Objective: Cognitive impairment is a common neurological complication in patients with end-stage renal disease undergoing maintenance hemodialysis. Brain network analysis based on graph theory is a promising tool for studying CI. Therefore, the purpose of this study was to analyze the changes of functional brain networks in patients on MHD with and without CI by using graph theory and further explore the underlying neuropathological mechanism of CI in these patients.Methods: A total of 39 patients on MHD and 25 healthy controls (...) matched for age, sex, and years of education were enrolled in the study. Resting-state functional magnetic resonance imaging and T1-weighted high-resolution anatomical data were obtained, and functional brain networks for each subject were constructed. The brain network parameters at the global and regional levels were calculated, and a one-way analysis of covariance was used to compare the differences across the three groups. The associations between the changed graph-theory parameters and cognitive function scores in patients on MHD were evaluated using Spearman correlation analysis.Results: Compared with HCs, the global parameters [sigma, gamma, and local efficiency ] in both patient groups decreased significantly. The clustering coefficient in patients with CI was significantly lower than that in the other two groups. The regional parameters were significantly lower in the right superior frontal gyrus, dorsolateral and gyrus rectus of patients with CI than those of patients without CI; however the nodal local efficiency in the left amygdala was significantly increased. The global Cp and regional parameters in the three brain regions were significantly correlated with the cognitive function scores.Conclusion: This study confirmed that the topology of the functional brain network was disrupted in patients on MHD with and without CI and the disruption of brain network was more severe in patients with CI. The abnormal brain network parameters are closely related to cognitive function in patients on MHD. (shrink)

In this short paper I will discuss the ambiguous and, even, controversial term ‘right to die’ in the context of the euthanasia debate and, in particular, in the case of passive euthanasia. First I will present the major objections towards the moral legitimacy of a right to die, most of which I also endorse myself; then I will investigate whether the right to die could acquire adequate moral justification in the case of passive euthanasia. In the light (...) of the Kantian tradition I will argue that since rights are understood as based upon duties, the right to die should also presuppose a corresponding duty, which to me could be either an imperfect, solidarity-related duty, or an autonomy-related one, at least as far as the unwanted prolongation of life is concerned. I will conclude with the view that the right to die could actually be considered a legitimate one in the case of passive euthanasia, when the application of life-supporting techniques is against the wishes and the best interests of the patient. (shrink)

The At Issue series includes a wide range of opinion on a single controversial subject. Each volume includes primary and secondary sources from a variety of perspectives -- eyewitnesses, scientific journals, government officials and many others. Extensive bibliographies and annotated lists of relevant organizations to contact offer a gateway to future research.

In the present article the concept of the right to die will be analyzed in English and American literature between 1990 and 1994.

The aim of this paper is to ponder the intricate issue of the right to die in dignity by focusing attention on the role of the patient's beloved people. I first provide critical examination of some of the arguments advanced by Ronald Dworkin. I proceed by contemplating relevant scenarios and examining three American court decisions: Saikewicz, Spring and Gray. The first case, Saikewicz, concerns a patient who had no family or other beloved people. I observe that this fact had (...) a significant bearing on the court's ruling not to provide him treatment. The second case, Spring, involves a patient whose family wanted to withhold treatment from him. I argue that we should be cautious of incidents in which the best interests of the patient's beloved people come at the expense of the best interests of the patient. Spring is an example of such a case. The third case, Gray, serves as an example whereby the best interests of the patient coincide with the best interests of her beloved people. I conclude by arguing that attention has to be given to the question of whether the patient's close-ones demonstrate a unified position in regard to the destiny of the patient. Gegenstand des Beitrags ist es, das schwierige Problem des Rechts, in Würde zu sterben, im Hinblick auf die Rolle der Personen zu überdenken, die dem Patienten nahestehen. Der Autor setzt sich zunächst kritisch mit einigen von Ronald Dworkin vorgetragenen Argumenten auseinander. Dann stellt er die relevanten Fallgestaltungen dar und untersucht drei Entscheidungen amerikanischer Gerichte: die Fälle Saikewicz, Spring und Gray. Der erste Fall, Saikewicz, betrifft einen Patienten ohne Familie oder andere ihm nahestehende Personen. Dieser Umstand hatte einen wesentlichen Einfluß auf die Entscheidung des Gerichts, von der Anordnung einer Behandlung des Patienten abzusehen. Im zweiten Fall, Spring, wünschte die Familie, daß der Patient nicht behandelt würde. Der Autor mahnt für alle die Fälle zur Vorsicht, bei denen die Umstände so beschaffen sind, daß das wohlverstandene Interesse der Angehörigen und das des Patienten kollidieren. Der Fall Spring ist ein Beispiel für eine solche Kollisionssituation. Der dritte Fall, Gray, dient als ein Beispiel, in dem sich das wohlverstandene Interesse des Patienten und das der ihm nahestehenden Personen decken. Zuletzt geht es um die Frage, ob die Angehörigen und andere dem Patienten nahestehende Personen in ihren Vorstellungen über das weitere Schicksal des Patienten übereinstimmen oder nicht. Die Frage verdient eine besondere Aufmerksamkeit. (shrink)

