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.

이 논문의 목적은 안락사에 관한 최근의 철학적 논증을 검토하는 것이다. 특히, 현대 미국 철학에서 영향력 있는 철학자 중의 하나인 J. David Velleman의 논문에 대한 반론을 시도한다. Velleman은 자신의 논문에서 사회가 개인에게 주는 죽음에 대한 선택의 권리부여는 그 자체로 하나의 선물로 여겨지는 반면, 선물이 그것의 수용자에게 항상 긍정적인 의미만을 갖지는 않음을 현상학적 논증을 통해 주장한다. 이러한 논증은 안락사의 공리주의적 측면을 새로운 시각에서 바라볼 수 있는 통찰력을 제공한다는 점에서 설득력 있게 여겨진다. 이 글은 그러한 논증이 갖는 타당성을 자율성 개념과 문화적 다양성 차원에서 (...) 검토함으로써 안락사의 법제화에 반대하는 논증을 재반박한다. (shrink)

_The purpose _of this article is to find out whether philosophical and anthropological studies of human nature affect the legitimization of decisions about human life and death, using the example of a philosophical analysis of the problem of euthanasia. _Theoretical__ basis._ Philosophically and anthropologically based situational analysis in bioethics is chosen as the research methodology, which reveals the legitimation of euthanasia as a complex and highly responsible moral decision, which should be based on both the consideration of (...) all the patient’s special circumstances and the competent and adequate application of fundamental knowledge about the human being. _Originality._ From a philosophical point of view, it would be correct to legalize euthanasia, but under the condition of significantly limiting the cases of its application, clearly defining the conditions for its provision and strict control over its implementation. It is morally unacceptable to justify either murder or torture, so euthanasia appears as an attempt to avoid both at the same time. _Conclusions._ Specific solutions to practical problems often indicate the necessary direction for solving theoretical difficulties. Thus, making proper moral decisions about euthanasia requires reliance on fundamental knowledge about human beings, but at the same time it provides arguments "for" and "against" artificial termination of life. The basic principles of bioethics – autonomy, nonmaleficence, beneficence and respect for the dignity of human life – serve as criteria for making balanced ethical decisions both in theory and in practice. These principles should be complemented by a coherent ethical, legal and philosophical position on euthanasia, which is achieved through legitimation procedures. Decisive for making a decision on euthanasia should be the strong desire of the patient himself. (shrink)

Belgium's policy of not permitting Catholic hospitals to refuse euthanasia services rests on ethical presuppositions concerning the secular justification of political power which reveal the paradoxical character of European liberalism: In endorsing freedom as a value (rather than as a side constraint), liberalism prioritizes first-order intentions, thus discouraging lasting moral commitments and the authority of moral communities in supporting such commitments. The state itself is thus transformed into a moral community of its own. Alternative policies (such as an explicit (...) moral diversification of public healthcare or the greater tolerance for Christian institutions in the Netherlands) are shown to be incompatible with Europe's liberal concern with securing social and material freedom resources, as well as the concern with equality of opportunity, as embodied in the European Union's anti-discrimination labor law. The essay's argument for the preferability of a libertarian solution closes with the challenge that only if the provision of public healthcare can be shown to be rationally indispensable for a morally justified polity, could the exposed incoherence of modern European liberalism be generously discounted. (shrink)

In this paper, I discuss an example from Buchanan of active voluntary euthanasia (AVE). I first refute objections to the intuitive permissibility of the killing described in the example. After explaining why the killing is intentional, I evaluate Buchanan's solution to the ‘problem of intending death’. According to Buchanan, what justifies a physician in intentionally bringing about a patient's death by AVE is a principle that embodies the values of patient self-determination and well-being. I argue that these two (...) considerations are not sufficient for justifying AVE. The motive of the physician matters, but it is his desire rather than his intention that is relevant. An ethical physician may bring about intentionally the death of his patient if in forming his intention, he began with an appropriate desire to keep the patient alive as well as a legitimate desire to prevent prolonged suffering, with the latter outweighing the former. The ethical physician also desires to respect the choice of his patient wherever possible. On my account, the physician should be guided by the virtues and goals of his profession rather than by strict ‘all-or-nothing’ principles. I defend my account by describing the advantages of my account, and dismissing possible objections. (shrink)

The point of departure is the empirical research by Marwijk, Haverkate, Van Royen and The. Starting from qualitative interviews, the act of euthanasia seems to be for the physician problematic and even traumatic, also in countries where euthanasia is a legal option. This emotional contrast-experience is an important locus for the ethical reflection. I will discuss one topic of the conclusion of the research: what is the place, meaning and limit of the moral integrity of the practitioner? In (...) the act of euthanasia, a relation of many years based on trust is often presupposed by the physician in order to legitimate morally his involvement in the act of euthanasia. At the same time, physicians experience an inconsistent relation between their acting and their personal emotional and moral experience. The legal possibility to refuse the involvement in the euthanasia, doesn’t take away the ethical unrest and physicians can experience to leave their patients to fend for themselves. Can the responsibility and the loyalty towards the patient implicate that one passes over his own moral integrity? A one-sided interpretation of the ethics of Levinas could suggest a positive answer to this question. A choice for the concrete goodness happens in the face-to-face relation with the other. The other’s interest and not the own existing values are decisive. This could lead to the suggestion of an absolute presence for the other. The own moral integrity is subordinated towards the ethical responsibility for the other. To this kind of reasoning, we put two questions: Every form of responsibility presupposes a moral integrity. The autonomy and the conscience of the physician is presupposed for taking up the responsibility towards the patient. It cannot be annihilated by the faithfulness and responsibility. The physician is not only responsible for the patient who is asking euthanasia, but also for his other patients. The act of euthanasia has consequences for his moral attitudes towards the third parties. The problem will be elaborated in a discussion with the concept of responsibility as developed by Emmanuel Levinas and Cathérine Chalier. The argument is based on a critical-philosophical reading of some biblical texts. The conclusion is relevant for the evaluation of the moral integrity of the physician as well as for the application of Levinas’ concept of responsibility in the field of biomedical ethics. (shrink)

