This textbook in Medical Ethics covers most of the standard issues. Each chapter begins with detailed comments by the editors, followed by the best available articles on each topic covered.

In lieu of an abstract, here is a brief excerpt of the content:Active Euthanasia and Assisted SuicidePat Milmoe McCarrick (bio)Although the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research in its 1983 report, Deciding to Forego Life-Sustaining Treatment, described the words and terms "euthanasia," "right to die," and "death with dignity" as slogans or code words—"empty rhetoric," (I, p. 24), the literature reviewed for this Scope Note continues to use these terms. Therefore, (...) to discuss the termination of a patient's life by a physician at the patient's request, the phrase active euthanasia is used, and the supplying of a means by a physician whereby a patient can end his or her life is referred to as assisted suicide.Euthanasia, either as the "good death" from classical Greek or "mercy killing" to end unbearable suffering in the dying, has long been a topic of interest in western civilization (III, Brody 1989). In recent years, public awareness of this discussion about control over the time of one's death has been informed by a series of well-publicized events. They include the November 1991 rejection by a vote of 54 percent to 46 percent of the Washington state Initiative 119, which would have allowed the option of requesting one's physician to "aid-in-dying" for adult patients in a "medically terminal condition" (V, Gross 1991); two medical journal articles describing physician's actions in helping bring death to two patients (V, Anonymous 1988; V, Quill 1991); Dr. Jack Kevorkian's assistance in the suicide of three women (V, Belkin 1990; V, Wilkerson 1991); and the best seller status of a how-to book on committing suicide with opiates obtained from a physician (III, Humphry 1991).For the most part, material included in the annotated bibliography in Scope Note 18 has been chosen from works published in the four years since "It's Over, Debbie" (V, Anonymous 1988) appeared in early January 1988 in the Journal of the American Medical Association.Dr. Edmund D. Pellegrino (V, 1991, pp. 3118-19) presented opposing views about active voluntary euthanasia as follows:Those who favor voluntary euthanasia argue that it is a beneficent and compassionate act; it respects autonomy by preserving the patient's control of the manner, method, [End Page 79] and timing of death; it takes the matter outside the reach of "medical power" (accessed in this Scope Note's bibliography at V, Fletcher 1973; V, Nowell-Smith 1989) and scrupulosity; and it prevents the injustice that allows some patients to choose death by refusal of life-support measures, while denying others the right to do so by active euthanasia....The opponents of active euthanasia argue that it undermines the value of, and respect for, all human life (V, Kass 1989; V, Coyle 1990; V, Singer 1990). They fear that guidelines cannot avoid sliding down the "slippery slope" to involuntary euthanasia and selective devaluation of the lives of the most vulnerable among us.... If euthanasia is legal, it is predicted that patients will feel subtle pressure to conform so as to relieve the economic and emotional burdens they impose on family and friends.Euthanasia, its opponents further argue, is socially destructive: it undermines trust in physicians, desensitizes society to killing, and imperils the ground already gained in legitimating passive euthanasia(IV, Wolf 1989).Physicians were not particularly involved with a patient's death until after World War II when participation grew in proportion to the growth of technology. Since the complex, life-sustaining equipment that could forestall death was located in a hospital, death itself became almost completely medicalized (V, Dagi 1991). For terminally ill persons who would like to die a painless death, either by their own hand or with assistance, physicians have almost a monopoly on obtaining strong drugs for distribution to patients (V, Abrams 1990).Active euthanasia for human beings is not legalized anywhere in the world (V, VonDrehle 1991). It is classified as homicide or murder in all fifty states and in Great Britain, Canada, Australia, and the Phillippines (V, Nerland 1989). Twentysix states in the United States prohibit assisted suicide by statute (V, Rosenblum 1990).In 1969 in the Netherlands, a physician named Jan Hendrik van... (shrink)

Objective: To explore the experiences of people with a “terminal illness”, focusing on the patients’ perspective of euthanasia and assisted suicide.Method: A qualitative study using narrative interviews was conducted throughout the UK. The views of the 18 people who discussed euthanasia and assisted suicide were explored. These were drawn from a maximum variation sample, who said that they had a “terminal” illness, malignant or non-malignant.Results: That UK law should be changed to allow assisted suicide or voluntary euthanasia was felt strongly (...) by most people. Those who had seen others die were particularly convinced that this should be a right. Some had multiple reasons, including pain and anticipated pain, fear of indignity, loss of control and cognitive impairment. Those who did not want to be a burden also had other reasons for wanting euthanasia. Suicide was contemplated by a few, who would have preferred a change in the law to allow them to end their lives with medical help and in the company of family or friends. The few who opposed a change in UK law, or who felt ambivalent, focused on involuntary euthanasia, cited religious reasons or worried that new legislation might be open to abuse.Conclusion: Qualitative research conducted on people who know they are nearing death is an important addition to the international debate on euthanasia and assisted suicide. Those who had seen others die were particularly convinced that the law should be changed to allow assisted death. (shrink)

Background:Attitudes of nurses towards death and related concepts influence end-of-life care. Determining nurses’ views and attitudes towards these concepts and the factors that affect them are necessary to ensure quality end-of-life care.Objectives:The purpose of this study was to determine nurses’ views and attitudes about death, dying patient, euthanasia and the relationships between nurses’ characteristics.Methods:Participants consist of the nurses who volunteered to take part in this descriptive study from 25 hospitals which has a paediatric or adult intensive care unit (...) and located within the boundaries of Ankara, Turkey. ‘Nurse Information Form’ and ‘Attitude Scale about Euthanasia, Death and Dying Patients ’ were used as data collection tool.Ethical consideration:Written permissions were received from the ‘Noninterventional Clinical Researches Ethics Board’ of authors’ university and education councils of each hospital. Informed consent was obtained from participants.Findings:It is found that there are statistically significant difference among the factors of marital status, having a child, years of experience, bereavement experience, affected by working with dying patient, definition of euthanasia, views about patients who are appropriate for euthanasia, views about patients who desire to die and feeling need for counselling on these concepts according to the mean total score of nurses’ attitudes about euthanasia, death and dying patient.Conclusion:The results indicate that nurses are negatively affected to face the concepts of death, euthanasia and work with dying patient. This is reflected in their attitude. In order to gain positive attitude towards death, dying patient and euthanasia, the implementation of training and consulting services to nurses at appropriate intervals during both education and professional life are required. (shrink)

