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The controversy over the equivalence of continuous sedation until death (CSD) and physician-assisted suicide/euthanasia (PAS/E) provides an opportunity to focus on a significant extended use of CSD. This extension, suggested by the equivalence of PAS/E and CSD, is designed to promote additional patient autonomy at the end-of-life. Samuel LiPuma, in his article, "Continuous Sedation Until Death as Physician-Assisted Suicide/Euthanasia: A Conceptual Analysis" claims equivalence between CSD and death; his paper is seminal in the equivalency debate. Critics contend that sedation follows proportionality protocols for which LiPuma's thesis does not adequately account. Furthermore, sedation may not eliminate consciousness, and as such LiPuma's contention that CSD is equivalent to neocortical death is suspect. We not only defend the equivalence thesis, but also expand it to include additional moral considerations. First, we explain the equivalence thesis. This is followed by a defense of the thesis against five criticisms. The third section critiques the current use of CSD. Finally, we offer two proposals that, if adopted, would broaden the use of PAS/E and CSD and thereby expand options at the end-of-life. [ABSTRACT FROM AUTHOR]

When two Christian prelates as internationally prominent as Desmond Tutu and George Carey call for the legalization of euthanasia and physician-assisted suicide, their arguments merit close consideration. This article sets out and evaluates their arguments. It concludes that the prelates rehearse the superficial case regularly advanced by euthanasia campaigners and fail adequately to engage with the arguments, both principled and practical, against legalization. [ABSTRACT FROM AUTHOR]

One major argument against prohibiting euthanasia and physician-assisted suicide (PAS) is that there is no rational basis for distinguishing between killing and allowing to die: if we permit patients to die by forgoing life-sustaining treatments, then we also ought to permit euthanasia and PAS. In this paper, the author argues, contra this claim, that it is in fact coherent to differentiate between killing and allowing to die. To develop this argument, the author provides an analysis of Saint Augustine's distinction between martyrdom and suicide, highlighting the relevance of intention in the assessment of an agent's actions. As a general matter of ethics, the intentions of agents, not just the outcomes of their actions, matter enormously for drawing distinctions between what is permissible and what is impermissible. Constructing an Augustinian account of this distinction between killing and allowing to die, the author argues that it is coherent to hold that assisted suicide is wrong, while also accepting that it is permissible to withhold or withdraw life-sustaining treatments. [ABSTRACT FROM AUTHOR]

Euthanasia and rational suicide were acceptable practices in some quarters in antiquity. These practices all but disappeared as Hippocratic, Jewish, Christian, and Muslim beliefs took hold in Europe and the Near East. By the late nineteenth century, however, a political movement to legalize euthanasia and physician-assisted suicide (PAS) began in Europe and the United States. Initially, the path to legalization was filled with obstacles, especially in the United States. In the last few decades, however, several Western nations have legalized euthanasia, and several US jurisdictions have now legalized PAS, giving state sanction to these once forbidden practices. With increasing social and political pressure to accept PAS, Christians need to understand how to think about this issue from an explicitly Christian perspective. Independent of the question of legalization, there are significant theological and ethical questions. This special issue aims to address those concerns, including: how does the practice of PAS or euthanasia impact our attitudes toward death, and what does it mean to "die well?" Should physicians, as healers, be involved in assisting patients who wish to bring about their own death? Are these methods significantly distinguished from other ethically justified practices in end-of-life care that also lead to a person's death? Can Christians, both as patients and practitioners, justify the use of these methods to relieve suffering in this manner as compatible with the faith? Although these questions are not new to the debate, it is increasingly important that these controversies are addressed as the practice of PAS is popularized. [ABSTRACT FROM AUTHOR]

In 2002, the Belgian Act on euthanasia came into effect, regulating the intentional ending of life by a physician at the patient's explicit request. Subsequently, the number of reported euthanasia deaths increased every year. Specifically, the proportion of euthanasia deaths in older persons has risen significantly in the last few years. Since the conception of the Euthanasia Act, Belgian physicians have been confronted with challenges concerning euthanasia requests in older persons with polypathology, tiredness of life or dementia. By exploring these issues, this commentary highlights the importance of a meticulous and team-based assessment of the (i) seriousness of the underlying condition, (ii) voluntariness of the request and (iii) decisional capacity of the older person requesting euthanasia. [ABSTRACT FROM AUTHOR]

