Assessing Spaniard men's willingness and determinants to use a male contraceptive pill.

OBJECTIVE: As the clinical trials to develop male contraceptive pills are underway, understanding men's attitudes towards this contraceptive method is transcendental. This research was conducted to identify the degree of willingness and the determinants to use male contraceptive pill among Spaniard men. METHODS: A sample of 402 Spaniards men was presented with 36 scenarios comprising four within-subject factors (cost of pills, pill efficacy, side effects and context). In each scenario, a man is asked by his partner to use the contraceptive pill. Participants indicated their own willingness to use the pill in each circumstance. RESULTS: Cluster analysis revealed that participants took one of seven different positions regarding their willingness to use a contraceptive pill: never agree (10%); mainly depends on pill efficacy (6%); mainly depends on side effects (10%); depends on side effects and efficacy (12%); depends on context and side effects (12%); quite always (25%); always agree (25%). Participants' willingness to use contraceptive pills was more pronounced in the case of mild side effects and higher pill efficacy. CONCLUSION: Fifty percent of participants would use the male pill regardless of the circumstances. Access to this contraceptive method, when available, can contribute to greater equity in reproductive rights of the population.

Assessing hospitalized patients' quality of life from external indices: the perspectives of lay people and health professionals.

PURPOSE: We examined the way people assess hospitalized patients' quality of life from what they immediately observe when entering the patient's room, from what they learn by conversing with the patient, and from what they know about the patient's social life. METHODS: A sample of 474 adults (among them 7 physicians, 57 nurses, and 42 nurse's aides) aged 18-90 years was presented with 54 realistic scenarios depicting the situation of a terminally ill patient, and created by orthogonally combining the levels of four factors: chronic pain (e.g., requiring powerful painkillers), social support (e.g., some visits), mental status (e.g., alterations of consciousness), and physical autonomy. In each case, they assessed the patient's health-related quality of life. RESULTS: Through cluster analysis, three different positions related to what is important when judging the quality of life of a hospitalized patient were found. They were labeled Almost Always Low (40%), Depends on Personal and Social Circumstances (49%), and Depends Mainly on Social Support (11%). Health professionals did not differ fundamentally from lay people in their positions regarding what determines the health-related quality of life of their patients. CONCLUSION: Many people take a particularly pessimistic view of the quality of life of people whose health is unlikely to improve. Others think that, in certain circumstances, a certain quality of life can be preserved but for this to happen, the situation must be nearly ideal. A minority expressed a position consistent with the insistence of voluntary patient-visiting associations on the importance of providing hospitalized patients with social support.

What motivates individuals to volunteer in Ebola epidemic response? A structural approach in Guinea.

BACKGROUND: The 2014-2016 Ebola epidemic in West Africa placed greater demands on the affected countries' already scarce health workforce. Consequently, governments in the most affected West African countries made appeals for volunteers to join Ebola response programs. Those volunteers played an important yet high-risk role in aiding the victims of the Ebola epidemic and in limiting its spread. However, little is known as to what motivated those volunteers to commit themselves to the Ebola response programs. This information is important for planning for volunteer recruitment strategies during future epidemics. The aim of the present study, therefore, was to identify and assess the motivations that led individuals to volunteer for Ebola response programs in West Africa. METHODS: The study participants were 600 persons who volunteered through the Guinean Ebola response program during the 2014-2016 epidemic. From February to May 2016, they were presented with a questionnaire that contained 50 assertions referring to possible motives for volunteering in the Ebola response program and indicated their degree of agreement with each of them on a scale of 0-10. The responses were analyzed using factor analysis. RESULTS: Seven separable volunteer motivations were identified. "Feeling of patriotic duty" (M = 9.02) and "Feeling of moral responsibility" (M = 8.12) clearly emerged as the most important. Second-tier motivations were "Compliance with authority" (M = 6.66), "Desire to use one's skills for a collective good" (M = 6.49), "Seeking personal growth" (M = 5.93), "Desire to gain community recognition" (M = 5.13), and "Hoping for a career reorientation" (M = 4.52). CONCLUSIONS: These findings strongly suggest that volunteer recruitment, if needed in future Ebola epidemics, must adopt a multifaceted motivational approach rather than focus on one single motivator. Putting relatively more emphasis on motivational messages referring to patriotic values, as well as to moral responsibility, would likely increase volunteering.

Why patients want to take or refuse to take antibiotics: an inventory of motives.

