Standard views of good death in human and veterinary medicine considerably differ from one another. Whereas the good death ideal in palliative medicine emphasizes the positive aspects of non-induced dying, veterinarians typically promote a quick and painless killing with the aim to end suffering. Recent developments suggest a convergence of both professions and professional attitudes, however. Palliative physicians are confronted with patients wishing to be ‘put to sleep’, while veterinarians have begun to integrate principles and practices from hospice care. (...) We will argue that the discourses on good human and animal deaths are not distinct, but that they interact and influence each other. On the one hand, veterinary medicine adapts techniques like chemotherapy or sedation from palliative end-of-life care. On the other hand, philosophers, veterinarians, pet owners, patients and the general public alike make certain assumptions about the analogy of human and animal dying or killing. Unfortunately, these interactions have only scarcely been reflected normatively, especially on the part of human medicine. Conflicts and misattributions with potential serious negative consequences for the patients’ wellbeing are provoked. For these reasons, palliative physicians and veterinarians are invited to engage in the debate around human and animal end-of-life care. (shrink)

When an individual facing intractable pain is given an estimate of a few months to live, does hastening death become a viable and legitimate alternative for willing patients? Has the time come for physicians to do away with the traditional notion of healthcare as maintaining or improving physical and mental health, and instead accept their own limitations by facilitating death when requested? The Universities of Oxford and Cambridge held the 2013 Varsity Medical Debate on the motion “This House Would Legalise (...) Assisted Dying”. This article summarises the key arguments developed over the course of the debate. We will explore how assisted dying can affect both the patient and doctor; the nature of consent and limits of autonomy; the effects on society; the viability of a proposed model; and, perhaps most importantly, the potential need for the practice within our current medico-legal framework. (shrink)

Some people willingly risk or give up their lives for something they deeply believe in, for instance standing up to a dictator. A good example of this are members of the White Rose student resistance group, who rebelled against the Nazi regime and paid for it with their lives. I argue that when the cause is good, such risky activities (and even deaths themselves) can contribute to meaning in life in its different forms – meaning-as-mattering, meaning-as-purpose, and meaning-as-intelligibility. Such cases (...) highlight the importance of integrity, or living up to one’s commitments, in meaningful living, or dying, as it may be, as well as the risk involved in commitment, since if you die for a bad cause, you have only harmed yourself. However, if leading a more rather than less meaningful life benefits rather than harms you, there are possible scenarios in which you yourself are better off dying for a good cause than living a longer moderately happy life. This presents a version of a well-known puzzle: what, then, makes dying for a cause a self-sacrifice, as it usually seems to be? I sketch some possible answers, and try to make sense of relevant work in empirical psychology. (shrink)

Dying Prepared in Medieval and Early Modern Northern Europe offers an analysis of the various ways in which people made preparations for death in medieval and early modern Northern Europe.

In the paper, titled ‘Choosing death in unjust conditions: hope, autonomy and harm reduction,’ Wiebe and Mullin argue that people living in unjust social conditions are sufficiently autonomous to request medical assistance in dying (MAiD). The ethical issue is that some people may request MAiD primarily because of unjust social conditions, not their illness, disease, disability or decline in capability. It is easily agreed that people living in unjust social conditions can be autonomous. Nevertheless, Wiebe and Mullin fail to (...) appreciate that autonomy is only a necessary condition for MAiD. In addition to autonomy, one must decide that providing assisted dying to a patient because they are living in unjust social conditions is ethical. Central to making this ethical decision is the principle of non-maleficence, famously articulated as ‘do no harm.’ The authors admit that performing MAiD in response to unjust social circumstances is harmful, but they justify this harmful action by appealing to the principle of harm reduction. A fundamental flaw of their approach is that it relies on the legislative definition of intolerable suffering, which is based on circular reasoning and given that 99.2% of patients that have applied for MAiD satisfied this criterion, it is essentially equivalent to no standard/criterion. Canadian society is struggling with the ethical implications of its permissive MAiD programme, and, fundamental to this debate, will be determining the proper balance between autonomy and non-maleficence for people living in unjust social conditions. (shrink)