The first edition of this book was published in 1977. At that time the field of thanatology, the study of death and dying, was still reasonably new and was dominated by research done by psychiatrists and social scientists. The most notable person in the field at the time was Elisabeth Kubler-Ross, who was widely credited with having brought thanatology into public view with the 1969 publication of her book On Death and Dying. Two research centers on death (...) and dying were gaining national reputations: The Foundation of Thanatology in New York (Austin Kutscher, director), and the Center for Death Education and Research (Robert Fulton, director) at the University of Minnesota. (shrink)

In his classic paper, ‘Why abortion is immoral’, Don Marquis argues that what makes killing an adult seriously immoral is that it deprives the victim of the valuable future he/she would have otherwise had. Moreover, Marquis contends, because abortion deprives a fetus of the very same thing, aborting a fetus is just as seriously wrong as killing an adult. Marquis’ argument has received a great deal of critical attention in the two decades since its publication. Nonetheless, there is a potential (...) challenge to it that seems to have gone unnoticed. A significant percentage of fetuses are lost to spontaneous abortion. Once we bring this fact to our attention, it becomes less clear whether Marquis can use his account of the wrongness of killing to show that abortion is the moral equivalent of murder. In this paper, I explore the relevance of the rate of spontaneous abortion to Marquis’ classic anti-abortion argument. I introduce a case I call Unexpected Death in which someone is about to commit murder, but, just as the would-be murderer is about to strike, his would-be victim dies unexpectedly. I then ask: what does Marquis’ account of killing imply about the moral status of what the would-be murderer was about to do? I consider four responses Marquis could give to this question, and I examine what implications these responses have for Marquis’ strategy of using his account of the wrongness of killing an adult to show that abortion is in the same moral category. (shrink)

With so much attention being paid to the development and refinement of appropriate criteria and tests for death, little attention has been given to the broader conceptual issues having to do with its definition or with the relation of a definition to its criterion. The task of selecting the correct criterion is, however, virtually impossible without proper attention to the broader conceptual setting in which the definition operates as the key feature. All of the issues I will discuss arise (...) because of this lack of concern with conceptual matters. Such problems as incorrectly diagnosing a patient as dead prior to the harvesting of his or her organs, defending the idea that death is reversible, and advocating a brainstem criterion of death, are all, I believe, errors that derive from this misplaced emphasis. (shrink)

The open practice of euthanasia in The Netherlands stood alone in the world until the government of the Northern Territories in Australia accepted the possibility of physician-assisted suicide. Even though the active ending of lives in The Netherlands is still a crime by law, the current practice allows it and acquits physicians if certain conditions have been met. Of the many facets of euthanasia, the teaching of this practice represents a further logical step. In this contribution, we intend to describe (...) the comprehensive teaching program of euthanasia of the Free University of Amsterdam's Postgraduate Family Medicine Program. Here students receive university-based training for 1 day a week in a cohort of 12 and on the job training for 4 days with individual family physicians for 2 consecutive years. We especially intend to portray the integration of euthanasia into the wider teaching of the process of counseling and aid of the dying. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Death and Dying in JapanRihito Kimura (bio)A majority of Japanese, at present, feel that the modern biomedical and technological innovations pertaining to human life and death have been forcing a change in our common understanding of what, historically, was simply the natural event and process of death and dying. The meaning of death and the dying process in our lives is changing as have the (...) traditional criteria for determining death, namely, cessation of heartbeat and respiration.An individual’s death should be a personal and private matter as well as a familial, communal, and social matter. It has been regarded as such for many thousands of years in our Japanese society and culture. It is well understood that our traditional socio-cultural understanding of human life positively admits the natural process of death as the final event of life. The ideas expressed in Zen-Buddhist phrases such as “accept death as it is” and “life-death as one phenomenon” have been key motifs totally integrated into our traditional understanding of life (Tomomatsu 1939).However, the traditional perception of death as an acceptable process has [End Page 374] been vanishing as the Japanese have applied modern biomedical technologies more frequently in well-equipped hospital settings. Although the involvement of family members in the process of dying and particularly in the death event continues in a variety of ways, the care of dying patients in Japan is becoming much more similar to that delivered in advanced hospital settings in many countries of the world, than it is different. Now, in Japan, a majority of people end their lives in the hospital, surrounded by high-technology machines. Yet, in a survey by the Yomiuri Shimbun of 15 June 1991, half of the respondents said they would prefer to die at home.In addition, there has been a tradition of not explaining to terminally ill people the true nature of their condition, on the ground that this is most appropriate way to proceed (Kashiwagi 1994, pp. 78–85). However, views on this matter are changing. There is a gradual move toward telling patients the truth, and the notion of informed consent has been widely publicized in the clinical setting (Leflar 1996, pp. 96–107). In the 1991 nationwide opinion poll by the Yomiuri Shimbun, 65 percent of the participants said that they would like to be given full diagnostic information about themselves even if they were terminally ill. Nevertheless, only 22 percent of the people questioned said they themselves would definitely be prepared to disclose such information to a family member.The same survey indicated that 78 percent of people considered palliative care desirable, even though it might shorten life, while 16 percent thought life should be sustained as long as possible, irrespective of the pain that patients might be suffering.Challenges of Care for the DyingA special task force on terminal care, set up by the Ministry of Health and Welfare, issued a report in 1989 that encouraged the disclosure of diagnostic information to patients, provided that consideration was given to patients’ life histories, personalities, relationships with family members, and other factors. The report favored the use of drugs for pain control; it also dealt with matters such as spiritual requirements and the care of the family members.Traditionally, the physician-patient relationship in Japan is based on a complete and unquestioning trust of the physician by the patient, such that the physician acts to make health care decisions on behalf of the patient (Kimura 1991). However, increasingly it is believed that people should not have to accept without question the authority of doctors in the treatment of disease. Responsibility for the care of the dying should be shared between family members and all health professionals, not only physicians. Changes are needed in the mentalities of health care providers, patients, and family members, and it must be recognized that the medical system and institutions are not immutable (Annas and Miller 1994, pp. 374–76). [End Page 375]To complicate matters even further, although a patient’s family is informed of the incurable nature of the disease affecting their family member, the patient, as noted above, usually is not told of... (shrink)

This article is in a larger textbook of articles in Medical Ethics.