BACKGROUND: Inappropriate use of antibiotics is a worldwide issue. In order to help public health institutions and each particular physician to change patterns of consumption among patients, it is important to understand better the reasons why people accept to take or refuse to take the antibiotic drugs. This study explored the motives people give for taking or refusing to take antibiotics. METHODS: Four hundred eighteen adults filled out a 60-item questionnaire that consisted of assertions referring to reasons for which the person had taken antibiotics in the past and a 70-item questionnaire that listed reasons for which the person had sometimes refused to take antibiotics. RESULTS: A six-factor structure of motives to take antibiotics was found: Appropriate Prescription, Protective Device, Enjoyment (antibiotics as a quick fix allowing someone to go out), Others' Pressure, Work Imperative, and Personal Autonomy. A four-factor structure of motives not to take antibiotics was found: Secondary Gain (through prolonged illness), Bacterial Resistance, Self-defense (the body is able to defend itself) and Lack of trust. Scores on these factors were related to participants' demographics and previous experience with antibiotics. CONCLUSION: Although people are generally willing to follow their physician's prescription of antibiotics, a notable proportion of them report adopting behaviors that are beneficial to micro-organisms and, as a result, potentially detrimental to humans.

Identifying determinants of Mozambican men's willingness to use a male contraceptive pill.

Objective: Given the possibility of a male contraceptive pill in the near future, understanding men's attitudes towards this contraceptive method is crucial, especially in high-risk populations with limited access to education. This research was conducted to identify the determinants of Mozambican men's willingness to use a contraceptive pill when it is made available. Methods: A sample of 412 Mozambican men was presented with 36 vignettes comprising four within-subject factors (cost of pills, pill efficacy, side effects and context). Each vignette presented a scenario in which a man is asked by his partner to use the contraceptive pill, and participants indicated their own willingness to use the pill under each circumstance. Results: Cluster analysis revealed that participants took one of four different positions regarding their willingness to use a contraceptive pill: never (11%); depends on side effects alone (25%); depends on side effects and costs (11%); depends on side effects and context (46%). These positions were associated with participants' sociodemographic characteristics. Conclusion: Among the Mozambican men in this study, a minority appeared to believe that the responsibility for contraception should be shared between sexual partners. Men's willingness to use a contraceptive pill was, however, more pronounced in the case of serious medical risk to their partner. Overall, only about one-fifth of participants were either reluctant or unwilling to consider using a male contraceptive pill.

Duty to provide care to Ebola patients: the perspectives of Guinean lay people and healthcare providers.

AIM: To examine the views of Guinean lay people and healthcare providers (HCPs) regarding the acceptability of HCPs' refusal to provide care to Ebola patients. METHOD: From October to December 2015, lay people (n=252) and HCPs (n=220) in Conakry, Guinea, were presented with 54 sample case scenarios depicting a HCP who refuses to provide care to Ebola patients and were instructed to rate the extent to which this HCP's decision is morally acceptable. The scenarios were composed by systematically varying the levels of four factors: (1) the risk of getting infected, (2) the HCP's working conditions, (3) the HCP's family responsibilities and (4) the HCP's professional status. RESULTS: Five clusters were identified: (1) 18% of the participants expressed the view that HCPs have an unlimited obligation to provide care to Ebola patients; (2) 38% held that HCPs' duty to care is a function of HCPs' working conditions; (3) 9% based their judgments on a combination of risk level, family responsibilities and working conditions; (4) 23% considered that HCPs do not have an obligation to provide care and (5) 12% did not take a position. CONCLUSION: Only a small minority of Guinean lay people and HCPs consider that HCPs' refusal to provide care to Ebola patients is always unacceptable. The most commonly endorsed position is that HCPs' duty to provide care to Ebola patients is linked to society's reciprocal duty to provide them with the working conditions needed to fulfil their professional duty.

Haitian people's expectations regarding post-disaster humanitarian aid teams' actions.

