ABSTRACT Belgium legalised voluntary euthanasia in 2002, thus ending the long isolation of the Netherlands as the only country in which doctors could openly give lethal injections to patients who have requested help in dying. Meanwhile in Oregon, in the United States, doctors may prescribe drugs for terminally ill patients, who can use them to end their life – if they are able to swallow and digest them. But despite President Bush's oft‐repeated statements that his philosophy is to ‘trust individuals (...) to make the right decisions’ and his opposition to ‘distant bureaucracies’, his administration is doing its best to prevent Oregonians acting in accordance with a law that its voters have twice ratified. The situation regarding voluntary euthanasia around the world is therefore very much in flux. This essay reviews ethical arguments regarding voluntary euthanasia and physician‐assisted suicide from a utilitarian perspective. I shall begin by asking why it is normally wrong to kill an innocent person, and whether these reasons apply to aiding a person who, when rational and competent, asks to be killed or given the means to commit suicide. Then I shall consider more specific utilitarian arguments for and against permitting voluntary euthanasia. (shrink)

In Belgium the legal conditions to practise euthanasia are governed by the act on euthanasia of 28 May, 2002 that entered into force on 23 September, 2002. There is no relevant jurisprudence and no guidance is offered by self-regulation made up by the medical profession itself before or after the enactment of the act. Thoughtful comments on the act are, understandably, lacking up to now while the discussions in parliament have been often unclear, contradictory and sometimes even misleading. In other (...) words, the law on euthanasia in Belgium almost coincides with the act on euthanasia.In this respect the situation in the Netherlands is totally different. The law on euthanasia is first of all governed by the "Termination of life on request and assisted suicide act" of 10 April, 2001 that entered into force on 1 April, 2002. This act is generally considered as the codification of the norms and procedures that have governed the practice of euthanasia in the Netherlands for almost three decades. These norms and procedures have largely emerged from within the medical profession itself and were later adopted by the courts in the context of criminal prosecutions. There also exists a very important legal doctrine that offers guidance in understanding this act. In other words, studying the law on euthanasia in the Netherlands is more than merely studying the act on euthanasia. The act is only the ‘tip of the iceberg’.While the Dutch act aims to codify existing practices, the Belgian act mainly aims to modify the behaviour of physicians when ending the life of their patients. It is hoped that a law that pretends to offer legal security to physicians and patients will stimulate patients to express a voluntary and explicit request and that physicians will abandon their practice of ending the lives of patients without their request. Research indeed had pointed out that Belgian physicians frequently 'forget' to obtain the patient’s request before ending his life.Is should be made clear from the outset that a comparison of the Belgian and the Dutch law regulating the practice of euthanasia is a hazardous undertaking. Just comparing both acts — at first sight the Belgian act, although much more detailed, could be considered a 'clone' of the Dutch act — will lead to misleading and even incorrect results. Not only the acts, but also medical practice and legal practice have to be considered when we try to compare the law on euthanasia in both countries. In this article I will make an attempt to do this. Lack of space requires omitting many details from the comparison. (shrink)

After a review of terminology, I identify—in addition to Margaret Battin’s list of five primary arguments for and against aid-in-dying—the argument from functional equivalence as another primary argument. I introduce a novel way to approach this argument based on Bernard Lonergan’s generalized empirical method. Then I proceed on the basis of GEM to distinguish palliative sedation, palliative sedation to unconsciousness when prognosis is less than two weeks, and foregoing life-sustaining treatment from aid-in-dying. I conclude that aid-in-dying must be justified on (...) its own merits and not on the basis of these well-established palliative care practices; and that societies must decide, in weighing the merits of aid-in-dying, whether or not to make the judgment that no life is better than life-like-this part of their operative value structure. (shrink)

Surveys carried out among palliative care physicians have shown that most participants do not support euthanasia and assisted suicide. Belgium, however, is one of the few countries in the world in which voluntary euthanasia is allowed by law. The potential influence of this legal dimension thus warranted a study of the attitudes of Belgian palliative care physicians toward euthanasia and assisted suicide. To this end, an anonymous self-administered questionnaire in Dutch was sent to all physicians working in Flemish palliative care. (...) 99 physicians responded .A majority of the physicians who responded are of the opinion that voluntary euthanasia can be ethically justified . Most physicians believe, nonetheless, that non-voluntary euthanasia is always unethical . More than three quarters of the respondents favour the inclusion of a ‘palliative filter’ in the law on euthanasia. Using a traditional cluster algorithm, the following three clusters were obtained: staunch advocates of euthanasia , opponents of euthanasia , and an intermediate group . There were no significant differences between the clusters on the level of gender, age, and years of experience in palliative care. A statistically significant association exists, however, between the euthanasia clusters and the religious or ideological clusters we had obtained in an earlier study. Church attending respondents are least likely to be staunch advocates of euthanasia. The majority of the physicians favour legalisation on assisted suicide. There is no significant association between the euthanasia clusters and attitudes toward assisted suicide.We conclude that although most Flemish palliative care physicians agree that there may be circumstances in which a euthanasia request is justified, they also strongly believe in the effects of good palliative care and want the ‘palliative filter’ to be included in the law on euthanasia. Religion and worldview are an important factor determining attitudes towards euthanasia. (shrink)

Margaret Otlowski investigates the complex and controversial issue of active voluntary euthanasia. She critically examines the criminal law prohibition of medically administered active voluntary euthanasia in common law jurisdictions, and carefully looks at the situation as handled in practice. The evidence of patient demands for active euthanasia and the willingness of some doctors to respond to patients' requests is explored, and an argument for reform of the law is made with reference to the position in the Netherlands (where active voluntary (...) euthanasia is now openly practiced). (shrink)