This article analyses domestic and foreign reactions to a 2008 report in the British Medical Journal on the complementary and, as argued, synergistic relationship between palliative care and euthanasia in Belgium. The earliest initiators of palliative care in Belgium in the late 1970s held the view that access to proper palliative care was a precondition for euthanasia to be acceptable and that euthanasia and palliative care could, and should, develop together. Advocates of euthanasia including author Jan Bernheim, independent from but (...) together with British expatriates, were among the founders of what was probably the first palliative care service in Europe outside of the United Kingdom. In what has become known as the Belgian model of integral end-of-life care, euthanasia is an available option, also at the end of a palliative care pathway. This approach became the majority view among the wider Belgian public, palliative care workers, other health professionals, and legislators. The legal regulation of euthanasia in 2002 was preceded and followed by a considerable expansion of palliative care services. It is argued that this synergistic development was made possible by public confidence in the health care system and widespread progressive social attitudes that gave rise to a high level of community support for both palliative care and euthanasia. The Belgian model of so-called integral end-of-life care is continuing to evolve, with constant scrutiny of practice and improvements to procedures. It still exhibits several imperfections, for which some solutions are being developed. This article analyses this model by way of answers to a series of questions posed by Journal of Bioethical Inquiry consulting editor Michael Ashby to the Belgian authors. (shrink)

The term futility has been widely used in medical ethics and clinical medicine for more than twenty years now. At first glance it appears to offer a clear-cut categorical characterisation of medical treatments at the end of life, and an apparently objective way of making decisions that are seen to be emotionally painful for those close to the patient, and ethically, and also potentially legally hazardous for clinicians. It also appears to deal with causation, because omission of a futile treatment (...) cannot surely be a cause of death. The problem is that futility can be argued to be a false friend , in that it gives an appearance of representing a reliable conceptual basis, in ethics, for limitation of medical treatment—usually in the context of dying—without actually doing so. In fact, the concept of futility is a conflation of clinical judgement about outcomes of treatment and the quality or even value of life, and has really failed to contribute much to the advancement of decision-making and hence care at the end-of-life. It also has the capacity to medicalise the personal space. Deliberations about the likely outcomes of medical treatment are necessary, and medical expertise is pivotal. However, futility is argued to have a better future in partnership with a broad social action agenda about the process of dying, such as that articulated in health promoting palliative care, as a basis for better death-ways in the 21st century (Kellehear 2005). Medicine needs to more honest and upfront about its limits, as death is, after all, the elephant in everybody's room. (shrink)

With some exceptions, it appears that the non-incarcerated world spends little time, if any at all, thinking about how prisoners are treated, whether during detainment or incarceration, after release, or when being put to state-sanctioned death. Of course, in part this is understandable, as the processes of punishment for breaking the social contract have moved from being public spectacle (once serving as a display of the sovereign’s power and as simultaneous warning and entertainment for lookers-on) to a private and “strange (...) scientifico-juridical complex” (Foucault 1995, 19) with the veneer of “modernity” and “civility,” theoretically drawing a clear line between the horrors of the crimes committed and those of the punishment (Sarat 2014). But even in the 21st century, the distinction is fuzzy at best. Incarcerated populations around the globe continue to be at greater risk of infectious diseases than non-incarcerated persons in the same communities (see da Cruz and Rich 2014), prison .. (shrink)

Discussing Difference and Dealing With Desolation and Despair Content Type Journal Article Category Editorial Pages 315-317 DOI 10.1007/s11673-011-9331-1 Authors Michael A. Ashby, Palliative Care and Persistent Pain Services, Royal Hobart, Hospital, Southern Tasmania Area Health Service, and School of Medicine, Faculty of Health Sciences, University of Tasmania, 1st Floor, Peacock Building, Repatriation Centre, 90 Davey Street, Hobart, TAS 7000 Australia Leigh E. Rich, Department of Health Sciences (Public Health), Armstrong Atlantic State University, 11935 Abercorn Street, Savannah, GA 31419, USA Journal (...) Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529 Journal Volume Volume 8 Journal Issue Volume 8, Number 4. (shrink)

Rethinking the Body and Its Boundaries Content Type Journal Article Category Editorial Pages 1-6 DOI 10.1007/s11673-011-9353-8 Authors Leigh E. Rich, Department of Health Sciences (Public Health), Armstrong Atlantic State University, 11935 Abercorn Street, Savannah, GA 31419, USA Michael A. Ashby, Palliative Care and Persistent Pain Services, Royal Hobart, Hospital, Southern Tasmania Area Health Service, and School of Medicine, Faculty of Health Sciences, University of Tasmania, 1st Floor, Peacock Building, Repatriation Centre, 90 Davey Street, Hobart, TAS 7000 Australia Pierre-Olivier Méthot, ESRC (...) Centre for Genomics in Society (Egenis), University of Exeter, Byrne House, St German’s Road, Exeter, EX4 4PJ UK Journal Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529 Journal Volume Volume 9 Journal Issue Volume 9, Number 1. (shrink)

[V]isibility is central to the shaping of political, medical, and socioeconomic decisions. Who will be treated—how and where—are the central questions whose answers are often entwined with issues of visibility … [and] the effects that media visibility has on the perception of particular bodies .In a documentary entitled Paris: The Luminous Years , writer Janet Flanner describes the intense friendship of Pablo Picasso and Georges Braque. Both were inspired by Paul Cézanne and his retrospective at the 1907 Salon d’Automne—which, according (...) to Paris: The Luminous Years, marked in Janus-like fashion the end of the 19th and the beginning of the 20th centuries in art. Flanner tells of the frequent visits between the two painters, where they “talked and talked … two or three months that they just spent gabbling, gabbling.” And from their camaraderie and gabble emerged someth .. (shrink)

A Tip of the Hat to Our Peer Reviewers Content Type Journal Article Category Editorial Pages 319-322 DOI 10.1007/s11673-011-9328-9 Authors Michael A. Ashby, Palliative Care and Persistent Pain Services, Royal Hobart Hospital, Southern Tasmania Area Health Service and School of Medicine, Faculty of Health Sciences, University of Tasmania, 1st Floor, Peacock Building, Repatriation Centre, 90 Davey St, Hobart, TAS 7000, Australia Leigh E. Rich, Department of Health Sciences (Public Health), Armstrong Atlantic State University, 11935 Abercorn Street, Savannah, GA 31419, USA (...) Journal Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529 Journal Volume Volume 8 Journal Issue Volume 8, Number 4. (shrink)