Euthanasia or mercy killing is, now a day, a major problem widely discussed in medical field. Medical professionals are facing dilemma to take decision regarding their incompetent patient while tend to do euthanasia. The dilemma is by nature moral i.e. whether it is morally permissible or not. In some countries of Europe and in some provinces of USA euthanasia is legally permitted fulfilling some conditions. It is claimed by Rachels that in our practical medical practice we (...) do euthanasia by forbidding patients from taking drugs. He concludes that if that type of euthanasia can be practiced in our society without any hesitation then why assisting euthanasia will not be permitted1. There are so many arguments both pro and con of euthanasia. But it is not the function of the current paper to discuss all the arguments. Philippa Foot in her article „Euthanasia‟ and J Velleman in his article titled as „A Right to Self-termination‟ discussed about the permissibility of euthanasia. The objective of the paper is to justify their arguments and then come to a conclusion regarding the permissibility of euthanasia. The focus will be given mainly on non- voluntary active and non-voluntary passive euthanasia. The method of discussion will be that an example will be given from Bangladesh and then the arguments provided by Foot and Velleman in their above mentioned papers will be discussed to justify the act of euthanasia on concerned patient. In the last section of the paper the situation of Bangladesh will also be considered for the permissibility of euthanasia i.e. whether the act of euthanasia can be permitted in our country considering the existing socio-cultural-religious practice. (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 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)

The primary aim of this paper is to critically evaluate the deductive model of ethical applications, which is based on normative ethical theories like deontology and consequentialism, and to show why a number of models have failed to furnish appropriate resolutions to practical moral problems. Here, for the deductive model, I want to call it a “Linear Mechanical Model” because the basic assumption of this model is that if a normative theory is sacrosanct, then the case is as it is. (...) The conclusion derived from the case will also be correct, true and acceptable. However, traditional ethicists used to apply their ethical theories, but they did not know which moral theory was effective on the ground level of reality. The study will show readers how ethical theories are in conflict with each other in the case of euthanasia. In more precise words, “which ethical theories are said to be applied, meta-ethical or normative, or both for the resolution of ethical problems? If normative theories are said to be applied, how the application can take place when it is contrary to our experience, that (then) in a situation of moral crises, no one really applies a theory?” For that, my argument is the linear model has failed because it is rigid, often ignores the agents’ intrinsic values, and has no space to amend it, no matter how bizarre the consequence is. Its alternative is the Inductive model. For that, the paper will take three moral principles (autonomy, beneficence including maleficence, and justice) of Beauchamp & Childress. This suggests us for resolving value-laden moral problems, we should consider some steps such as a) recognising moral issues to start with; b) developing the moral imagination; c) sharpening analytical/critical skills; d) testing out disagreements; e) effecting decisions and behavior; and f) implementation, closure, and process are of vital importance, in other words, it starts with the free and informed consensus of all interested parties, but this model also has been failed because the model could not give a systematic organization to their way of resolution. Here, my argument is that the inductive model provides resolution of the practical problem but ignores what is ethically obligatory, permissible, or wrong in that situation, and there are no appropriate suggestions in the case of a moral crisis. (shrink)

I question whether, in those cases where physician-assisted suicide is invoked to alleviate unbearable pain and suffering, there can be such a thing as voluntary euthanasia. The problem is that when a patient asks to die under such conditions there is good reason to think that the decision to die is compelled by the pain, and hence not freely chosen. Since the choice to die was not made freely it is inadvisable for physicians to act in accordance with (...) it, for this may be contrary to the patient's genuine wishes. Thus, what were thought to be cases of voluntary euthanasia might actually be instances of involuntary euthanasia. (shrink)

This paper takes up one of the least apparent problems of Philosophy. It believes that there are problems in philosophy as a discipline; especially in the field of Metaphysics. Problems of Body and Mind, Freewill and Determinism, Euthanasia and Sanctity of life, are such problems which have been given spectacular cognitions and ameliorative opinions. But problems in philosophy are not restrained to these ones. That is why the paper seeks to appraise the ‘Problem of Method’ as it occurs (...) to the universal frame of Philosophy. It also claims that the Existentialist approach can be a model that the philosophical traditions should follow in solving or evading the metaphilosophical problem. The above will be carried out by looking at what the word ‘method’ means, its affiliation with disciplines generally then with philosophy; emphasizing much on its problematic features as vivid in some philosophical quests. Furthermore, the notion of existentialism shall be explicated as the sublime, in putting to a halt the problematic trend of method in the whole enterprise of Philosophy. (shrink)

The aim of this work is twofold. On the one hand, the intention is to provide analysis of the issue of euthanasia. On the other hand, this approach necessarily leads to a discussion toward the provision of an adequate definition of euthanasia. Therefore the article, first of all, refers to the multi?layered aspect of the term euthanasia. To avoid ambiguity and other uncer?tainties while providing the definition of euthanasia, the authors carefully perform a conceptual analysis. This (...) leads to the establishment of a clear distinction between actions which, due to their motives or their method of execution, cast a shadow on the meaning of this medical procedure. (shrink)