Homer'sIliadis an epic poem full of war and battles, but scholars have noted that ‘[t]he Homeric poems are interested in death far more than they are in fighting’. Even though long passages of the poem, particularly the so-called ‘battle books’ (Il.Books 5–8, 11–17, 20–2), consist of little other than fighting, individual battles are often very short with hardly ever a longer exchange of blows. Usually, one strike is all it takes for the superior warrior to dispatch his opponent, and death (...) occurs swiftly. The prominence of death in Homeric battle scenes raises the question of how and in which terms dying in battle is being depicted in theIliad: for while fighting can be described in a straightforward fashion, death is an abstract concept and therefore difficult to grasp. Recent developments in cognitive linguistics have ascertained that, when coping with difficult and abstract concepts, such as emotions, the human mind is likely to resort to figurative language and particularly to metaphors. (shrink)

It might seem counterintuitive to think transhumanists, who are typically characterized by extreme techno-optimism and hope for radical life-extension, would be interested in assisted dying. Because the technological enhancements they long for will probably not be available during their natural lifetimes, many transhumanists at least entertain the idea of having themselves cryonically preserved to buy some additional time for real-world technology to catch up to their dreams. However, since an ideal preservation would take place before serious cellular deterioration sets (...) in, controlling the time and manner of death would be very attractive for transhumanist cryonicists. This chapter identifies some circumstances under which they might be justified in seeking assistance in dying (even though they would describe it as something more akin to hibernating). After providing a fundamental overview of both transhumanism and cryonics, and then making my case for what some scholars have called “cryothanasia” (i.e. assisted dying for the purpose of improved preservation quality), I proceed to consider some scenarios meant to test the limits of this justification. While things are admittedly murkier when considering the possibility of cryothanasia outside the context of imminent medical collapse, I can see no insurmountable criticisms of cryothanasia as a last resort in cases of (currently) terminal and irreparable neurodegeneration or other forms of progressive brain damage. (shrink)

This paper argues that a lonely death is, by definition, a bad death and that society as a whole, as well as individuals in society are obligated to assure a certain degree of well‐being, flourishing, or care among and for fellow individuals. Individuals can then be said to have a right against dying a lonely death. Such a right has corresponding duties. The paper further specifies what such duties may entail based on what individuals may need on their deathbed, (...) specifically focusing on the need for human touch. Assuming that human touch might indeed be needed by some individuals in order to avoid a lonely death, the paper explores potential implications from a public health perspective, particularly during infectious disease outbreaks such as COVID. (shrink)

I had been on the phone with Madeleine's mother for fifteen minutes, and she had sobbed throughout. She pleaded with me, “You won't even let our family visit her together. If you really want to help my daughter, you will let us stay with her.” Madeleine, who was twenty‐four years old, was dying of end‐stage acute myeloid leukemia and was intubated in one of our intensive care units. Her intensivist had requested a clinical ethics consultation for potentially inappropriate medical (...) treatment—in my world of clinical ethics consultation, routine stuff. Except that, in March 2020, nothing was routine anymore. The Covid‐19 pandemic calls for creative thinking about ad hoc and post hoc bereavement efforts, and it may result in efforts to revise existing accounts of what constitutes a good death in order to accommodate patients’ and families’ experiences at the end of life during a pandemic. (shrink)

Some jurisdictions that allow assisted dying require participating patients to have a terminal illness. This includes all Australian and US states where assisted dying is allowed. 1 Philip Reed 2 argues that this requirement constitutes discrimination against the dying. As Reed 2 argues: ‘assisted death laws that limit their services to the dying discriminate against them because death is offered to them to solve their problems’. This discrimination could take two forms: (1) via harm to (...) class='Hi'>dying patients as a group as a result of the existence of assisted dying programmes; (2) via a negative message that such programmes communicate about whether the lives of dying patients are worth living. Assisted dying programmes are not unjustly discriminatory in either sense so long as we assume that unjust discrimination requires harm to the group in question. If assisted dying singles out the terminally ill for a programme... (shrink)

Debates over physician-assisted suicide comprise a small portion of broader culture wars. Their role in the culture wars obscures an under-acknowledged consensus between those who support PAS and those who oppose it. Drawing insights from personalism, this essay situates PAS within larger moral obligations of solidarity with the dying and their caregivers. The contributions of Roman Catholic personalism relocate debates over PAS and allow us to harness shared moral impulses.