Major considerations of disability studies—such as provision of care, accommodation for disabled people, and issues surrounding institutionalization—have been consistently marginalized in American bioethical discourse. The right to die, however, stands out as a paradigmatic bioethical debate. Why do advocates for expanding the volition and self-direction of disabled people emerge from the periphery only to help those disabled people who choose death? And why do the majority of people assume an unrealistically low quality of life for those with disabilities? This (...) paper will argue that the dominance of the Western liberal tradition in American culture motivates both these phenomena: by emphasizing individual rights over duties and responsibilities, assuming the isolated and independent rights-bearer as the prototypical person, and evoking an unrealistically atomistic view of human interaction. As an alternative, I offer a framework rooted in feminist ethics that emphasizes context, gives moral weight to human relationships, abandons the problematic ideal of a lone rights-bearer, and emphasizes the mutual vulnerability of embodied individuals. (shrink)

A 96 page guide to the background, program, uses for and contact time needed with the CD-ROM A Right to Die? The Dax Cowart Case . This guide is supplied free with every multi-user copy of the CD-ROM, and will prove invaluable for all those planning to use the program in a classroom setting. This guide is not available to purchase separately.

A 96 page guide to the background, program, uses for and contact time needed with the CD-ROM _A Right to Die? The Dax Cowart Case_. This guide is supplied free with every multi-user copy of the CD-ROM, and will prove invaluable for all those planning to use the program in a classroom setting. This guide is not available to purchase separately.

Cohen-Almagor's book represents a remarkable contribution to the discussion of the right to die with dignity. It offers the discussion of a wide range of topics. They include: the terminology respectful of human dignity ; the question of autonomy; the sanctity-of life – quality of life debate; criticism of some extreme quality-of-life position; criticism of Ronald Dworkin's distinction between critical and experiential interests and the consequences this author draws from it; active and passive euthanasia; the Dutch experience and the (...) Oregon Death with Dignity Act; and many others. The book is discussed from a basically sympathetic view, where some details are focused on as meriting some further examination. Some remarks are offered to indicate the complexity of the definition of autonomy; a defense of Dworkin's argument is offered; an insistence on the necessity to rely on moral conferring features is remarked. (shrink)

Using the right to die and the United States Supreme Court case of Cruzan v. Director, Missouri Department of Health as exemplars, this article explores the notion of third-order decisionmaking. If first order decisionmaking is about what should happen, and second-order decisionmaking is about who should decide what should happen, then third-order decisionmaking is about who should decide who decides. This turns out to be an apt characterization of constitutionalism, which is centrally concerned with the allocation of responsibility for (...) making decisions about the allocation of responsibility. Deference to erroneous second-order decisions, as in the Cruzan case itself, may merely be an example of this central feature of constitutionalism. Keywords: constitutionalism, Cruzan case, right-to-die, rules CiteULike Connotea Del.icio.us What's this? (shrink)

Discusses the moral and ethical aspects of euthanasia and related topics.

Discusses the moral and ethical aspects of euthanasia and related topics.

Argument about euthanasia in Australia intensified following the world's first legal euthanasia death of Bob Dent under the Northern Territory's short-lived Rights of the Terminally Ill Act 1995. This paper takes stock of the implacably opposed positions on euthanasia following Bob Dent's death, which provides a focus for the controversy, and identifies the key doctrines which separate adversaries in the euthanasia debate and their associated incommensurable intuitions.

The article discusses the way people wish to die, analyzing the legal situation in countries that permit either euthanasia or physician-assisted suicide. While criticizing the Dutch, Belgian and Swiss models, I argue that the Oregon model is the one with apparently little abuse. Building on the experiences of Oregon, the Netherlands, Belgium, Switzerland, and the Northern Territory of Australia, the article ends with a set of guidelines to improve the conduct of PAS.

