Search

In 2016, a Dutch physician complied with the advance euthanasia directive of a patient with severe dementia. In the ensuing lawsuit, the physician was charged principally with termination of life on request, with euthanasia, that is, and alternatively with murder. A district court acquitted her of both charges, a decision later upheld by the Dutch Supreme Court. Euthanasia is still a criminal offense in the Netherlands, but in 2002, a new euthanasia act came into effect allowing a physician to perform euthanasia if she has fulfilled six due‐care criteria, the two most important of which are that she must be satisfied that the patient's request is voluntary and well considered and that the patient's suffering is unbearable, with no prospect of improvement. Neither of these two criteria is controversial; particular cases are controversial when it is disputed that these criteria were fulfilled. Other euthanasia cases, however, are controversial because they belong to a category that is contentious for independent reasons. One such disputed category is euthanasia performed on incompetent patients with an advance directive. Since determining whether these criteria are fulfilled in a particular case depends on the particular circumstances, we describe this 2016 case in detail. We then focus on three general philosophical reasons for doubting the validity of advance euthanasia directives for incompetent patients: the someone else problem, the problem of response shift, and the problem of normative authority. These problems have been discussed before, but our primary aim is to show how they are connected. Taken together, we believe that our two lines of argument make a strong moral case for supporting the Dutch Supreme Court's decision. [ABSTRACT FROM AUTHOR]

Many people are afraid they will, as they age or fall ill, become burdens to others. Some who fear this say they would be willing to hasten their own deaths—engaging in self‐sacrifice through suicide, assisted suicide, or euthanasia—to avoid it. Still, some bioethicists and other critics of medical aid in dying reject the idea that fear of being a burden can be a good reason for self‐sacrifice. They argue that dependency is nearly universal, emphasize that caregiving is a valuable pursuit, and raise concerns about the impact of aid‐in‐dying policies on vulnerable groups. After defining what it is to be a burden, articulating why being a burden is morally significant, and, crucially, distinguishing burdensomeness from what I call "mere dependency," I defend the intuition that self‐sacrifice can be justified by the desire to avoid being a burden and by the concern for the well‐being of one's caregivers that this choice implies. [ABSTRACT FROM AUTHOR]

If you developed Alzheimer disease, would you want to go all the way to the end of what might be a decade‐long course? Some would; some wouldn't. Options open to those who choose to die sooner are often inadequate. Do‐not‐resuscitate orders and advance directives depend on others' cooperation. Preemptive suicide may mean giving up years of life one would count as good. Do‐it‐yourself methods can fail. What we now ask of family and clinicians caring for persons with dementia, and of patients given no better option than to go on with lives they may not want, is unacceptable. To explore how one might better control one's own dying and avoid burdening others with overwhelming care and morally painful choices, we propose a thought experiment: an advance directive implant that would enable persons with early dementia, while competent, to arrange their own deaths without the subsequent intervention of anyone else. [ABSTRACT FROM AUTHOR]

Many critics of the legalization of physician‐assisted death oppose it in part because they fear it will further disadvantage those who are already economically disadvantaged. This argument points to a serious problem of how economic considerations can influence medical decisions, but in the context of PAD, the concern is not borne out. We will provide empirical evidence suggesting that concerns about money influence medical decisions throughout the full course of illness, but at the end of life, financial pressure is much more likely to influence a decision to pursue or reject aggressive life‐extending care than it is to influence a request for PAD. We will also address the question of whether financial pressure as a result of being poor—particularly in the context of an inadequate social safety net—robs people of their autonomy, rendering their informed request and consent invalid. We argue that it does not. We will emphasize the impracticality and injustice of rejecting the role of poverty as a legitimate factor in decision‐making, the irrational distinction between PAD and withdrawal of life‐sustaining care, and the more appropriate focus on the great flaws in the American health care system. [ABSTRACT FROM AUTHOR]

The authors respond to a letter by Tim Holland in the January‐February 2023 issue of the Hastings Center Report concerning their article "On the Authority of Advance Euthanasia Directives for People with Severe Dementia: Reflections on a Dutch Case.". [ABSTRACT FROM AUTHOR]

Many people are afraid they will, as they age or fall ill, become burdens to others. Some who fear this say they would be willing to hasten their own deaths-engaging in self-sacrifice through suicide, assisted suicide, or euthanasia-to avoid it. Still, some bioethicists and other critics of medical aid in dying reject the idea that fear of being a burden can be a good reason for self-sacrifice. They argue that dependency is nearly universal, emphasize that caregiving is a valuable pursuit, and raise concerns about the impact of aid-in-dying policies on vulnerable groups. After defining what it is to be a burden, articulating why being a burden is morally significant, and, crucially, distinguishing burdensomeness from what I call "mere dependency," I defend the intuition that self-sacrifice can be justified by the desire to avoid being a burden and by the concern for the well-being of one's caregivers that this choice implies., (© 2022 The Hastings Center.)

A personal narrative is presented which explores the author's experience of dealing with the issue on physician-assisted suicide and euthanasia during the period before her father's death.

