Running head: ATTITUDE TOWARDS EUTHANASIA ASSESSMENT SCALE 1

Development of the Attitude Towards Euthanasia Assessment (ATEA) Scale: A Study of the

Relationship Between Dogmatism and Attitude Towards Euthanasia

Daniel M. Wright

The University of New England

Word Count: 1,633

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Abstract

The following research paper outlines a study in which an original 16-item Attitude Towards

Euthanasia (ATEA) scale was constructed. This scale trialled 427 participants to investigate

whether it was a reliable and valid tool to assess the relationship between attitude towards

euthanasia and dogmatism. Previous studies have shown a negative relationship between the

acceptance of euthanasia and religious dogmatism. However, research has yet to examine the

relationship between attitude towards euthanasia and dogmatism as an entire construct. One

item from the ATEA scale was removed to increase the scales internal consistency (α = .90).

Therefore, the scale was modified to a 15-item scale. The results showed a significant

negative association between the ATEA and the DOG scale, suggesting a positive attitude

towards euthanasia was negatively associated with dogmatism. Future research is required to

replicate the results.

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Development of the Attitude Towards Euthanasia

Assessment (ATEA) Scale: A Pilot Study

Euthanasia remains a controversial and sensitive subject in both public and political

discourse (Stolz et al., 2015). For this reason, social scientists have sought to investigate

specific attributes influencing public attitude towards euthanasia (Moulton, Hill, and

Burdette, 2006). Despite the rise in support for euthanasia from people in western

industrialised countries, research has shown religiosity and right-wing conservatism are

negatively associated with the acceptance of euthanasia (Moulton, Hill, and Burdette, 2006).

For instance, Sikora & Lewins (2006) reported the adherence to the Christian doctrine as the

largest predictor for the rejection of active voluntary, passive non-voluntary, and active non-

voluntary euthanasia in Australia. To explain, active voluntary euthanasia is described as

intentionally administering medication which ends the patient’s life at their request and with

informed consent (Sikora and Lewins, 2006). Moreover, passive non-voluntary euthanasia

refers to the withdrawal of treatment with the intention for the patient to die; finally, active

non-voluntary euthanasia is euthanasia conducted when the consent of the patient is

unavailable (Sikora & Lewins, 2006). Although adherence to the Christian doctrine is

negatively associated with attitudes towards euthanasia, Moulton, Hill, & Burdette (2006)

discovered the strength of the negative association can vary depending on the denomination

of the individual. For example, conservative protestants are almost two times less likely to

accept euthanasia compared to Catholics (Moulton, Hill, and Burdette, 2006).

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The current scales for measuring attitudes towards euthanasia are proven to be reliable

and valid (Wasserman, Clair, and Richey, 2005). However, one possible limitation is that the

current scales do not include statements describing family members and the role they may

have in the patient’s right to die. In this paper a new measure of attitudes towards euthanasia

entitled ‘Attitude Towards Euthanasia Assessment’ (ATEA) scale was constructed. The

ATEA scale was created to measure a participant’s attitude toward euthanasia. Items relating

to active voluntary, passive non-voluntary, and active non-voluntary euthanasia were based

on research conducted by Sikora and Lewins (2006). In addition, research conducted by

Aghababaei and Wasserman (2013) emphasise the importance of family and culture

regarding euthanasia. Thus, an item relating to a family member’s involvement in euthanasia

was included in the new scale.

Although the literature describes a negative correlation between euthanasia and religious

dogma (Stolz et al., 2015), there is a lack of research exploring the relationship between

euthanasia and dogmatism as an entire construct. For this reason, the DOG scale was also

included in the study to assess the participant’s attitude towards euthanasia. The DOG scale

was found to be valid, reliable, and internally consistent in measuring dogmatism (Altemeyer,

2002).

The original ATEA scale contained 16 items measuring attitudes towards euthanasia.