Maung argues that an externalist understanding of mental disorder exposes how, if society was more just for the most deprived, patterns of access to assisted dying might be different. I counter that reducing inequality lacks relevance to the immediate permissibility of assisted dying for mental disorder, owing to the need for solutions for those in distress. I suggest that the question of assistance in death for mental disorders is one of pragmatic politics, not for obfuscatory philosophy.

The claim that the Resurrection of Jesus is historical fact is often justified on the basis that the disciples died for the belief. I analyze the argument, and show that three key premises cannot be accepted. The first is the claim that the disciples died for their beliefs. I give a detailed analysis of what is involved in dying for a belief in this context, and show that we have no assurance that the disciples died for their beliefs in (...) that sense at all. The second is that the disciples could not have been sincerely mistaken, and the third is that the beliefs of the disciples were those attributed to them by apologists. I suggest that neither of these premises can be established with any certainty. (shrink)

Although many studies have previously examined medicalisation, we add a new dimension to the concept as we explore how contemporary oncological medicine shapes the dying self as predominantly medical. Through an analysis of multiple case studies collected within a comprehensive cancer centre in Ontario, Canada, we examine how people with late‐stage cancer and their healthcare providers enacted the process of medicalisation through engaging in the search for oncological treatments, such as experimental drug trials, despite the incurability of their disease. (...) The seven cases included 20 interviews with patients, family, physicians and nurses, the analysis of 30 documents and 5 hr of field observation. A poststructural perspective informed our study. We propose that searching for life extension enacts medicalisation by shaping the dying person afflicted with terminal cancer into new medical subjectivities that are knowledgeable, active, entrepreneurial and curative. Participants initially took up medical thinking from the formal oncology system, but then began to apply and internalise medical rationalities to alter their personhood, thereby generating new curative possibilities for themselves. For people seeking life extension, the embodied and day‐to‐day experiences of suffering and being close to death became expressed and moderated in fundamentally medicalised terms. (shrink)

One of the greatest merits of Costica Bradatan's book is that it explores a cluster of topics that represent the untold, the unuttered, almost the unutterable in contemporary philosophy: death, dying, sacrifice and self-sacrifice. Ours is a culture of 'happy endings' and, in this respect, most philosophers of today are the spokespersons of their time. Bradatan is a dissenter. His book approaches death head-on. Indeed, what makes this project fascinating is the fact that, while the book purports to be (...) about 'dying for an idea,' it in fact sings praise to life. Death, in Bradatan's view, is something that brings new meaning to life, a renewed intensity to the act of living. Simon Critchley, New School for Social Research, New York, USA. (shrink)

If political statements and media coverage are any guide, it seems Australians today are dying for security. At no other moment in our history has the spectre of war and terrorism so haunted popular, political and scholarly perceptions of Australia’s colonial past and of its geopolitical future. And yet, debates over colonial war or genocide and contemporary terrorism have been conducted in more or less complete isolation. In this article I argue that our contemporary obsession with ‘security’ is premised (...) on the perennial threat of ‘insecurity’. This is the problem of in/security, and it has played a central role in the development of Western political thought. More importantly, its formulation in Western political thought provided a powerful justification for the violence of the early decades of Australia’s colonisation during which Indigenous Australians could also be said to have been dying for security. (shrink)

This article aims to dissect Thomas Abbt's (1738–1766) theory of aesthetic patriotism as laid out in his On Dying for the Fatherland (1761) and his prize-essay On Mathematical, Metaphysical and Moral Certainty (1763). Aesthetic idioms, such as the emphasis on the intrinsic pleasure from the order and beauty of virtue, had been invoked throughout the eighteenth century to vindicate the morally optimistic view of humanity against the sceptical vision of an exclusively utility-centred mankind. In the post-Montesquieu debates on the (...) moral foundations of modern politics, German-speaking authors in particular, from both republics (Switzerland) and monarchies (Prussia), appropriated the aesthetic idioms in order to reject those theories which grounded patriotism in some sort of self-interest or proclaimed it redundant in modern society. Thomas Abbt was one of the most prominent representatives of this intellectual position. Combining the general emphasis of Shaftesbury on the role of aesthetic appreciation in moral and political agency with the more specific German Baumgartenian analysis of ‘beauty’ as a central principle in human ‘empirical psychology’, Abbt argued that patriotism in modern monarchies could be grounded in an aesthetic passion of enthusiasm generated through sensuous examples of great virtue. The example of a king fighting for his country on the battlefield could inspire monarchical subjects to follow his example as well as regenerate patriotism among them. Abbt was adamant that patriotism based on aesthetic foundations had to be supported and stabilised by a pervasive patriotic culture of remembrance and emulation of dead heroes through the fine arts, as well as by a system of meritocratic honour in the army. (shrink)