Background: Euthanasia and assisted suicide laws in the Netherlands require physicians meet clinical guidelines when performing the practice to ensure death is peaceful and painless. Despite oversight by the regional review committees over each case, little research exists into the frequency of guideline deviation and the reasons for nonadherence.Methods: Cases reported and reviewed between 2012 and 2017 that did not meet due medical care were analysed for thematic content. Semistructured interviews were conducted with 11 Dutch physicians on their experience with the clinical and pharmacological elements of euthanasia and assisted suicide, their interaction and comportment with the recommended guidelines, and reasons why guideline deviation might occur. Reported case reviews and interviews were used to obtain themes and subthemes to understand how and why deviations from clinical guidelines happened.Results: Violations of due medical care were found in 42 (0.07%) of reported cases. The regional review committees found physicians in violation of due medical care mostly for inadequate confirmation of coma-induction and deviations from recommended drug dosages. Physicians reported that they rarely deviated from the guidelines, with the most common reasons being concern for the patient's family, concern over the drug efficacy, mistrust in the provided guidelines, or relying on the poor advice of pharmacists or hospital administrators.Conclusions: Deviations from the guidelines and violations of due medical care are rare, but should nonetheless be monitored and prevented. A few areas for improvement include skills training for physicians, consistency between review committee rulings, and further clarity on dosage recommendations. [ABSTRACT FROM AUTHOR]

Edmund Pellegrino and David Thomasma's writings have had a worldwide impact on discourse about the philosophy of medicine, professionalism, bioethics, healthcare ethics, and patients' rights. Given their works' importance, it is surprising that commentators have ignored their admission of an unresolved and troubling dilemma and inconsistency in their theory. The purpose of this article is to identify and state what problems worried them and to consider possible solutions. It is argued that their dilemma stems from their concerns about how to justify professional rules restricting colleagues from performing acts they view as direct, active, and formal (intentional) killings, such as physician-assisted suicide, mercy killing, and abortion. It is further argued that their inconsistency is that they both assert and deny that professional colleagues should not use their moral or theological values to impose professional restrictions on other colleagues without adequate philosophical grounds. At risk are their arguments about the nature of an internal morality for medicine, a secular and multicultural basis for medical ethics, and a nonarbitrary way to determine what acts fall outside the ends of medicine. These are arguments they claim also apply to other healthcare professions. The article begins with a brief overview of their key positions to provide the context in which they make their admission. [ABSTRACT FROM AUTHOR]

Christianity's opposition to euthanasia and assisted suicide is grounded in its recognition of such actions as serious violations of the prohibition against murder and self-murder, even in cases where those individuals consent or otherwise signal their willingness to die as in cases of voluntary euthanasia. Fully to appreciate the implications of assimilating assisted death into medical practice, one must recognize the spiritual significance of killing on the physicians who euthanize patients or who aid and abet patients in killing themselves. One will also need to appreciate the spiritual importance of such actions on the patients killed. Physician-assisted suicide and voluntary euthanasia are not neutral actions. Moreover, that the patient desired or requested the killing does not change the moral character of the act or its spiritual significance. This issue of Christian Bioethics explores the implications for medicine and society as physician-assisted suicide and voluntary euthanasia are assimilated into contemporary healthcare practice. [ABSTRACT FROM AUTHOR]

According to the Standard View, a doctor who withdraws life-sustaining treatment does not kill the patient but rather allows the patient to die-an important distinction, according to some. I argue that killing (and causing death) can be understood in either of two ways, and given the relevant understanding, the Standard View is insulated from typical criticisms. I conclude by noting several problems for the Standard View that remain to be fully addressed. [ABSTRACT FROM AUTHOR]

Background: In the Netherlands, euthanasia or assisted suicide (EAS) is neither a right of the patient nor a duty of the physician. Beside the legal requirements, physicians can weigh their own considerations when they decide on a request for EAS.Objective: We aim at a better understanding of the considerations that play a role when physicians decide on a request for EAS.Methods: This was a qualitative study. We analysed 33 interviews held with general practitioners (GPs) from various regions in the Netherlands.Results: The considerations found can be divided in three main types. (i) Perceived legal criteria, (ii) individual interpretations of the legal criteria and (iii) considerations unrelated to the legal criteria. Considerations of this 3rd type have not been mentioned so far in the literature and the debate on EAS. Examples are: the family should agree to EAS, the patient's attitude must reflect resignation, or conflicts must be resolved.Conclusions: Our study feeds the ethical discussion on the tension that can arise between a physician's own views on death and dying, and the views and preferences of his patients. When considerations like 'no unresolved conflicts' or 'enough resignation' influence the decision to grant a request for EAS this poses questions from an ethical and professional point of view. We hypothesise that these considerations reflect GPs' views on what 'good dying' entails and we advocate further research on this topic. [ABSTRACT FROM AUTHOR]