However, following feedback received by two peer reviewers, several items were rephrased

to improve simplicity and understanding. For example, item 2 and 5 were both reframed

because they were too similar (Appendix). The scale instructed participants to rate how much

they agreed to each item on a scale of 1 (strongly disagree) to 5 (strongly agree). Factoring

reverse scores, the total scores ranged from 16 to 80, with 80 being the maximum positive

attitude towards euthanasia. The present study explored the relationship between attitudes
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towards euthanasia and dogmatism. Therefore, it is hypothesised that a positive attitude

towards euthanasia will negatively correlate with dogmatism.

Method

Participants

The current study involved a moderate sized sample of 427 anonymous participants. The

participants were a mix of undergraduate psychology students from the University of New

England, Australia, and individuals from the social networking website Facebook.

Participants ranged from 18-85 years, with a mean of 44 (SD = 14.66), of which 72% were

female.

Materials

The DOG scale (Altemeyer, 2002) was used to measure a participant’s level of

dogmatism. The DOG scale consisted of 20 items rated in a Likert format. Participants rated

each statement (e.g., ‘There are no discoveries or facts that could possibly make me change

my mind about the things that matter most in life’) on a scale of 1 (very strongly disagree) to

9 (very strongly agree). The total scores on the DOG scale ranged from 20 to 180 (extremely

high dogmatism). Altemeyer (2002) validated the DOG scale with a non-clinical sample (n =

781). Altemeyer (2002) found the DOG scale to yield an alpha coefficient of .90 indicating

high internal consistency. As described above, the ATEA scale was implemented to measure

attitude towards euthanasia.

Procedure

The study was first approved by the UNE’s Human Research Ethics Community. An

anonymous survey was created online; which included the ATEA, the DOG, age, and gender
ATTITUDE TOWARDS EUTHANASIA ASSESSMENT SCALE 6

of the participant. The URL containing the online survey and participant information sheet

was distributed to a UNE online discussion board for PSYC371, and the social networking

website Facebook. SPSS v.25 was used to conduct all analyses.

Results

The internal consistency reliability of all the ATEA items was an acceptable α = .87. The

best performing item was number 9 (‘If the patient is diagnosed with a terminal illness

euthanasia should be an available option’), as it reported the highest item-total correlation,

r(425) = .76 removal of item 9 would have resulted in a reduction of internal reliability (α =

.86). In contrast, the worst reported item was number 13 (‘Euthanasia should be the last

option the patient and family can choose if all other options to reduce suffering have failed’).

It was the only item with a negative item-total correlation. When item 13 was removed

internal reliability increased to .90. For this reason, item 13 was deleted and not included in

the total ATEA score. All further analyses are based on the participant’s responses to the

remaining 15 items. A table summary of the results is detailed below.

Table 1. Descriptive Information and Cronbach’s α for the Attitude Towards Euthanasia

Assessment (ATEA) and the Dogmatism Scale (DOG).

Scale Male M (SD ) Female M (SD ) Total M (SD) Cronbach’s α

n = 121 n = 305 n = 426

DOG 68.93 (19.62) 69.00 (19.40) 68.97 (19.38) .84

ATEA 63.50 (9.83) 65.13 (9.97) 64.70 (9.95) .90

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Two independent t-tests (two tailed) were conducted, comparing females and males on

the ATEA and DOG scale. In both analyses, a Levene’s test for equality of variances was not

significant indicating the assumption of equal variance. Moreover, females scored higher than

males in both analyses (refer to Table 1 for means and standard deviations). The t-test for the

ATEA was observed to be non-significant t(425) = - 1.53, p = .126, 95% CI [- 3.73, .463] d =

0.16. In addition, the t-test for the DOG scale was also found to be non-significant t(425) =

-.051, p = .959, 95% CI [- 4.20, 3.99] d = 0.01. Therefore, no further analysis was required

for gender.

A Spearman’s rho correlation was conducted to measure the relationship between the

attitudes towards euthanasia and the level of dogmatism. The ATEA and DOG indicated a

presence of a significant negative correlation rs = -.120, p = .014 (two-tailed).