A letter to the editor is presented in response to the article "Ending the Life of a Newborn: The Groningen Protocol," by Hilde Lindemann and Marian Verkerk in the January-February 2008 issue of the magazine.

An essay is presented on euthanasia. It describes the autobiographical "Apologie" by French surgeon Ambroise Paré, wherein he recalled how in 1536, he witnessed a case of mercy killing. It explains the important implications of Paré's story. Based on the article, physicians Carl Georg Theodor Kortum and Christian Ludwig Mursinna publicly endorsed active euthanasia on terminally ill patients.

The article explains why the Groningen Protocol guide on decision making in euthanasia in newborns under Dutch law and medical practice should be rejected as the basis for obstetric and neonatal practice in the Netherlands and throughout the world. It says that the contemporary clinical fact that high-quality obstetric ultrasound examination can detect spina bifida via fetal spine examination is ignored by the protocol.

One of the most potent arguments against physician‐assisted death hinges on the worry that people with disabilities will be subtly coerced to accept death prematurely. The argument is flawed. There is nothing new in PAD: the risk of coercion is already present in current policies about end of life care. And to hold that any such risk is too much is tacitly to endorse vitalism and to deny that people with disabilities are capable of choosing authentically. [ABSTRACT FROM AUTHOR]

Discusses the ways gender roles and social circumstances affect the patients' request for euthanasia. Views of feminist Susan Wolf; Implication of physicians' acceptance of voluntary active euthanasia and physician-assisted suicide; Comparison of women with men with regards to death requests; Historical background of the social rejection of women's knowledge.

Talks about the controversy over the distinction between passive and active euthanasia. Intervention and `natural' death; `Natural' states as morally neutral; Special treatment for the `artificial'; Problem with the connection between passive euthanasia and machines; Serious effects of the rhetoric of the natural.

Focuses on the justification of euthanasia or assisted suicide. Rejection of euthanasia initiative in Washington and California; Marketing technique to promote the normalization of assisted suicide and euthanasia; `Death on Request' film on Dutch television; Proving the value of assisted suicide to American audience; Empowerment in assisted suicide.

Examines the views held on euthanasia and assisted suicide in Germany, the Netherlands and the United States, emphasizing their similarities and differences. Differences in law, health care systems and other social factors; Reasons for differing attitudes toward euthanasia and assisted suicide; Character of German medicine; Suicide and euthanasia under German law; German Society for Humane Dying; Language and cultural acceptance of suicide; From language to practice; More.

Discusses the present state of the debate in the Netherlands, first through an analysis of research into the practice of euthanasia and then through a moral evaluation of its political and legal implications. Research into the practice of euthanasia; Results of the study; Interpretation of the data; Discussion of the Committee's conclusions; Response of the Cabinet; Final comments.

Reports on the observations made by American visitors during and after the Maastricht meeting where Dutch hosts opened a window on their society and invited a look at euthanasia practices in the Netherlands. Cultural specificity of Dutch practices still applicable to U.S. proposals to legalize `physician aid-in-dying'; Clarity about the subject; Force majeure and physician freedom; Analogy with respect to autonomy; Importing the Dutch model; More.

Examines the current Dutch definition of euthanasia, which is the active termination of a patient's life at his or her request, by a physician. Three important conditions recognized by the courts and endorsed by the State Commission on Euthanasia; Public debate and private decisions; Institutional considerations; Euthanasia and the law; Religious perspectives; Critical discourse, constructive criticism; List of conference participants; Details.

An increasing number of jurisdictions allow individuals to obtain medication prescribed by their physicians for medical assistance in dying (MAID). But discussion of whether (and to what extent) individuals have the right to use the health care system to control the time and manner of their death is not limited to MAID. The right also exists in other contexts, such as directing the withdrawal of life‐sustaining treatments. Palliative (or terminal) sedation involves medications to render a patient unconscious, coupled with either the withdrawal of artificial nutrition and hydration or their not being administered at all. In high‐enough doses, these medications may further suppress already‐weakened cardiopulmonary function even if there is no intent to hasten death. When teaching about these topics, I challenge students to consider whether there are meaningful differences between practices like euthanasia, MAID, aggressive use of morphine, terminal sedation, or the withdrawal of ventilator support. Whether their differences are morally, ethically, or legally meaningful can be difficult to tease out. After recently watching a loved one, whom I call "Stephan," direct the time and manner of his death within hospice care in a state that does not allow MAID, I am less inclined than ever to believe that the differences are meaningful in a way the law should recognize. [ABSTRACT FROM AUTHOR]

This article discusses advocacy for physician-assisted suicide. There is currently debates over this issue with a ballot initiative in Washington. Advocates for physician-assisted suicide have been using a method, called obfuscation. This is an effort to render something unclear, evasive or confusing. They have used organized obfuscation as a political tactic. The proposed legislation in Washington is entitled, Death with Dignity. The implication of this phrase is that physician-assisted suicide is the only route to a death with dignity.

Presents a hypothetical case study in which the medical team of a patient needing a feeding tube, at the request of the patient's husband, allows the patient to go unfed. Question of what can be done when the views of primary care providers differ from those of the patient's family and of the staff distant from the case; Commentary; More.