: This paper examines the main Jewish sources relevant to end-of-life ethics, two Talmudic stories, the early modern code of law (Shulhan Aruch), and contemporary Halakhaic (religious law) responsa. Some Orthodox rabbis object to the use of artificial life support that prolongs the life of a dying patient and permit its active discontinuation when the patient is suffering. Other rabbis believe that every medical measure must be taken in order to prolong life. The context of the discussion is the recent (...) release of the "Steinberg Report," which proposes a law regulating end-of-life issues in Israel. It is argued that the Orthodox rabbis base their views on a strongly positivist concept of the religious law. The rabbis deliberate the law as a manifestation of the will of God and try to stretch the law as much as possible in order to benefit the patient, even when it is good for the patient to die. Direct and active actions that kill are prohibited; certain forms of passive euthanasia and contrivances that terminate life support without needing direct human action are accepted. (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)

Joel Feinberg : In Memoriam. Preface. Part I: INTRODUCTION TO THE NATURE AND VALUE OF PHILOSOPHY. 1. Joel Feinberg: A Logic Lesson. 2. Plato: "Apology." 3. Bertrand Russell: The Value of Philosophy. PART II: REASON AND RELIGIOUS BELIEF. 1. The Existence and Nature of God. 1.1 Anselm of Canterbury: The Ontological Argument, from Proslogion. 1.2 Gaunilo of Marmoutiers: On Behalf of the Fool. 1.3 L. Rowe: The Ontological Argument. 1.4 Saint Thomas Aquinas: The Five Ways, from Summa Theologica. 1.5 Samuel (...) Clarke: A Modern Formulation of the Cosmological Argument. 1.6 William L. Rowe: The Cosmological Argument. 1.7 William Paley: The Argument from Design. 1.8 Michael Ruse: The Design Argument. 1.9 David Hume: Dialogues Concerning Natural Religion. 2. The Problem of Evil. 2.1 Fyodor Dostoyevsky: Rebellion. 2.2 J. L. Mackie: Evil and Omnipotence. 2.3 Peter van Inwagen: The Argument from Evil. 2.4 Michael Murray and Michael Rea: The Argument from Evil. 2.5 B. C. Johnson: God and the Problem of Evil. 3. Reason and Faith. 3.1 W. K. Clifford: The Ethics of Belief. 3.2 William James: The Will to Believe. 3.3 Kelly James Clark: Without Evidence or Argument. 3.4 Blaise Pascal: The Wager. 3.5 Lawrence Shapiro: Miracles and Justification. 3.6 Simon Blackburn: Infini-Rien. Part III. HUMAN KNOWLEDGE: ITS GROUNDS AND LIMITS. 1. Skepticism. 1.1 John Pollock: A Brain in a Vat. 1.2 Michael Huemer: Three Skeptical Arguments. 1.3 Robert Audi: Skepticism. 2. The Nature and Value of Knowledge. 2.1 Plato: Knowledge as Justified True Belief. 2.2 Edmund Gettier: Is Justified True Belief Knowledge? 2.3 James Cornman, Keith Lehrer, and George Pappas: An Analysis of Knowledge. 2.4 Gilbert Ryle: Knowing How and Knowing That. 2.5 Plato: "Meno". 2.6 Linda Zagzebski, Epistemic Good and The Good Life. 3. Our Knowledge of the External World. 3.1 Bertrand Russell: Appearance and Reality and the Existence of Matter. 3.2 René Descartes: Meditations on First Philosophy. 3.3 John Locke: The Causal Theory of Perception. 3.4 George Berkeley: Of the Principles of Human Knowledge. 3.5 G. E. Moore: Proof of an External World. 4. The Methods of Science. 4.1 David Hume: An Inquiry Concerning Human Understanding. 4.2 Wesley C. Salmon: An Encounter with David Hume. 4.3 Karl Popper: Science: Conjectures and Refutations. 4.4 Philip Kitcher: Believing Where We Cannot Prove. Part IV: MIND AND ITS PLACE IN NATURE. 1. The Mind-Body Problem. 1.1 Brie Gertler: In Defense of Mind--Body Dualism. 1.2 Frank Jackson: The Qualia Problem. 1.3 David Papineau: The Case for Materialism. 1.4 Paul Churchland: Functionalism and Eliminative Materialism. 2. Can Non-Humans Think? 2.1 Alan Turing: Computing Machinery and Intelligence. 2.2 John R. Searle: Minds, Brains, and Programs. 2.3 William G. Lycan: Robots and Minds. 3. Personal Identity and the Survival of Death. 3.1 John Locke: The Prince and the Cobbler. 3.2 Thomas Reid: Of Mr. Locke’s Account of Our Personal Identity. 3.3 David Hume: The Self. 3.4 Derek Parfit: Divided Minds and the Nature of Persons. 3.5 Shelly Kagan: What Matters. 3.6 John Perry: A Dialogue on Personal Identity and Immortality. Part V: DETERMINISM, FREE WILL, AND RESPONSIBILITY. 1. Libertarianism: The Case for Free Will and Its Incompatibility with Determinism. 1.1 Roderick M. Chisholm: Human Freedom and the Self. 1.2 Robert Kane: Free Will: Ancient Dispute, New Themes. 2. Hard Determinism: The Case for Determinism and its Incompatibility with Its Incompatibility with Any Important Sense of Free Will. 2.1 James Rachels: The case against Free Will. 2.2 Derk Pereboom: Why We Have No Free Will and Can Live Without It. 3. Compatibilism: The Case for Determinism and Its Compatibility with the Most Important Sense of Free Will. 3.1 David Hume: Of Liberty and Necessity. 3.2 Helen Beebee: Compatibilism and the Ability to do Otherwise. 4. Freedom and Moral Responsibility. 4.1 Galen Strawson: Luck Swallows Everything. 4.2 Harry Frankfurt: Alternate Possibilities and Moral Responsibility. 4.3 Thomas Nagel: Moral Luck. 4.4 Susan Wolf: Sanity and the Metaphysics of Responsibility. Part VI: MORALITY AND ITS CRITICS. 1. Changes to Morality. 1.1 Joel Feinberg: Psychological Egoism. 1.2 Plato: The Immoralist’s Challenge. 1.3 Friedrich Nietzche: Master and Slave Morality. 1.4 Richard Joyce: The Evolutionary Debunking of Morality. 2. Proposed Standards and Right of Conduct. 2.1 Russ Shafer-Landau: Ethical Subjectivism. 2.2 Mary Midgley: Trying Out One’s New Sword. 2.3 Aristotle: Virtue and the Good Life. 2.4 Thomas Hobbes: Leviathan. 2.5 Plato: Euthyphro. 2.6 Immanuel Kant: The Good Will and the Categorical Imperative. 2.7 J.S. Mill: Utilitarianism, Chapters 2 and 4. 2.8 W. D. Ross: What Makes Right Acts Right? 2.9 Hilde Lindemann: What Is Feminist Ethics? 3. Ethical Problems. 3.1 Kwame Anthony Appiah: What Will Future Generations Condemn Us For? 3.2 Peter Singer: Famine, Affluence and Morality. 3.3 John Harris: The Survival Lottery. 3.4 James Rachels: Active and Passive Euthanasia. 3.5 Mary Anne Warren: The Moral and Legal Status of Abortion. 3.6 Don Marquis: Why Abortion Is Immoral. 4. The Meaning of Life. 4.1 Epicurus: Letter to Menoeceus. 4.2 Richard Taylor: The Meaning of Life. 4.3 Richard Kraut: Desire and the Human Good. 4.4 Leo Tolstoy: My Confession. 4.5 Susan Wolf: Happiness and Meaning. 4.6 Thomas Nagel: The Absurd. (shrink)