Purpose of the Study: This study aims to contribute an alternative understanding of the position of older people in the euthanasia and assisted suicide (EU/AS) debate. Design and Methods: Seven interviews were analyzed using Foucauldian discourse analysis, to explore concepts like knowledge, power, subjectifkation and surveillance. Results: The participants presented a "confused and conflicted" discourse, expressing the view that EU/AS is a family affair, whilst also articulating a strong sense of self-determination. Although a discourse of the medicalization of dying through medical control and surveillance was endorsed, an alternative discourse of "dying outside the medical gaze" emerged. Participants, who were in favor of EU/AS, felt "voiceless," as apparent double standards were applied in the debate, and powerful others, for example, physicians and politicians, seemed reluctant to engage. Within an "aged death" discourse, the anticipated dependency on poor care from (professional) others, made participants consider EU/AS as ways of avoiding this stage of life and the associated loss of dignity. Implications: By using Foucauldian discourse analysis, alternative power relationships were revealed which might give a different interpretation to the concept of the "slippery slope." Societal discourses and related behaviors, which devalue the dependent and old, might become internalized by older people, leading them to consider EU/AS as preferable end-of-life options. [ABSTRACT FROM AUTHOR]

Patients who are imminently dying sometimes experience symptoms refractory to traditional palliative interventions, and in rare cases, continuous sedation is offered. Samuel H. LiPuma, in a recent article in this Journal, argues that continuous sedation until death is equivalent to physician-assisted suicide/euthanasia based on a higher brain neocortical definition of death. We con- test his position that continuous sedation involves killing and offer four objections to the equivalency thesis. First, sedation practices are proportional in a way that physician-assisted suicide/euthanasia is not. Second, continuous sedation may not entirely abolish consciousness. Third, LiPuma's particular version of higher brain neocortical death relies on an implausibly weak construal of irreversibility--a position that is especially problematic in the case of continuous sedation. Finally, we explain why continuous sedation until death is not functionally equivalent to neocortical death and, hence, physician-assisted suicide/euthanasia. Concluding remarks review the differences between these two end-of-life practices. [ABSTRACT FROM AUTHOR]

Objective This review wished to determine the reported prevalence of suffering in various patient diagnostic groups and examine the evidence for the association of pain and suffering. Design/Setting Twenty-four studies fulfilled inclusion-exclusion criteria. They were divided into the following groups: advanced cancer/terminal illness/hospice patients (AC/TI/H) (7 studies); hastened death/assisted suicide/euthanasia patients (HD/AS/E) (14 studies); noncancer (NC) patients (3 studies). No chronic nonmalignant pain (CNMP) suffering studies fulfilled inclusion-exclusion criteria of this review. The reported prevalence of suffering for each study was abstracted and the overall percentage of sufferers in each grouping calculated. For those studies that provided a statistical relationship between pain and suffering information was abstracted for whether these studies supported/did not support the association of pain and suffering. A vote counting method was utilized to determine the overall percentage of studies supporting/not supporting this association. The consistency of this data for supporting this association was then rated by Agency for Health Care Research and Quality guidelines. Results The prevalence of suffering in each grouping was as follows: AC/IT/H 45.7%; HD/AS/E 81.9%; NC 19.2%; and all groupings combined 59.9%. AC/TI/H and all groupings combined received an A rating (consistent evidence multiple studies for a statistical relationship between suffering and pain). HD/AS/E received a C (evidence which is inconsistent). For NC there were not enough studies for a consistency rating. Conclusions The above results indicate a consistent association between suffering and pain in some patient groups. Studies addressing suffering are needed in CNPM patients. [ABSTRACT FROM AUTHOR]

This commentary discusses the decision in R (Nicklinson) v Ministry of Justice;1 it will argue that the court should have allowed the use of the defence of necessity. It argues that the official response of the law should be to outlaw euthanasia or assisted suicide, but also to recognise that in exceptional circumstances these should be permitted. The use of the defence of necessity permits this nuanced response to the issue. The commentary also argues that the treatment of suicidal and elderly people is a far more important issue than creating the correct legal response to assisted dying. [ABSTRACT FROM AUTHOR]

The article focuses on assisted dying and examines the possibilities of bringing changes in the area of assisted dying through common law defenses. It analyzes the features of defences of necessity, a defense asserted by a civil defendant that he/she had no choice but to break the law, and consent of patients and reflects the changes that should be made to adapt them to assisted dying.