Background: Debates over legalisation of physician-assisted suicide or euthanasia often warn of a “slippery slope”, predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period.Methods: The data from Oregon comprised all annual and cumulative Department of Human Services reports 1998–2006 and three independent studies; the data from the Netherlands comprised all (...) four government-commissioned nationwide studies of end-of-life decision making and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought.Results: Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured , people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups.Conclusions: Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges. (shrink)

In this brief paper, a case is made for the moral permissibility of assisted dying. The paper proceeds by highlighting a common critique from within disability rights scholarship and advocacy that emphasizes the vulnerability of people with disabilities and the risks associated with permitting assisted dying. The paper suggests that because medicine necessarily involves risk, primarily through the high likelihood of medical error, that the risk and harm being utilized as a justification to prohibit assisted dying by (...) disability rights scholars is in fact, not conceptually or morally unique. Finally, it is argued that because all medicine involves a risk of harm, and assisted dying is not unique in this respect, that one cannot effectively launch a critique of assisted dying on this basis. (shrink)

Shavelson and colleagues (2023) describe how medical aid-in-dying laws in the United States prohibit assistance in administering aid-in-dying medication. This prohibition distinguishes aid in dying...

This book examines when it is morally appropriate for medical intervention to hasten the dying process. The authors’ overriding goal is to humanize the dying process by expanding patient centered autonomous control.

In earlier publications, we had argued that Paul Ramsey is inconsistent because he simultaneously asserts that (i) 'all our days and years are of equal worth' and (ii) 'that it is permissible to refrain from prolonging the lives of some dying patients'. Thomas Long has suggested that we have not shown that Paul Ramsey is inconsistent. Ramsey and we, he holds, start from incommensurable metaphysical views: for Ramsey, the dying process has religious significance--God is calling his servant home. (...) While it is normally a good thing to keep a patient alive, it would, for Ramsey, show deafness to God's call to keep a dying patient alive. It is true we do not share Paul Ramsey's religious views. It is, however, not necessary to rely on any particular metaphysical views to refute Ramsey's position. For Ramsey's view to be internally consistent, Ramsey would have to be able to distinguish between dying and non-dying patients. We examine some of Ramsey's examples and show that his practical judgements do not allow us to draw this distinction. This means that, contra Long, we hold fast to our charge that Ramsey's view is inconsistent. (shrink)

This book challenges fundamental doctrines of established medical ethics. It is argued that the routine practice of stopping life support technology causes the death of patients and that donors of vital organs (hearts, liver, lungs, and both kidneys) are not really dead at the time that their organs are removed for life-saving transplantation. Although these practices are ethically legitimate, they are not compatible with traditional medical ethics: they conflict with the norms that doctors must not intentionally cause the death of (...) their patients and that vital organs can be obtained only from dead donors. The aim of this book is to undertake an ethical examination that aims to honestly face the reality of medical practices at the end of life. This involves exposing the misconception that stopping life support merely allows patients to die from their medical conditions, that there is an ethical bright line separating withdrawal of life support from active euthanasia, and that determination of death of hospitalized patients prior to vital organ donation is consistent with the established biological conception of death. A novel ethical justification is required for procuring vital organs from still-living donors. It is contended that in the context of plans to withdraw life support, donors of vital organs are not harmed or wronged by organ procurement prior to death, provided that valid consent is obtained for stopping treatment and organ donation. In view of serious practical difficulties in facing the truth regarding organ donation, an alternative pragmatic account is developed for justifying current practices that relies on the concept of transparent legal fictions. In sum, it is the thesis of this book that to preserve the legitimacy of end-of-life practices, we need to reconstruct medical ethics. (shrink)