Presents opposing viewpoints on various ethical, moral, legal, and medical issues concerning euthanasia.

For euthanasia the case is deceptively easy to make. When the suffering of others is ended by death we often feel relief. Commonly we accept that animals must sometimes, as the saying goes, be 'put out of their misery'. And, while most people who advocate euthanasia do not rely simply on our revulsion from suffering as though there were no other considerations, the public appeal of their view probably does rest largely on it.

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)

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)

Analysis of ethical and legal issues in battlefield euthanasia or military mercy-killing.

Brussen, Kerri Anne In 2002, euthanasia became legal in the Netherlands. Since then, the Groningen Protocol has been endorsed, allowing infanticide for disabled babies. More recently, a citizen's initiative is being prepared to propose to the Dutch government that people should be allowed to legally terminate their life if they consider it completed. The slippery slope in the Netherlands appears to be well lubricated.

In lieu of an abstract, here is a brief excerpt of the content:Euthanasia in Utopian LiteratureLyman Tower Sargent (bio)The word euthanasia, meaning a peaceful, gentle, or easy death, has been traced back to Roman times. But the "good" in a good death is obviously open to interpretation. Good for whom? The individual? The family of the individual? The society? And, who decides? The individual? The doctor? The family of the individual? The legal system? These questions are constantly raised (...) throughout the literature with diametrically opposed answers given from the earliest times to the present. And, unfortunately, one word is used for all the positions, with two subcategories, voluntary and involuntary, both of which are perceived as good for someone.Death is universal but whether or not a person should have a choice about when to die or voluntary euthanasia is deeply controversial.1 Inducing such a death, primarily in cases of a painful terminal disease, appears to be largely a nineteenth-century invention while, of course, existing as a concept well before that.2 Also, discussions of voluntary euthanasia raise related issues, suicide, involuntary euthanasia, and how eugenics has determined the criteria for involuntary euthanasia. Also, the fear of someone [End Page 238] being putting to death for the convenience or advantage of the living has been the most prominent issue, and one must wonder if involuntary euthanasia, at least when consent was possible but not given, ever constitutes a "good" death. As simply a peaceful and painless death, the earliest use of the word was by Suetonius in the early first century, where in his life of Augustus he reports Augustus's position on death as that "on hearing that anyone had died swiftly and painlessly, he prayed that he and his might have a like euthanasia, for that was the term he was wont to use."3 In his De Augmentis Scientiarum [Advancement of Learning], Francis Bacon refers to this statement, commenting, "For it is no small fidelity which Augustus Caesar was wont so earnestly to pray for, that same Euthanasia … was not so much like death as like falling into a deep and pleasant sleep." And Bacon continued: "In our times the physicians make a kind of scruple and religion to stay with the patient after he is given up, whereas in my judgment, if they would be wanting in their office, and indeed to humanity, they ought to acquire the skill and to bestow the attention whereby the dying may pass more easily out of life. This part I call the inquiry concerning outward Euthanasia, or the easy dying of the body (to distinguish from that Euthanasia which regards the preparation of the soul)."4The most explicit statement, generally ignored for sixty years, was that made in an 1870 speech to the Birmingham Speculative Club by Samuel D. Williams Jr., about whom little is known. Williams proposed:That in all cases of hopeless and painful illness, it should be the recognized duty of the medical attendant, whenever so desired by the patient, to administer chloroform or such other anæsthetic as may by-and-bye supersede chloroform—as to destroy consciousness at once, and put the sufferer to a quick and painless death; all needful precautions being adopted to prevent any possible abuse of such duty; and means being taken to establish, beyond the possibility of doubt or question, that the remedy was applied at the express wish of the patient.5This was not, though, the usual practice and many doctors saw no need to act. In an 1887 book one doctor contended that "as long as there was proper medical care, there was no need to speed up death to relieve suffering."6 Still, Williams's position is in almost all respects the position taken by advocates [End Page 239] of voluntary euthanasia since then, although it did not get much of an airing again until C. Killick Millard, the Medical Officer of Health of Leicester, gave the Presidential address to the Society of Medical Officers of Health in late 1931. There he said, referring to Bacon, thatthe proposition merely is that individuals, who have attained to years of discretion, and who are suffering from an incurable and fatal disease which usually... (shrink)