The paper classifies euthanasia and discusses its typological presence in storytelling video games. It aims to illustrate the importance of experiencing simulated moral challenges in the context of gameworlds as a significantly influential, exponentially growing form of interactive media. In contrast to older works of art and media, such as film and literature, the difference should be emphasized in light of the player’s ability to make choices in video games. Although the influence of gameworld content depends on the player, (...) the experiences and knowledge gained from playing storytelling video games may influence the player’s problem-solving orientation in the landscape of difficult moral dilemmas they may encounter throughout their lives. (shrink)

sirDr Campbell presents proponents of euthanasia with a dilemma.1 Only voluntary euthanasia is permissible; involuntary euthanasia is always impermissible. The question of allowing euthanasia arises most frequently when patients are terminally ill and experiencing great pain. But in these cases, he argues, if patients request euthanasia, their decision “is not freely chosen but is compelled by the pain”.2 It is easy to exaggerate the problem here; patients may have periods when they are pain-free and (...) affirm repeatedly their desire that death be hastened. Putting this aside, however, what should we conclude if euthanasia performed on patients who are suffering greatly is not voluntary?Dr Campbell concludes: “If the request to end one's life is not made freely, then it is doubtful that such requests ought to be followed”.2 An advance directive will not help, we are …. (shrink)

Although euthanasia is seen as the problem of the individual will and as one’s right to privacy, to a better quality of life or to a dignified death, it has major institutional implications. They are closely related to the juridical system, to the way of understanding state involvement in protecting the individuals and respecting their freedoms, to the institutional system of health care, to the government rules that establish social, political or professional practices. The public debate around the (...) topics related to the human condition, like euthanasia, grants a special force to public communication, to organizational communication, to communication in professional environments, to physician-patient communication and, more generally, to interpersonal communication. In this text we emphasize the importance of public debate on euthanasia from the perspective of organizational ethics, of medical deontology, of patients’ rights, but especially of elaborating public policies and national programs, and we underline the importance of the need to establish protocols for health care, as well as to build a framework of democratic communication. (shrink)

Approximately 30 years ago, a son prepared a cup of milk mixed with insecticide and arranged for his mother to unknowingly administer the poison to his father, who had been suffering severe pain after a cerebral apoplectic attack and demanding that his son assist him. in dying. After drinking the mixture, the father died, and the son was charged with homicide.

이 글은 양가가치에 관한 한 입장을 검토하고 그러한 입장이 지적하고 있는 문제점을 해소하고자 한다. 학자들 대다수는 소위 이상적인 인간이기 위해 양가적이기보다는 자기 통합적이어야 한다는 입장을 취하는데, 군나르손(Logi Gunnarsson)은 이 입장을 전면 거 부한다. 군나르손은 사람이 때로는 양가적일 수 있으며 심지어는 극단적인 양가가치가 자 기진실성을 위한 유일한 방식이라고 주장한다. 이 주장은 브래스코라는 가명으로 활동한 실제 FBI 요원 피스톤의 삶이 극단적으로 양가적이라는 데에 근거한다. 군나르손에 따르 면, 그는 잠입 요원과 범죄자의 삶 양자를 자기 것으로 받아들일 뿐만 아니라 양가적인 상 태를 자기 것으로 (...) 받아들인다. 그러나 나는 이 경우가 극단적인 양가가치라는 군나르손의 해석이 잘못되었으며, 적어도 그것의 양가적 가능성은 행위자가 처한 작위적 특수성에 달 려 있다고 본다. 군나르손의 주장과 달리, 브래스코의 양가가치는 그러한 양가가치에 도달 한 시간적 흐름을 따져 보았을 때 그 자신의 가치로만 구성될 수 없는 것들의 대립을 내포 한다. 가치의 대립을 포함하는 유사한 상황, 곧 안락사의 다양한 양가적 상황을 고려해보 더라도, 행위자의 양가가치는 극단적인 형태보다는 자기통합의 방향을 지향하는 것으로 보인다. (shrink)

