To study Finnish physicians’ attitudes and opinions toward euthanasia and physician-assisted suicide (PAS).

A nationwide cross-sectional study.

An online survey was conducted via the Finnish Medical Association in the autumn of 2023 covering all Finnish physicians.

8857 Finnish physicians answered the survey, yielding a response rate of 31%.

Finnish physicians’ attitudes towards euthanasia and PAS and background factors influencing these attitudes and opinions.

Of the responders, 29% fully agreed and 29% fully disagreed with the statement ‘Euthanasia should be legalised in Finland’, respectively. Fewer responders (18%) fully agreed that physicians should be able to assist a patient in suicide. Factors such as being female and having experience in end-of-life care were associated with disagreement about legalising euthanasia and assistance in suicide. Conversely, having faced a request for euthanasia or PAS was associated with agreeing on legalising euthanasia and assistance in suicide. One out of seven respondents fully agreed that they could practise euthanasia, and one out of six fully agreed that they could assist a patient in suicide if these practices were legal in Finland.

Finnish physicians’ attitudes and opinions towards assistance in dying are highly divided, emphasising the controversy of this challenging subject.

Histopathological evaluation of prostate biopsies using the Gleason scoring system is critical for prostate cancer diagnosis and treatment selection. However, grading variability among pathologists can lead to inconsistent assessments, risking inappropriate treatment. Similar challenges complicate the assessment of other prognostic features like cribriform cancer morphology and perineural invasion. Many pathology departments are also facing an increasingly unsustainable workload due to rising prostate cancer incidence and a decreasing pathologist workforce coinciding with increasing requirements for more complex assessments and reporting. Digital pathology and artificial intelligence (AI) algorithms for analysing whole slide images show promise in improving the accuracy and efficiency of histopathological assessments. Studies have demonstrated AI’s capability to diagnose and grade prostate cancer comparably to expert pathologists. However, external validations on diverse data sets have been limited and often show reduced performance. Historically, there have been no well-established guidelines for AI study designs and validation methods. Diagnostic assessments of AI systems often lack preregistered protocols and rigorous external cohort sampling, essential for reliable evidence of their safety and accuracy.

This study protocol covers the retrospective validation of an AI system for prostate biopsy assessment. The primary objective of the study is to develop a high-performing and robust AI model for diagnosis and Gleason scoring of prostate cancer in core needle biopsies, and at scale evaluate whether it can generalise to fully external data from independent patients, pathology laboratories and digitalisation platforms. The secondary objectives cover AI performance in estimating cancer extent and detecting cribriform prostate cancer and perineural invasion. This protocol outlines the steps for data collection, predefined partitioning of data cohorts for AI model training and validation, model development and predetermined statistical analyses, ensuring systematic development and comprehensive validation of the system. The protocol adheres to Transparent Reporting of a multivariable prediction model of Individual Prognosis Or Diagnosis+AI (TRIPOD+AI), Protocol Items for External Cohort Evaluation of a Deep Learning System in Cancer Diagnostics (PIECES), Checklist for AI in Medical Imaging (CLAIM) and other relevant best practices.

Data collection and usage were approved by the respective ethical review boards of each participating clinical laboratory, and centralised anonymised data handling was approved by the Swedish Ethical Review Authority. The study will be conducted in agreement with the Helsinki Declaration. The findings will be disseminated in peer-reviewed publications (open access).