The way people at the receiving end of humanitarian assistance perceive this intervention may provide invaluable bottom-up feedback to improve the quality of the intervention. We analyzed and mapped Haitians' views regarding international humanitarian aid in cases of natural disaster. Two hundred fifty participants-137 women and 113 men aged 18-67-who had suffered from the consequences of the earthquake in 2010 were presented with a series of vignettes depicting a humanitarian team's action and were asked to what extent these actions corresponded to what ought to be expected from an international aid mission. Four factors were considered in the vignettes (a) whether the team worked in close association with local institutions, (b) whether it was composed of competent people who were prepared for their mission, (c) whether they treated people as a function of immediate needs, and (d) whether they behaved in a respectful way. Through cluster analysis, five qualitatively different positions were found: (a) Complete hostility to any kind of humanitarian aid (6%); (b) Strong hostility to humanitarian aid in the case of disrespectful attitudes or behaviors (4%); (c) Technical competence is the only factor that matters (25%); (d) Both manifestation of respect for the population and technical competence matter (38%) and (e) Undetermined (27%). Most Haitians expect humanitarian teams to be technically competent, but even very competent aid is not considered adequate if provided in an arrogant and disrespectful manner.

Mapping French people and health professionals' positions regarding the circumstances of morphine use to relieve cancer pain.

BACKGROUND: Cancer patients suffer in part because some health professionals prescribe or administer amounts of analgesics, namely opioids, which are too small or too widely spaced to be fully effective. Patients' reluctance to use opioids for pain treatment is often mentioned as a reason not to apply the official guidelines, but very few studies have been conducted on people's attitudes about opioid use to relieve cancer pain. METHODS: One hundred twenty lay participants and 30 health professionals (7 physicians and 23 nurses) were presented with a set of vignettes describing a terminally ill woman with cancer who is in pain. The vignettes were composed according to a four within-subject factor design: (a) level of pain reported by the patient, (b) patient's explicit request for additional administration of analgesics, (c) the physicians' final decision (e.g., to use a stronger analgesic combining paracetamol and codeine), and (d) the way the decision was made (collectively or not). Participants were asked to assess the extent to which the physician's decision was, in their view, acceptable. RESULTS: Seven qualitatively different positions were found among participants. They were called as follows: tend to disagree with any decision (9%), increase the strength of the painkiller in any case (16%), give morphine preferentially (9%), partly depends on pain level (23%), fully depends on pain level (6%), depends on decision process and on pain level (22%), and tend not to disagree with any collective decision (25%). CONCLUSIONS: Overall, 91% of participants agreed with the use of morphine in terminally ill cancer patients when the pain level was high (score of 7) and the decision to increase the strength of the painkiller was taken collectively. This percentage dropped to 69% when the team was not involved in the decision and to 40% when the pain level was lower (score of 4). If opposition to the use of morphine exists, it is not opposition to morphine itself but opposition to the circumstances of its use.

Allocation of antiretroviral drugs to HIV-infected patients in Togo: perspectives of people living with HIV and healthcare providers.

AIM: To explore the way people living with HIV and healthcare providers in Togo judge the priority of HIV-infected patients regarding the allocation of antiretroviral drugs. METHOD: From June to September 2015, 200 adults living with HIV and 121 healthcare providers living in Togo were recruited for the study. They were presented with stories of a few lines depicting the situation of an HIV-infected patient and were instructed to judge the extent to which the patient should be given priority for antiretroviral drugs. The stories were composed by systematically varying the levels of four factors: (a) the severity of HIV infection, (b) the financial situation of the patient, (c) the patient's family responsibilities and (d) the time elapsed since the first consultation. RESULTS: Five clusters were identified: 65% of the participants expressed the view that patients who are poor and severely sick should be treated as a priority, 13% prioritised treatment of patients who are poor and parents of small children, 12% expressed the view that the poor should be treated as a priority, 4% preferred that the sickest be treated as a priority and 6% wanted all patients to get treatment. CONCLUSIONS: WHO's guideline regarding antiretroviral therapy allocation (the sickest first as the sole criterion) currently in use in many African countries does not reflect the preferences of Togolese people living with HIV. For most HIV-infected patients in Togo, patients who cannot get treatment on their own should be treated as a priority.

The ethics of postoperative pain management: Mapping nurses' views.

AIM: We explored the positions of nurses working in hospitals regarding the acceptability of refusing to give a repeat dose of painkiller to a postoperative patient who requested it. These positions were compared with that of lay people, physicians, and other health professionals. DESIGN AND METHODS: Factorial design was used to assess the impact of 6 situational factors: the patient's age, the current level of pain as assessed by the nurse, the number of requests, the level of risk associated with the administration of a repeat dose, the outcome of surgery, and the giving of alternative mild analgesics. We implemented a combination of scenario technique and of cluster analysis. Data were collected from April 2013 to December 2015. PARTICIPANTS: 138 registered nurses, 32 nurse's aides, 33 physicians, 23 psychologists, and 169 lay people participated in the study. RESULTS: We found 4 qualitatively different meaningful positions. A plurality of participants (57% of nurses) considered that refusing was not acceptable, irrespective of circumstances. A substantial minority of participants (but 52% of physicians) considered that refusing was acceptable only if the level of pain was low and the risk was high. Other participants (mostly lay people) considered that refusing was always acceptable each time a risk of side effects, either serious or simply mild, was present.