Definition of the problem: In order to discuss the normative aspects of euthanasia one has to clarify what is meant by active and passive euthanasia. Arguments and conclusion: Many theoreticians deny the possibility of distinguishing between the two by purely descriptive means, e.g. on the basis of theories of action or the differences between acting and omitting. On the contrary, such a purely descriptive distinction will be defended in this paper by summarizing and refining the theory of (...) Dieter Birnbacher, which he developed in his book Tun und Unterlassen. I will suggest a new definition of active and passive euthanasia. (shrink)

The working party on euthanasia set up by the British Medical Association produced its report in 1988 (1). The first of its terms of reference was 'to examine the ethical problems relating to euthanasia, terminal illness, and suicide' and as far as active voluntary euthanasia (AVE) is concerned it failed conspicuously to do its job. The purpose of this article is not to restate the case for AVE but to examine the reason for the failure. (Figures in (...) square brackets refer to sections in the report.). (shrink)

As a new approach to the still unsettled problem of a morally significant difference between active and passive euthanasia, the meanings of the notion of killing are distinguished on the levels of causality, intention, and motivation. This distinction allows a thorough analysis and refutation of arguments for the equality of killing and letting die which are often put forward in the euthanasia debate. Moreover, an investigation into the structure of the physician's action on those three levels yields (...) substantial differences between the two ways of acting. As can be demonstrated, only a teleological notion of the organism is able to grasp the characteristic feature of active euthanasia. On this basis it is argued that an action against the organism as a whole must, on the interpersonal level, be at once directed against the patient as a person himself. (shrink)

The religious legitimacy of medical practice was an issue of serious contention amongst medieval Jewish scholars. For Nahmanides, altering the patient's fate through manipulation of natural causality amounts to circumventing divine judgment. For Maimonides, however, human accomplishment is part of God's providential design; this view generally prevails in contemporary Jewish bioethics. But the doctrine of deligitimizing human intervention continues, even while unacknowledged, to underlie certain contemporary positions. These include arguments within Jewish bioethics about end-of-life decisions, which are therefore imbued with (...) inconsistencies. It is suggested that, given the overall endorsement of modern medicine, the Nahmanidean approach must be explicitly confronted. Keywords: euthanasia, Jewish bioethics, Nahmanides, naturalism, nature, Maimonides, providence CiteULike Connotea Del.icio.us What's this? (shrink)

In the Netherlands and Belgium, it is lawful for voluntary euthanasia to be offered on the grounds of psychiatric suffering. A recent case that has sparked much debate is that of Aurelia Brouwers, who was helped to die in the Netherlands on account of her suffering from borderline personality disorder. It is sometimes claimed that whether or not a mentally ill person’s wish to die is valid hinges on whether or not that wish is a symptom of the person’s (...) mental disorder. This article addresses the philosophical problems raised by this claim, with a specific focus on the diagnosis of borderline personality disorder. After considering descriptivist and causal conceptualizations of mental disorder, I argue that the current approach to borderline personality disorder in psychiatry precludes the possibility of dissociating the wish to die from the disorder. I then examine the implications of this analysis for the question of whether or not the request for voluntary euthanasia in the case of borderline personality disorder can be considered valid. Ultimately, I conclude that the inability to dissociate the wish to die from the disorder does not invalidate the wish in the case of borderline personality disorder. (shrink)

Definition of the problem: Concerning the debate on euthanasia, a widely held position is that it should be accepted in its so-called passive and indirect form, while so-called active euthanasia should be rejected. The problem, now, is that at least some of the usual arguments to defend this view are invalid. Arguments: Three kinds of failures are examinded: First, if taken seriously, some of the arguments against active euthanasia undermine the accepted passive and indirect forms, (...) too. For example, this is the case concerning the claim that the patient's decision can be manipulated. Second, the rejection of active euthanasia partly rests on empirical data unsuited for this task. Euthanasia in The Netherlands as evidence for the so-called slippery slopes is presented as an example. Third, some of the objections against active euthanasia rest on assumptions that contradict our empirical knowledge, e.g. in the field of motives of patients asking for euthanasia. Conclusion: Those who want to defend the view mentioned above have to present more conclusive arguments. (shrink)

ABSTRACT In a recent issue of this journal, David Silver and Gerald Dworkin discuss the physicians' role in execution by lethal injection. Dworkin concludes that discussion by stating that, at that point, he is unable to think of an acceptable set of moral principles to support the view that it is illegitimate for physicians to participate in execution by lethal injection that would not rule out certain other plausible moral judgements, namely that euthanasia is under certain conditions legitimate and (...) that organ‐donation surgery is sometimes permissible. This article draws attention to some problems in the views of Silver and Dworkin and suggests moral principles which support the three moral views just mentioned. (shrink)