A distinction is commonly drawn between continuous sedation until death and physician-assisted suicide/euthanasia. Only the latter is found to involve killing, whereas the former eludes such characterization. I argue that continuous sedation until death is equivalent to physician-assisted suicide/euthanasia in that both involve killing. This is established by first defining and clarifying palliative sedation therapies in general and continuous sedation until death in particular. A case study analysis and a look at current practices are provided. This is followed by a defense of arguments in favor of definitions of death centering on higher brain (neocortical) functioning rather than on whole brain or cardiopulmonary functioning. It is then shown that continuous sedation until death simulates higher brain definitions of death by eliminating consciousness. Appeals to reversibility and double effect fail to establish any distinguishing characteristics between the simulation of death that occurs in continuous sedation until death and the death that occurs as a result of physician-assisted suicide/euthanasia. Concluding remarks clarify the moral ramifications of these findings. [ABSTRACT FROM AUTHOR]

Background. In the Netherlands, many (45%) cancer patients die at home, in the care of GPs. About 1 out of 10 end-of-life cancer deaths is hastened by GPs through euthanasia or physician-assisted suicide. However, the relationship between depression and requests for euthanasia has never been prospectively studied directly in primary care.Objective. This study aimed to assess the prevalence of depression in end-of-life cancer patients requesting euthanasia in primary care, as well as to assess the relationship between depression and requesting euthanasia.Methods. Primary care patients with incurable cancer and an estimated life expectancy of half a year or shorter were interviewed every 2 months, using standardized psychometric instruments. Also, non-recruited eligible patients were monitored.Results. Out of 258 eligible patients, 76 patients were recruited, of whom 64 patients were followed up until death. Of these, 27% (n = 17) explicitly requested euthanasia. One patient suffered from major depression. According to the depression subscale of the Hospital Anxiety and Depression Scale, 47% of the patients who explicitly requested euthanasia versus 28% of those without an euthanasia request suffered from a depressed mood at inclusion; the difference was not significant (P = 0.2). Corresponding figures for the last interview before death were 40% and 41% (P = 0.6).Conclusions. Major depression was not a major factor in explicit requests for euthanasia in end-of-life cancer patients in primary care. Further depressed mood was not associated with explicitly requesting euthanasia in this patient group, although statistical underpower cannot be ruled out in this small sample. [ABSTRACT FROM AUTHOR]

The debate over euthanasia and physician-assisted suicide (EPAS) continues to ignore the philosophical anthropology on which certain critical claims rest. In this paper, I offer several anthropologically based arguments against one prominent justification for EPAS: the Argument from the Evil of Suffering. I demonstrate that the argument is, at its core, a utilitarian one, and that a sound rebuttal can be found by examining Karol Wojtyla/Pope John Paul II's view of suffering as a transformative experience for the human person. Wojtyla both rejects the secular bioethics vision of meaningless, quantifiable suffering, but also offers to take Christian bioethics far beyond the story of Job and into the realm of phenomenological change. By focusing on participation of the suffering sick in community with others, and rejecting alienation, Christians can arrive at a more complete conception of suffering that embraces the complementarities of philosophy and theology. [ABSTRACT FROM PUBLISHER]

This paper provides a reflective analysis of the nature of normative critiques of law generally, and within medical law specifically. It first seeks to establish the context within which critical analysis of law and legal measures takes place, and develops an argument that critiques should focus on political norms. Entailed in this claim is the contention that positions that seek to address controversial social problems can not resort simply to moral philosophy. It then provides a brief account of political liberalism that can contain and expose normative constraints on questions of moral and social contention. The focus then moves to a more direct reflection on medico-legal analysis. Considering both medical law as a discipline, and the study of end-of-life issues, the argument highlights the range of relevant issues that must be accounted for, and addresses the question of whether these are well conceived as ones of medical law. It is argued that a political framing offers a good general analytic context, but that when working in legal sub-disciplines analysts risk allowing ‘locally’ pertinent norms to dominate or unduly constrain wider debate. Thus it is questioned whether ‘medical law’ provides a coherent frame for social questions related to assisted-dying. [ABSTRACT FROM PUBLISHER]

