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Background: Physician-administered euthanasia (PAE) was legalized, along with physician-assisted suicide (PAS), in The Netherlands in 2001. Sources of data: Annual reports of the Dutch Regional Euthanasia Review Committees, the committees' 2015 published Code of Practice and research studies Areas of agreement: There is a general openness about the practice of PAE/PAS in The Netherlands and an avoidance of misleading euphemisms. The 2001 law also includes arrangements for post-event review of PAE/PAS decisions. Areas of controversy: Rising numbers of annually reported deaths from PAE and uncertainty over actual numbers. Movement away from the principle that euthanasia must take place within an established doctor--patient relationship. Increasing extension of the 2001 law to people with mental health conditions, dementia and multiple co-morbidities. Nature of the post-event scrutiny applied to reported cases. Growing points: The predominance of PAE over PAS where both are legalized raises questions over how these two acts are perceived and whether there are implications for such laws. Areas for timely research: Are the criteria for PAE/PAS in the 2001 law appropriate for a law of this nature? What should be the respective roles of the second-opinion doctors and the review committees? [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]

Handling, weaning, and euthanasia are some of the most stressful practices performed on cow-calf operations. Although strategies to minimize stress exist, their use on western Canadian cow-calf operations is unknown. The objectives were to describe current stress-associated practices on western Canadian cow-calf operations, describe producer and operation demographics associated with the use of nonabrupt weaning methods, and explore producer perceptions toward these practices. A questionnaire focusing on stressful management practices was delivered to 109 cow-calf producers in western Canada. Fifteen respondents were purposively selected for individual interviews. The majority of producers reported calves less than 1 wk of age were handled by manual restraint (87%) and those older than 1 wk of age were handled using a cattle squeeze or table. Most producers performed abrupt weaning (70%). Interviewees often mentioned that cost and logistics were major factors in deciding on a weaning strategy. Pasture availability and facilities were viewed as constraints toward the adoption of a nonabrupt weaning method. Animal stress was considered, as producers expressed concern that nonabrupt weaning methods may cause increased stress because of the additional handling required. Producers conveyed that animal age was a major factor that impacted weaning stress and that improved animal performance might motivate them to adopt a nonabrupt weaning strategy. Producers also expressed reluctance to change previously successful traditional approaches. Of respondents, 13% did not euthanize cattle on farm and 8% did not confirm death. Producers interviewed reported that the decision to euthanize cattle on farm was difficult and that veterinary advice was often considered. Factors that influenced their decision to euthanize included the animal's likelihood of recovery and degree of pain and distress. Finally, producers explained that they considered whether the animal was salvageable and able to be transported. Identification of common methods of handling provides focus for future research to determine optimal handling strategies. Identified barriers to nonabrupt weaning may be addressed through research, extension, or policy to encourage the adoption of weaning methods that could improve animal welfare. Confirmation of death after euthanasia was identified as an area that needs to be addressed by producer education to minimize animal stress during on-farm euthanasia. [ABSTRACT FROM AUTHOR]

The Common Swine Industry Audit (CSIA) was developed and scientifically evaluated through the combined efforts of a task force consisting of university scientists, veterinarians, pork producers, packers, processers, and retail and food service personnel to provide stakeholders throughout the pork chain with a consistent, reliable, and verifiable system to ensure on-farm swine welfare and food safety. The CSIA tool was built from the framework of the Pork Quality Assurance Plus (PQA Plus) site assessment program with the purpose of developing a single, common audit platform for the U.S. swine industry. Twenty-seven key aspects of swine care are captured and evaluated in CSIA and cover the specific focal areas of animal records, animal observations, facilities, and caretakers. Animal-based measures represent approximately 50% of CSIA evaluation criteria and encompass critical failure criteria, including observation of willful acts of abuse and determination of timely euthanasia. Objective, science-based measures of animal well-being parameters (e.g., BCS, lameness, lesions, hernias) are assessed within CSIA using statistically validated sample sizes providing a detection ability of 1% with 95% confidence. The common CSIA platform is used to identify care issues and facilitate continuous improvement in animal care through a validated, repeatable, and feasible animal-based audit process. Task force members provide continual updates to the CSIA tool with a specific focus toward 1) identification and interpretation of appropriate animal-based measures that provide inherent value to pig welfare, 2) establishment of acceptability thresholds for animal-based measures, and 3) interpretation of CSIA data for use and improvement of welfare within the U.S. swine industry. [ABSTRACT FROM AUTHOR]

Euthanasia is a necessary act for any facility keeping live animals. Nevertheless, the crucial role and responsibility of the stockperson in deciding and conducting on-farm euthanasia has been overlooked. Stockperson characteristics and knowledge that lead to appropriate decision-making and the skills to competently perform the procedure remain to be identified. An important component of the stockperson's characteristics that predict behavior is the stockperson's attitudes. This preliminary study investigated the factors that influence stockperson attitudes toward the practice of on-farm euthanasia in the pork industry. A total of 120 stockpeople from 10 Australian pig farms (ranging in size from 50 to 4,754 sows and from 2 to 32 employees) completed a questionnaire based on focus group input to assess their attitudes toward euthanasia and decision processes. Factors identified included stockperson attitudes and attributes (empathy affect, empathy attribution, feeling bad about euthanizing, and negative attitudes to pigs), beliefs about the working environment (perceived time constraints and relying on others), and factors related to decision-making (comfortable with euthanasia, trouble deciding and avoid if possible, confidence, insufficient knowledge, seeking knowledge, and using sources to get advice). Numerous significant correlations were found between these variables. Furthermore, regression analyses showed confidence as the only significant predictor of being comfortable with euthanasia (12.5% of the variance; P < 0.001); insufficient knowledge and empathy attribution both as predictors of trouble deciding and avoid if possible (15.1% of the variance; P = 0.001 and P = 0.032, respectively); and empathy affect, insufficient knowledge, and perceived time constraints as predictors of feeling bad about euthanizing (23.2% of the variance; P < 0.001, P = 0.006, and P = 0.022, respectively). Stockpeople reported seeking more knowledge if they had not euthanized an animal before working with pigs (P = 0.05), and women reported greater difficulty than men in conducting euthanasia (P < 0.01). The findings indicate that euthanasia, which comprises both a decision-making process and the act itself, can adversely affect stockpeople. This preliminary study offers insights for implementation of successful practical and humane pig euthanasia protocols on farm. This will benefit stockperson well-being and animal well-being alike. [ABSTRACT FROM AUTHOR]