This paper re-evaluates euthanasia and assisted suicide from the perspective of eudaimonia, the ancient Greek conception of happiness across one’s whole life. It is argued that one cannot be said to have fully flourished or had a truly happy life if one’s death is preceded by a period of unbearable pain or suffering that one cannot avoid without assistance in ending one’s life. While death is to be accepted as part of life, it should not be left to nature (...) to dictate the way we die, and it is fundamentally unjust to grant people liberal latitude in how they live their lives while granting them little control over the conclusion of their life narratives. Three objections to this position are considered and rejected; the paper also offers an explanation of why we think killing can be a benefit. Ultimately, euthanasia may be necessary in some cases in order to achieve eudaimonia. (shrink)

Belgium has recently extended its euthanasia legislation to minors, making it the first legislation in the world that does not specify any age limit. I consider two strands in the opposition to this legislation. First, I identify five arguments in the public debate to the effect that euthanasia for minors is somehow worse than euthanasia for adults—viz. arguments from weightiness, capability of discernment, pressure, sensitivity and sufficient palliative care—and show that these arguments are wanting. Second, there is (...) another position in the public debate that wishes to keep the current age restriction on the books and have ethics boards exercise discretion in euthanasia decisions for minors. I interpret this position on the background of Velleman’s “Against the Right to Die” and show that, although costs remain substantial, it actually can provide some qualified support against extending euthanasia legislation to minors. (shrink)

Authorising euthanasia and assisted suicide with advance euthanasia directives is permitted, yet debated, in the Netherlands. We focus on a recent controversial case in which a Dutch woman with Alzheimer’s disease was euthanised based on her AED. A Dutch euthanasia review committee found that the physician performing the euthanasia failed to follow due care requirements for euthanasia and assisted suicide. This case is notable because it is the first case to trigger a criminal investigation since (...) the 2002 Dutch euthanasia law was enacted. Thus far, only brief descriptions of the case have been reported in English language journals and media. We provide a detailed description of the case, review the main challenges of preparing and applying AEDs for persons with dementia and briefly assess the adequacy of the current oversight system governing AEDs. (shrink)

Whether the law should permit voluntary euthanasia or physician-assisted suicide is one of the most vital questions facing all modern societies. Internationally, the main obstacle to legalisation has proved to be the objection that, even if they were morally acceptable in certain 'hard cases', voluntary euthanasia and physician-assisted suicide could not be effectively controlled; society would slide down a 'slippery slope' to the killing of patients who did not make a free and informed request, or for whom palliative (...) care would have offered an alternative. How cogent is this objection? This book provides the general reader with a lucid introduction to this central question in the debate, not least by reviewing the Dutch euthanasia experience. It will interest all in any country whether currently for or against legalisation, who wish to ensure that their opinions are better informed. (shrink)

The purpose of this study was to investigate the impact of euthanasia education on the opinions of health sciences students. It was performed among 111 final year students at the College of Health Sciences, Dokuz Eylül University, IRzmir, Turkey. These students train to become paramedical professionals and health technicians. Fifteen hours of educational training concerning ethical values and euthanasia was planned and the students’ opinions about euthanasia were sought before and after the course. Statistical analyses of the (...) data were performed with the related samples t -test by means of the Epi-Info program. Significant changes were shown in the students’ opinions on people’s right to decide about their own life, euthanasia in unconscious patients, and reasons for their objection to euthanasia after completing the course. The results of this study suggest that education can significantly change a person’s approach to euthanasia. (shrink)

The growing support for voluntary active euthanasia is evident in the recently approved Dutch Law on Termination of Life on Request. Indeed, the debate over legalized VAE has increased in European countries, the United States, and many other nations over the last several years. The proponents of VAE argue that when a patient judges that the burdens of living outweigh the benefits, euthanasia can be justified. If some adults suffer to such an extent that VAE is justified, then (...) one may conclude that some children suffer to this extent as well. In an attempt to alleviate the suffering of extremely ill neonates, the University Medical Center Groningen developed a protocol for neonatal euthanasia. In this article, I first present the ethical justifications for VAE and discuss how these arguments relate to euthanizing ill neonates. I then argue that, even if one accepts the justification for VAE in adults, neonatal euthanasia cannot be supported, primarily because physicians and parents can never accurately assess the suffering of children. I argue that without the testament of the patient herself as to the nature and magnitude of her suffering, physicians can never accurately weigh the benefits and burdens of a child’s life, and therefore any such system would condemn to death some children whose suffering is not unbearable. I conclude that because the primary duty of physicians is to never harm their patients, neonatal euthanasia cannot be supported. (shrink)

