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Attitudes of atheists and Muslims toward euthanasia.

Dionne Angela Donnelly Module: PSYC222: Research Methods & Statistics Word Count: 2056 (excluding tables and quotations) 2642 (including tables and quotations)

Abstract Research has shown that people who are religious are less likely to support euthanasia. The researchers hypothesised that Muslims would be less likely than atheists to agree with the practise of euthanasia. An opportunity sample of 25 Muslim and 25 atheist participants were surveyed on their attitudes towards euthanasia using a 5 response Likert scale. Following reliability analysis, 19 items were removed and the questionnaire was redistributed to the original participants. The scale was found to be tridimensional and showed inter-item consistency and reliability over time. Atheists were significantly more likely to agree with the practice of euthanasia than Muslims. The results support previous research in the area, indicating a strong relationship between religion and attitude toward euthanasia. Future research could follow a more qualitative route to provide a better understanding of the relationship between religion and euthanasia.

Euthanasia is defined as intentionally causing the death of a person, to...protect [them] from further suffering (Perry, n.d.). Assisted suicide occurs when the patient performs the act of suicide. The other person simple helps (Perry, n.d.). In this study, euthanasia was used to refer to both terms. There are conflicting views as to whether euthanasia should be legalised (e.g. Mak, Elwyn & Finlay, 2003; Roscoe, 1998; Wilson et al., 2000). Religious people are more likely to oppose euthanasia (Gielen, van den Branden & Broeckart, 2009; see also, Anderson & Caddell, 1993; Aslan & Cavlak, 2007; Frde, Aasland & Falkum, 1997; Haghbin, Streltzer & Danko, 1998; Ward & Tate, 1994).

Muslims believe we should not take life which God has made sacred except in the course of Justice (Quran, 6:151, cited in Zahedi, et al., 2007, p.11). But, in Islamic law, removing 2

hindrances to death (i.e. life support) to ease suffering is allowed as long as death is not the primary motivation (Sachedina, 2005, see also, Ebrahim, 2005). One study found that 85 per cent of Muslim doctors are opposed to euthanasia (Ahmed, Kheir, Rahman, Ahmed & Abdalla, 2001). However, other research suggests this high figure may be more to do with doctors experience with dying patients (Roscoe, 1998). Aslan and Cavlak (2007) found that 40 per cent of Muslim students were opposed to euthanasia. Conversely, they also found that 47 per cent accepted it.

An explanation may be degree of religiosity. Gearing and Lizardi (2009) state that decreased suicidal behaviour is related to religious commitment, not membership of a specific religion (see also Aslan & Cavlak, 2007; Donnison, 1997; Grassi, Magnani & Ercolani, 1999; Haghbin et al., 1998). Therefore, it is important to compare religious groups with groups that are non-religious. Although atheists have no specific belief system, they generally do not believe in God or the afterlife (Lizardi & Gearing, 2009). Smith-Stoner (2007) found that 95 per cent of self-reported atheists supported euthanasia. Aslan and Cavlak found that 86.7 per cent of atheist students were in favour of euthanasia (2007). This is higher than the average: Horsfall, Alcocer, Duncan and Polk (2001), found that 72-74 per cent of students had a positive attitude towards euthanasia.

An attitude is predisposition to attend to the social world in a favourable or unfavourable way (Oskamp & Schultz, 2005, see also Reich & Adcock, 1976). Attitudes consist of three components: affective, behavioural, and cognitive (ABC) (Triandis, 1971). Likert scales are used in the majority of survey research measuring attitudes (Hinkin, 1998; Taylor & Heath, 1996).

New measures are important because attitudes change over time: Wolfe, Fairclough, Clarridge, Daniels and Emanual (1999), observed that one third of patients changed their attitude to euthanasia in a follow-up interview (see also, DeCesare, 2000). Also, peoples attitudes towards euthanasia 3

may be more developed following exposure to the issue, especially since the case of Terry Schiavo (e.g. Annas, 2005; Perry, Churchill & Kirshner, 2005).

This study aimed to create a uni-dimensional Likert scale, assess the reliability of the scale over time, and assess whether commitment to a religion leads to opposition of euthanasia. We predicted that atheists would be more likely to agree with the practise of euthanasia than Muslims, as indicated by previous research.

Method Participants 25 Muslims and 25 atheists were found using opportunity sampling. Participants were aged between 17 and 36 (M = 21.38, SD = 3.07). Other demographics were not collected as they were deemed unnecessary. Materials The pilot questionnaire (T1) (see Appendix 1) was created by a brainstorming session focusing on a balance of positive and negative items to avoid acquiescence bias (Taylor & Heath, 1996). Attempts at a balance between affective, behavioural and cognitive related items were made. Questionnaire T1 consisted of 50 short, simple statements (in accordance with Hinkin, 1998) relating to attitudes toward euthanasia. It was designed so that positive attitudes towards euthanasia would achieve a high score and negative attitudes a low score. The participant information sheet (see Appendix 3) was attached to both T1 and T2 (see Appendix 2) questionnaires. Following the reliability analysis (see Appendix 5) 19 items were removed from the questionnaire (see Table 1). As Cronbachs alpha was high (.98, see Appendix 5), removal criteria were stringent and included removal for violation of only one assumption. Questionnaire T2 consisted of 31 items originally from Questionnaire T1.