Figure 1. Correlation between the DOG and ATEA scale.

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Discussion

The purpose of this study was to develop a new scale that measures attitudes toward

euthanasia and to investigate whether an association exists between attitudes toward

euthanasia and dogmatism. To ensure internally consistent reliability, the psychometric

properties of the ATEA scale were measured and reported to be acceptable. Furthermore, it

was hypothesised that a positive attitude towards euthanasia would be negatively associated

with dogmatism. This hypothesis was supported, as there was a significant negative

correlation between the ATEA and DOG scale. This finding suggests that individuals who

hold a positive attitude towards euthanasia are less likely to be dogmatic. This finding is

supported by previous studies linking religious dogmatism to low acceptance of euthanasia

(Stolz et al., 2015). However, it is important to note the current study measured dogmatism as

an entire construct open to any dogmatic predisposition an individual may hold (e.g.,

religiosity, environmentalism, or political ideology).

A limitation of this study was a gender imbalance. Of the 427 individuals who

participated in the survey, only 28% were male. A lack of gender balance could prove to be

problematic as it reduces the generalisability of the sample to the population. Furthermore, a

bivariate correlation cannot account for any confounding variables. For instance, Stolz et al.,

(2015) found religiosity, socioeconomic status, and authoritarianism to be associated with the

degree of acceptance for euthanasia. Finally, the euthanasia scale did not use any sub-scales

to differentiate between passive and active euthanasia. The use of sub-scales is important if

the research is interested in measuring whether there are differences in the attitudes toward

specific types of euthanasia.

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In summary, although the ATEA Scale tested high for internal consistency, it needs to be

modified to include sub-scales accounting for both passive and active euthanasia. In addition,

larger studies that are gender balanced are also needed to increase validity. Future research

should assess and modify the current items within the scale to further maximise validity and

reliability.
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References

Aghababaei, N., & Wasserman, J. A. (2013). Attitude Toward Euthanasia Scale. American

Journal of Hospice and Palliative Medicine®, 30(8), 781-785.

Altemeyer, B. (2002). Dogmatic Behavior Among Students: Testing a New Measure of

Dogmatism. The Journal of Social Psychology, 142(6), 713-721.

Moulton, B. E., Hill, T. D., & Burdette, A. (2006). Religion and Trends in Euthanasia

Attitudes among U.S. Adults, 1977–2004. Sociological Forum, 21(2), 249-272.

Sikora, J., & Lewins, F. (2007). Attitudes concerning euthanasia: Australia at the turn of the

21stCentury. Health Sociology Review, 16(1), 68-78.

Stolz, E., Burkert, N., Großschädl, F., Rásky, É., Stronegger, W. J., & Freidl, W. (2015).

Determinants of Public Attitudes towards Euthanasia in Adults and Physician-

Assisted Death in Neonates in Austria: A National Survey. PLOS ONE, 10(4)

Wasserman, J., Clair, J. M., & Ritchey, F. J. (2005). A Scale to Assess Attitudes toward

Euthanasia. OMEGA - Journal of Death and Dying, 51(3), 229-237.

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Appendix

Original ATEA Scale

ATE (Attitude Towards Euthanasia Assessment) Scale

INSTRUCTIONS: Please read the following statements carefully and select the answer that most applies to you on a range of 1 (strongly
disagree) to 5 (strongly agree).