Current research guidelines for ectothermic tetrapod vertebrates prohibit the use of cold as an adjunct to gaseous anesthesia, and they prohibit freezing as a means of euthanasia of these same animals. Here, we argue that those guidelines merit re-evaluation. Under natural conditions, numerous amphibians and reptiles experience large variations of body temperature, and life at low temperatures is natural. In tropical species less tolerant of cold, nociception is likely to be extinguished at low temperatures because of the anesthetizing actions of cold on membranes and cold block of nerve conduction. Physical principles and physiological data suggest that smaller ectothermic vertebrates do not experience pain attributable to ice crystals that form during freezing. Therefore, whole-body cooling, followed by freezing, should be a humane form of euthanasia for numerous smaller ectothermic species. In addition, we believe that cooling offers a humane and useful means of supplementing currently acceptable methods of anesthesia. [ABSTRACT FROM AUTHOR]

Many proponents of euthanasia eschew appeals to religious premises as good reasons for thinking that human life has intrinsic worth. The reasons offered are that religious reasons do not meet some theory-neutral epistemic standard. My first argument is to show that pro-euthanasia arguments fail to meet those same standards. In order to avoid this incoherence, the rejection of religious reasons is a function of thinking that such reasons are simply false. Arguing against religious belief has typically fallen to the evidential argument from evil. My second argument is to show that the argument from evil must hold to a basic goods account of human life. Such an account is contrary to the view of human life held by most euthanasia proponents. So, euthanasia proponents who reject religious belief on the basis of an argument from evil must hold to a contradictory view of human worth. One cannot both be a euthanasia proponent and reject arguments against euthanasia (that are based in part on religious premises). I explore ways to resolve this tension, but none save pro-euthanasia arguments. [ABSTRACT FROM AUTHOR]

Christian bioethics starts with different metaphysical, epistemological, and teleological assumptions. It starts with God as Creator and Sustainer of the universe who as the second person of the Godhead became incarnate as our Redeemer and Lord. Morality reflects God's nature and is known through reason and intuition guided by revelation. The end of a Christian bioethics is to discover the way our God intends for us to live and to discover the type of person He intends for us to be in order to live a holy and sanctified life. Christian bioethicists will seek integration among their core beliefs and between their beliefs and actions, and they will bear witness to their beliefs in a world that is not yet redeemed. Each contribution in this issue represents an example of these types of Christian integration. Each bears witness to the fact that a Christian bioethics is different. [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]

In the United States as well as in many other countries, early reports of industrialized mass murder perpetrated by the Germans during the Second World War were connected not with the Holocaust but—beginning in early 1941—with crimes committed as part of the German “euthanasia” program. The writings and reports of journalist and popular radio personality William L. Shirer in particular shaped public perception of the murder of disabled people. The author of this article traces Shirer’s German and American sources, drawing possible connections to journalists, State Department officials, and members of the German resistance. [ABSTRACT FROM AUTHOR]

On-farm euthanasia of pigs considers aspects of welfare and economics, but few comprehensive guidelines are available for swine producers and further, do not consider cultural barriers. The Hispanic workforce largely represents the bulk of agricultural workers. Euthanasia requires the ability to identify compromised pigs, technical skills, and willingness to euthanize pigs. In addition, timely euthanasia is part of the Common Swine Industry Audit (CSIA) and thus, can lead to failed audits. The U.S. swine industry employs a large percentage of Latin American workers through NAFTA visas. These workers vary in their degree of education and pig experience. Proper training of this workforce and identification of the barriers to performing timely euthanasia is critical. The objectives of this study were to: 1) develop and validate surveys (including demographic information, swine management, moral injury events scale, impact of event scale and the professional quality of life scale) in Spanish to determine Hispanic caretaker attitudes towards timely euthanasia and 2) to assess Hispanic caretakers using the validated surveys to determine the barriers associated to timely euthanasia. A total of 163 workers were surveyed and data were analyzed using Chi-Square. The results indicated that employees with less time working in the company presented less CSIA knowledge and a reduced capacity to identify pigs that needed to be euthanizing (P< 0.001). Spearman's rankorder correlations indicated that stress was the most frequently correlated scale, related with burnout, transgressions, betrayals, and worker satisfaction (P=0.022). A Mann-Whitney U test determined that there was a gender difference, presenting a high level of stress and a low level of satisfaction in females and the opposite results in males (P=0.026). It is important to identify the factors that decrease or negatively affect the ability of employees to perform euthanasia in order to provide efficient training that improves good practices in the swine industry. [ABSTRACT FROM AUTHOR]