Using 20 video recordings of Emergency Room treatment and over 5 years of Emergency Room fieldwork data, this study elucidates how interactional processes serve as resources for generating a cultural script of death in Japan called ‘Mitori’. A sudden death at a hospital, in which a patient is removed from their social network, is often considered as the opposite of a ‘good home death’. This study shows how hospital deaths in Japan are strongly interrelated with family participation. (...) After showing the point where medical professionals decide to terminate resuscitation attempts, the analysis depicts interactional steps that shift the definition of environment from a place for treatment toward a place where ‘Mitori’ occurs; that is, a family encounter occurs with a dying patient. Conversation between a doctor and a family member consists of a step-by-step evidence- building story. The final section displays both conversational and physical resources used to establish ‘Mitori’. (shrink)

Introduction -- Rational anthropology and the difference between persons and animals -- Human freedom and conscience -- The three moral determinants and doubts of conscience -- The principle of double effect and consequentialism -- Cooperation and scandal -- Virtues--natural and supernatural -- Sin and grace -- Revelation -- Reproductive technologies -- Homosexuality and same-sex marriage -- Contraception -- Abortion -- Marriage and family -- End of life issues -- Appendix A : Summary of Evangelium Vitae -- Appendix B : Summary (...) of Savifici Doloris. (shrink)

Some opponents of abortion claim that fetuses are persons from the moment of conception. Following Berg (2017), let us call these individuals “Personhood-At-Conception” (or PAC), opponents of abortion. Berg argues that if fetuses are persons from the moment of conception, then miscarriage kills far more people than abortion. As such, PAC opponents of abortion face the following dilemma: They must “immediately” and “substantially” shift their attention, resources, etc., toward preventing miscarriage or they must admit that they do not actually believe (...) that fetuses are persons from the moment of conception (or, at least, they must recognize that they are not acting in ways that are consistent with this belief). In this essay, I show that Berg’s argument fails at each step. Specifically, after outlining her argument (in section 1), I consider the central claim of Berg’s style of argument: That “miscarriage…is much deadlier than abortion.” In section 2, I argue that this claim is false (when taken literally) and misleading otherwise. In section 3, I show that Berg’s style of argument is identical in structure to a criticism that is sometimes levied against the recent “Black Lives Matter” movement. In the latter context, the argument has been vehemently rejected. I argue that Berg’s style of argument should be rejected for the same reasons. Finally, in section 4, I show that Berg’s suggestion that opponents of abortion should divert “substantial” amounts of money and attention to miscarriage prevention faces two problems. First, these claims are made without any evidence regarding the actual priorities and spending habits of PAC opponents of abortion. If we are told “not enough is being done,” one wonders: What is being done and how much counts as “enough”? Berg gives no answer to either question. Second, even if it is true that opponents of abortion do not pay substantial attention to miscarriage prevention, Berg fails to notice that this may be for good reason. I conclude that PAC opponents of abortion do not face the dilemma that Berg presents. (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 (...) class='Hi'>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)

Disputes in Bioethics tackles some of the most debated questions in contemporary scholarship about the beginning and end of life. This collection of essays takes up questions about the dawn of human life, including: Should we make children with three (or more) parents? Is it better never to have been born? and Is the so called 'after-birth' abortion wrong? This volume also asks about the dusk of human life: Is 'death with dignity' a dangerous euphemism? Should euthanasia be permitted (...) for children? and Does assisted suicide harm those who do not choose to die? Still other questions are asked concerning recent views that health care professionals should not have a right to conscientiously object to legal and accepted medical practices. Finally, the book addresses questions about separating conjoined twins as well as the issue of whether the species of an individual makes a difference for the individual's moral status. Christopher Kaczor critiques some of the most recent and influential positions in bioethics, while eschewing both consequentialism and principalism. Rooted in the Catholic principle that faith and reason are harmonious, this book shows how Catholic bioethical teaching is rationally defensible in terms that people of good will, secular or religious, can accept. Proceeding from a natural law perspective, Kaczor defends the inherent dignity of all human beings and argues that they merit the protection of their basic human goods because of that inherent dignity. Philosophers interested in applied ethics, as well as students and professors of law, will profit from reading Disputes in Bioethics. The book aims to be both philosophically sophisticated and accessible for students and experienced researchers alike. (shrink)

