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Two revolutionary developments impacted the United States criminal justice system over the past 30 years that are now primed for an institutional reckoning—the legalization of medical marijuana at the state level and the exponential rise of adult drug treatment courts across the country. The states that have legalized medical marijuana also provide criminal immunity protections for qualifying medical marijuana patients, including those serving probationary sentences. Drug treatment courts are a form of intensive probation offering treatment services for participants plagued by substance use disorders. Most drug treatment courts operate on an abstinence‐based model and do not permit the use of medical marijuana. Consequently, challenges by drug court participants to the continued prohibition of medical marijuana are on the horizon. The purpose of this article is to highlight the contours of these knotty issues from a sociolegal perspective. The material for this article stems from a review of existing judicial decisions in addition to qualitative data collected during my case studies of three different adult drug treatment courts. [ABSTRACT FROM AUTHOR]

Colombia was one of the first countries to decriminalise euthanasia. However, what is known in the international academic literature about the country's regulations is scarce and outdated. Such lack of information on the situation in Latin America is even more evident in the case of Peru, where the Lima Superior Court of Justice set a precedent by allowing a person to have access to euthanasia in 2021. Ecuador, which has just decriminalised euthanasia for all its citizens in February 2024, risks being similarly absent from the international dialogue. This article summarises for the first time all the regulations in force regarding euthanasia in Latin America, through a study of primary sources in Spanish, and analyses some of the convergences between these three neighbouring countries. [ABSTRACT FROM AUTHOR]

This article starts by examining the present state of death ethics by attending to the euthanasia debate. Given that voluntary active euthanasia has seen strong support in the academic community, insights on the choiceworthiness of continued existence may be derived. Having derived cases of choiceworthy nonexistence (which I refer to as choiceworthy nonexistence [CNE] cases), I extend these intuitions to lives not worth starting, or choiceworthy nonexistence for potential people (which I refer to as foetal‐CNE, or fCNE cases). Although I depart from Benatarian antinatalism by rejecting Benatar's claim that all existence is necessarily a harm, I posit a weaker argument that all existence is likely a harm since we cannot know until later in life if an existence is a harm. If I am right, then we have prudential reasons not to bear children, since they are more likely to suffer in lives not worth living than not. [ABSTRACT FROM AUTHOR]

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

Background: In the context of nationwide law reform, New South Wales (NSW) became the last state in Australia to legalise voluntary assisted dying (VAD) – commencing 28 November 2023. Clinicians have divergent views regarding VAD, with varying levels of understanding, support, and willingness to be involved, and these may have a significant impact on the successful implementation. Aims: To understand levels of support, understanding and willingness to be involved in VAD among clinical staff across NSW during implementation of VAD. Methods: A multisite, cross‐sectional online survey of clinicians across four local health districts, assessing relevant demographics, awareness of and support for VAD legislation and willingness to be involved in different levels of VAD‐related clinical activities. Results: A total of 3010 clinical staff completed the survey. A majority of participants were aware of VAD legislation in NSW (86.35%) and supportive of it (76%), with nursing and allied health clinicians significantly more likely than medical specialists to express support. Among medical specialists, support was statistically more likely in those who did not care for patients at the end of life and those with limited knowledge of the legislation. Willingness of medical specialists to perform key roles was significantly lower, with 41.49% willing to act in coordinating or consulting roles, and only 23.21% as administering practitioners. Conclusions: The majority of clinical staff surveyed across NSW supported VAD legislation. While many eligible clinicians were reluctant to be actively involved, sufficient numbers appear willing to provide VAD services, indicating that successful implementation should be possible. [ABSTRACT FROM AUTHOR]

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

Through an innovative interspecies analysis, this article explores narratives surrounding the medical treatment of humans and pet animals at the end of life among U.K. veterinary surgeons, medical practitioners, and members of the public. Contrasting the care options open to pet owners with those available to human patients, and through a thematic focus on treatments and medicines, euthanasia, and palliation, this article pays close attention to the ways that practitioners and members of the public make sense of—and express ideas about—interspecies family kinship at the end of life. We highlight the utility of interactionist approaches for understanding microsocial human‐animal kinship ties and argue that health policy and practice during end‐of‐life care should better reflect the lived reality of the multispecies family. In so doing, we highlight the significance and complexities of interspecies conversations for the development of contemporary end‐of‐life care debates. [ABSTRACT FROM AUTHOR]

The article focuses on the complexities of managing death and dying in emergency departments (EDs), highlighting changes in societal attitudes towards death, challenges faced by ED clinicians, and the spectrum of death and dying experiences in EDs. Topics include the transition of death from home to healthcare facilities, the impact of medical advancements on end-of-life care, and the challenges and learning opportunities associated with unexpected deaths in EDs.