Guidelines for use of wild mammal species in research are updated from Sikes et al. (2011). These guidelines cover current professional techniques and regulations involving the use of mammals in research and teaching; they also incorporate new resources, procedural summaries, and reporting requirements. Included are details on capturing, marking, housing, and humanely killing wild mammals. It is recommended that Institutional Animal Care and Use Committees (IACUCs), regulatory agencies, and investigators use these guidelines as a resource for protocols involving wild mammals, whether studied in the field or in captivity. These guidelines were prepared and approved by the American Society of Mammalogists (ASM), in consultation with professional veterinarians experienced in wildlife research and IACUCs, whose collective expertise provides a broad and comprehensive understanding of the biology of nondomesticated mammals. [ABSTRACT FROM AUTHOR]

In its landmark decision Carter v Canada (Attorney General), the Supreme Court of Canada ruled that the criminal prohibition on physician-assisted suicide and euthanasia for certain persons in certain circumstances violated their rights to life, liberty, and security of the person in sec. 7 of the Canadian Charter of Rights and Freedoms and thus was unconstitutional. The Supreme Court in effect overruled its earlier decision, Rodriguez v British Columbia (Attorney General), which upheld the prohibition as constitutionally valid, on the basis of changes in Charter jurisprudence and in the social facts since Rodriguez was decided. We argue that the Supreme Court's Carter decision shows conceptual disagreements with its Rodriguez decision concerning the nature and scope of the sec. 7-protected interests and the accompanying principles of fundamental justice. Not only do these conceptual differences have little to do with the changes that the Court in Carter invoked for 'revisiting' Rodriguez, the Court's articulation of the sec. 7 interests, particularly the right to life, and the principles of fundamental justice, especially the principle of over breadth, are problematic on their own terms. Furthermore, the way in which the Court dealt with evidence regarding abuses in permissive jurisdictions is also subject to criticism. We recommend that if, as now seems inevitable, legislation is introduced, it should mandate that assisted suicide and euthanasia be performed by specially licensed non-medical personnel and only on the authorization of a Superior Court judge. We also reject the key recommendations recently issued by the Provincial- Territorial Expert Advisory Group on Physician-Assisted Dying. [ABSTRACT FROM AUTHOR]

In Memory of Ed Pellegrino. Euthanasia in Belgium is not limited to terminally ill patients. It may be applied to patients with chronic degenerative diseases. Currently, people in Belgium wish to make it possible to euthanize incompetent patients who suffer from dementia. This article explains the Belgian law and then explores arguments for and against euthanasia of patients with dementia. It probes the dementia paradox by elucidating Dworkin's distinction between critical and experiential interests, arguing that at the end-of-life this distinction is not clearcut. It argues against euthanasia for patients with dementia, for respecting patients' humanity and for providing them with more care, compassion, and good doctoring. [ABSTRACT FROM AUTHOR]

The gathering of power unto themselves by physicians, a process supported by evidence-based practice, clinical guidelines, licensure, organizational culture, and other social factors, makes the ethics of power--the legitimation of physicians' power--a core concept of clinical ethics. In the absence of legitimation, the physician's power over patients becomes problematic, even predatory. As has occurred in previous issues of the Journal, the papers in the 2016 clinical ethics issue bear on the professionally responsible deployment of power by physicians. This introduction explores themes of physicians' power in papers from an international group of authors who address autonomy and trust, the virtues of perinatal hospice, conjoined twins in ethics and law, addiction and autonomy in clinical research on addicting substances, euthanasia of patients with dementia in Belgium, and a pragmatic approach to clinical futility. [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]

Analysing survey data from the European Values Study, we investigate whether and how changes in church attendance bring about changes in people's acceptance of abortion, homosexuality, divorce, and euthanasia. We argue that decreasing church attendance not only should enhance overall acceptance of these moral issues, but it should also lead to greater diversity in opinions on them. From our analyses, we can indeed conclude that declining levels of church attendance have been accompanied by greater permissiveness and increased diversity in attitudes towards abortion, divorce, and euthanasia. However, opinions about homosexuality hardly seem affected by developments in religiosity. Moreover, the trends in Western and Eastern Europe appear rather different. Eastern Europeans are far more conservative; in fact, no significant changes in church attendance levels (on average) were found there. The association between church attendance and moral views is in general weaker in Central and Eastern Europe than in Western Europe, and is even absent in some cases. [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]

In the UK, end-of-life care strategies recommend patients and families are involved in decision making around treatment and care. In Bolivia, such strategies do not exist, and access to oncology services depends on finance, geography, education and culture. Compared to more developed countries, the delivery of oncology services in Latin America may result in a higher percentage of patients presenting with advanced incurable disease. The objective of this study was to explore decision-making experiences of health and social care professionals who cared for oncology and palliative care patients attending the Instituto Oncologico Nacional, Cochabamba (Bolivia). Patients were predominantly from the Quechua tradition, which has its own ethnic diversity, linguistic distinctions and economic systems. Qualitative data were collected during focus groups. Data analysis was conducted using Interpretative Phenomenological Analysis. Three interrelated themes emerged: (i) making sense of structures of experience and relationality; (ii) frustration with the system; and (iii) the challenges of promoting shared decision making. The study uncovered participants' lived experiences, emotions and perceptions of providing care for Quechua patients. There was evidence of structural inequalities, the marginalisation of Quechua patients and areas of concern that social workers might well be equipped to respond to, such as accessing finances for treatment/care, education and alleviating psychological or spiritual suffering. [ABSTRACT FROM AUTHOR]