In a recent article, Henri Wijsbek discusses the 1991 Chabot “psychiatric euthanasia” case in the Netherlands, and argues that Chabot was justified in helping his patient to die. Dutch legislation at the time permitted physician assisted suicide when the patient’s condition is severe, hopeless, and unbearable. The Dutch Supreme Court agreed with Chabot that the patient met these criteria because of her justified depression, even though she was somatically healthy. Wijsbek argues that in this case, the patient’s integrity had (...) been undermined by recent events, and that this is the basis for taking her request seriously; it was unreasonable to expect that she could start again. In this paper, I do not challenge the Dutch euthanasia criteria in the case of somatic illness, but I argue that both Chabot and Wijsbek are wrong because we can never be sufficiently confident in cases of severe exogenous depression to assist the patient in her irreversible act. This is partly because of the essential difference between somatic and mental illness, and because of the possibility of therapy and other help. In addition, I argue that Wijsbek’s concept of integrity cannot do the work that he expects of it. Finally, I consider a 2011 position paper from the Royal Dutch Medical Association on euthanasia, and the implications it might have for Chabot-style cases in the future. (shrink)

Nigeria is developing country where the practice of euthanasia is not legalized. But a look at the socio-economic conditions of Nigeria calls for the need to legalize the practice in this country. This paper examines the features of this country such as poverty, endemic diseases and a low level of investment in healthcare systems . It argues for the need to legalize euthanasia by justifying it as a policy and practice and identifying factors which are to be taken (...) into account. They include poor standard of living which reduces the life span of many and limited health care resources which prevents access to health care. The paper justifies legalizing euthanasia in Nigeria by responding to some arguments against euthanasia raised by critics emphasizing at the same time ethical issues such as autonomy, dignity and quality of life for euthanasia debate. It concludes by stressing that in Nigeria, a competent person who is terminally ill and undergoing severe pain should be able to determine how and when to end his life; the possibility of this will only depend on the legalization of euthanasia in this country. (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)

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

Euthanasia and assisted suicide have proved to be very contentious topics in medical ethics. Some ethicists are particularly concerned that allowing physicians to carry out these procedures will undermine their professional obligations and threaten the very goals of medicine. However, I maintain that the fundamental goals of medicine not only do not preclude the practice of euthanasia and assisted suicide by physicians, but can in fact be seen to support these practices in some instances. I look at two (...) influential views of the goals of medicine, one based on the broad guiding principles of autonomy, beneficence and nonmaleficence, and the other focusing on several more concrete aims, concluding that both approaches can be seen to support euthanasia and assisted suicide. I then turn to the popular concern that allowing physicians to carry out euthanasia and assisted suicide will lead to widespread abuse. I argue that the possibility for abuse can be minimised if we make the patient's autonomous consent an essential requirement of the practice. (shrink)

In 2011, Frank Van Den Bleeken became the first detainee to request euthanasia under Belgium’s Euthanasia Act of 2002. This article investigates whether it would be lawful and morally permissible for a doctor to accede to this request. Though Van Den Bleeken has not been held accountable for the crimes he committed, he has been detained in an ordinary prison, without appropriate psychiatric care, for more than 30 years. It is first established that VDB’s euthanasia request plausibly (...) meets the relevant conditions of the Euthanasia Act and that, consequently, a doctor could lawfully fulfill it. Next, it is argued that autonomy-based reasons for euthanizing VDB outweigh complicity-based reasons against doing so, and that, therefore, it is also morally permissible for a doctor to carry out the euthanasia request. (shrink)

Euthanasia has become the subject of ethical and political debate in many countries including Mexico. Since many physicians are deeply concerned about euthanasia, due to their crucial participation in its decision and implementation, it is important to know the psychological meaning that the term ‘euthanasia’ has for them, as well as their attitudes toward this practice. This study explores psychological meaning and attitudes toward euthanasia in 546 Mexican subjects, either medical students or physicians, who were divided (...) into three groups: a) beginning students, b) advanced students, and c) physicians. We used the semantic networks technique, which analyzed the words the participants associated with the term ‘euthanasia’. Positive psychological meaning, as well as positive attitudes, prevailed among advanced students and physicians when defining euthanasia, whereas both positive and negative psychological meaning together with more ambivalent attitudes toward euthanasia predominated in beginning students. The findings are discussed in the context of a current debate on a bill proposing active euthanasia in Mexico City. (shrink)