Although assisted dying has been most commonly presented within a medicalised framework, the notion of de-medicalisation is employed in this paper to suggest that there are emerging models of assisted dying in which some medical aspects assumed to be an integral part of the phenomenon are both challenged and diminished. The paper considers cases where relatives have facilitated a loved one's assisted suicide abroad, cases of assisted death in which the assistor in the actual suicide act is a non-medic, and the growing debate surrounding non-medical grounds for desiring death. In evaluating the potential impact of partial de-medicalisation on the assisted dying debate, the argument presented is that whilst a de-medicalised model could well contribute to a richer understanding of assisted dying and a better death for the person who is assisted, there are cogent reasons to retain some aspects of the medicalised model and that a completely de-medicalised model of assisted dying is unrealistic. [ABSTRACT FROM PUBLISHER]

The article focuses on the speculation that voluntary euthanasia and physician-assisted suicide are indications of personal autonomy. It argues that the women's experience reveals the uncertainty of choice as the basis of policies that approve such death. It takes into account available empirical evidence in evaluating relative incidence of assisted death in women. It further considers the decision of women for euthanasia and physician-assisted suicide.

The article examines an approach to legalising assisted dying proposed in France. The use of human rights documents to legalise assisted dying in the U.S., Canada and Great Britain is discussed. The duty-based approach to legalising euthanasia in the Netherlands is tackled. The Comité Consultatif National d'Éthique (CCNE) in France proposed to allow euthanasia based on compassion and human solidarity, the strengths and weaknesses of this approach are explored.

It is plausible that what possible courses of action patients may legitimately expect their physicians to take is ultimately determined by what medicine as a profession is supposed to do and, consequently, that we can determine the moral acceptability of voluntary euthanasia and physician-assisted suicide on the basis of identifying the proper goals of medicine. This article examines the main ways of defining the proper goals of medicine found in the recent bioethics literature and argues that they cannot provide a clear answer to the question of whether or not voluntary euthanasia and physician-assisted suicide are morally acceptable. It is suggested that to find a plausible answer to this question and to complete the task of defining the proper goals of medicine, we must determine what is the best philosophical theory about the nature of prudential value. [ABSTRACT FROM AUTHOR]

End-of-life circumstances have changed dramatically in recent years. In the past century life expectancy has increased by 62 percent and people are living longer with chronic illness. This article discusses evolving health practices and polices in end-of-life decisions. Treatments to prolong life and provide comfort, and interventions that hasten death, are discussed. Recent assisted suicide and euthanasia laws are analyzed and compared. Implications for social work and social work practitioners are addressed. [ABSTRACT FROM AUTHOR]

The article explores the logical slippery slope argument in physician-assisted suicide (PAS) and euthanasia debate presented by John Keown. The author remarks that Keown's argument appears to be an argument from consistency, which uses two primary justifications that are necessary to justify the acceptance of PAS and euthanasia. He suggests that based on the various justifications and concerns with the argument, it should not be given importance in the debate on PAS and euthanasia.

The article discusses the role of personhood in end-of-life decision-making and examines the way in which the concept of a person interacts with the notion of a right to die. It claims that the right to die embodies a critical paradox of a personhood and explains the significance of personhood-based account of moral status. Moreover, it emphasizes that personhood is ascribed to beings on the basis of the qualities or characteristics which they possess.

Two rival paradigms permeate bioethics. One generally favors eugenics, euthanasia, assisted suicide and other methods for those with severely restricting physical and cognitive attributes. The other typically opposes these and favors instead ample support for“persons of difference”and their caring families or loved ones. In an attempt to understand the relation between these two paradigms, this article analyzes a publicly reported debate between proponents of both paradigms, bioethicist Peter Singer and lawyer Harriet McBryde Johnson. At issue, the article concludes, are two distinct axiomatic sets of values resulting in not simply different styles of rhetoric but different vocabularies, in effect two different languages of ethics. [ABSTRACT FROM AUTHOR]