The general reaction of the press to Pope Francis' Address to Doctors has been generally very positive. However, the address is in many ways quite puzzling. Among other things, it contains a doctrinal error in describing abortion as a scientific problem, not a philosophical problem. It also has a strikingly secular character. In all, Pope Francis' Address is inferior in substance to Pope John Paul II's Evangelium Vitae, with which it has been compared. Pope Francis often relies on moral intuitions and secular argument, while showing again his propensity to desacralize theological discourse: the pope avoids focusing on transcendent concerns and realities. Pope Francis' Address presents the Roman Catholic community with opinions as one among others, and not as an institution called by God to preach the truth. The Address is also articulated in the terms of common language, avoiding the technical distinctions of theology and engaging unclear terms such as "playing with life." [ABSTRACT FROM AUTHOR]

The aim of this study was to identify parameters that may be used as objective measures of wellbeing in weaner pigs on farm. Eighty-six weaner pigs were categorized into 3 groups based on their BCS: very compromised (VC, BCS = 1), moderately compromised (MC, BCS = 2), or healthy (HY, BCS ≥ 3). Nonphysiological and physiological measures were then collected from the pigs. Nonphysiological measures included 3 subjective binary scores that assessed the activity, hairiness, and responsiveness of each pig. Physiological measures included rectal temperature, skin temperature, and 11 blood-based parameters. Each physiological measure was assessed in a ternary manner, with pigs being classed as being above, below, or within the normal physiological range. Fisher's exact tests (FET) were used to identify differences between the numbers of pigs in each BCS category for each variable, and ANOVA of physiological measures was also conducted. Correlations between all variables were also conducted. The FET results identified significant differences for 8 of the measures, with activity, hairiness, responsiveness, rectal temperature, and blood concentrations of glucose, creatinine kinase (CK), albumin, and globulin all differing significantly (all P < 0.05) according to category. Rectal temperature, glucose, and globulin concentrations were significantly different in ANOVA analyses. Of these measures, there were significant correlations between hairiness, rectal temperature, and glucose (all R > 0.30 and P < 0.05). Based on these results, rectal temperature, glucose, and hairiness all warrant further investigation as simple to apply, on-farm measures that can be used in conjunction with body condition and subjective assessment to aid management decisions on pig welfare. [ABSTRACT FROM AUTHOR]

Sodium pentobarbital, a euthanasia drug, can persist in animal carcasses following euthanasia and can cause secondary toxicosis to animals that consume the remains. This experiment was conducted to observe the effects of composting on euthanized horse carcass degradation and sodium pentobarbital residues in compost material up to 367 d. Six separate compost bins were constructed on pastureland. Three bins served as the control while 3 served as the treatment. The carbonaceous material, or bulking agent, consisted of hardwood chips mixed with yard waste wetted to approximately 50% moisture content. Bulking agent was added to each bin at a depth of 0.46 m, creating the pad. A licensed veterinarian provided 6 horse carcasses for use in the experiment. These horses had required euthanasia for health reasons. All horses were weighed and then sedated with an intravenous injection of 8 mL of xylazine. After sedation the 3 horses in the treatment group were euthanized by intravenous injection of 60 mL of sodium pentobarbital. The 3 control group horses were anesthetized by intravenous injection of 15 mL of ketamine hydrochloride and then humanely euthanized by precise gunshot to the temporal lobe. Following euthanasia, each carcass was placed on the center of the pad and surrounded with 0.6 m of additional bulking agent. Serum and liver samples were obtained immediately following death. Compost samples were obtained on d 7, 14, 28, 56, 84, 129, 233, and 367 while soil samples were obtained on d -1 and 367. Each sample was analyzed for sodium pentobarbital concentration. Compost pile and ambient temperatures were also recorded. Composting successfully degraded soft tissue with only large bones remaining. Data illustrate that sodium pentobarbital was detectable up to 367 d in compost piles with no clear trend of concentration reduction. Drug residues were detected in soil samples indicating that sodium pentobarbital leached from the carcass and through the pad. These findings confirm the persistence of sodium pentobarbital from equine mortality compost piles and emphasize the importance of proper carcass management of animals euthanized with a barbiturate to reduce environmental impact and secondary toxicosis. [ABSTRACT FROM AUTHOR]