This book is a comprehensive and unique text and reference in medical ethics. By far the most inclusive set of primary documents and articles in the field ever published, it contains over 100 selections. Virtually all pieces appear in their entirety, and a significant number would be difficult to obtain elsewhere. The volume draws upon the literature of history, medicine, philosophical and religious ethics, economics, and sociology. A wide range of topics and issues are covered, such as law and medicine, (...) truth-telling by the physician, research, population policy, genetics, abortion, dying, and individual rights in medical care. The selections span the centuries, beginning with material from the works of Hippocrates, continuing through Thomas Percival, John Stuart Mill, and Claude Bernard, down to modern commentators like Henry K. Beecher, Walsh McDermott, David L. Bazelon, Paul Freund, H. L. A. Hart, John Rawls, Paul Ramsey, Richard McCormick, Rashi Fein, and Bernard Barber. The text has eight major divisions, beginning with sections on the ethical dimensions of the physician-patient relationship in history; the moral bases of medical ethics; and regulation, compulsion, and protection of the consumer in clinical medicine and public health. Each of these sections includes key essays that appear for the first time. All of the book's major divisions contain primary documents: codes such as the Hippocratic Oath, Medieval Law for the Regulation of Medicine, and the first as well as the most recent code of the American Medical Association; court decisions, including those on Karen Quinlan and on abortion in the United States and West Germany; government documents such as the statement of the National Commission on the Protection of Human Subjects, the Tuskegee Syphilis Report, the British Parliamentary debate on euthanasia, and the Council of Europe on rights of the sick and dying; and various published guidelines such as the Harvard Medical School brain death criteria, the American Hospital Association on patient's rights, and Pope Pius XII on the prolongation of life. Cases that illustrate moral dilemmas are provided for discussion purposes. Each section is preceded by a succinct editor's introduction. The documents and essays are of practical value for practitioners and students in medicine, law, ethics, and counselling, and for individual patients and groups concerned with medical care. Through encompassing divergent viewpoints, the essays and primary documents were selected to encourage humane practices and deepen understanding of the multiple traditions that shaped and do shape the development of medicine. (shrink)

ABSTRACTOn 28 October 2012, Savita Halappanavar, an Indian woman living in Ireland, died in hospital while under medical care for a miscarrying pregnancy. According to her husband, her repeated requests for an abortion were ignored because of the presence of a foetal heartbeat. Ms Halappanavar’s death was a critical event in the process leading to a referendum on 25 May 2018, when the Irish electorate voted to repeal the Eighth Amendment of the Constitution, removing the constitutional ban on abortion. (...) The name Savita has become indelibly linked to the changing course of abortion politics, so it is timely to reassess the role of the media in shaping the parameters of the debate about the impact of her death on the issue. This study presents a frame analysis of Irish newspapers in the weeks following her death, mapping the political, medical, legal and socio-ethical discourses, as well as the related contemporaneous events that set the agenda for the type of debate that was to follow. It identifies four media frames: Public Tragedy, Political Opportunity, Abortion Legacy and Maternal Health. Our central argument is that the overall effect of media framing provided much face-saving for politicians in the way that the legislative issue was viewed through a conservative party-political lens, despite public outrage. (shrink)

The ever-present possibility of death forces upon us the question of life's meaning and for this reason death has been a central concern of philosophers throughout history. From Socrates to Heidegger, philosophers have grappled with the nature and significance of death. In "Annihilation", Christopher Belshaw explores two central questions at the heart of philosophy's engagement with death: what is death; and is it bad that we die? Belshaw begins by distinguishing between literal and metaphorical uses (...) of the term and offers a unified and biological account of death, denying that death brings about non-existence. How our death relates to the death of the brain is explored in detail. Belshaw considers the common-sense view that death is often bad for us by examining the circumstances that might make it bad as well as the grounds for thinking that one death can be worse than another. In addition, Belshaw explores whether we can be harmed after we die and before we were born. The final chapters explore whether we should prevent more deaths and whether, via cryonics, brain transplants, data storage, we might cheat death. Throughout Belshaw shows how questions of personhood and life's value are bound up with our views on the sense and significance of death. "Annihilation's" in-depth analysis and insightful exposition will be welcomed not only by philosophers working on the metaphysics of death but also by students and scholars alike looking for a foundation for discussions of the ethics of abortion, euthanasia, life-support and suicide. (shrink)

Philosophical reflection on death dates back to ancient times, but death remains a most profound and puzzling topic. Samantha Brennan and Robert Stainton have assembled a compelling selection of core readings from the philosophical literature on death. The views of ancient writers such as Plato, Epicurus, and Lucretius are set alongside the work of contemporary figures such as Thomas Nagel, John Perry, and Judith Jarvis Thomson. -/- Brennan and Stainton divide the anthology into three parts. Part I (...) considers questions about the nature of death and our knowledge of it. What does it mean to be dead? Is it possible to survive death? Is the end of life a mystery? Part II asks how we should view death. What (if anything) is so bad about dying? If death is nothingness, should it be feared or regretted? Part III examines ethical questions related to killing, particularly abortion, euthanasia and suicide. Is killing ever permissible? Under what conditions or circumstances? (shrink)

The ever-present possibility of death forces upon us the question of life's meaning and for this reason death has been a central concern of philosophers throughout history. From Socrates to Heidegger, philosophers have grappled with the nature and significance of death. In "Annihilation", Christopher Belshaw explores two central questions at the heart of philosophy's engagement with death: what is death; and is it bad that we die? Belshaw begins by distinguishing between literal and metaphorical uses (...) of the term and offers a unified and biological account of death, denying that death brings about non-existence. How our death relates to the death of the brain is explored in detail. Belshaw considers the common-sense view that death is often bad for us by examining the circumstances that might make it bad as well as the grounds for thinking that one death can be worse than another. In addition, Belshaw explores whether we can be harmed after we die and before we were born. The final chapters explore whether we should prevent more deaths and whether, via cryonics, brain transplants, data storage, we might cheat death. Throughout Belshaw shows how questions of personhood and life's value are bound up with our views on the sense and significance of death. "Annihilation's" in-depth analysis and insightful exposition will be welcomed not only by philosophers working on the metaphysics of death but also by students and scholars alike looking for a foundation for discussions of the ethics of abortion, euthanasia, life-support and suicide. (shrink)

If pressed to identify the philosophical foundations of contemporary bioethics, most bioethicists would cite the four-principles approach developed by Tom L Beauchamp and James F Childress,1 or perhaps the ethical theories of JS Mill2 or Immanuel Kant.3 Few would cite Aristotle's metaphysical views surrounding death and posthumous harm.4 Nevertheless, many contemporary bioethical discussions are implicitly grounded in the Aristotelian views that death is a harm to the one who dies, and that persons can be harmed, or wronged, by (...) events that occur after their deaths. The view that death is a harm to the one who dies infuses, for example, the debates over abortion and euthanasia, while the view that persons could be harmed or wronged after their deaths informs much of the debate over, for example, policies for the posthumous procurement of transplant and the ethics of research on the dead.In Death, Posthumous Harm, and Bioethics, I argue that we should reject this cluster of influential Aristotelian thanatological claims, and instead endorse a trio of views that together constitute what I term full-blooded epicureanism: That death is not a harm to the person who dies, and that persons can neither be harmed nor wronged by events that occur after their deaths. …. (shrink)