Currently, euthanasia is officially allowed only in a number of countries, in most countries, as well as in the Russian Federation, it is prohibited by law. However, in clinical practice, there are a large number of incurable patients who experience intractable pain, so the problem of euthanasia is relevant. Aim: to analyze the current state of the problem of euthanasia and palliative care in pulmonology. Material and methods: review of domestic and foreign literature on the (...) problem of euthanasia over the past 10 years has been carried out. Literature search was carried out using the e-library and PubMed databases. Results: We present a medical and philosophical perspective. Currently, euthanasia is a way to quickly and painlessly die if there is a serious illness that is incurable, suffering and pain. The best and perhaps the only alternative to euthanasia is palliative care. In pulmonology, palliative care focuses on early detection of respiratory failure, dyspnea, fear and pain relief. The effective organization of palliative care in respiratory medicine depends on the well-coordinated work of pulmonologists, physiotherapists, nurses, and psychologists. Conclusion: The problem of euthanasia to date still remains controversial from both medical and ethical points of view. The adoption of euthanasia by law may be a deterrent to governments from funding research into new treatments. The risk of abuse of euthanasia in order to obtain organs for transplantation or to get rid of seriously ill burdensome relatives cannot be ruled out. It is necessary to consider the issue of introducing additional educational cycles on the issues of modern achievements in palliative medicine, technical means of rehabilitation and the peculiarities of their use in patients with various diseases in the terminal stage in the training of doctors and nurses. (shrink)

Pleasants argues in favour of the idea of basic moral certainties. Analogous to Wittgenstein’s basic empirical certainties, basic moral certainties are universal certainties that cannot be justified, asserted or meaningfully doubted. They are a fundamental condition of morality as such, thus allowing us to carry out other moral operations. Brice and Rummens have criticized Pleasants’ proposal, arguing that basic moral certainties are significantly disanalogous to Wittgenstein’s basic empirical certainties. Brice argues that Pleasants does not differentiate between a bottom-up and a (...) top-down approach to basic certainties nor does he acknowledge the difference that this distinction constitutes in the foundational role of a certainty. Meanwhile, Rummens claims that basic moral certainties are not universal. Conversely, they are moral hinges embedded in certain culturally and historically specific moral language-games. Pleasants has provided a response to these criticisms, while defending the universality and naturalism of basic moral certainties. In this article, I single out the problems in Pleasants’ response to the criticisms introduced by Brice and Rummens. I argue that Pleasants must present further arguments in order to demonstrate that basic moral certainties are analogous to basic empirical certainties. I also argue that the existence of basic moral certainties that coalesce with numerous exceptions and suspensions generates significant problems in Pleasants’ proposal. I advance two cases regarding euthanasia that meaningfully challenge and doubt Pleasants’ central basic moral certainty: the wrongness of killing innocent human beings. Additionally, both cases are employed to meaningfully doubt and challenge Pleasants’ basic moral certainty of the badness of death. (shrink)

Dutch developments on euthanasia have drawn much attention over the years. Defenders and opponents have been telling very different stories about the practice of euthanasia and the frequency of cases, and the Dutch government has been struggling with the legal and moral problems involved. Concern about the procedures followed by physicians as well as questions on the “real” figures led the government to decide to organize an epidemiological study on the extent and the decision making. The results of (...) the study were published in November 1991. Interpretation of the data may lead to a final settlement of the debate on euthanasia and has inevitably led to a revival of the moral debate of the 1970s. For the moment it has been decided that euthanasia will remain officially illegal under the Penal Code. However, in cases where euthanasia does occur, Attorneys General will continue to check the procedures followed by physicians to ensure no abuses have occurred and to safeguard physicians against prosecution. In this contribution, we discuss the development and intertwinement of legal, medical, and moral aspects of euthanasia in The Netherlands and the effects of the empirical studies of 1991, both on definitions and procedures for medical decisions at the end of life. (shrink)

Battlefield euthanasia, the purposeful killing of wounded soldiers (or even civi- lians) in order to hasten their foreseeable death, has been an issue in military medicine and in soldiers’ moral codes at all times. During conflicts since anti- quity, there have been severely wounded who would not die immediately but whose fate seemed clear, nevertheless. But can it ever be morally justified to kill those wounded out of mercy in order to end their suffering? Can death ever be the (...) better option? And if so, what conditions have to be fulfilled? This paper investigates some of the moral aspects of battlefield euthanasia. Analogies to physician-assisted suicide in civil settings will be drawn and contrasted with the additional aspects that the military environment adds to the problem. (shrink)

A comprehensive study of the ethics of killing in cases in which the metaphysical or moral status of the individual killed is uncertain or controversial. Among those beings whose status is questionable or marginal in this way are human embryos and fetuses, newborn infants, animals, anencephalic infants, human beings with severe congenital and cognitive impairments, and human beings who have become severely demented or irreversibly comatose. In an effort to understand the moral status of these beings, this book develops and (...) defends distinctive accounts of the nature of personal identity, the evaluation of death, and the wrongness of killing. The central metaphysical claim of the book is that we are neither nonmaterial souls nor human organisms but are instead embodied minds. In ethical theory, one of the central claims is that the morality of killing is not unitary; rather, the principles that determine the morality of killing in marginal cases are different from those that govern the killing of persons who are self‐conscious and rational. Another important theme is that killing in marginal cases should be evaluated in terms of the impact it would have on the victim at the time rather than on the value of the victim's life as a whole. What primarily matters is how killing would affect that which would be rational for the victim to care about at the time of death. By appealing to various foundational claims about identity, death, and the morality of killing, this book yields novel conclusions about such issues as abortion, prenatal injury, infanticide, the killing of animals, the significance of brain death, the termination of life support in cases of persistent vegetative state, the use of anencephalic infants as sources of organs for transplantation, euthanasia, assisted suicide, and advance directives in cases of dementia. In particular, the book defends the moral permissibility of abortion, infanticide, and euthanasia in certain cases and argues that brain death is not the appropriate criterion of death either for a person or a human organism. (shrink)