The objective of this study was to determine the effectiveness of a nonpenetrating captive bolt, Zephyr-E, for euthanasia of suckling and weaned pigs from 3 to 9 kg (5-49 d of age) using signs of insensibility and death as well as postmortem assessment of traumatic brain injury (TBI). The Zephyr-E was used by 15 stock people to euthanize 150 compromised pigs from 4 farrowing and nursery units from commercial farms and 2 research stations. Brainstem reflexes, convulsions, and heartbeat were used to assess insensibility, time of brain death, and cardiac arrest following Zephyr-E application. Skull fracture displacement (FD) was quantified from computed tomography (CT) scans (n = 24), macroscopic scoring was used to assess brain hemorrhage and skull fracture severity (n = 150), and microscopic scoring was used to assess subdural hemorrhage (SDH) and parenchymal hemorrhage within specific brain regions that are responsible for consciousness and vital function (n = 32). The Zephyr-E caused immediate, sustained insensibility until death in 98.6% of pigs. On average, clonic convulsions (CC) ceased in 82.2 s (±3.4 SE), brain death was achieved in 144.9 s (±5.4 SE), and cardiac arrest occurred in 226.5 s (±8.7 SE). Time of brain death and cardiac arrest differed significantly among stock people (P = 0.0225 and P = 0.0369). Age was positively related to the duration of CC (P = 0.0092), time of brain death (P = 0.0025), and cardiac arrest (P = 0.0068) with shorter durations seen in younger pigs. Average FD was 8.3 mm (±1.0 SE). Macroscopic scores were significantly differnt among weight classes for subcutaneous (P = 0.0402) and subdural-ventral (P = 0.0037) hemorrhage with the lowest severity hemorrhage found in the 9-kg weight category. Microscopic scores differed among brain sections (P = 0.0070) for SDH with lower scores found in the brainstem compared to the cerebral cortex and midbrain. Parenchymal hemorrhage differed among brain sections (P = 0.0052) and weight categories (P = 0.0128) with the lowest scores in the midbrain and brainstem and the 7- and 9-kg weight categories. The Zephyr-E was highly effective for the euthanasia of pigs up to 9 kg (49 d) based on immediate insensibility sustained until death. Postmortem results confirmed that severe skull fracture and widespread brain hemorrhage were caused by the Zephyr-E nonpenetrating captive bolt. [ABSTRACT FROM AUTHOR]

The influence of body position and microclimate on ketamine (KET) and metabolite distribution in decomposed bone tissue was examined. Rats received 75 mg/kg (i.p.) KET (n = 30) or remained drug-free (controls, n = 4). Following euthanasia, rats were divided into two groups and placed outdoors to decompose in one of the three positions: supine (SUP), prone (PRO) or upright (UPR). One group decomposed in a shaded, wooded microclimate (Site 1) while the other decomposed in an exposed sunlit microclimate with gravel substrate (Site 2), roughly 500 m from Site 1. Following decomposition, bones (lumbar vertebrae, thoracic vertebra, cervical vertebrae, rib, pelvis, femora, tibiae, humeri and scapulae) were collected and sorted for analysis. Clean, ground bones underwent microwave-assisted extraction using acetone : hexane mixture (1 : 1, v/v), followed by solid-phase extraction and analysis using GC–MS. Drug levels, expressed as mass normalized response ratios, were compared across all bone types between body position and microclimates. Bone type was a main effect (P < 0.05) for drug level and drug/metabolite level ratio for all body positions and microclimates examined. Microclimate and body position significantly influenced observed drug levels: higher levels were observed in carcasses decomposing in direct sunlight, where reduced entomological activity led to slowed decomposition. [ABSTRACT FROM AUTHOR]

The objective of this project was to determine the impact of cooling on the soft tissue thickness, cranial thickness, and cross-sectional brain area of cadaver heads from market pigs. Documenting the effect of cooling on tissue dimensions of swine heads is valuable and important for future investigations of physical stunning and euthanasia methods that use cadaver heads. Cadaver heads were sourced from market pigs stunned with CO2. After transport to the data collection location, a captive bolt shot was applied in the frontal position. Following captive bolt application, each head (n=36) underwent an UNCHILLED and CHILLED treatment. The UNCHILLED treatment involved images collected immediately after splitting the head along the bolt path and the CHILLED treatment involved images of the same heads after storage in a walk-in cooler for 24 h at 2-4°C. All measurements for each treatment were determined from images of the heads cut along the plane of the bolt path immediately prior to and immediately after the refrigeration treatment. Measurements were performed by two observers; across all measurements, mean interobserver percent coefficient of variation (%CV) was 11.3±0.6%. The soft tissue posterior to the bolt path was different (P=0.0120) between treatments (CHILLED: 6.4±0.2mm; UNCHILLED: 7.2±0.2mm). The soft tissue thickness anterior to the bolt path was different (P=0.0378) between treatments (CHILLED: 5.5±0.2mm; UNCHILLED: 6.1±0.2mm). There was not a significant difference (P=0.8659) in cranial thickness posterior to the bolt path (CHILLED: 18.1±0.6mm; UNCHILLED: 18.3±0.6mm), nor was there a significant difference (P=0.2593) in cranial thickness anterior to the bolt path between treatments (CHILLED: 16.2±0.6mm; UNCHILLED: 15.2±0.6mm). Cross-sectional brain area did not differ (P=0.0737) (CHILLED: 3633.4±44.1mm; UNCHILLED: 3519.9±44.1mm). A correction factor of 1.12 was determined from this study for cases where estimation of UNCHILLED soft tissue thickness from CHILLED soft tissue thickness is necessary. [ABSTRACT FROM AUTHOR]

This article discusses recent arguments of Franklin Miller and Robert Truog about withdrawal of life-sustaining treatment and causation. The authors argue that traditional medical ethics, and the law, are mistaken to take the view that withdrawal merely allows the patient to die, rather than causing the patient's death, describing such a view as ‘patently false’. They argue that the law's continued position to the contrary stems from a moral bias, resulting in the moral and legal fiction that withdrawal does not cause death but lets the patient die. In so arguing, Miller and Truog join a long line of academic criticism of the law that extends back to the seminal decision of Airedale NHS Trust v Bland [1993] AC 789 (HL) and beyond. In this article, I take issue with these claims. I argue that there are reasonable grounds upon which traditional medical ethics and the law can regard withdrawal of life-sustaining treatment as allowing the patient to die rather than causing death, and so the authors' claims that such a view is patently false cannot be sustained. I then tease out the implications of my conclusions for the authors' claim that there is not such a great distinction between withdrawal of life-sustaining treatment, euthanasia, and assisted dying. I conclude by discussing some possible objections to my own view. [ABSTRACT FROM AUTHOR]