What is death? Do people survive death? What do we mean when we say that someone is "dying"? Presenting a clear and engaging discussion of the classic philosophical questions surrounding death, this book studies the great metaphysical and moral problems of death. In the first part, Feldman shows that a definition of life is necessary before death can be defined. After exploring several of the most plausible accounts of the nature of life and demonstrating their (...) failure, he goes on to propose his own conceptual scheme for death and related concepts. In the second part, Feldman turns to ethical and value-theoretical questions about death. Addressing the ancient Epicurean ethical problem about the evil of death, he argues that death can be a great evil for those who die, even if they do not exist after death, because it may deprive them of the goods they would have enjoyed if they had continued to live. Confrontations with the Reaper concludes with a novel consequentialist theory about the morality of killing, applying it to such thorny practical issues as abortion, suicide, and euthanasia. (shrink)

The Liverpool Care Pathway for the Dying Patient (LCP) was an integrated care pathway for patients in the final days or hours of life, developed at the Royal Liverpool University Hospital in conjunction with the Marie Curie Palliative Care Institute, Liverpool. The LCP became increasingly the normative style of care for patients in the terminal stage across NHS England from the 1990s onwards. Following significant questions raised in Parliament, by the media and other stakeholders, an independent review panel was established (...) under Baroness Neuberger in 2013 to investigate the LCP. The findings of the panel were published as More Care Less Pathway: a Review of the Liverpool Care Pathway identifying significant failings in the delivery of the LCP thus leading to it being phased out some six months later. Rather than being euthanasia through the backdoor, many of the criticisms of the LCP and its poor implementation are indicative of poor communication, limited knowledge of the dying process and a paucity of death education. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Journal of the History of Ideas 63.2 (2002) 323-344 [Access article in PDF] Darwinism and Death: Devaluing Human Life in Germany 1859-1920 Richard Weikart The debate over the significance of Social Darwinism in Germany has special importance, because it serves as background to discussions of Hitler's ideology and of the roots of German imperialism and World War I. 1 There is no doubt that Hitler was a Social (...) Darwinist, viewing history as a struggle for existence among unequal races. All Hitler scholars agree on this point, and it is too obvious to deny when one reads Mein Kampf. 2 Whether Social Darwinism contributed to imperialism and militarism is less clear, though some have argued it did, at least as a justification for them. 3 Some Anglo-American writers during and immediately after World War I blamed Social Darwinism for inflaming German militarism. 4 [End Page 323]This discussion over both Social Darwinism in general and its German form in particular has reached something of an impasse lately. While some scholars insist that Darwinism contributed to or at least reinforced a competitive ethos in European political and social thought, others have stressed the varieties of Social Darwinism. 5 The latter remind us that, although some Darwinian social thinkers stressed competition, socialists were also avid Darwinists and saw it as support for their vision of a more cooperative socialist society. 6 Some scholars focus so much on the cooperative and peaceful thrust of Darwinian thinkers that one might think that Peter Kropotkin's Mutual Aid had carried the day in the late nineteenth century. For example, Paul Crook argues that Darwinism produced pacifist inclinations more than it did militarism. 7Another important debate in Darwin scholarship concerns the compatibility or incompatibility of Darwinism with other world views, especially traditional religion. The warfare thesis, which sees religion and science in perpetual conflict (often with science heroically winning the battle), has largely been abandoned by historians of science, who now see greater complexity in the interactions of science and religion. 8 Reacting against the warfare thesis, some have emphasized accommodation, showing how science and religion often work in harmony. As applied to Darwinism the accommodationist view stresses the receptivity of many Christians, including prominent evangelical pastors and [End Page 324] theologians, to evolutionary theory in the nineteenth century. 9 While the warfare thesis was clearly a crude caricature, an overemphasis on accommo-dationism can render the intensely emotional debates over Darwinism in the nineteenth century unintelligible and ignores the polemical uses of Darwinism by materialists and positivists in their fight against religion. 10This essay will attempt to make a contribution to both these debates by focusing on aspects of Darwinism that have been insufficiently explored to date—not the issues of competition vs. cooperation or capitalism vs. socialism or explicitly on religion, as is usual in the discussion over warfare or accommodation, but how Darwinism impacted thinking about the value of human life and the significance of human death. Indeed Darwinism, in harmony with the growth of materialism and positivism, helped alter many people's views on matters of life and death. Many prominent German Darwinists urged their society to reevaluate its stance on what today is known as biomedical ethics—infanticide, euthanasia, suicide, abortion, etc. By focusing on these issues, we will see that leading Darwinists invoked Darwinian science to undermine traditional Judeo-Christian ethical values; this went far beyond merely dismissing the Genesis creation story or even rejecting the supernatural.The scientists and physicians most important in embracing, developing, and popularizing Darwinism in late nineteenth and early twentieth-century Germany vigorously argued that Darwinism did have important implications for religion, ethics, and social thought. Darwinism in the nineteenth and early twentieth centuries produced a significant shift in the world views of many who embraced it, and leading Darwinists insisted that their newly-found world view undermined traditional ways of thinking, including traditional ideas about religion and ethics. Ernst Haeckel, the most famous German Darwinist of the late nineteenth and early twentieth centuries, believed the most important aspect... (shrink)