Age: _____ Gender: M or F (please circle)

Strongly Not Agree Strongly

Statement Disagree
Disagree
Sure Agree
1 If I am dying I should have the right to end my own life 1 2 3 4 5
A medical practitioner should be able to administer enough
2 1 2 3 4 5
medicine to end a patient’s life if the pain is too severe
A family member should be able to administer enough
3 1 2 3 4 5
medicine to end a patient’s life if the pain is too severe
The removal of life support should be an option if the medical
4 1 2 3 4 5
practitioner does not believe the patient will recover
A medical practitioner should not be allowed to end a patient’s
5 1 2 3 4 5
life even if the pain is too severe
6 Euthanasia should be a human right 1 2 3 4 5
If the patient is in intolerable pain and requests life support to
7 1 2 3 4 5
be turned off the medical practitioner should allow it
8 Euthanasia should never be an option to end someone’s life 1 2 3 4 5
If the patient is diagnosed with a terminal illness euthanasia
9 1 2 3 4 5
should be an available option
If the patient is severely disabled euthanasia should be an
10 1 2 3 4 5
available option
I am concerned if euthanasia is legalised the elderly will be
11 1 2 3 4 5
coerced into ending their life
12 Euthanasia leads to a more humane society 1 2 3 4 5
Euthanasia should be the last option the patient and family can
13 1 2 3 4 5
make if all the other options to reduce suffering have failed
14 Euthanasia leads to more pain and suffering 1 2 3 4 5
A medical practitioner should be able to morally object to the
15 1 2 3 4 5
practice of euthanasia
16 People who support euthanasia are immoral 1 2 3 4 5

Reply all
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PSYC371/471 PEER REVIEW TEST FEEDBACK

Name of Test under review ATE (Attitude Towards Euthanasia) Scale

1. Did you find it was hard to understand exactly what was being asked of you in any of the
questions? (please circle)
NO
YES . . . Which questions were hard to understand?

2. Were there any questions that you found hard to answer due to not having enough response
options you wanted? (please circle)
NO
YES . . . For which questions was this the case? What other response options should have been
included?

3. Did you feel reluctant to answer any of the questions (please circle)
NO
YES . . . Which questions were you reluctant to answer? Why?

4. General comments. Can you suggest ways of improving the scale? (e.g., aspects of the construct
not asked about, some items too similar, some too long, double negatives)

Q2 and Q5 are the same question just reframed – just change the wording a bit in one of the
questions. Perhaps something like “A medical practitioner should be able to legally administer
enough medicine to end a patient’s life at the patient’s request.”
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PSYC371/471 PEER REVIEW TEST FEEDBACK

Name of Test under review ___Euthanasia Scale___________________________________

1. Did you find it was hard to understand exactly what was being asked of you in any of the
questions? (please circle)
NO
YES . . . Which questions were hard to understand?

2. Were there any questions that you found hard to answer due to not having enough response
options you wanted? (please circle)
NO
YES . . . For which questions was this the case? What other response options should have been
included?

3. Did you feel reluctant to answer any of the questions (please circle)
NO
YES . . . Which questions were you reluctant to answer? Why?

4. General comments. Can you suggest ways of improving the scale? (e.g., aspects of the construct
not asked about, some items too similar, some too long, double negatives)

• I would consider whether Item 1 “If I am dying I should have the right to end my own life” should be
“If someone is dying they should have the right to end their life”
• Perhaps consider if your survey results may be affected if respondents agree with euthanasia under
certain circumstances, but not others – you may actually be measuring a subscale?
• Other than that, awesome
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ATEA Scale Revised

ATEA (Attitude Towards Euthanasia Assessment) Scale

INSTRUCTIONS: Please read the following statements carefully and select the answer that
most applies to you on a range of 1 (strongly disagree) to 5 (strongly agree).

Age: _____ Gender: M or F (please circle)

Strongly Not Agree Strongly

Statement Disagree Disagree Sure Agree
If someone is dying they should have the right to end their own
1 1 2 3 4 5
life
A medical practitioner should be able to legally administer
2 1 2 3 4 5
enough medicine to end a patient’s life at the patient’s request
A family member should be able to administer enough
3 1 2 3 4 5
medicine to end a patient’s life if the pain is unbearable
The removal of life support should be an option if the medical
4 1 2 3 4 5
practitioner does not believe the patient will recover
A medical practitioner should not be allowed to end a patient’s
5 1 2 3 4 5
life even if the pain is too severe
6 Euthanasia should be a human right 1 2 3 4 5