Our goal in this article is to explicate the way, and the extent to which, euthanasia can be voluntary from both the perspective of the patient and the perspective of the health care providers involved in the patient’s care. More significantly, we aim to challenge the way in which those engaged in ongoing philosophical debates regarding the morality of euthanasia draw distinctions between voluntary, involuntary, and nonvoluntary euthanasia on the grounds that drawing the distinctions in the traditional manner (1) fails to reflect what is important from the patient’s perspective and (2) fails to reflect the significance of health care providers’ interests, including their autonomy and integrity. [ABSTRACT FROM PUBLISHER]

The article discusses England and Wales Court of Appeals case Aintree University Hospital NHS Foundation Trust v. James that dealt with various issues surrounding medicalised dying process. It mentions that Aintree has appealed against defendant's refusal to favor Aintree's withdrawal of medical treatment in specified circumstances and for permission to place a "Do not attempt resuscitation" instruction on the medical records of James.

The objective of this study was to determine the effectiveness of a nonpenetrating captive bolt (NPCB), the Zephyr-Euthanasia (Zephyr-E), for euthanasia of neonatal piglets < 72 h of age using signs of insensibility and death, as well as postmortem assessment of traumatic brain injuiy (TBI). The Zephyr-E was used by 10 stock people to euthanize 100 low viability neonatal piglets from 3 commercial farrowing units and 1 research farm. Brainstem reflexes, convulsions, and heartbeat were used to assess insensibility, time of brain death, and cardiac an-est after Zephyr-E application. Hemorrhage severity and skull fracture displacement (FD) were quantified from computed tomography scans (n = 10), macroscopic scoring was used to assess brain hemorrhage and skull fracture (SK) severity (n = 100), and microscopic scoring was used to assess subdural (SDH) and parenchymal (PH) hemorrhage within specific brain regions that are responsible for consciousness and vital function (n = 10). All 100 piglets were rendered immediately insensible withoutreturn to sensibility. On average, clonic convulsions (CC) ceased in 101 s (±7.4 SE), brain death was achieved in 229 s (±9.18 SE), and cardiac arrest occurred in 420 s (±13.57 SE). Time of cardiac arrest differed significantly among stock people when either body weight (BW: P = 0.0053) or body mass index (BMI: P = 0.0059) was used as a covariate. The BMI was inversely related to the duration of CC (P = 0.0227). Moderate to severe hemorrhage severity was reported in 9 of 10 piglets. There was no relationship between FD and BW (P = 0.8408) or BMI (P = 0.6439). Macroscopic analyses indicated moderate to severe hemorrhage and SK in all piglets. No differences were found among brain sections for SDH (P = 0.2302); PH was greater in the cerebral cortex than in the midbrain and brainstem (P = 0.0328). The Zephyr-E NPCB reliably caused immediate, sustained insensibility followed by death in neonatal piglets. Postmortem assessment confirmed that application of the Zephyr-E caused widespread, irreversible brain damage. [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.

There has been substantial debate about whether certain forms of universal moral intuitions "exist"--intuitions that are non-reflective and undefended--and, if so, whether these intuitions have a privileged normative status. This debate arguably has implications for jurisprudential debates about the existence of "natural law." This essay explores the underappreciated homology between one instantiation of the debates about the nature and quality of intuitive "moral" reasoning, and debates, associated with the Heuristics and Biases (H&B) school and the "Fast and Frugal" (F&F) school, about the nature and quality of our capacity to make "self-interested" decisions. [ABSTRACT FROM AUTHOR]

Introduction or background The public assumes that if euthanasia and assisted suicide were to be legalized they would be carried out by physicians. Sources of data In furthering critical analysis, we supplement the discourse in the ethics and palliative care literature with that from medical education and evolving jurisprudence. Areas of agreement Both proponents and opponents agree that the values of respect for human life and for individuals' autonomy are relevant to the debate. Areas of controversy Advocates of euthanasia and assisted suicide give priority to the right to personal autonomy and avoid discussions of harmful impacts of these practices on medicine, law and society. Opponents give priority to respect for life and identify such harmful effects. These both require euthanasia to remain legally prohibited. Growing points Proposals are emerging that if society legalizes euthanasia it should not be mandated to physicians. Areas timely for developing research The impact of characterizing euthanasia as ‘medical treatment’ on physicians' professional identity and on the institutions of medicine and law should be examined in jurisdictions where assisted suicide and euthanasia have been de-criminalized. [ABSTRACT FROM AUTHOR]

In their book Debating Euthanasia, Emily Jackson and John Keown present respectively arguments in favour of and against the legalization of (some instances of) euthanasia and assisted suicide. Jackson advances a case based on a principled commitment to a secular, liberal legal system, arguing that obligations rooted in compassion require the careful development of laws to permit assisted dying. Keown defends the status quo, arguing that the law ought to sustain a prohibition against assisted dying, both out of a principled commitment to the inviolability of life doctrine, and because satisfactory regulation will be impossible to draft. I question the strength of each author’s essay. Jackson, I argue, does not take sufficiently seriously the plausibility of secular moral objections to assisted dying. Keown, meanwhile, overstates the inviolability principle’s place in English law. Focusing particularly on Keown’s essay, I go on to consider the approach taken to ‘debating euthanasia’, and suggest that it betrays more about the direction of the public debate, and the fragility of ‘the case against’, than he would perhaps wish. [ABSTRACT FROM PUBLISHER]