Twenty years ago, the passage of the Oregon Death with Dignity Act prompted vigorous debate in my bioethics classrooms; now, the issue barely generates a ripple. Instead, we focus on an issue my students' generation will confront, as illustrated by an amendment to the ODDA introduced in the last Oregon legislative session that would have effectively rescinded two core procedural safeguards: patient decision‐making capacity when requesting life‐ending medication and self‐administration of the medication. Patient requests for medication could be stipulated on an advance directive that appoints an "expressly identified agent" authorized, in the event of loss of decision‐making capacity, "to collect and to administer to the patient the prescribed medication." The amendment heralds a shift from physician‐assisted death to medical aid in dying and from prescriptions ingested by patients to life‐ending medication administered by a physician or even by the patient's "agent." This prospect generates a bit more angst amongst my students, but their acculturation in the ethics of individual choice prevails. Our discussion about the ethics of medical aid in dying inescapably turns to a deeper issue: is there a professional ethos independent of autonomy? [ABSTRACT FROM AUTHOR]

The November‐December 2018 issue of the Hastings Center Report celebrates two anniversaries. In a supplement to the issue, the fifty‐year‐old debate about what "dead" means—a debate launched in 1968 by the publication of the Harvard report on brain death—is dissected and reinvigorated in a set of essays assembled by Robert Truog, of Harvard Medical School's Center for Bioethics, and The Hastings Center's Nancy Berlinger, Rachel Zacharias, and Mildred Solomon. Inside the regular issue, a set of essays celebrates the two‐hundredth anniversary of the publication of Frankenstein; or, The Modern Prometheus, the novel about death, dissection, and reinvigoration and a touchstone for much commentary about emerging biotechnologies. Elsewhere in the issue are contrasting perspectives on physician‐assisted death, and in the lead article, Danielle Wenner explores the requirement, often noted but recently challenged, that medical research must have "social value" to be worth conducting. [ABSTRACT FROM AUTHOR]

A personal narrative is presented which explores the author's experience of making end-of-life decision for her mother who is suffering from an end-stage Alzheimer's disease.

Presents several views related to research ethics, including an argument on physician-assisted euthanasia.

Discusses issues concerning gender differences in euthanasia and genes patents.

Discusses issues related to bioethics from around the world. Reason people seek alternative care; Details on the report on alternatives for legally regulating euthanasia submitted by the Belgian Advisory Committee on Bioethics in 1997; Supporters of the 1997 recommendation of the Belgian Advisory Committee on the regulation of euthanasia.

Presents information on xenotransplantation and euthanasia. Success of the tests on artificial kidney lined with kidney filtration cells from pigs; Feasibility of using pig cells for human kidneys; Euthanasia in Netherlands; Cases of euthanasia and the process of handling such cases.

Focuses on the disputes on approving the practice of euthanasia in Belgium. Options on the issue recommended by the deliberations committee; Legal basis of the practice.

Comments on the issue of euthanasia in the United States. Explanation of what it means to die with dignity; Disadvantages of making people think that euthanasia as the only means of dying with dignity.

Discusses the pros and cons of Proposition 161, a ballot measure permitting physicians to perform active euthanasia. Defeat in Californian state on November 1991; Medical, moral implications of loss; Risks for minorities; Life-control systems and care for dying patients.

Comments on the bioethics debate on euthanasia in the U.S. Difference in euthanasia practices in the Netherlands and the U.S.; Evidence of the preference of medical professionals for the legalization of infanticide; Implication of the silence of bioethicists on misinformation on the public discussion of euthanasia.

Editorial. Focuses on an argument of the important ethnical difference between physician-assisted suicide and euthanasia. Views from supporters of assisted suicide; What Stan van Hooft suggest of suffering; Examination of growing tensions by Dorothy Nelkin and Lori Andrews.

Reports that Australia has become the first jurisdiction in the world to make euthanasia legal in May 1995, when it passed the Rights of the Terminally Ill Act. Australian Medical Association's stand on the issue; Public opinion in Australia.

Informs that a Dutch television documentary explores the topic of euthanasia and includes the actual death of a patient who requested assistance in dying from his general practitioner and invited the camera crew to be present. Report in the `British Medical Journal.'

Reports on the debate on legalized physician assisted suicide in Oregon. Role of the organization, Oregon Right to Die; Requirements for aid in dying measures; Procedural safeguards.

Traces the European debate on euthanasia. Rome 120 A.D.; The German Reischtag debate; Second World War; First attempt in Britain to legalize euthanasia; The Dr.Cox case; The Tony Bland case; The British Medical Association's statement on living wills; The Danish Medical Association on living wills; Progress of a euthanasia bill in Holland; Vatican reaction to codification of voluntary euthanasia.

Reports that, according to the Morgan poll conducted in March 1992, some 76 percent of 1,452 members of the Australian general public would support allowing physicians to give lethal doses of medication on request to `hopelessly ill' patients `in great pain.' 1987 survy of Victoria, Australia, physicians by Helga Kuhse and Peter Singer; Details.