Mapping people's views regarding the acceptability of surrogate motherhood.

The aims of the present study were to map French laypersons' views regarding the acceptability of maternal surrogacy and to delineate the circumstances under which surrogacy is considered, by different groups of people, as especially problematic. Participants (N = 236) were presented with a number of scenarios depicting the circumstances in which a couple has contracted with a surrogate mother and were asked to indicate the extent to which such a contract may present a moral problem. The scenarios were created by varying four factors: the type of surrogacy (traditional or gestational), the surrogate mother's level of autonomy, the family context in which the surrogate mother lives, and whether surrogacy was commercial or altruistic. Three qualitatively different personal positions were found: (a) a majority group for which surrogacy always (30%) or often (34%) presents a moral problem, (b) a minority group (14%) for which maternal surrogacy does not systematically present a moral problem, and

Mapping French people's views regarding posthumous reproduction.

OBJECTIVE: The study mapped French people's views regarding the acceptability of posthumous reproduction. BACKGROUND: Posthumous reproduction - the use of a deceased person's gametes for procreative purposes -is a controversial procedure because it involves a series of ethical issues, namely the surviving partner's rights to procreation, the emotional feelings and financial interests of other family members, and the government's interest in maintaining orderly inheritance rules. METHODS: A convenience sample of participants aged 19-68 (104 lay people, 47 health professionals and 15 lawyers) were presented with 48 realistic stories that were composed according to a four-factor within-subject design: marital status (married for about 10 years with children, married for about three years without children, and cohabiting for three years without children) × attitude of the deceased's parents (favourable vs. unfavourable to posthumous procreation) × time elapsed since the partner's death (three months vs. nine months) × deceased's wishes (written consent, oral consent given in front of credible witnesses, unknown wishes, and unfavourable attitude). RESULTS: Through cluster analysis, four qualitatively different positions were found. They were called Never Acceptable (35% of the sample, mostly health professionals, lawyers and regular attendees to the church or temple), Tolerable in a Few Cases (28%), Depends on Deceased's Wishes (22%, mostly lay people) and Quite Acceptable (16%, mostly lay people). CONCLUSIONS: About half of French lay people view the current legislation regarding posthumous assisted reproduction in a country such as the UK as more appropriate than the French legislation.

Estimates of lay views about reversal multiple intelligences for self and others: Sex and cross-cultural comparisons.

This study focuses on lay conceptions of intelligence. It examined sex and cross-cultural similarities and differences in estimated intelligences and beliefs about intelligence in two countries, Angola and East Timor, within the reversal theory framework. A total of 209 Angolan (109 women and 100 men) and 183 Timorese (89 women and 94 men) students were participated in this study. Participants completed a questionnaire in order to estimate their parents', partners' and own overall intelligence and the 8 reversal multiple intelligences (telic, paratelic, conformist, negativistic, autic mastery, autic sympathy, alloic mastery and alloic sympathy intelligence). Respondents also rated 6 questions about intelligence. Men rated their overall, conformist and autic mastery higher than women. Angolans rated their overall, telic, paratelic, conformist, negativistic, autic mastery, autic sympathy, alloic mastery and alloic sympathy intelligence higher than Timorese. In both countries, fathers have been perceived as more intelligent than mothers, and telic intelligence emerged as a significant predictor of overall intelligence. Principal component analysis of the 8 reversal multiple intelligences yielded one factor. Angolan participants revealed more IQ test experience than Timorese participants. Most of respondents in both countries did not believe in sex differences in intelligence. These findings are discussed by means of cross-cultural literature.

French laypeople's and health professionals' views on the acceptability of terminal sedation.