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]

The present ethical advice tackles the question as to how caregivers in a Catholic mental health service can take care of psychiatric patients requesting euthanasia because of their unbearable mental suffering. The question arises because the Belgian act on euthanasia allows euthanasia under certain conditions, while the Roman Catholic Church forbids euthanasia in all circumstances. The ethical advice is based on the assessment of fundamental values: the inviolability of life, the patient’s autonomy, and the care relationship between caregivers and patient. To integrate these values, caregivers should in a timely fashion make clear that life is inviolable, attentively respect the patient’s autonomy, and provide the best possible care relationship, including counseling for existential questions. If the request for euthanasia persists, the only sensible option is to refer the patient to another physician, guaranteeing the continuity of the care relationship. In the tension between the inviolability of life and the patient’s autonomy, the care relationship is the binding value. [ABSTRACT FROM AUTHOR]

The search for alternative methods to euthanize piglets is critical to address public concern that current methods are not optimal. Scientific evidence supports that blunt force trauma is humane when performed correctly, but most people find it visually difficult to accept. The use of C09 is often recommended; at the same time, it is criticized as being aversive to pigs. This research sought to 1) identify a method of scientifically determining if piglets find a gas aversive, using an approach-avoidance test, which relies on the perspective of the piglet, and 2) test different gas mixtures to determine if they are effective and humane for neonatal piglet euthanasia. Pigs were allowed to walk freely between 1 chamber filled with air and another chamber either gradually filled with gas mixtures (Exp. 1) or prefilled with gas mixtures (Exp. 2). Experiment 1 tested C02 (90%) and air (10%), N20 (60%) and CO, (30%), Ar (60%) and C02 (30%), and N2 (60%) and C02 (30%). Because piglets had to be removed when they started to flail, the test was shortest (P <0.01) for the pigs in the C02 treatment compared with pigs in the N2O/C02, Ar/CO2, and N2/C02 treatments, 3.1 ± 0.2, 8.5 ± 0.6, 9.6 ± 0.4, and 9.9 ± 0.1 min, respectively. Nonetheless, all gas mixtures adversely affected the pigs, causing the pigs to leave the test chamber. In Exp. 2, piglets were allowed to enter a chamber prefilled with N2/C02 orN2O/C02 (both 60/30%). Pigs exposed to the prefill chambers started to flail in fewer than 20 s, much faster in comparison with the gradual fill method, which supports that this method was more aversive. In Exp. 3, piglets were euthanized using a 2-step procedure. Pigs were first placed in a gradual fill chamber with 1 of 4 gas mixtures: 90% C02, N2/C02, N2O/C02, orN2O/02 (the last 3 mixtures at 60/30%) followed by placement into a 90% CO? prefill chamber when the pigs started to flail or were anesthetized. All 3 gas treatments that contained C02 killed pigs more quickly than N2O/02 (P < 0.05). However, N2O/02 was the only treatment that anesthetized the pigs instead of causing squeals or flailing although requiring about 12 min longer. Although longer, a 2-step procedure in which pigs are anesthetized with a mixture of N2O and 02 before being euthanized by immersion in C02 may prove to be more humane than CO2 alone. [ABSTRACT FROM AUTHOR]

Background: Belgium legalized euthanasia in 2002. Physicians must report each euthanasia case to the Federal Control and Evaluation Committee. This study examines which end-of-life decisions (ELDs) Belgian physicians label ‘euthanasia’, which ELDs they think should be reported and the physician characteristics associated with correct labelling of euthanasia cases, the awareness that they should be reported and the reporting of them. Methods: Five hypothetical cases of ELDs: intensified pain alleviation, palliative/terminal sedation, euthanasia with neuromuscular relaxants, euthanasia with morphine and life-ending without patient request were presented in a cross-sectional survey of 914 physicians in Belgium in 2009. Results: About 19% of physicians did not label a euthanasia case with neuromuscular relaxants ‘euthanasia’, 27% did not know that it should be reported. Most physicians labelled a euthanasia case with morphine ‘intensification of pain and symptom treatment’ (39%) or ‘palliative/terminal sedation’ (37%); 21% of physicians labelled this case ‘euthanasia’. Cases describing other ELDs were sometimes also labelled ‘euthanasia’. Factors associated with a higher likelihood of labelling a euthanasia case correctly were: living in Flanders, being informed about the euthanasia law and having a positive attitude towards societal control over euthanasia. Whether a physician correctly labelled the euthanasia cases strongly determined their reporting knowledge and intentions. Conclusion: There is no consensus among physicians about the labelling of euthanasia and other ELDs, and about which cases must be reported. Mislabelling of ELDs could impede societal control over euthanasia. The provision of better information to physicians appears to be necessary. [ABSTRACT FROM PUBLISHER]

Background. In the Netherlands, GPs performed euthanasia or physician-assisted suicide (EAS) in ∼1 of 10 end-of-life cancer patients in their care. Of all explicit requests for EAS directed at GPs, ∼44% resulted in EAS. However, the suffering of patients who do and do not request EAS has never been studied. An important barrier for such research is the low prevalence of end-of-life cancer patients per practice (on average two/year). We studied whether it is possible to recruit end-of-life cancer patients, following-up for requests for EAS (if any), in an interview study in general practice, whether selection occurred and which were the threats and opportunities to recruitment. Our target was to recruit at least 50 patients.Methods. Characteristics of all eligible patients were monitored.Results. One in every three eligible patients were recruited by 44 GPs in a 3-year inclusion period, resulting in 64 patients in the interview study with follow-up until death. The prevalence of explicit requests for EAS was higher (27%; P = 0.026) in the interview sample, and the presence of a depressed mood according to the GP was lower (5%; P = 0.013) than in the sample with eligible but not participating patients.Conclusions. Recruitment of slightly more than the minimal target number of end-of-life cancer patients in this study in general practice was realized. Monitoring of all eligible patients permitted to evaluate the selection which occurred. Recruitment through GPs who were direct professional colleagues of one of the researchers was a positive recruitment factor. [ABSTRACT FROM AUTHOR]

