A psychometric evaluation conducted among medical students in Türkiye has validated the Turkish adaptation of the Attitudes Toward Euthanasia scale, identifying a novel two-factor structural model. The study, undertaken by researchers Beytullah Ural, Ahmet Nezih Kök, and Talip Vural, confirmed that the instrument reliably captures student perspectives within a specific medicolegal framework. Rather than replicating the four-factor conceptual structure documented in earlier international literature, the empirical data gathered from the Turkish cohort coalesced into two distinct dimensions labeled Patient Request and Doctor’s Authority, demonstrating robust statistical fit and internal consistency across independent samples.
Euthanasia remains a complex ethical, legal, and medical issue. In Türkiye, euthanasia is not legally permitted, making the systematic assessment of emerging healthcare professionals’ viewpoints particularly vital. The investigative team highlighted that evaluating the attitudes of future physicians is essential for informing undergraduate medical curricula, enriching bioethical discourse, and establishing an empirical foundation for future legal and health policy discussions surrounding end-of-life care decisions.
To evaluate the instrument’s psychometric performance, the investigators enrolled a total analytical sample of 967 medical faculty students. Although the initial investigative protocol was designed to survey both medical and law faculty students to assess cross-disciplinary medicolegal perspectives, the actual participation rate among law students proved insufficient for rigorous quantitative modeling. Because their low representation precluded meaningful and robust psychometric validation, the researchers restricted all subsequent statistical and factor analytic procedures exclusively to the dataset generated by the medical student cohort.
Before conducting statistical assessments, the research team ensured rigorous cross-cultural and linguistic equivalence through a multi-stage translation protocol. The Attitudes Toward Euthanasia instrument underwent forward–backward translation, followed by comprehensive expert review and targeted pilot testing.
Because prior cross-cultural adaptations of the scale in different countries had yielded divergent factor structures, the researchers adopted a rigorous split-sample analytical strategy. The total dataset of 967 participants was randomly partitioned into two independent subsamples, with one reserved for exploratory factor analysis and the second allocated to confirmatory factor analysis. Analyses were based on the polychoric correlation matrix. Principal axis factoring served as the extraction method during the exploratory stage, while the confirmatory stage implemented the unweighted least squares with mean and variance adjustment estimator.
The exploratory factor analysis identified a two-dimensional framework, which was subsequently substantiated in the independent confirmatory subsample with favorable goodness-of-fit indices. The structural equation model achieved a comparative fit index of 0.977, a Tucker–Lewis index of 0.970, a root mean square error of approximation of 0.079, and a standardized root mean square residual of 0.029. The two-factor solution differed from the original four-factor conceptual structure and suggested that patient request was interpreted together with severe suffering in this medical student sample.
Reliability testing yielded high internal consistency across all dimensions of the adapted scale. McDonald’s omega reached 0.926 for the Patient Request subscale and 0.931 for the Doctor’s Authority subscale, while the stratified alpha for the total scale was calculated at 0.927. Additionally, item discrimination values attained statistical significance across all evaluated items. The authors concluded that the Turkish adaptation of the Attitudes Toward Euthanasia scale provides a valid and psychometrically sound instrument for bioethics research and medical education, while noting that certain items exhibit context-dependent interpretations that warrant ongoing investigation in future content-validity research.
Beyond establishing the statistical properties of the instrument, the investigators noted that establishing this measurement tool opens practical opportunities for cross-cultural comparisons across different countries and healthcare settings.
Consequently, the team recommended that future research conduct comprehensive content-validity studies to examine these subtle contextual interpretations more thoroughly, while also noting that initial efforts to sample law students were halted due to low representation, leaving the medicolegal evaluation centered entirely on the medical cohort.
Subject of Research: Psychometric validation and factor structure of the Turkish Attitudes Toward Euthanasia scale among medical students
Article Title: A medicolegal evaluation of attitudes toward euthanasia: psychometric validation of the ATE scale in Türkiye
Article References: Ural, B., Kök, A. N., & Vural, T. (2026). A medicolegal evaluation of attitudes toward euthanasia: psychometric validation of the ATE scale in Türkiye. BMC Medical Ethics. https://doi.org/10.1186/s12910-026-01611-3
Image Credits: AI Generated
DOI: 10.1186/s12910-026-01611-3
Keywords: Attitudes Toward Euthanasia scale, psychometric validation, medical students, bioethics, medicolegal evaluation, exploratory factor analysis, confirmatory factor analysis, Patient Request factor, Doctor's Authority factor, McDonald's omega, stratified alpha, polychoric correlation matrix, unweighted least squares estimator, comparative fit index, forward-backward translation, Turkish medical education
News Source: Courtney Benton. (November 13, 2026). Turkish Study Validates Two-Factor Attitudes Toward Euthanasia Scale Among Medical Students. Scienmag.
