There is a growing trend among some physicians, psychiatrists, bioethicists, and other mental health professionals not to treat physician-assisted suicide (PAS) as suicide. The grounds for doing so are that PAS fundamentally differs from other suicides. Perhaps most notably, in 2017 the American Association of Suicidology argued that PAS is distinct from the behavior that their organization seeks to prevent. This paper compares and contrasts suicide and PAS in order to see how much overlap there is. Contrary to the emerging (...) view that emphasizes their differences, I argue that there is significant overlap such that we ought not to separate PAS into its own category, making it diverge from how we think about and address suicide more generally. I start by examining several prominent theories of suicide and argue that PAS fits squarely within them. I then examine several apparent differences between PAS and other kinds of suicide and argue that these differences are merely apparent or they do not justify treating PAS as a fundamentally different kind of thing from suicide. (shrink)

Das belgische Parlament verabschiedete am 28. Mai 2002 das Euthanasiegesetz. Hierdurch wurden die verschiedenen Pflegeeinrichtungen mit einem neuen rechtlichen Rahmen konfrontiert. Das neue Gesetz lässt Euthanasie unter bestimmten Voraussetzungen zu. Dieser Beitrag möchte einige Orientierungspunkte für einen vertretbaren Umgang mit dem Euthanasiegesetz in katholischen Pflegeeinrichtungen liefern. Als Ausgangspunkt hierfür gilt der Grundsatz, dass alles Mögliche getan werden muss, um dem Sterbenden und seiner Umgebung den nötigen Beistand und die bestmögliche Betreuung zu geben und seinem Verlangen nach einem menschenwürdigen Lebensende entgegenzukommen. (...) Wird um Euthanasie gebeten, so entscheiden sich die katholischen Pflegeeinrichtungen Belgiens für die palliative Filterprozedur. Bevor hier die Konturen einer solchen Sorge für ein menschenwürdiges Lebensende umrissen werden, werden zunächst einige fundamentale Annahmen zum Menschsein und dem Wert der Autonomie inhaltlich beleuchtet. Der Autor stützt sich hierfür auf eine relationale Auffassung der Person, wie diese innerhalb der personalistischen Strömungen der Ethik entwickelt wird. (shrink)

ZusammenfassungDas belgische Parlament verabschiedete am 28. Mai 2002 das Euthanasiegesetz. Hierdurch wurden die verschiedenen Pflegeeinrichtungen mit einem neuen rechtlichen Rahmen konfrontiert. Das neue Gesetz lässt Euthanasie unter bestimmten Voraussetzungen zu. Dieser Beitrag möchte einige Orientierungspunkte für einen vertretbaren Umgang mit dem Euthanasiegesetz in katholischen Pflegeeinrichtungen liefern. Als Ausgangspunkt hierfür gilt der Grundsatz, dass alles Mögliche getan werden muss, um dem Sterbenden und seiner Umgebung den nötigen Beistand und die bestmögliche Betreuung zu geben und seinem Verlangen nach einem menschenwürdigen Lebensende entgegenzukommen. (...) Wird um Euthanasie gebeten, so entscheiden sich die katholischen Pflegeeinrichtungen Belgiens für die palliative Filterprozedur. Bevor hier die Konturen einer solchen Sorge für ein menschenwürdiges Lebensende umrissen werden, werden zunächst einige fundamentale Annahmen zum Menschsein und dem Wert der Autonomie inhaltlich beleuchtet. Der Autor stützt sich hierfür auf eine relationale Auffassung der Person, wie diese innerhalb der personalistischen Strömungen der Ethik entwickelt wird. (shrink)

Most people who defend physician-assisted death (PAD) endorse the Joint View, which holds that two conditions—autonomy and welfare—must be satisfied for PAD to be justified. In this paper, we defend an Autonomy Only view. We argue that the welfare condition is either otiose on the most plausible account of the autonomy condition, or else is implausibly restrictive, particularly once we account for the broad range of reasons patients cite for desiring PAD, such as “tired of life” cases. Moreover, many of (...) the common objections to an Autonomy Only view fail once we understand the extent of the autonomy condition’s requirements—in particular, the importance of one’s values for autonomous choices. If our view is correct, then the scope of permissible PAD is broader than is currently accepted in both the philosophical literature and the law, and therefore poses an important challenge to this widely accepted view on justified PAD. (shrink)

Mark J. Cherry; Foundations of the Culture Wars: Compassion, Love, and Human Dignity, Christian bioethics: Non-Ecumenical Studies in Medical Morality, Volume 7.

An individual’s right to refuse life-sustaining treatment is a fundamental expression of patient autonomy; however, supporting this right poses ethical dilemmas for healthcare providers when the patient has attempted suicide. Emergency physicians encounter patients who have attempted suicide and are likely among the first medical providers to face the dilemma of honoring the patient’s DNR or intervening to reverse the effects of potentially fatal actions. We illustrate this issue by introducing a case example in which the DNR of a terminally (...) ill woman was not honored because the cause of her cardiac arrest was suicide. We argue that although a terminal diagnosis should change the way health care providers respond to a suicide attempt, many of the theoretical underpinnings for how one should treat suicide attempts—especially the criterion of external reasonability, that is the action to withhold or withdraw life-sustaining measures is reasonable independent of the precipitating event—are common to all situations :3–12, 2013). The presumption that patients who attempt suicide lack capacity due to acute mental illness is flawed because it fails to account for a competent individual’s reasonable preference to not be forced to live in an unbearable, terminal condition. In states without legislation allowing physician aid in dying, patients and providers must grapple with these limitations on a case-by-case basis. In cases where the patient has a limited life expectancy and there is not concern for psychiatric illness as the primary cause of the suicidal action, we argue that the negative right to refuse life-sustaining treatment should prevail. (shrink)

In several jurisdictions, irremediable suffering from a medical condition is a legal requirement for access to assisted dying. According to the expressivist objection, allowing assisted dying for a specific group of persons, such as those with irremediable medical conditions, expresses the judgment that their lives are not worth living. While the expressivist objection has often been used to argue that assisted dying should not be legalised, I show that there is an alternative solution available to its proponents. An autonomy-based approach (...) to assisted suicide regards the provision of assisted suicide (but not euthanasia) as justified when it is autonomously requested by a person, irrespective of whether this is in her best interests. Such an approach has been put forward by a recent judgment of the German Federal Constitutional Court, which understands assisted suicide as an expression of the person’s right to a self-determined death. It does not allow for beneficence-based restrictions regarding the person’s suffering or medical diagnosis and therefore avoids the expressivist objection. I argue that on an autonomy-based approach, assisted suicide should not be understood as a medical procedure but rather as the person’s autonomous action. (shrink)