Although the debate about whether an individual with a life-threatening illness should have the right to hasten his or her death continues, few researchers have examined why someone might consider such an option. This study examined factors that contribute to consideration of hastening death among people with life-threatening illnesses. A discriminant function analysis was conducted to determine what factors distinguished between people who had self-identified as either contemplating or not contemplating hastening their deaths. Of the variables examined, depression, social support, and hope distinguished between the two groups. Pain and anxiety appeared to play no role in distinguishing between the two groups. The results are presented and implications for social work practice and research are discussed. [ABSTRACT FROM AUTHOR]

The cardinal question in Christian moral theory and bioethics is whether the knowledge that Christians have (1) by grace and (2) by revelation (e.g., regarding the character of human and cosmic history as reaching from creation through the Incarnation and the Redemption to the Second Coming and the restoration of all things) makes a crucial contribution to understanding morality, as for example issues such as the good death and the morality of physician-assisted suicide and euthanasia. This article argues that Such a Contribution is made by grace and revelation. The reduction of Roman Catholic moral theology and bioethics to secular bioethics is explored, as well as the necessity of the unique knowledge possessed by Christians for adequate end-of-life decision-making. [ABSTRACT FROM AUTHOR]

The debate about voluntary euthanasia arises (essentially) from a fundamental anthropological question: do humans own themselves? An answer to this question is developed which starts out from the foundational ethic of Emmanuel Lévinas, The metaphysics of the countenance of the Other in Lévinas is then related to Karl Rahner's description of as the absolute enigma which is fated towards us. God, understood an that enigma, is experienced for us concretely in our relationship to the countenance of our neighbor, the other human being. Our being thus referred to the absolutely Other in the countenance of the other human grounds not only the non-disposability of that other human being, but also the non-disposability of myself. This is the decisive point for how one should think about euthanasia. In contrast to the (so called) voluntary euthanasia, accompaniment in dying takes account of that dialogical constitution of man. [ABSTRACT FROM AUTHOR]

In this essay I shall describe and analyse the current debate on physician assisted suicide in contemporary German Protestant church and theology. It will be shown that the Protestant (mainly Lutheran) Church in Germany together with her Roman Catholic sister church has a specific and influential position in the public discussion: The two churches counting the majority of the population in Germany among their members tend to "organize" a social and political consensus on end-of-life questions. This cooperation is until now very successful: Speaking with one voice on end-of-life questions, the two churches function as the guardians of a moral consensus which is appreciated even by many non-believers. Behind this joint service to society the lines of the theological debate have to be re-discovered. First it will he argued that a Protestant reading of the joint memoranda has to be based on the concept of individual conscience. The crucial questions are then: Whose conscience has the authority to decide? and: Can physician assisted suicide be desired faithfully? Prominent in the current debate are Ulrich Eibach as a strict defender of the sanctity of life. and on the other side Waiter Jens and Hans Küng, who argue for a right to physician assisted suicide under extreme conditions. I shall argue that it will he necessary to go beyond this actual controversy to the works of Gerhard Eheling and Karl Barth for a clear and instructive account of conscience and a theological analysis of the concepts of life and suicide. On the basis of their considerations, a conscience-related approach to physician assisted suicide is developed. [ABSTRACT FROM AUTHOR]

The Roman Catholic theological approach to euthanasia is radically prohibitive. The main theological argument for prohibition is the so-called "stewardship argument": Christians cannot escape accounting to God for stewardship of the bodies given them on contribution presents alternative approach based on European existentialist and philosophical traditions. The suggestion is that exploring the fullness of our relational responsibility is more apt for a pluralist -- and even secular debate on the legitimacy of euthanasia. [ABSTRACT FROM AUTHOR]

Discussions in Germany regarding appropriate end-of-life decision-making have been heavily influenced by the liberalization of access to physician-assisted suicide and voluntary active euthanasia in the Netherlands and Belgium. These discussions disclose conflicting moral views regarding the propriety of physician-assisted suicide and euthanasia, threatening conflicts within not only the medical profession, but also the mainline churches in Germany, whose membership now entertains views regarding end-of-life decision-making at odds with traditional Christian doctrine. On the surface, there appears to be a broad consensus supporting the hospice movement and condemning physician-assisted suicide and euthanasia, The German Supreme Court has held that treatment decisions should, in absence of known patients' wishes, be made in light of commonly shared values, unless these violate the principle of "in dubio pro vita". The Roman Catholic church and the Evangelical Lutheran church in Germany have developed an advance directive for treatment choices at the end of life, while condemning physician-assisted suicide and euthanasia. This stance is in tension with the strong emerging support for physician-assisted suicide and euthanasia, a development that promises to open up foundational disagreements within mainline German Christianity regarding the appropriate approach to intentionally terminating human life. [ABSTRACT FROM AUTHOR]