The New Orleans catastrophe and the subsequent allegation of homicides at Memorial Medical Center have complicated our thinking about end-of-life care. Can the conditions in a collapsed health care system ever excuse euthanasia? Following a review of current legal and ethical standards for the causation of death in the clinical setting, and an assessment of the most common argument for euthanasia — the argument from intractable suffering — a different argument is set out for the excusability of (...) class='Hi'>euthanasia, one based on forced abandonment. While more familiar in battlefield medicine, this line of reasoning may have applied in post-Katrina New Orleans. When health care professionals are compelled to leave a hazardous clinical setting, and where it is impossible to evacuate patients who are not expected to survive, clinicians must choose between abandoning these patients to die unattended and unmedicated, or euthanizing them before leaving themselves. Because each of these options stands as an egregious violation of an important health care norm, and because there is no third option, neither violation can be rightly condemned. (shrink)

The objective of this paper is to understand from a sociological perspective how the moral question of euthanasia, framed as the “right to die”, emerges and is dealt with in society. It takes France and Germany as case studies, two countries in which euthanasia is prohibited and which have similar legislation on the issue. I presuppose that, and explore how, each society has its own specificities in terms of practical, social and political norms that affect the ways in (...) which they deal with these issues. The paper thus seeks to understand how requests for the “right to die” emerge in each society, through both the debate (analysis of daily newspapers, medical and philosophical literature, legal texts) and the practices (ethnographic work in three French and two German hospitals) that elucidate the phenomenon. It does so, however, without attempting to solve the moral question of euthanasia. In spite of the differences observed between these two countries, the central issue at stake in their respective debates is the question of the individual’s autonomy to choose the conditions in which he or she wishes to die; these conditions depend, amongst others, on the doctor-patient relationship, the organisation of end-of-life care in hospital settings, and more generally, on the way autonomy is defined and handled in the public debate. (shrink)

Blackford, Russell In the United Kingdom, ongoing social and political controversy over voluntary euthanasia, or assisted suicide, has reached a new stage. Labour MP Rob Marris has put forward a private member's bill, to be debated in the House of Commons in September. Thus, the UK now becomes a focus of attention for those of us with an interest in the issue of assisted suicide.

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)

Sadly, there are people in very bad medical conditions who want to die. They are in pain, they are suffering, and they no longer find their quality of life to be at an acceptable level anymore. -/- When people like this are kept alive by machines or other medical treatments, can it be morally permissible to let them die? -/- Advocates of “passive euthanasia” argue that it can be. Their reasons, however, suggest that it can sometimes be not wrong (...) to actively kill some patients, i.e., that “active euthanasia” can be permissible also. This essay reviews these arguments. (shrink)

Argues that considerations central to the justification of euthanizing humans do not readily extrapolate to the euthanasia of pets and companion animals; that the comparative account of death's badness can be successfully applied to such animals to ground the justification of their euthanasia and its timing; and proposes that companion animal guardians have authority to decide to euthanize such animals because of their epistemic standing regarding such animals' welfare.

In this article we discuss the moral and legal aspects of causing the death of a terminal patient in the hope of extending their life in the future. We call this theoretical procedure cryothanasia. We argue that administering cryothanasia is ethically different from administering euthanasia. Consequently, objections to euthanasia should not apply to cryothanasia, and cryothanasia could also be considered a legal option where euthanasia is illegal.

Consensual homicide remains a crime in jurisdictions where active voluntary euthanasia has been legalized. At the same time, both jurisdictions, in which euthanasia is legal and those in which it is not, recognize that all patients (whether severely ill or not) have the right to refuse or withdraw medical treatment (including life-saving treatment). In this paper, I focus on the tensions between these three norms (the permission of active euthanasia, the permission to reject life-saving treatment, and the (...) prohibition of consensual homicide), assuming a justification of euthanasia based on the right to (personal) autonomy. I argue that the best way to provide a coherent account of these norms is to claim that patients have two distinct rights: the right to autonomy and the right to bodily integrity. This solution has some relevant implications for the discussion of the legalization of active euthanasia. (shrink)

Pike, Gregory K Organisations agitating for legal euthanasia often use the term 'dignity'. They have discovered that it is more effective to avoid the words euthanasia or suicide and instead try to get 'dignity' somewhere in their name. Thus we have Dying with Dignity Victoria, Death with Dignity Oregon, and the Dying with Dignity Bill in Tasmania.