Welby’s request to die was widely publicized in Italy, where it led to heated debate. At the time of writing, it is unclear whether Riccio will be charged with any offense. At least one Italian politician has called for his arrest on a charge of homicide.

How a "right to die" may become a "coercive option".

The right to die has for decades been recognised for persons in a vegetative state, but there remains controversy about ending life-sustaining medical treatment for persons in the minimally conscious state. The controversy is rooted in assumptions about the moral significance of consciousness, and the value of life for patients who are conscious and not terminally ill. This paper evaluates these assumptions in light of evidence that generates concerns about quality of life in the MCS. It is argued that (...) surrogates should be permitted to make decisions to withdraw life-sustaining medical treatment from patients in the MCS. (shrink)

First published in 1996. Routledge is an imprint of Taylor & Francis, an informa company.

abstract In 2002 Diane Pretty went to the European Court of Human Rights to gain a ruling about assisted suicide. In the course of this she argued that the right to life implied a right to die. This paper will consider, from an ethical rather than a legal point of view, how the right to life might imply (or not) a right to die, and whether this includes either a right that others shall help us (...) die, or a right against non‐interference if others are willing to help us. It does this by comparing the right to life to conceptions of property rights. This is not because I think human life is property, but because some of our ways of talking and thinking about our control over our own lives seem to be similar to our thoughts about our control over our own property. The right to life has traditionally been taken as a negative right, that is a right that others not deprive us of life. Pretty's argument, however, seems to be moving towards a positive right, not just to remain alive, but to be enabled in doing what we want to with our lives, and thus disposing of them if we so choose. The comparison with property rights suggests that the right to die only applies if our lives are ours absolutely, and may itself be modified by the suggestion that suicide harms all of us by devaluing human life in general. (shrink)

In this paper, we analyze the legal situation regarding physician-assisted suicide in the world. Our hypothesis is that the prohibitive stance on physician-assisted suicide in most societies in the world today seems to be related to our moral attitudes toward suicide. This brings us to a discussion about life itself. We claim that the total lack of legal protection for physician-assisted suicide from international organizations and most countries in the world lies in a philosophical assumption that supports much of our (...) common beliefs about what life really is. This assumption states that life must be thought of as not belonging exclusively to the individual. We argue that this assumption is a misconception that can be heard in the debate on suicide. Consequently we endorse a different conception of life which tends to favor a pro-choice stance towards suicide and assisted death in general. This position takes the patient’s decision about when to die more seriously. We conclude that there is no reason why physician-assisted suicide does not deserve legal protection as an individual right to die under international law. (shrink)

Consider these three positions about physician-assisted suicide:Physician-assisted suicide should be illegal for everyone.Physician-assisted suicide should be legal for only the terminally ill.Physician-assisted suicide should be legal for all competent adults.So far, the debate in America has been primarily between positions 1 and 2. I think it should be between positions 1 and 3. Both those positions embody reasonable viewpoints, and I will not try to decide between them in this chapter. But I will argue that the double standard embodied in (...) position 2 is morally untenable. (shrink)

The reemergence of the question of suicide in the medical context of physician-assisted suicide seems to me one of the most interesting and fertile facets of late modernity. Aside from the disruption which this issue may cause in the traditional juridical relationship between individuals and the state, it may also help to transform the dominant conception of subjectivity that has been erected upon modernity's medicalized order of death. To enhance this disruptive potential, I am going to examine the perspectives on (...) death offered by two contemporary writers: Zygmunt Bauman and Jean Baudrillard. Each of these writers recognizes the centrality of death to modern culture, as Heidegger did, but they also go beyond him in specifying the ways in which death maintains a presence in late modernity, despite efforts to conceal it. In particular, both of these writers recognize the important role that medicine has played in ordering the modern conception of death. After situating these two perspectives in relation to each other, and in relation to Heidegger, who will serve here as a sort of benchmark, I will return to the issue of suicide. Given the differences in their readings of the role that death and medicine play in modern culture, these post-Heideggerians take strikingly different positions on this issue. By engaging these perspectives, I intend not only to point out the tremendous potential which this issue holds for a fundamental rethinking of modern subjectivity, but also reveal some of the dangers that may beset any naive optimism about the right to die. (shrink)

John Rawls was the most influential political thinker of the twentieth century. This book applies his theory of justice to four perennial matters of concern that remain contested in the twenty-first century. Drawing surprising implications, this book deepens our understanding of these issues and points the way toward rational, just policy reform.