Adequate response to physician-assisted suicide and euthanasia depends on fundamental philosophical and theological issues, including the character of an appropriate philosophically and theologically anchored anthropology, where the central element of traditional Christian anthropology is that humans are created to worship God. As I will argue, Christian morality and moral epistemology must be nested within and understood through this background Christian anthropology. As a result, I will argue that physician-assisted suicide and euthanasia can only be one-sidedly and inadequately appreciated through rational appeal to central values, such as "human dignity" and "self-determination", or through "sola scriptura" biblical interpretation, or individual judgments of conscience. Adequately addressing physician-assisted suicide and euthanasia will depend on a more fundamental spiritual-therapeutic approach. This cluster of moral, epistemological, anthropological, and bioethical claims will be explored by drawing on the texts of St. Basil the Great, St. Maximos the Confessor, and St. Isaac the Syrian. Their reflections on medicine, the human good, and its relationship to worship, spiritual therapy, and God will be used as a basis to indicate a broader philosophical perspective, which will be needed to avoid a one-sided, incomplete approach to the challenges of physician-assisted suicide and euthanasia. Medical morality, I argue, is best understood within categories that transcend the fight, the good, the just, and the virtuous: namely, the holy. [ABSTRACT FROM AUTHOR]

Evangelicals are unconditionally opposed to active euthanasia. Indirect euthanasia is as simply belonging to the risks inherent in any medical intervention, Passive euthanasia is accepted if used in order to save the dignity of dying seen as merely ceasing to interfere with irreversible dying process. The basis of evangelical ethics is the Bible supplemented by science and experience a kind Of natural law. Even though natural law comes under Biblicial revelation, its acceptance is the reason for the similarity of the Evangelical and the Roman-Catholic position of Evangelicals. Evangelicals stress the necessity of a better counseling and investment for the deadly ill patient. [ABSTRACT FROM AUTHOR]

Comments on the article "Relational Responsibility, and Not Only Stewardship. A Roman Catholic View on Voluntary Euthanasia for Dying and Non-Dying Patients," by Paul Schotsman, published in the 2003, Volume 9, Numbers 2 and 3 issue of "Christian Bioethics." Analysis of the weaknesses of the traditional Roman Catholic moral thought on euthanasia; Positive contributions of the traditional Roman Catholic moral thought; Summary of the article.

This essay addresses the problem of communication between Christianity and the secular world in an area where the tatter tends to oppose the moral norms endorsed by the former. How, in the interest of missionary outreach (and with which understandings of what such outreach involves) can the language barriers be bridged? Whereas the Roman Catholic natural law tradition posits a neutral common ground of (traditional or hermeneutical) rationality between Christianity and the world, an Ebeling- and Barth-modified Lutheranism engages in an argument ad hominem by seizing upon an admitted deficiency within that world, and by recommending Christianity for mending that deficiency, Both positions differ from the Evangelical claim that since that which the world politically values is derived from Christianity, it must remain subject to Christianity's moral legislation. An entirely different approach to the communication- and outreach-problem is taken by Orthodox Christianity: The gulf which separates it from the world is acknowledged, and the possibility of trans-gulf-traffic is referred to God's grace. It is only this latter model, however, which preserves Christianity's theological terms (such as "Scripture", "law", and "holiness") from common-ground-securing, deficiency-mending, or authority-imposing secularisizing, and thus from compromising that very theological context into which communicative outreach enadeavors were to invite. [ABSTRACT FROM AUTHOR]

Proponents of the legalization of assisted suicide often appeal to our supposed right to "die with dignity" to defend their case. I examine and assess different notions of "dignity" that are operating in many arguments for the legalization of assisted suicide, and I find them all to be deficient. I then consider an alternative conception of dignity that is based on Aristotle's conception of the conditions on the best life. I conclude that, while such a conception of dignity fits best with our intuitions about the conditions under which a life has dignity, it supports the legalization of assisted suicide only under very limited circumstances. [ABSTRACT FROM AUTHOR]

Deals with a study which compared the sociodemographic and clinical characteristics of Kevorkian euthanasia cases with Oregon physician-assisted suicide (PAS) cases and mortality data in the United States. Description of Kevorkian euthanasia cases; Risk factors of euthanasia and legalized PAS; Limitations of the study.