The moral discourse surrounding end-of-life (EoL) decisions is highly complex, and a comparison of Germany and Israel can highlight the impact of cultural factors. The comparison shows interesting differences in how patient’s autonomy and doctor’s duties are morally and legally related to each other with respect to the withholding and withdrawing of medical treatment in EoL situations. Taking the statements of two national expert ethics committees on EoL in Israel and Germany (and their legal outcome) as an example of this (...) discourse, we describe the similarity of their recommendations and then focus on the differences, including the balancing of ethical principles, what is identified as a problem, what social role professionals play, and the influence of history and religion. The comparison seems to show that Israel is more restrictive in relation to Germany, in contrast with previous bioethical studies in the context of the moral and legal discourse regarding the beginning of life, in which Germany was characterized as far more restrictive. We reflect on the ambivalence of the cultural reasons for this difference and its expression in various dissenting views on passive euthanasia and advance directives, and conclude with a comment on the difficulty in classifying either stance as more or less restrictive. (shrink)

Near the beginning of the last chapter of Life's Dominion, Ronald Dworkin expounds the following problem. Margo has Alzheimer's disease. She suffers from ‘serious and permanent dementia’. It transpires that some years ago, at a time when she was mentally fully competent, Margo executed an advance directive. In this formal document she expressed her wishes concerning what should happen to her if she were to develop Alzheimer's. Should those wishes now be acceded to? For instance, suppose that in her (...) document Margo directed that she should not receive treatment for any life-threatening illness she might contract. Should a doctor therefore now refrain from such treatment? What if, more than this, Margo indicated in her will that after the definitive onset of Alzheimer's ‘she should be killed as soon and as painlessly as possible’? Could it possibly be right to grant that request? (shrink)

Amongst other countries, the Netherlands currently allows euthanasia, provided the physician performing the procedure adheres to a strict set of requirements. In 2016, Second Chamber member Pia Dijkstra submitted a law proposal which would also allow euthanasia without the reason necessarily having any medical foundation; euthanasia on the basis of a completed life. The debate on this topic has been ongoing for over two decades, but this law proposal has made the discussion much more immediate and concrete. (...) This paper considers the moral permissibility of Pia Dijkstra’s law proposal, focusing on the ethics of the implementation Dijkstra describes in her proposal. I argue that, at present, Dijkstra’s law proposal is unsuitable for implementation, due to a number of as of yet unaddressed problems, including the possible development of an ageist stigma and undue pressure on the profession of end-of-life coordinator. Perhaps adequate responses can be conceived to address these issues. However, the existence of a radically different, yet currently equally unacceptable position regarding the implementation of euthanasia for a completed life as proposed by fellow party member Paul Schnabel suggests it may be difficult to formulate an ethically acceptable implementation for this, in principle, ethically acceptable concept. (shrink)

Lam, Joseph Peter Fitzsimons is a competent journalist who does not shy away from expressing his personal opinion on controversial social and ethical issues. In a Sydney Morning Herald online comment published on 11 December 2016, he not only praised the courage of the premier of Victoria, Daniel Andrews, but also appealed to members of the New South Wales parliament to follow Andrews' lead to legalise euthanasia. Anticipating the eventual collapse of his own health in the future, Fitzsimons insisted (...) that lawmakers should respect his autonomy and his choice of a peaceful and dignified death. As far as I can see, however, respect for a person's autonomy is not the main problem here. Rather, the key difficulty rests with Fitzsimons's reasoning. He argued: Let's say that at the age of 80 or so, I decide that my meaningful life is over, and all that awaits me is-I know, I know, too much detail- incontinent pain for the next five years. And let's say that I don't want that, and would rather pass away peacefully, and with dignity, in a medically supervised manner. My question to the opponents of euthanasia: if I choose to do that, what business is it of yours? (shrink)

This paper examines some of the arguments advanced and acted upon by doctors concerned in decisions about whether severely handicapped patients should live or die. It criticises the view that 'selective treatment' is morally preferable to infanticide and shows how the standard arguments advanced for this preference fail to sustain it. It argues that the self-deception, which is sometimes cited as a sign of humanity in these cases, and which is implicit in the term 'selective treatment' is more dangerous than (...) is the remote chance of brutalisation which is often cited as the danger of active euthanasia. (shrink)

The public debate on voluntary termination of life by elderly people, which has been an intensely controversial subject in the Netherlands for some time, has centered around the issue of “completed life” in recent years. In 2016, an ad hoc governmental advisory committee concluded that the already existing Euthanasia Act provided sufficient scope to resolve most of the problems related to the issue. Most of the older adults who feel they no longer have anything to look forward to in (...) their lives and who have developed a wish to die as a result would be able to invoke this Act. Partly for this reason, the committee considered broadening the legal options relating to assisted suicide undesirable. Analysis of the assessment practice of the regional euthanasia review committees reveals that the room for interpretation offered by the Euthanasia Act is indeed considerable. (shrink)