Table 1: Item deletion list. Item Item No. 1 I view death as a positive and natural life occurrence. 4 Euthanasia should be punished by law. 13 Death is random and not determined by a higher power. 15 I would be morally obliged to euthanize someone who was incapable of making the decision themselves. 16 I would actively seek to punish those who assisted with euthanasia. 19 When I think of someone committing suicide it makes me feel sad. 21 I feel that death is the end. 26 Euthanasia is an easy way out of a difficult situation. 32 Death never really crosses my mind. 36 Religious or spiritual people are more likely to have a negative view of euthanasia. 37 I would never consider ending my own life. 38 I am not afraid of death 39 Euthanasia is immoral and the same as murder. 40 I would assist someone who wished to commit suicide. 41 Others judgement would stop me assisting euthanasia. 46 Those who believe in the afterlife have a more positive view of euthanasia. 47 Everybody has the right to choose how and when they die. 48 I feel that everyone can be pushed to believe that suicide is their only option. 50 The method used to carry out euthanasia would affect my decision to carry it out on either myself or another person.

Reasons for deletion 1, 2, 3, 4, 5, 6 4 2 1, 2, 4, 5, 6 1, 2 1, 2, 4, 6 3, 5, 6 4, 5, 6 4, 5, 6 1, 2, 3, 4, 5, 6 1, 4 1, 4, 6 4 1 2, 4, 5, 6 1, 2, 3, 4, 5 4 4 1, 4

Design This study was a mixed design as participants filled out the scale twice (to test scale reliability) and their responses then compared against one another to test for differences. This was done using a 5 response Likert scale (optimal for reliability, validity, discriminating power and test-retest reliability, Preston & Colman, 1999). The independent variable (IV) was religious belief and consisted of two levels; as participants were either Muslims or atheists (groups perceived by the researchers to have strong opinions on death, to avoid central tendency bias). The dependent variable (DV) was the extent to which participants would agree with the practise of euthanasia (i.e.

1= disparate mean [below 2.5, above 3.5]. 2 = disparate SD [below 1.05, above 1.7]. 3 = Negative inter-item correlations [for more than 10 items]. 4 = Low inter-item correlation [below .4 (Kim & Mueller, 1978, cited in Hinkin, 1998) in more than 5 items]. 5 = increases Cronbachs alpha. 6 = Pearsons correlation below .5.

T2 score). The predictor variable (PV) was T1 score and the outcome variable (OV) was T2 score. Procedure Questionnaire T1 was created by a group of five Psychology undergraduates as a pilot scale. Questionnaires were distributed to self-reported Muslims and atheists. Participants were informed of their right to withdraw and assured that their data would be confidential and anonymous (for ethical reasons and to help avoid social desirability bias). Once the data was collected it was analysed using SPSS to test for reliability, using the most accepted measure of reliability Cronbachs alpha (Price and Mueller, 186, cited in Hinkins, 1998). Questionnaire T2 contained 31 questions which were all originally from Questionnaire T1. These were re-distributed to the same participants as Questionnaire T1. This was followed by a second reliability analysis, t-test, and linear regression analysis. No questions were excluded following the final analysis.

Results T1 Reliability A reliability analysis was conducted using the SPSS programme. Cronbachs alpha was .98 (see Appendix 5) indicating that the questionnaire had internal consistency. However, the mean interitem correlation was .42 (see Table 2), which is relatively low and indicated that the questionnaire may be multi-dimensional. Therefore, a factor analysis using Varimax orthogonal rotation was conducted which extracted 8 factors with Eigen values 1.0. These factors accounted for 79.47 per cent of variation in participants responses (see Table 4 and Appendix 6). This means that whilst the scale was measuring 8 different psychological constructs, only approximately 20 per cent of responses were due to noise in the data. The mean item means were 2.9, close to the optimal number of 3, meaning that one group responded with mostly strongly agree and the other strongly disagree, the mean therefore showing a balance between the two extremes. Mean item variances were 1.87 (see Table 2).