Physician-assisted suicide and euthanasia (PAS/E) have been outside the bounds of acceptable behavior for physicians for hundreds of years and remain illegal in all jurisdictions except Oregon and The Netherlands. The morally, legally, and professionally acceptable alternative is excellent end-of-life care. In this article, the arguments in favor of PAS/E are discussed briefly and rebutted. The arguments against this practice are outlined and supported. Because pain (and fear of pain) at the end of life is one of the driving forces behind the recurrent debate about legalization of PAS/E, the medical profession as a whole, and pain specialists in particular, have an obligation to use all available means to relieve pain. [ABSTRACT FROM AUTHOR]

Against the backdrop of ancient, mediaeval and modern Catholic teaching prohibiting killing (the rule against killing), the question of assisted suicide and euthanasia is examined. In the past the Church has modified its initial repugnance for killing by developing specific guidelines for permitting killing under strict conditions. This took place with respect to capital punishment and a just war, for example. One wonders why in the least objectionable instance, when a person is already dying, suffering, and repeatedly requesting assistance in dying, there is still such widespread condemnation of assisted suicide and euthanasia. In a Gedankexperiment , I suggest that certain stories of martyrdom in the history of the Christian Church shed some light on the role of taking one's life, or putting one's life in danger out of love. I further suggest that requesting assisted suicide and/or euthanasia from the motive of love of one's family or care givers might possibly qualify as one instance of justifiable euthanasia, although I acknowledge that the Church will not be making changes in its stance any time soon. [ABSTRACT FROM AUTHOR]

Examines the characteristics of patients of Dutch nursing homes to whom euthanasia/assisted suicide (EAS) was administered. Reasons for requesting EAS; Avoidance of deterioration; Fear of suffocation; Unbearable suffering; Emotional circumstances.

A letter to the editor is presented in response to the article "A Comparison of Characteristics of Kevorkian Euthanasia Cases and Physician-Assisted Suicides in Oregon," by L. A. Roscoe, J. A. Malphurs, L. J. Dragovic, and D. Cohen from the August 2001 issue on physician-assisted suicide (PAS), euthanasia, the actions of Dr. Jack Kevorkian, and medical law in Oregon regarding the right to die.

A letter to the editor is presented in response to the article "A Comparison of Characteristics of Kevorkian Euthanasia Cases and Physician-Assisted Suicides in Oregon," by L. A. Roscoe, J. A. Malphurs, L. J. Dragovic, and D. Cohen from the August 2001 issue on the difference between physician-assisted suicide (PAS) and euthanasia in regard to the actions of Dr. Jack Kevorkian.

Editorial. Offers observation on euthanasia, physician-assisted suicide and forgoing artificial administration of food and fluids at the end of life. Justification for end-of-life research; Discussion on artificial nutrition near the end of life; Conclusion.

The article offers information on the research conducted on assisted suicide of individuals and mass media worldwide. Researchers found that since suicide is usually the method employed by those individuals who have terminal illness. Moreover, researchers suggested that the media people should carefully broadcast these incident to avoid romanticizing or idealizing suicide as a heroic one.

A letter to the editor is presented in response to the article "A Comparison of Characteristics of Kevorkian Euthanasia Cases and Physician-Assisted Suicides in Oregon by L. A. Roscoe, J. E. Malphurs, L. J. Dragovic, and D. Cohen with a written reply from the authors regarding the characteristics of patients who died with the assistance of Dr. Jack Kevorkian, along with information on the definition of euthanasia, patient consent, laws in Oregon regarding the right to die, and bioethics.

Anita Silvers (1998) has criticized those who argue that members of marginalized groups are vulnerable to a special threat posed by physician-assisted suicide (PAS) and voluntary active euthanasia (VAE). She argues that paternalistic measures prohibiting PAS/VAE in order to protect these groups only serve to marginalize them further by characterizing them as belonging to a definitively weak class. I offer a new conception of vulnerability, one that demonstrates how rich, educated, white males, who are typically regarded as having their autonomy enhanced by their social status, are just as, if not more, vulnerable to threats posed by PAS/VAE as a result of the harmful social messages at work just below the surface of contemporary Western culture. I use this new conception of vulnerability to reinforce arguments for continued statutory prohibitions on PAS/VAE. [ABSTRACT FROM PUBLISHER]