What is death? Do people survive death? What do we mean when we say that someone is "dying"? Presenting a clear and engaging discussion of the classic philosophical questions surrounding death, this book studies the great metaphysical and moral problems of death. In the first part, Feldman shows that a definition of life is necessary before death can be defined. After exploring several of the most plausible accounts of the nature of life and demonstrating their (...) failure, he goes on to propose his own conceptual scheme for death and related concepts. In the second part, Feldman turns to ethical and value-theoretical questions about death. Addressing the ancient Epicurean ethical problem about the evil of death, he argues that death can be a great evil for those who die, even if they do not exist after death, because it may deprive them of the goods they would have enjoyed if they had continued to live. Confrontations with the Reaper concludes with a novel consequentialist theory about the morality of killing, applying it to such thorny practical issues as abortion, suicide, and euthanasia. (shrink)

The increased prevalence of advanced‐stage chronic diseases has augmented the need for palliative care teams. In Colombia, although the legislation promotes palliative care development, people still die without receiving management from a palliative care team. In addition, judiciary regulations regarding euthanasia have generated public confusion and ethical conflicts among members of the palliative care teams. Therefore, this study aimed to perform a bioethical reflection on the relationship between palliative care and euthanasia supported by data on euthanasia requests in a palliative (...) care program. This reflection is based on retrospective and descriptive observational data, collected in two highly complex hospitals in Bogotá, Colombia. A total of 50 euthanasia requests were identified, of which 62% met the defined criteria, 16% did not, and 22% were not considered by the interdisciplinary committee for the right to die with dignity due to early death. All patients were treated and followed up by a palliative care team until their death. This study considered that palliative care could be a complement management for patients requesting euthanasia based on their experience by supporting the decision‐making, alleviating suffering, and providing emotional support in the last days of life. (shrink)

Volume 19, Issue 10, October 2019, Page 88-90.

Contrary to the views of Alasdair MacIntyre and others who assert that modern Western morality is in disarray, torn by incommensurable moral views, John Reeder believes that there is much agreement about taking and saving lives. Many people might, in fact, agree on the various circumstances in which the death of a person constitutes a violation of the right to life, or that people have a right to our help, especially a right to life-saving aid. In_ Killing and Saving_, (...) Reeder analyzes five sorts of situations in which we are morally permitted or even obligated to take human life: e.g., when we repel an attacker who voluntarily "forfeits" the right to life; when we are confronted with "involuntary pursuit" or "material aggression"; when someone "yields" the right to life; when all will die if nothing is done, but some can be saved if others are killed; and when there is a "double effect" in which we take life as a foreseen but unintended consequence of attempt to achieve a greater good. Reeder argues that these categories account for many of our convictions ranging from abortion to infanticide, to starvation, to war. He also examines the concept of absolute or exceptionless right to life. Reeder draws on a number of moral views, from theological ethics to Enlightenment notions of natural rights or respect for rational creatures. He does not attempt to argue for a foundation for the right not to be killed and the right to be saved. Rather, he focuses on the content of the convictions themselves and argues that where disagreements remain, such as the case of abortion, they can be accounted for by the way the rights in question are explained and justified. (shrink)

Contrary to the views of Alasdair MacIntyre and others who assert that modern Western morality is in disarray, torn by incommensurable moral views, John Reeder believes that there is much agreement about taking and saving lives. Many people might, in fact, agree on the various circumstances in which the death of a person constitutes a violation of the right to life, or that people have a right to our help, especially a right to life-saving aid. In_ Killing and Saving_, (...) Reeder analyzes five sorts of situations in which we are morally permitted or even obligated to take human life: e.g., when we repel an attacker who voluntarily "forfeits" the right to life; when we are confronted with "involuntary pursuit" or "material aggression"; when someone "yields" the right to life; when all will die if nothing is done, but some can be saved if others are killed; and when there is a "double effect" in which we take life as a foreseen but unintended consequence of attempt to achieve a greater good. Reeder argues that these categories account for many of our convictions ranging from abortion to infanticide, to starvation, to war. He also examines the concept of absolute or exceptionless right to life. Reeder draws on a number of moral views, from theological ethics to Enlightenment notions of natural rights or respect for rational creatures. He does not attempt to argue for a foundation for the right not to be killed and the right to be saved. Rather, he focuses on the content of the convictions themselves and argues that where disagreements remain, such as the case of abortion, they can be accounted for by the way the rights in question are explained and justified. (shrink)

For the living, death has a moral dimension. When we confront death and dying in our own lives and in the lives of others, we ask questions about the good, right, and fitting as they relate to our experiences of human mortality. When others die, the living are left with moral questions--questions that often generate personal inquiry as to whether a particular death was "good" or whether it was tragic, terrifying, or peaceful. In The Ethics of (...) class='Hi'>Death, the authors, one a philosopher and one a religious studies scholar, undertake an examination of the deaths that we experience as members of a larger moral community. Their respectful and engaging dialogue highlights the complex and challenging issues that surround many deaths in our modern world and helps readers frame thoughtful responses. Unafraid of difficult topics, Steffen and Cooley fully engage suicide, physician-assisted suicide, euthanasia, capital punishment, abortion, and war as areas of life where death poses moral challenges." -- Publisher's description. (shrink)

There is currently a dearth of bioethical literature presenting what might be called a more traditional approach to medicine and health care. Life and Death in Healthcare Ethics promises a reasoned and clear alternative. It considers ethical concerns raised by reproduction and death and dying. The issues considered include euthanasia and withdrawal of treatment, the persistent vegetative state, abortion, cloning and in vitro fertilization. Given its clarity and simplicity the book is likely to be read eagerly by students (...) from a range of different disciplines. For those who want a basic text to introduce them to life and death issues in bioethics, this is a most welcome contribution. (shrink)

The term “euthanasia” is used in conflicting ways in the bioethical literature, as is the term “assisted suicide,” resulting in definitional confusion, ambiguities, and biases which are counterproductive to ethical and legal discourse. I aim to rectify this problem in two parts. Firstly, I explore a range of conflicting definitions and identify six disputed definitional factors, based on distinctions between (1) killing versus letting die, (2) fully intended versus partially intended versus merely foreseen deaths, (3) voluntary versus nonvoluntary versus (...) class='Hi'>involuntary decisions, (4) terminally ill versus non-terminally ill patients, (5) patients who are fully conscious versus those in permanent comas or persistent vegetative states, and (6) patients who are suffering versus those who are not. Secondly, I distil these factors into six “building blocks” and combine them to develop an unambiguous, value-neutral taxonomy of “end-of-life practices.” I hope that this taxonomy provides much-needed clarification and a solid foundation for future ethical and legal discourse. (shrink)