The problem of euthanasia as seen by Robert SpaemannThe main aim of the article is to present some aspects of euthanasia in the perspective of Robert Spaemann—one of the most significant contemporary German thinkers. First of all, the paradox of the right to euthanasia derived from one’s own decision is pointed out. It is illustrated by the practice of legalising these acts in the Netherlands, Belgium and Luxembourg. On the one hand, such acts are to be (...) motivated by our personal right to self-determination, but on the other, relevant decisions are taken by a doctor. Ultimately, the law protects the doctor, not the patient. Next, the nature of two main types of euthanasia is discussed and defined: active euthanasia and passive euthanasia. Also, an attempt is made to show the inevitable consequences of the right to kill oneself by answering the question whether the right to euthanasia breeds a sense of duty. Finally, a polemic between Robert Spaemann and Peter Singer is presented, which gives us an opportunity to see the three fundamental differences between these philosophers in their views on the problem of the so-called good death.The author of the article emphasizes that the patient’s living will, introduced in Germany in 2009 Patientenverfugung, may indirectly imply consent to passive euthanasia, which is omitted in specialist literature. He then indicates the specificity of the philosophical argumentation of the eminent thinker against euthanasia. He also highlights two aspects of Spaemann’s discussion with Singer: one concerns the downward spiral argument which undermines the legitimacy of euthanasia legalisation, and the other distinguishes two ways of abandoning the treatment if a person faces death. (shrink)

The essays in this volume, with the exception of Gary Ferngren's, derive from ancestral versions originally presented at a symposium, 'Conflicts with Newborns: Saving Lives, Scarce Resources, and Euthanasia: held May 10-12,1984, at the Mercer University School of Medicine, Macon, Georgia. We wish to express our gratitude to the Georgia Endowment for the Humanities for a generous grant for the symposium and to Mercer University and the Medical Center of Central Georgia for additional financial support. The vit:ws expressed in (...) this volume do not necessarily represent those of the Georgia Endowment for the Humani ties, Mercer University, or the Medical Center of Central Georgia. We have endeavored to bring together a group of individuals with contrast ing viewpoints to display some of the range of approaches to a major problem in public policy: medical decisions regarding the treatment of defective newborns. So many persons contributed to the symposium that acknowledg ment of each would be impossible. Although unnamed, we express our sincere appreciation to each. Three individuals, however, must be recognized: R. Kirby Godsey, President, Mercer University; William P. Bristol, Dean, Mercer University School of Medicine; and Kenneth C. Henderson, Medical Director and Director of Medical Education, Medical Center of Central Georgia. Without their support, the symposium could not have succeeded and this volume would not have been possible. We wish also to express our gratitude to S. G. M. (shrink)

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)

This book deal with ethico-legal issues. Muslims believe that everything they own has been given to them as an amanah (trust) from Allah. Would it constitute a breach of that trust to consent to enrol oneself as an organ donor? Cloning could rectify the problem of infertile couples, but such technology could also be abused with dire consequences. While euthanasia may apparently alleviate the suffering of the terminally ill, would that not compound their agony in the life hereafter? (...) The author sheds light on these issues and acquaints the reader with the latest Islamic rulings on these biotechonological manipulations. (shrink)

On September 22, 1998, California Governor Pete Wilson signed Senate Bill 1785 into law, dramatically affecting the entire California animal sheltering community. Dubbed the "Hayden law" by the animal protection community after the bill's sponsor, it represents the state of California's attempt to legislate a solution to both the companion animal overpopulation problem and the friction between the agencies trying to end it. The persistence of the bill's primary supporters, a Los Angeles veterinarian and a UCLA law school professor (...) and the overall lack of opposition to it helped SB 1785 sail through the California legislature. Because of the scope of the bill and the immense cost of implementation, its passage shocked many in the sheltering community. This case study highlights the consequences of legislation that was crafted based on worse case scenarios and over which there was little collaborative effort. It concludes with suggestions that might be useful to other states contemplating similar such legislation. (shrink)

Dr Neil Campbell suggests that when patients suffering extremes of protracted pain ask for help to end their lives, their requests should be discounted as made under compulsion. I contend that the doctors concerned should be referred to and then act upon advance directives made by those patients when of sound and calm mind and afflicted by no such intolerable compulsion.

Contrary to the common view, this paper suggests that the Hippocratic oath does not directly refer to the controversial subjects of euthanasia and abortion. We interpret the oath in the context of establishing trust in medicine through departure from Pantagruelism. Pantagruelism is coined after Rabelais' classic novel Gargantua and Pantagruel. His satire about a wonder herb, Pantagruelion, is actually a sophisticated model of anti-medicine in which absence of independent moral values and of properly conducted research fashion a flagrant over-medicalization (...) of human problems. Ultimately this undermines the therapeutic core of medicine itself. We contend that PAS is a case of such over-medicalization and that its institution creates medicophobia. This article does not express an opinion about euthanasia in general. Rather, we claim that physicians should learn from the oath and from Rabelais that they should keep their practice to medical care and not to exploit their expertise and social privileges for the sake of ulterior motives, even when their patients desire those goals. (shrink)

ABSTRACTThis paper examines how decisions to limit treatment to critically ill patients under uncertainty can be made rationally. Expected utility theory offers one way of making rational decisions under uncertainty. One problem with using this approach is that we may not know the value of each option. One rational course open is to treat until further information becomes available. However, treatment can limit the range of options open. With treatment, a patient may recover such that he no longer requires (...) life‐supporting treatment. However, his life may be not worth living. If active euthanasia of %on‐terminal’conditions is prohibited, the option of dying will no longer be available. Taking a rational‘wait and see’course may result in being trapped within an unbearable life. On the other hand, sometimes present practice‘lets nature takes its course'. Critically ill patients are allowed to die because it is believed that their lives will be not worth living. It is likely that some patients are allowed to die when there is some objective chance of worthwhile future life. This paper argues that a policy of treating critically ill patients until the nature of future options can be better evaluated, in company with an offer of subsequent euthanasia where appropriate, allows a more rational and humane approach to treatment limitation decisions under uncertainty. (shrink)