Health literacy, end-of-life health literacy and assisted suicide: attitudes in older adults - a cross-sectional study.

Abstract

Objectives: As societal debates around assisted suicide persist, understanding the factors influencing individual attitudes is essential. Health literacy (HL) and end-of-life HL (EOL-HL) are critical for informed decision-making but remain underexplored in relation to attitudes towards assisted suicide. This study investigates the association between HL, EOL-HL and attitudes towards assisted suicide among older adults in Switzerland.

Methods: Data were derived from 1461 participants aged 58+ from the Swiss component of the Survey of Health, Ageing, and Retirement in Europe, 2019/2020. Attitudes towards assisted suicide were assessed using three measures: support for its legality, consideration of personal use and membership in a right-to-die organisation. HL and EOL-HL were assessed using standardised scales. Probit regression models analysed the associations, controlling for sociodemographic and health characteristics.

Results: The majority supported the legality of assisted suicide (82%) and could consider asking for it (64%), while 9% were members of a right-to-die association. Higher EOL-HL was significantly associated with greater support for assisted suicide (β=0.05, p<0.001), consideration of personal use (β=0.08, p<0.001) and membership in a right-to-die organisation (β=0.06, p<0.001). However, general HL was not statistically significantly associated with membership in such organisations.

Conclusions: The findings underscore the distinct role of EOL-HL in shaping attitudes towards assisted suicide, particularly in decisions involving active engagement, such as joining right-to-die organisations. Enhancing EOL-HL among older adults could empower informed decision-making and promote meaningful engagement in end-of-life planning. These insights contribute to ongoing ethical and policy discussions surrounding assisted suicide in Switzerland and beyond.