AIM: To study the views on the acceptability of terminal sedation (TS) of laypeople and health professionals in France. METHOD: In November 2013-June 2015, 223 laypeople and 53 health professionals (21 physicians and 32) judged the acceptability of TS in 48 realistic scenarios composed of all combinations of four factors: (a) the patients' life expectancy, (b) their request for sedation, (c) the decision-making process and (d) the type of sedation. In all scenarios, the patients were women with a terminal illness suffering from intractable pain and receiving the best possible care. The ratings were subjected to cluster analysis and analyses of variance. RESULTS: Five qualitatively different positions were found that were termed TS acceptable if decision taken collectively (15%), TS acceptable if patient explicitly requested it (19%), TS acceptable if patient did not explicitly oppose it (47%), 24-hour sedation not acceptable (6%) and TS always acceptable (13%). The percentage of older participants in the 'always acceptable' cluster was higher than the percentage of younger participants. CONCLUSIONS: Laypeople and health professionals do not appear to be systematically opposed to TS. The most important factors in increasing its acceptability were the patients' request for sedation and the collective character of the decision-making process.

Breaking Bad News to Togolese Patients.

The aim of this study was to map Togolese people's positions regarding the breaking of bad news to elderly patients. Two hundred eleven participants who had in the past received bad medical news were presented with 72 vignettes depicting communication of bad news to elderly female patients and asked to indicate the acceptability of the physician's conduct in each case. The vignettes were all combinations of five factors: (a) the severity of the disease, (b) the patient's wishes about disclosure, (c) the level of social support during hospitalization, (d) the patient's psychological robustness, and (e) the physician's decision about how to communicate the bad news. Five qualitatively different positions were found. Two percent of the participants preferred that the physician always tell the full truth to both the patient and her relatives, 8% preferred that the truth be told depending on the physician's perception of the situation, 15% preferred that the physician tell the truth but understood that in some cases nondisclosure to the patient was not inappropriate, 33% preferred that the physician tell the full truth to the relatives but not as much information to the patient, and 42% preferred that the physician tell the full truth to the relatives only. These findings present a challenge to European physicians taking care of African patients living in Europe or working in African hospitals, and to African physicians trained in Europe and now working in their home countries. If these physicians respect the imperative of always telling the truth directly to their patients, their behavior may trigger anger and considerable misunderstanding among African patients and their families.

Aging, Functional Learning, and Inhibition.

BACKGROUND/STUDY CONTEXT: The study compared the learning performance of younger and older adults in situations differing in the number of cues that could be relied on for predicting the value of a criterion. Two hypotheses were tested: one based on the assumption that the greater the inhibition effort needed in the task, the greater the difference between younger and older participants, and the other based on the fact that the context in which inhibition occurs plays a role, and consequently that the level of difficulty of the four learning conditions can be better predicted from the number of possible sets of valid cues. METHODS: A total of 240 adults (18-90 years old) had to learn to predict the amount of drink delivered by a drink dispenser on the basis of four cues (the height of four vertical bars). The participants were randomly distributed between four experimental conditions, one valid cue, two valid cues, three valid cues, and all valid cues. The measures that were calculated for each participant under each condition included the squared mean differences between judgment and criterion as an index of performance, and cue utilizations as a test of both the learning of the strength of direct linear relationships and of inhibition. RESULTS: The results validated the hypothesis that the level of difficulty of the four learning conditions can be better predicted from the number of possible sets of valid cues. In all conditions and in each age group, cue utilizations were direct in the first block with no feedback. Older adults discounted the nonpertinent cues as well as younger adults, whereas participants aged over 76 only succeeded under the least demanding conditions. The presence of nonpertinent cues affected the learning of direct cues, even among the younger participants. CONCLUSION: This study shows that older adults' ability to detect (and use) valid cues in an environment that contains both valid and invalid cues is relatively well preserved. It also shows that the mere presence of invalid cues can affect the learning of direct cues, which constitutes a new result in functional learning. Future research conducted in cognitive aging should examine the role of invalid cues in functional learning.

A mapping of people's positions regarding the breaking of bad news to patients.

The objective of this study was to map people's positions regarding the breaking of bad news to patients. One hundred forty adults who had in the past received bad medical news or whose elderly relatives had in the past received bad news, 25 nurses, and 28 nurse's aides indicated the acceptability of physicians' conduct in 72 vignettes of giving bad news to elderly patients. Vignettes were all combinations of five factors: (a) the severity of the disease (severe but not lethal, extremely severe and possibly lethal, or incurable), (b) the patient's wishes (insists on knowing the full truth vs. does not insist), (c) the level of social support during hospitalization, (d) the patient's psychological robustness, and (e) the physician's decision about communicating bad news (tell the patient that the illness is not severe and minimize the severity of the illness when talking to the patient's relatives, tell the full truth to her relatives, or tell the full truth to both the elderly patient and her relatives). Four qualitatively different positions were found. Twenty-eight percent of participants preferred the full truth to be told; 36% preferred the truth to be told but understood that the physician would inform the family first; 13% did not think that telling the full truth is best for patients; and 23% understood that the full truth would be told in some cases and not in others, depending on the physician's perception of the situation. The present mapping could be used to detect the position held by each patient and act accordingly. This would be made easier if breaking bad news was conceived as a communication process involving a range of health care professionals, rather than as a single occurrence in time.