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

Euthanasia and assisted suicide have been legally possible in the Netherlands since 2001, provided that statutory due care criteria are met, including: voluntary and well-considered request; unbearable suffering without prospect of improvement; informing the patient; lack of a reasonable alternative; independent second physician’s opinion. ‘Unbearable suffering’ must have a medical basis, either somatic or psychiatric, but there is no requirement of limited life expectancy. All EAS cases must be reported and are scrutinised by regional review committees. The purpose of (...) this study was to investigate whether any particular difficulties arise when the EAS due care criteria are applied to patients with an intellectual disability and/or autism spectrum disorder. The 416 case summaries available on the RTE website were searched for intellectual disability and autism spectrum disorder. Direct content analysis was used on these nine cases. Assessment of decisional capacity was mentioned in eight cases, but few details given; in two cases, there had been uncertainty or disagreement about capacity. Two patients had progressive somatic conditions. For most, suffering was due to an inability to cope with changing circumstances or increasing dependency; in several cases, suffering was described in terms of characteristics of living with an autism spectrum disorder, rather than an acquired medical condition. Some physicians struggled to understand the patient’s perspective. Treatment refusal was a common theme, leading physicians to conclude that EAS was the only remaining option. There was a lack of detail on social circumstances and how patients were informed about their prognosis. Autonomy and decisional capacity are highly complex for patients with intellectual disabilities and difficult to assess; capacity tests in these cases did not appear sufficiently stringent. Assessment of suffering is particularly difficult for patients who have experienced life-long disability. The sometimes brief time frames and limited number of physician-patient meetings may not be sufficient to make a decision as serious as EAS. The Dutch EAS due care criteria are not easily applied to people with intellectual disabilities and/or autism spectrum disorder, and do not appear to act as adequate safeguards. (shrink)

The aim of this study is to assess the knowledge, attitudes and experiences of Spanish nurses in relation to euthanasia and physician-assisted suicide. In an online questionnaire completed by 390 nurses from Andalusia, 59.1% adequately identified a euthanasia situation and 64.1% a situation involving physician-assisted suicide. Around 69% were aware that both practices were illegal in Spain, while 21.4% had received requests for euthanasia and a further 7.8% for assisted suicide. A total of 22.6% believed that cases (...) of euthanasia had occurred in Spain and 11.4% believed the same for assisted suicide. There was greater support (70%) for legalisation of euthanasia than for assisted suicide (65%), combined with a greater predisposition towards carrying out euthanasia (54%), if it were to be legalised, than participating in assisted suicide (47.3%). Nurses in Andalusia should be offered more education about issues pertaining to the end of life, and extensive research into this area should be undertaken. (shrink)

In current Western societies, increasing numbers of people express their desire to choose when to die. Allowing people to choose the moment of their death is an ethical issue that should be embedded in sound clinical and legal frameworks. In the case of persons with dementia, it raises further ethical questions such as: Does the person have the capacity to make the choice? Is the person being coerced? Who should be involved in the decision? Is the person’s suffering untreatable? The (...) use of Advance Euthanasia Directives (AED) is suggested as a way to deal with end-of-life wishes of persons with dementia. However, in the Netherlands—the only country in which this practice is legal—the experiences of patients, doctors, and relatives have been far from satisfactory.Our paper analyses this complex ethical challenge from a Dignity-Enhancing Care approach, starting from the Dutch experiences with AED as a case. We first consider the lived experiences of the different stakeholders, seeking out a dialogical-interpretative understanding of care. We aim to promote human dignity as a normative standard for end-of-life care practices. Three concrete proposals are then presented in which this approach can be operationalised in order to deal respectfully with the end-of-life choices of persons with dementia. (shrink)

The article examines the so-called slippery slope argument (SSA) against the legalization of active voluntary euthanasia (AVE). According to the SSA, by legalizing AVE, the least morally controversial type of euthanasia, we will take the first step onto a slippery slope and inevitably end up in the moral abyss of widespread abuse and violations of the rights of the weakest and most vulnerable patients. In the first part of the paper, empirical evidence to the contrary is presented and (...) analyzed: None of the forecasted regrettable trends can be elicited from the body of existing statistical data. Accordingly, we have no good reason to believe either that we already are, or are sooner or later going to be, sliding into a moral abyss. A related question is then considered: Would it not be wiser and safer to stick to the status quo and preserve the existing legal ban on AVE even if the risk of its abuse is uncertain and may well turn out to be relatively low? It is argued that such an appeal to precautionary reasoning fails to justify an outright legal ban on AVE for at least two reasons: (i) it grossly underestimates the hidden moral costs of current legal arrangements (competent terminal patients suffer both disrespect for their autonomous will and deprivation of the good of a timely death) and (ii) the ban is both too inefficient and disproportionate to qualify as a reasonable measure of precaution. (shrink)

Essays discuss active and passive euthanasia, the right to die, and the care of the terminally ill.