When it is considered to be in their best interests, withholding and withdrawing life-supporting treatment from non-competent physically ill or injured patients – non-voluntary passive euthanasia, as it has been called – is generally accepted. A central reason in support of the procedures relates to the perceived manner of death they involve: in non-voluntary passive euthanasia death is seen to come about naturally. When a non-competent psychiatric patient attempts to kill herself, the mental health care providers treating her (...) are obligated to try to stop her. Yet it has been suggested that death by suicide can be a part of the natural course of a severe mental illness. Accordingly, if the perceived naturalness of the deaths occurring in connection with non-voluntary passive euthanasia speaks for their moral permissibility, it could be taken that a similar reason can support the moral acceptability of the suicidal deaths of non-competent psychiatric patients. In this article, I consider whether the suicidal death of a non-competent psychiatric patient would necessarily be less natural than those of physically ill or injured patients who die as a result of non-voluntary passive euthanasia. I argue that it would not. (shrink)

ObjectivesIn 2015, the Province of Quebec, Canada passed a law that allowed voluntary active euthanasia. Palliative care stakeholders in Canada have been largely opposed to euthanasia, yet there is little research about their views. The research question guiding this study was the following: How do palliative care physicians in Quebec position themselves regarding the practice of VAE in the context of the new provincial legislation?MethodsWe used interpretive description, an inductive methodology to answer research questions about clinical practice. A total of (...) 18 palliative care physicians participated in semistructured interviews at two university-affiliated hospitals in Quebec.ResultsParticipants positioned themselves in opposition to euthanasia. Their justifications were framed within their professional commitment to not hasten death, which sat in tension with the value of patients’ autonomy to choose how to die. Participants described VAE as unacceptable if it impeded opportunities to evaluate and alleviate suffering. Further, they contested government rhetoric that positioned VAE as a way to improve end-of-life care. Participants felt that VAE would diminish the potential of palliative care to relieve suffering. Dilemmas were apparent in their narratives, about reconciling respect for patient autonomy with broader palliative care values, and the value of accompanying and not abandoning patients who make requests for VAE while being committed to neither prolonging nor hastening death.ConclusionsThis study provides insight into nuanced positions of experienced palliative care physicians in Quebec and confirms expected tensions between an important stakeholder and the practice of VAE as guided by the new legislation. (shrink)

When it is considered to be in their best interests, withholding and withdrawing life-supporting treatment from non-competent physically ill or injured patients – non-voluntary passive euthanasia, as it has been called – is generally accepted. A central reason in support of the procedures relates to the perceived manner of death they involve: in non-voluntary passive euthanasia death is seen to come about naturally. When a non-competent psychiatric patient attempts to kill herself, the mental health care providers treating her (...) are obligated to try to stop her. Yet it has been suggested that death by suicide can be a part of the natural course of a severe mental illness. Accordingly, if the perceived naturalness of the deaths occurring in connection with non-voluntary passive euthanasia speaks for their moral permissibility, it could be taken that a similar reason can support the moral acceptability of the suicidal deaths of non-competent psychiatric patients. In this article, I consider whether the suicidal death of a non-competent psychiatric patient would necessarily be less natural than those of physically ill or injured patients who die as a result of non-voluntary passive euthanasia. I argue that it would not. (shrink)

In Australia and Oregon, USA, legislation to permit statutory sanctioned physician-assisted dying was enacted. However, opponents, many of whom held strong religious views, were successful with repeal in Australia. Similar opposition in Oregon was formidable, but ultimately lost in a 60-40% vote reaffirming physician-assisted dying. This paper examines the human dilemma which arises when technological advances in end-of-life medicine conflict with traditional and religious sanctity-of-life values. Society places high value on personal autonomy, particularly in the United States. We compare the (...) potential for inherent contradictions and arbitrary decisions where patient autonomy is either permitted or forbidden. The broader implications for human experience resulting from new legislation in both Australia and Oregon are discussed. We conclude that allowing autonomy for the terminally ill, within circumscribed options, results in fewer ethical contradictions and greater preservation of dignity. (shrink)

In his recent book, Death, Posthumous Harm, and Bioethics (Routeledge 2012), James Stacey Taylor challenges two ideas whose provenance may be traced all the way back to Aristotle. The first of these is the thought that death (typically) harms the one who dies (mortal harm thesis). The second is the idea that one can be harmed (and wronged) by events that occur after one’s death (posthumous harm thesis). Taylor devotes two-thirds of the book to arguing against both (...) theses and the remainder to working out the implications of their falsity for various bioethical concerns, including euthanasia, suicide, organ procurement, etc. In this brief article, I concentrate on Taylor’s case against the mortal harm thesis and suggest that his main argument against this claim begs the question. (shrink)

Patients who are imminently dying sometimes experience symptoms refractory to traditional palliative interventions, and in rare cases, continuous sedation is offered. Samuel H. LiPuma, in a recent article in this Journal, argues that continuous sedation until death is equivalent to physician-assisted suicide/euthanasia based on a higher brain neocortical definition of death. We contest his position that continuous sedation involves killing and offer four objections to the equivalency thesis. First, sedation practices are proportional in a way that physician-assisted suicide/euthanasia (...) is not. Second, continuous sedation may not entirely abolish consciousness. Third, LiPuma’s particular version of higher brain neocortical death relies on an implausibly weak construal of irreversibility—a position that is especially problematic in the case of continuous sedation. Finally, we explain why continuous sedation until death is not functionally equivalent to neocortical death and, hence, physician-assisted suicide/euthanasia. Concluding remarks review the differences between these two end-of-life practices. (shrink)

Essays raise and discuss moral questions concerning euthanasia, suicide, war, capital punishment, abortion, famine relief, and the environment.