A mapping of the positions of adults in Toulouse, France, regarding induced abortion.

BACKGROUND: Are people's views on abortion as polarised as is suggested by the 'marches for life' that regularly take place in Paris and other capitals? Objective To map French people's positions regarding the acceptability of induced abortion. METHODS: One hundred and fifty-nine participants were presented with stories composed according to a three within-subject design: Reason for abortion (e.g., the woman's life is endangered) × Gestational age × Woman's age. They assessed the extent to which abortion would be, in each case, an acceptable medical/surgical procedure. RESULTS: Five qualitatively different positions were identified: (i) always acceptable, irrespective of circumstances (31% of the sample), (ii) strictly depends on the reason for abortion (27%), (iii) legalist (23%), (iv) depends on the reason and on the gestational age (18%), and (v) always unacceptable (1%). CONCLUSIONS: Only one-fifth of the participants agreed with the part of the French law that permits abortion on request when gestational age does not exceed ten weeks. The others disagreed either because they thought that abortion on demand should never be permitted or because they thought that the age limit should be extended. This divide in people's opinions guarantees that the debate over induced abortions will continue.

The acceptability among young Hindus and Muslims of actively ending the lives of newborns with genetic defects.

AIM: To explore the views in non-Western cultures about ending the lives of damaged newborns. METHOD: 254 university students from India and 150 from Kuwait rated the acceptability of ending the lives of newborns with genetic defects in 54 vignettes consisting of all combinations of four factors: gestational age (term or 7 months); severity of genetic defect (trisomy 21 alone, trisomy 21 with serious morphological abnormalities or trisomy 13 with impending death); the parents' attitude about prolonging care (unknown, in favour or opposed); and the procedure used (withholding treatment, withdrawing it or injecting a lethal substance). RESULTS: Four clusters were identified by cluster analysis and subjected to analysis of variance. Cluster I, labelled 'Never Acceptable', included 4% of the Indians and 59% of the Kuwaitis. Cluster II, 'No Firm Opinion', had little variation in rating from one scenario to the next; it included 38% of the Indians and 18% of the Kuwaitis. In Cluster III, 'Parents' Attitude+Severity+Procedure', all three factors affected the ratings; it was composed of 18% of the Indians and 16% of the Kuwaitis. Cluster IV was called 'Severity+Parents' Attitude' because these had the strongest impact; it was composed of 40% of the Indians and 7% of the Kuwaitis. CONCLUSIONS: In accordance with the teachings of Islam versus Hinduism, Kuwaiti students were more likely to oppose ending a newborn's life under all conditions, Indian students more likely to favour it and to judge its acceptability in light of the different circumstances.

Togolese lay people's and health professionals' views about the acceptability of physician-assisted suicide.

AIM: To study the views on the acceptability of physician-assisted-suicide (PAS) of lay people and health professionals in an African country, Togo. METHOD: In February-June 2012, 312 lay people and 198 health professionals (75 physicians, 60 nurses and 63 health counsellors) in Togo judged the acceptability of PAS in 36 concrete scenarios composed of all combinations of four factors: (a) the patient's age, (b) the level of incurability of the illness, (c) the type of suffering and (d) the patient's request for PAS. In all scenarios, the patients were women receiving the best possible care. The ratings were subjected to cluster analysis and analyses of variance. RESULTS: Most lay people (59%) were not systematically opposed to PAS, whereas most health professionals (80%) were systematically opposed to it. The most important factors in increasing acceptability among people not systematically opposed were advanced age of the patient and incurability of the illness. Additional acceptability was provided by the patient's request to have her life ended, although much less so than in studies in Western countries, and by suffering characterised by complete dependence rather than by extreme physical pain. CONCLUSIONS: These empirical findings--the first ones gathered in the African continent--suggest that most Togolese lay people are not categorically for or against PAS, but judge its degree of acceptability as a function of concrete circumstances.