The author discusses euthanasia in India and the Indian Supreme Court case of Aruna Ramchandra Shanbaug v. Union of India which the court decided on the legality of euthanasia of a person with non-progressive irreversible brain damage. Information is provided on the legal meaning of the word "dead" interpreted by Indian courts.

Sporadic inclusion body myositis is considered to be a slowly progressive myopathy. Long-term follow-up data are, however, not yet available. Follow-up data are important with a view to informing patients about their prognosis and selecting appropriate outcome measures for clinical trials. We performed a follow-up study of 64 patients with sporadic inclusion body myositis who participated in a national epidemiological study in the Netherlands. Case histories were recorded, and manual and quantitative muscle tests as well as laboratory tests were performed at baseline and 12 years (median) after the first out-patient visit. Date and cause of death were recorded for all deceased patients. Forty-six patients died during the follow-up period, two patients chose not to participate and one patient was lost to follow-up. The remaining 15 surviving patients had a mean disease duration of 20 years and were clinically evaluated at the second time point. The mean decline in strength was 3.5 and 5.4% per year according to the manual muscle testing and quantitative muscle testing, respectively. This decline was most pronounced in the lower legs, which were also the weakest extremities. Life expectancy was normal at 81 years, but activities of daily life were clearly restricted. At follow-up, all patients were found to be using a wheelchair, seven of them (47%) being completely wheelchair-bound. Disorders of the respiratory system were the most common cause of death. In three patients, euthanasia was requested and in another three, continuous deep sedation was applied. The fact that end-of-life care interventions were used in six patients (13%) reflects the severe disability and loss of quality of life at the end stage of this disease. Sporadic inclusion body myositis is a chronic progressive disorder, leading to major disabilities at the end stage of the disease due to extensive muscle weakness. [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 implications of Pope John Paul II's 2004 Allocution on vegetative states remain unclear despite dozens of articles and a recent clarifying statement from the Vatican. Yet few have considered its implications for those with end-stage progressive dementia, such as Alzheimer's disease. Although recent studies suggest tube feeding is burdensome and not beneficial for such patients, the Allocution would nonetheless seem to forbid patients from forgoing it. But this seems to be in tension with the Catholic bioethical tradition as a whole and may therefore be a consequence that the pope did not intend. Because the recent Vatican clarification specifically addresses Alzheimer’s, it is especially important to know what duties it intends to impose on those with dementia. Problems with how it would apply to such patients casts doubt on whether it should be applied to patients in vegetative states at all. [ABSTRACT FROM PUBLISHER]

Decisions about withdrawing or continuing life-sustaining treatments are often not made in a reasoned manner: those who must make the decisions are often not sure what would constitute an upright decision and, therefore, doubt the correctness of the decisions they have made or are about to make. Making use especially of what Thomas Aquinas says about omissions (i.e., omitting to do something), this article attempts to establish some principles regarding when and why one might (and might not) morally withdraw life-sustaining treatments, regarding the grounds on which a family might resist a doctor's decision to withdraw treatment (or a doctor the family's wishes) and regarding other related issues. [ABSTRACT FROM PUBLISHER]

J. L. A. Garcia holds that my defense of voluntary euthanasia in an earlier paper amounts to an “assault on traditional common sense” about what medical ethics permits physicians to do, particularly insofar as I hold that a physician's duty to abstain from intentionally killing is only a defeasible duty, not an unconditional one. But I argue here that it is Garcia's views that are more at odds with common sense, and that voluntary euthanasia is in fact a humane alternative that respects patient autonomy and is consistent with the most fundamental moral duties of physicians. Among these is a duty to relieve suffering, which can sometimes outweigh the fundamental duty to conserve life. [ABSTRACT FROM PUBLISHER]

The article presents a case study on the determination of quaternary ammonium compound mebezonium as an active ingredient in T61, a euthanasia drug. It states the use of liquid chromatography-tandem mass spectrometry (LC-MS-MS) method and solid-phase extraction (SPE) to detect mebezonium and other active ingredients in T61 such as xylazine and analgesics. It relates on suicide cases, wherein T61 was injected. It shows that LC-MS-MS with SPE let quantitative detection of mebezonium.

The gap between Christian and secular bioethics appears to be widening, and inevitably so. In this essay, I identify four areas in which the differences between Christian and secular bioethics are significant, and in light of which secular bioethics, by its inability to attend to key concerns of Christian thought, will inevitably continue to marginalize the latter. How Christian bioethicists should view this marginalization will be the subject of the final section of this paper. [ABSTRACT FROM PUBLISHER]

The article discusses various papers published within the issue including "Commentary on the Concept of Brain Death Within the Catholic Bioethical Framework," "Suffering in the Context of Euthanasia and Assisted Suicide: Transcending Job Through Wojtyla's Anthropology," and "A Review and Taxonomy of Argument-Based Ethics Literature Regarding Conscientious Objections to End-of-Life Procedures."