Medicalized Death and the Right to Die Movement Prior to the 20th Century, most Americans died at home, surrounded by family, friends, and neighbors. Religion, not medicine, governed the death bed for there was little physicians could do for the dying. Eventually, however, advances in medicine and technology would lead to dramatic changes in the timing and location of death: patients not only began living longer, they were also dying longer, and unlike their predecessors, were more likely to die alone, (...) in institutions, and among strangers. Modern medicine, in its zeal to conquer death, had become obsessed with its curative function and ability to extend the lives of the dying. To many in the medical community, death represented failure and was something to be avoided at all costs, and like many other social problems in the United States, had become medicalized. (shrink)

In response to the paper by Keown and Jochemsen in which the latest empirical data concerning euthanasia and other end-of-life decisions in the Netherlands is discussed, this paper discusses three points. The use of euthanasia in cases in which palliative care was a viable alternative may be taken as proof of a slippery slope. However, it could also be interpreted as an indication of a shift towards more autonomy-based end-of-life decisions. The cases of non-voluntary euthanasia are a serious problem in (...) the Netherlands and they are only rarely justifiable. However, they do not prove the existence of a slippery slope. Persuading the physician to bring euthanasia cases to the knowledge of the authorities is a problem of any euthanasia policy. The Dutch notification procedure has recently been changed to reduce the underreporting of cases. However, many questions remain. (shrink)

Objectives: To discover what factors affect lay people’s judgments of the acceptability of physician assisted suicide and euthanasia and how these factors interact.Design: Participants rated the acceptability of either physician assisted suicide or euthanasia for 72 patient vignettes with a five factor design—that is, all combinations of patient’s age ; curability of illness ; degree of suffering ; patient’s mental status , and extent of patient’s requests for the procedure .Participants: Convenience sample of 66 young adults, 62 middle aged adults, (...) and 66 older adults living in western France.Main measurements: In accordance with the functional theory of cognition of N H Anderson, main effects, and interactions among patient factors and participants’ characteristics were investigated by means of both graphs and ANOVA.Results: Patient requests were the most potent determinant of acceptability. Euthanasia was generally less acceptable than physician assisted suicide, but this difference disappeared when requests were repetitive. As their own age increased, participants placed more weight on patient age as a criterion of acceptability.Conclusions: People’s judgments concur with legislation to require a repetition of patients’ requests for a life ending act. Younger people, who frequently are decision makers for elderly relatives, place less emphasis on patient’s age itself than do older people. (shrink)

Objectives: To clarify how lay people and health professionals judge the acceptability of ending the life of a terminally ill patient.Design: Participants judged this acceptability in a set of 16 scenarios that combined four factors: the identity of the actor , the patient’s statement or not of a desire to have his life ended, the nature of the action as relatively active or passive , and the type of suffering .Participants: 115 lay people and 72 health professionals in Toulouse, France.Main (...) measurements: Mean acceptability ratings for each scenario for each group.Results: Life ending interventions are more acceptable to lay people than to the health professionals. For both, acceptability is highest for intractable physical suffering; is higher when patients end their own lives than when physicians do so; and, when physicians are the actors, is higher when patients have expressed a desire to die than when they have not . In contrast, when patients perform the action, acceptability for the lay people and nurse’s aides does not depend on whether the patient has expressed a desire to die, while for the nurses and physicians unassisted suicide is more acceptable than physician assisted suicide.Conclusions: Lay participants judge the acceptability of life ending actions in largely the same way as do healthcare professionals. (shrink)

Aim To study the views of people in a largely Muslim country, Kuwait, of the acceptability of a life-ending action such as physician-assisted suicide (PAS). Method 330 Kuwaiti university students judged the acceptability of PAS in 36 scenarios composed of all combinations of four factors: the patient's age (35, 60 or 85 years); the level of incurability of the illness (completely incurable vs extremely difficult to cure); the type of suffering (extreme physical pain or complete dependence) and the extent to (...) which the patient requests a life-ending procedure, euthanasia or PAS (no request, some form of request, repeated requests). In all scenarios, the patients were women who were receiving the best possible care. The ratings were subjected to cluster analysis and analyses of variance. Results Five clusters were found. For 44%, PAS was always very unacceptable, no matter what the circumstances. For 23%, it was unacceptable, but less so if the patient was older or requested it repeatedly. For 16%, it was unacceptable if the patient was young but was acceptable if the patient was elderly. For 5%, it was unacceptable if the patient had extreme pain but was acceptable if completely dependent. For 11%, it was unacceptable if the patient did not request it but acceptable if she did. Conclusion The majority of the Kuwaiti university students opposed PAS either categorically or with a slight variation according to circumstances. Nonetheless, a minority approved of PAS in some cases, particularly when the patient was elderly. (shrink)