies which accounts for 84% of the global population. While the 2016 crude suicide rate was 10.5 per 100,000 people, the crude suicide rate for Africa was (12 per 100,000), Europe (12.9 per 100,000) and South-East Asia (13.4 per 100,000); all exceeding the crude global rate (WHO 2019). Similarly, although the relationship between suicide and mental health is well established, estim
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