A widely adopted approach to end-of-life ethical questions fails to make explicit certain crucial metaphysical ideas entailed by it and when those ideas are clarified, then it can be shown to be inadequate. These metaphysical themes cluster around the notions of personal identity, personhood and humanness, and the metaphysics of substance. In order to clarify and critique the approach just mentioned, I focus on the writings of Robert N. Wennberg as a paradigm case by, first, stating his views of personal (...) identity, humanness, personhood, and the relations among them; second, offering a comparison of a view of humans as substances (understood in the classic interpretation of Aristotle and Aquinas) vs. a view of humans as property-things; third, applying the metaphysical distinctions surfaced in the second section towards a critique of Wennberg. (shrink)

Assuming that both humans and nonhuman organisms have intrinsic value, the concept of a “death with dignity” should extend to the natural world. Recently, an effort has been undertaken to save the razorback sucker, an endangered species of fish in the Colorado River. Razorback are bred and raised in captivity and transferred to the river only when large enough to survive predation by nonnative fish. While this effort is well-intentioned, there is little chance that the razorback will again live unassisted (...) in the Colorado River. There may be human-centered reasons for saving the razorback. However, just as respecting a person sometimes requires limiting his or her life-sustaining medical treatment, so too respecting the razorback may require removing human assistance with its reproductive cycle. (shrink)

Assuming that both humans and nonhuman organisms have intrinsic value, the concept of a “death with dignity” should extend to the natural world. Recently, an effort has been undertaken to save the razorback sucker, an endangered species of fish in the Colorado River. Razorback are bred and raised in captivity and transferred to the river only when large enough to survive predation by nonnative fish. While this effort is well-intentioned, there is little chance that the razorback will again live unassisted (...) in the Colorado River. There may be human-centered reasons for saving the razorback. However, just as respecting a person sometimes requires limiting his or her life-sustaining medical treatment, so too respecting the razorback may require removing human assistance with its reproductive cycle. (shrink)

In this essay, I maintain that the issue of whether the right to die is viable as a constitutionally protectable right remains open. I intend to reconcile the Supreme Court's holdings in Glucksberg and Quill by examining the different rationales the Justices offered for their decisions. I do not believe this issue can be resolved simply by asserting that the intention of the actor is different when assisting suicide, as compared to when life-sustaining treatment is withdrawn. Rather, the (...) right to die continues to be viable due to the level of abstraction at which the Court chose to frame the issue in these cases. (shrink)

Name der Zeitschrift: Jahrbuch für Wissenschaft und Ethik Jahrgang: 19 Heft: 1 Seiten: 91-106.

The isolation of the Netherlands as the only country in which voluntary euthanasia is legal is about to end. In October 2001 the Belgian Senate voted by almost a 2:1 margin to allow doctors to act on a patient's request for assistance in dying. The legislation is expected to pass the lower house shortly. That the Netherlands' closest neighbor is likely to be the next country to take this step should provide food for thought among those who have denounced voluntary (...) euthanasia in the Netherlands as rife with abuses. If that were really the case, why would the country that is better placed than all others to know what goes on in the Netherlands – not only because of its geographical proximity, but because most of its people are Dutch-speaking – be ready to copy the Dutch model? (shrink)

The isolation of the Netherlands as the only country in which voluntary euthanasia is legal is about to end. In October 2001 the Belgian Senate voted by almost a 2:1 margin to allow doctors to act on a patient's request for assistance in dying. The legislation is expected to pass the lower house shortly. That the Netherlands' closest neighbor is likely to be the next country to take this step should provide food for thought among those who have denounced voluntary (...) euthanasia in the Netherlands as rife with abuses. If that were really the case, why would the country that is better placed than all others to know what goes on in the Netherlands – not only because of its geographical proximity, but because most of its people are Dutch-speaking – be ready to copy the Dutch model? (shrink)

Preserving dignity during the dying process requires reviewing the roles of those involved in the treatment, care methods and decision-making. This article examines the participation and responsibility assigned to nurses regarding decision-making in the final stages of life, as laid out in the Rights to and Guarantee of Dignity for the Individual During the Process of Death Act. This text has been analysed on the levels of socio-cultural practice and discourse practice, using the critical discourse analysis methodology. The results show (...) that, although the law is another result of the social trend of patient empowerment, the responsibility of the nurses is not recognised, and they are left out of the decision-making process in the final stages of life. (shrink)