Table 2: Summary Item data T1. N Item Means Item Variances Inter-Item Correlations T2 Reliability Cronbachs alpha was .98 (see Appendix 7), an increase on the previous questionnaire due to the removal of 19 items from T1 (based on criteria set out in Table 1). Mean inter-item correlation was . 66 (see Table 3), which indicated that there were fewer factors than the previous questionnaire. Factor analysis using Varimax orthogonal rotation extracted 3 factors with Eigen values 1.0. They accounted for 77.67% of variation in participants responses (see Table 4 and Appendix 8). This meant the scale was multi-dimensional, and only approximately 22 per cent of responses were due to noise. In this instance, mean item-means decreased to 2.88, indicating that respondents were less likely to respond in the extreme to the items. Mean item variances increased to 2.17 (see Table 3). Table 3: Summary Item Data T2. N Item Means Item Variances Inter-Item Correlations 31 31 31 Mean (Variance) 2.88 (.08) 2.17 (.42) .66 (.03) 50 50 50 Mean (Variance) 2.9 (.28) 1.87 (.5) .42 (.13)

Table 4: Factor Analysis T1 and T2 Variance Accounted For (%) 77.62 79.47

Factors Found T1 T2 8 3

Test-Retest Reliability Bivariate correlatory analysis showed that there was a significant positive relationship between 7

participants T1 and T2 scores (N = 50, r = .96, p < .001, see Appendix 9), indicating that the scale was reliable over time. Linear regression analysis showed that scores on T1 predicted 91 per cent of variance of T2 scores (R2 = .92, R2 = .91, F (1, 48) = 522.7, p < .001, VIF = 1) (see Appendix 11). The regression equation is y = .92x + 1.41 (where y = bx + c) (see Figure 1). Figure 1: Scatterplot and regression line showing the relationship between T1 and T2 scores.

Criterion Levenes Test for Equality of Variance was non-significant. Therefore, homogeneity of variance was assumed. An independent sample t-test (one-tailed) found that atheists were significantly more likely to agree with the practise of euthanasia (M = 116.28, SD = 11.64) than Muslims (M = 50.96, SD = 10.3), (t(48) = 20.99, p < .01) (see Table 5 and Appendix 10). Table 5 Total means for each group at T1 and T2. Group T1 Total Score Atheist Muslim T2 Total Score Atheist Muslim N 25 25 25 25 Mean (SD) 122.96 (11.89) 55.2 (10.82) 116.28 (11.64) 50.96 (10.33) 8

Discussion It was found that atheists were significantly more likely to agree with euthanasia than Muslims. This is in concordance with previous research suggesting that Muslims are likely to be opposed to the practise of euthanasia, due to their religious views (e.g. Sachedina, 2005, Ahmed et al., 2001; Ebrahim, 2005; Zahedi, et al., 2007) and level of religious commitment (Gearing & Lizardi, 2009, see also Donnison, 1997; Grassi, Magnani & Ercolani, 1999; Haghbin et al., 1998). Furthermore, atheists have been shown to be highly supportive of euthanasia (Aslan & Cavlak, 2007; SmithStoner, 2007). This study therefore provides supporting evidence for the above research.

In this study 88 per cent of atheists disagreed or strongly disagreed (the remaining 12 per cent were neutral) with the statement Euthanasia is never acceptable, even when performed by a loved one or qualified physician (see Appendix 2, Item 4). This points to their acceptance of the practise of euthanasia. Despite being a high figure, it was lower than the 95 per cent of atheists who agreed with euthanasia in Smith-Stoners (2007) study. The difference may be due to participant characteristics, as her participants were all members of an atheist organisation, and the majority had cared for an atheist who had died. However, the figure is slightly higher than the 86.7 per cent found by Aslan and Cavlak (2007), which may be due to their smaller sample size (30 atheist participants).

All Muslim participants agreed or strongly agreed with Item 4 thus indicating their opposition to euthanasia. This figure is much higher than the 40 per cent who opposed euthanasia in the study by Aslan & Cavlak (2007) and the 85 per cent found by Ahmed et al. (2001). This may be due to the fact that the above studies were conducted in Islamic countries, and respondents in the UK may feel more pressure to respond in a socially desirable way (Saroglou & Galand, 2004) in order to strengthen other groups view of commitment to their religion. Conversely, atheists do not have 9

rigid set of beliefs (Gearing & Lizardi, 2009) and so may not feel as pressured to conform to others view of them.

Aside from assessing the effect of religion on attitudes to euthanasia, this study aimed to create a uni-dimensional Likert scale, and assess the reliability of the scale over time. Ultimately a tridimensional scale was created which was found to be highly reliable over time. However, there were several limitations of the study; the first being a relatively small sample size, which could cause difficulty for generalising to a wider population. The researchers also had difficulty in balancing ABC components of the scale, meaning the scale may have been biased in favour of affective and cognitive items.

In light of such limitations, there are a number of implications for future research. Other groups, such as agnostics and Christians, could be included to evaluate whether different religious beliefs will contrast with atheism as strongly as Islam did. Also, a more qualitative study could be conducted, presenting hypothetical situations and asking participants to decide how they would behave, followed by open questions asking about their opinions. This could help establish the reasons why there is a difference between the groups. This may also establish if other factors, such as the type of illness and time left to live, have an effect on whether euthanasia is deemed appropriate.

In conclusion, it was found that atheists were significantly more likely to approve of euthanasia than Muslims. This is in accordance with the majority of research into this area, which states that religiosity exerts an effect on attitudes towards euthanasia.


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Appendices For appendices, please refer to the compact disc provided.