The Philosophy of Death is a discussion of the basic philosophical issues concerning death, and a critical introduction to the relevant contemporary philosophical literature. Luper begins by addressing questions about those who die: What is it to be alive? What does it mean for you and me to exist? Under what conditions do we persist over time, and when do we perish? Next, he considers several questions concerning death, including: What does dying consist in; in particular, how (...) does it differ from ageing? Must death be permanent? By what signs may it be identified? Is death bad for the one who dies? If so why? Finally he discusses whether, and why, killing is morally objectionable, and suggests that it is often permissible; in particular, suicide, euthanasia and abortion may all be morally permissible. His book is a lively and engaging philosophical treatment of a perennially fascinating and relevant subject. (shrink)

This volume meets the increasing interest in a range of philosophical issues connected with the nature and significance of life and death, and the ethics of killing. What is it to be alive and to die? What is it to be a person? What must time be like if we are to persist? What makes one life better than another? May death or posthumous events harm the dead? The chapters in this volume address these questions, and also discuss (...) topical issues such as abortion, euthanasia, and suicide. They explore the interrelation between the metaphysics, significance, and ethics of life and death, and they discuss the moral significance of killing both people and animals, and the extent to which death harms them. The volume is for all those studying the philosophy of life and death, for readers taking applied ethics courses, and for those studying ethics and metaphysics more generally. (shrink)

Suicide is the 10th leading cause of death in the United States and the second cause of death among those ages 15–24 years. The current standard of care for suicidality management often involves an involuntary hospitalization deemed necessary by the attending psychiatrist. The purpose of this article is to reexamine the ethical tradeoffs inherent in the current practice of involuntary psychiatric hospitalization for suicidal patients, calling attention to the often-neglected harms inherent in this practice and proposing (...) a path for future research. With accumulating evidence of the harms inherent in civil commitment, we propose that the relative value of this intervention needs to be reevaluated and more efficacious alternatives researched. Three arguments are presented: (1) that inadequate attention has been given to the harms resulting from the use of coercion and the loss of autonomy, (2) that inadequate evidence exists that involuntary hospitalization is an effective method to reduce deaths by suicide, and (3) that some suicidal patients may benefit more from therapeutic interventions that maximize and support autonomy and personal responsibility. Considering this evidence, we argue for a policy that limits the coercive hospitalization of suicidal individuals to those who lack decision-making capacity. (shrink)

In this book, C. G. Prado addresses the difficult question of when and whether it is rational to end one's life in order to escape devastating terminal illness. He specifically considers this question in light of the impact of multiculturalism on perceptions and judgements about what is right and wrong, permissible and impermissible. Prado introduces the idea of a 'coincidental culture' to clarify the variety of values and commitments that influence decision. He also introduces the idea of a 'proxy premise' (...) to deal with reasoning issues that are raised by intractably held beliefs. Primarily intended for medical ethicists, this book will be of interest to anyone concerned about the ability of modern medicine to keep people alive, thereby forcing people to choose between living and dying. In addition, Prado calls upon medical ethicists and practitioners to appreciate the value of a theoretical basis for their work. (shrink)

In their account of passive euthanasia, Garrard and Wilkinson present arguments that might lead one to overlook significant moral differences between killing and letting die. To kill is not the same as to let die. Similarly, there are significant differences between active and passive euthanasia. Our moral duties differ with regard to them. We are, in general, obliged to refrain from killing each and everyone. We do not have a similar obligation to try to prevent each and everyone from dying. (...) In any case, to be morally obliged to persist in trying to prevent their deaths would be different from being morally obliged to refrain from killing all other people even if we had both obligations. (shrink)

In the debate surrounding the morality and legality of the practices of physician-assisted death and euthanasia, a common logical argument regularly employed against these practices is the “slippery slope argument.” One formulation of this argument claims that acceptance of physician-assisted death will eventually lead down a “slippery slope” into acceptance of active euthanasia, including its voluntary, non-voluntary, and/or involuntary forms, through psychological and social processes that warp a society’s values and moral perspective of a practice over an (...) extended period of time. This formulation is known as the psychological slippery slope argument. This paper analyzes the psychological slippery slope argument as it is applied to the practice of physician-assisted death, and utilizing recent empirical evidence from various nations around the world that practice physician-assisted death and/or euthanasia, the paper argues that employing the psychological slippery slope argument against physician-assisted death is logically fallacious, this kind of slippery slope is unfounded in practice, and thus the psychological slippery slope argument is insufficient on its own to justify continued legal prohibition of physician-assisted death. (shrink)

This paper considers the problems that arise when death, which is a philosophically difficult concept, is incorporated into healthcare metrics, such as the quality-adjusted life year (QALY). These problems relate closely to the debate over euthanasia and assisted suicide because negative QALY scores can be taken to mean that patients would be ‘better off dead’. There is confusion in the literature about the meaning of 0 QALY, which is supposed to act as an ‘anchor’ for the surveyed preferences on (...) which QALYs are based. In the context of the debate over euthanasia, the QALY assumes an ability to make meaningful comparisons between life-states and death. Not only is this assumption questionable, but the ethical debate is much more broad than the question of whether death is preferable to a state of living. QALYs are derived from preferences about health states, so do not necessarily reflect preferences about events (eg, dying) or actions (eg, killing). This paper presents a new kind of problem for the QALY. As it stands, the QALY provides confused and unreliable information when it reports zero or negative values, and faces further problems when it appears to recommend death. This should preclude its use in the debate over euthanasia and assisted suicide. These problems only apply where the QALY involves or seems to involve a comparison between life-states and death, and are not relevant to the more general discussion of the use of QALYs as a tool for comparing the benefits derived from treatment options. (shrink)

Discusses the biological meaning of death, attitudes of the dying, survivors, and society toward it, and such related topics as euthanasia, abortion, murder, suicide, and immortality.