If the patient is in intolerable pain and requests life support to

7 1 2 3 4 5
be turned off the medical practitioner should allow it
8 Euthanasia should never be an option to end someone’s life 1 2 3 4 5

If the patient is diagnosed with a terminal illness euthanasia

9 1 2 3 4 5
should be an available option
If the patient is severely disabled euthanasia should be an
10 1 2 3 4 5
available option
I am concerned if euthanasia is legalised the elderly could be
11 1 2 3 4 5
coerced into ending their lives
12 Euthanasia could lead to a more humane society 1 2 3 4 5

Euthanasia should be the last option the patient and family can
13 1 2 3 4 5
choose, if all the other options to reduce suffering have failed
14 Euthanasia could lead to more pain and suffering 1 2 3 4 5

A medical practitioner should be able to object to the practice

15 1 2 3 4 5
of euthanasia on ethical grounds
16 People who support euthanasia are immoral 1 2 3 4 5

The following scale measures a positive attitude toward euthanasia. I am planning to correlate the results from
this scale with the results from the Dogmatism Scale (DG).
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Independent Samples Test

Levene's Test
for Equality of
Variances t-test for Equality of Means
95% Confidence
Interval of the
Sig. (2- Mean Std. Error Difference
F Sig. t df tailed) Difference Difference Lower Upper
Total Attitude Equal .067 .795 - 424 .113 -1.72294 1.08389 -3.85341 .40753
Towards variances 1.590
Euthanasia assumed
Equal - 225.110 .110 -1.72294 1.07307 -3.83748 .39161
variances not 1.606
assumed
Total Equal .009 .925 -.051 424 .959 -.10717 2.08621 -4.20776 3.99343
Dogmatism variances
assumed
Equal -.051 217.599 .959 -.10717 2.09916 -4.24445 4.03012
variances not
assumed

Descriptive Statistics

Total Attitude
Towards
Euthanasia Dogmatism
N Valid 427 427

Missing 0 0

Mean 61.0562 68.9672

Std. Deviation 10.10400 19.38561

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ATEA Scale Reliability

Reliability Statistics
Cronbach's
Alpha Based on
Cronbach's Standardized
Alpha Items N of Items
.874 .889 16

Item-Total Statistics

Scale Mean if Scale Variance Corrected Item- Squared Multiple Cronbach's Alpha
Item Deleted if Item Deleted Total Correlation Correlation if Item Deleted
EUQ1 60.17 87.212 .678 .619 .861
EUQ2 60.33 85.378 .720 .611 .859
EUQ3 61.38 87.264 .415 .259 .873
EUQ4 60.60 87.227 .524 .357 .866
EUQ5R 60.57 85.678 .565 .402 .864
EUQ6 60.20 86.302 .704 .614 .860
EUQ7 60.27 86.751 .672 .527 .861
EUQ8R 60.20 87.290 .638 .509 .862
EUQ9 60.37 84.933 .759 .646 .857
EUQ10 60.80 84.718 .656 .500 .860

EUQ12 60.74 84.802 .708 .569 .858

EUQ14R 60.65 88.025 .527 .388 .866

EUQ15R 61.65 87.706 .382 .237 .875
EUQ16R 60.04 92.198 .471 .309 .869
EUQ13 61.06 102.091 -.181 .140 .900
X
EUQ11R 61.33 87.737 .438 .330 .871
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DOG Scale Reliability

Reliability Statistics
Cronbach's
Alpha Based on
Cronbach's Standardized
Alpha Items N of Items
.835 .837 20

Correlations
Total Attitude
Towards
Dogmatism Euthanasia
Spearman's rho Dogmatism Correlation Coefficient 1.000 -.119*
Sig. (2-tailed) . .014
N 427 427
Attitude Towards Euthanasia Correlation Coefficient -.119* 1.000
Sig. (2-tailed) .014 .
N 427 427
*. Correlation is significant at the 0.05 level (2-tailed).
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