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)

Why do so many doctors have profound misgivings about the push to legalise euthanasia and assisted suicide? Ole Hartling uses his background as a physician, university professor and former president of the Danish Council of Ethics to introduce new elements into what can often be understood as an all too simple debate. Alive to the case that assisted dying can be driven by an unattainable yearning for control, Hartling concentrates on two fundamental questions: whether the answer to suffering is (...) to remove the sufferer, and whether self-determination in dying and death is an illusion. He draws on his own experience as a medical doctor to personalize the ethical arguments, share patients' narratives and make references to medical literature. Here is a sceptical stance towards euthanasia, one that is respectful to those who hold different opinions and well-informed about the details and nuances of different euthanasia practices. Written from a Scandinavian perspective, where respect for autonomy and high quality palliative care go hand in hand, Hartling's is a nuanced, valuable contribution to the arguments that surround a question doctors have faced since the birth of medicine. He shows us how the intentions of doing something good can sometimes lead to even greater dilemmas, opening us up to those situations where an inclination to end suffering by ending life is deeply conflicting both for the clinician and for any fellow human being. (shrink)

Presents arguments on both sides of the issue of euthanasia, including questions regarding ethics and legality, physician-assisted suicide, living wills, and removing life support from patients in a persistent vegetative state.

One of the common domains in health care in which the concept of vulnerability is used is end-of-life care, including euthanasia and assisted suicide (EAS). Since different uses and implications of the notion have been recognised in the literature on EAS, this paper aims to analyse them and reflect on who is the most vulnerable in the context of EAS. A prior exploratory review of the literature has served as a starting point for the discussion. We concluded that vulnerability (...) is a complex, multi-perspective and multi-layered concept, which implies the vulnerability of different stakeholders involved in EAS practices and vulnerability in different aspects of being human (i.e., physical, mental, moral, social and spiritual). A comprehensive understanding of the notion of vulnerability, which balances as well as complements the concept of autonomy, seems to be an indispensable element of the discourse on EAS. (shrink)

Almost a year after the enactment of the law regulating euthanasia in Spain, public opinion was shocked to learn that a defendant in criminal proceedings obtained medical assistance in dying following injuries sustained in an exchange of gunfire with the police after having committed a series of severe crimes. Although there are very few cases in the world where prisoners have received euthanasia, the one we will discuss in this article is the only known case where both the (...) public prosecutor's office and the private prosecutors judicially opposed the defendant's euthanasia. This article aims to offer a new perspective on the ethical legitimacy of detainees' access to euthanasia: the ethics of caring solidarity. To do this, we will first place the case in its legal context. Subsequently, we will address the two main arguments proposed in the literature to justify euthanasia in detention: respect for the autonomy of the detainee and the principle of equivalence of care. Finally, after having identified serious shortcomings in both arguments, we will argue that the perspective of caring solidarity offers a better ethical basis for people in detention's access to euthanasia. (shrink)

I consider four recently suggested difference between killing and letting die as they apply to active and passive euthanasia : taking vs. taking no action; intending vs. not intending the death of the person; the certainty of the result vs. leaving the situation open to other possible alternative events; and dying from unnatural vs. natural causes. The first three fail to constitute clear differences between killing and letting die, and "ex posteriori" cannot constitute morally significant differences. The last constitutes (...) a difference but is not morally significant. (shrink)

This paper introduces a series of papers dealing with the topic of euthanasia as an introduction to a variety of attitudes by health-care professionals and philosophers interested in this issue. The lead in paper—and really the lead in idea—stresses the fact that what we are discussing concerns only a minority of people lucky enough to live in conditions of acceptable sanitation and who have access to medical care. The topic of euthanasia and PAS really has three questions: (1) (...) is killing another ever ethically acceptable; (2) is the participation of health professionals ethically different and (3) is it wiser to permit and set criteria (being fully aware of some dangers that lurk in such a move) or to forbid (knowing that it will occur clandestinely and uncontrolled). This paper takes no definite stand although it is very troubled by useless suffering (not only pain) by many who would wish their life and with it their suffering ended. (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)