title: Trust increases euthanasia acceptance: a multilevel analysis using the European Values Study.
abstract: BACKGROUND
  This study tests how various kinds of trust impact attitudes toward euthanasia among the general public. The indication that trust might have an impact on euthanasia attitudes is based on the slippery slope argument, which asserts that allowing euthanasia might lead to abuses and involuntary deaths. Adopting this argument usually leads to less positive attitudes towards euthanasia. Tying in with this, it is assumed here that greater trust diminishes such slippery slope fears, and thereby increases euthanasia acceptance.
  
  
  METHODS
  The effects of various trust indicators on euthanasia acceptance were tested using multilevel analysis, and data from the European Values Study 2008 (N = 49,114, 44 countries). More precisely, the influence of people's general levels of trust in other people, and their confidence in the health care system, were measured--both at the individual and at the country level. Confidence in the state and the press were accounted for as well, since both institutions might monitor and safeguard euthanasia practices.
  
  
  RESULTS
  It was shown that the level of trust in a country was strongly positively linked to euthanasia attitudes, both for general trust and for confidence in health care. In addition, within countries, people who perceived their fellow citizens as trustworthy, and who had confidence in the press, were more supportive of euthanasia than their less trusting counterparts. The pattern was, however, not true for confidence in the state and for confidence in the health care system at the individual level. Notably, all confirmative effects held, even when other variables such as religiosity, education, and values regarding autonomy were controlled for.
  
  
  CONCLUSIONS
  Trust seems to be a noteworthy construct to explain differences in attitudes towards euthanasia, especially when drawing cross-country comparisons. Therefore, it should be added to the existing literature on correlates of euthanasia attitudes.
authors.affiliation: Cologne Graduate School and SOCLIFE Research Training Group, University of Cologne, Albertus-Magnus-Platz, 50931 Cologne, Germany. koeneke@wiso-uni-koeln.de.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Köneke
mesh_terms: D000328:Adult; D000368:Aged; D001290:Attitude; D003431:Cross-Cultural Comparison; D003466:Cultural Characteristics; D003695:Delivery of Health Care; D005060:Europe / Q000453:epidemiology; D005065:Euthanasia; D005260:Female; D040821:Human Characteristics; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008402:Mass Media; D008875:Middle Aged; D055361:Multilevel Analysis; D010342:Patient Acceptance of Health Care; D026684:Personal Autonomy; D010817:Physician-Patient Relations; D011639:Public Opinion; D012107:Research Design; D012945:Social Values; D011795:Surveys and Questionnaires; D013727:Terminal Care; D035502:Trust; D035761:Wedge Argument