Although considerable gains in survival have been observed in developed countries, particularly in the last stretch of life, part of these additional years of life are lived in bad health. In this context, a number of actions/inactions that limit or may limit life span are becoming increasingly common. Demography and quantitative sociology are well‐positioned to make a significant contribution to the measurement of the consistency of different end‐of‐life interventions, to the examination of differences over time, space and among different social groups, and to the analysis of the behaviors and attitudes of different stakeholders (the sufferers, their relatives, health care personnel, public opinion). We focus here on euthanasia and assisted suicide (EAS). First, we discuss changes in public opinion on EAS in developed countries. Second, we analyze the diffusion and temporal trends of EAS, with a particular focus on Switzerland, the Netherlands, and Belgium; three countries for which it is also possible to consider the connections between the diffusion of EAS and palliative care. Third, we consider several differential aspects of the spread of EAS (mainly by sex, age, and cause of death). [ABSTRACT FROM AUTHOR]

Background: Clients want to know the ultimate cause of death in their pet after cancer treatment. The cause of euthanasia and investigation of urinary obstruction in treated dogs with urothelial carcinoma (UC) has not been specifically reported in veterinary literature. Hypothesis/Objectives: Our hypothesis was that the majority of treated dogs with UC are euthanized secondary to primary tumor factors, such as urinary obstruction. Animals: Fifty‐nine client‐owned dogs diagnosed with UC. Methods: Retrospective observational study on clinical signs and disease at euthanasia of dogs with UC treated by radiation therapy or chemotherapy or both. Results: The median overall survival time (OST) of all dogs was 339 days (range, 17‐1996; 95% confidence interval [CI], 185‐392; interquartile range [IQR], 112‐505). Of dogs deemed to have been euthanized because of UC (50/59, 85%), the primary cause was considered to be local progression in 31/50 (62%), most often because of perceived complete or partial urinary obstruction (24/31, 77%). No variables were found to be predictive of urinary obstruction. The overall documented metastatic rate was 56%. In dogs euthanized because of UC, metastasis was deemed to be the cause in 19/50 (38%) dogs. Conclusions and Clinical Importance: Regardless of the type of treatment, UC in dogs has a poor prognosis and there is a continuing need to improve treatments that focus on local control of the primary tumor, given its high contribution to the decision for euthanasia. Proactive management to avoid the high frequency of urinary obstruction may be worthy of future investigation. [ABSTRACT FROM AUTHOR]

Background: Immune‐mediated polyarthritis (IMPA) is a well‐recognised disease in dogs, but studies evaluating the response rates, relapse rates and long‐term outcomes are scarce. Objectives: To provide an updated description of the signalment, clinical signs, clinicopathological findings, distribution between subgroups, rates of response and relapse and long‐term outcome of 84 dogs diagnosed with IMPA at a single referral hospital. Methods: Dogs diagnosed with IMPA between January 2011 and December 2021 were identified. Dogs with neutrophilic inflammation in ≥2 joints were included. Cases with <1 month of follow‐up, or those missing pertinent data, were excluded. Results: A total of 84 cases were included. An initial response was achieved in 77/84 (92%) cases. Of the cases that initially responded, 37/77 (48%) suffered at least one relapse and 18/77 (23%) suffered multiple relapses. Indefinite treatment was recommended in 17/84 (20%) cases. Of the 70 dogs for which at least 12 months of follow‐up data were available, 12/70 (17%) were euthanised due to IMPA or for unknown reasons. Conclusion: IMPA carries a fair prognosis, but relapses occur in many cases and euthanasia due to relapsing or refractory disease is not uncommon. [ABSTRACT FROM AUTHOR]

Background: This is the second article in a two‐part series on tortoise health, and focuses on two areas of significant clinical concern: reproductive and respiratory diseases. Although both common, the clinical presentation of these conditions in tortoises varies greatly from that of more familiar domestic mammal patients. The first part of the series was published in the January/February 2024 issue of In Practice and covered husbandry and husbandry‐related diseases. Aim of the article: This article outlines further clinical conditions commonly seen in captive tortoises and their aetiopathogenesis, diagnosis and management. Euthanasia technique is also discussed and is a procedure which is possible to be carried out in any veterinary clinic where welfare of a tortoise is significantly compromised. [ABSTRACT FROM AUTHOR]

This article focuses on the complex aspects of veterinary euthanasia and aims to highlight the emotional, ethical and logistical challenges of euthanasia in veterinary practice. It advocates for compassionate and consistent euthanasia protocols to improve experiences for pets, owners and veterinary teams, and stresses the importance of understanding and respecting the diverse views within veterinary teams regarding euthanasia. This article also details the considerations in selecting and administering euthanasia protocols for a stress‐free and painless procedure and addresses the need for aftercare and support for both pet owners and veterinary teams after euthanasia, including external grief support resources. [ABSTRACT FROM AUTHOR]

Background and Aims: Euthanasia is a controversial issue related to the right to die. Although euthanasia is mostly requested by terminally sick individuals, even in societies where it is legal, it is unclear what medical conditions lead to euthanasia requests. In this scoping review, we aimed to compile medical conditions for which euthanasia has been requested or performed around the world. Methods: The review was preferred reporting items for systematic reviews and meta‐analysis for scoping reviews (PRISMA‐ScR) checklist. Retrieved search results were screened and unrelated documents were excluded. Data on reasons for conducting or requesting euthanasia along with the study type, setting, and publication year were extracted from documents. Human development index and euthanasia legality were also extracted. Major medical fields were used to categorize reported reasons. Group discussions were conducted if needed for this categorization. An electronic search was undertaken in MEDLINE through PubMed for published documents covering the years January 2000 to September 2022. Results: Out of 3323 records, a total of 197 papers were included. The most common medical conditions in euthanasia requests are cancer in a terminal phase (45.4%), Alzheimer's disease and dementia (19.8%), constant unbearable physical or mental suffering (19.8%), treatment‐resistant mood disorders (12.2%), and advanced cardiovascular disorders (12.2%). Conclusion: Reasons for euthanasia are mostly linked to chronic or terminal physical conditions. Psychiatric disorders also lead to a substantial proportion of euthanasia requests. This review can help to identify the features shared by conditions that lead to performing or requesting euthanasia What is already known about the topic?: Euthanasia is a challenging issue that has sparked numerous controversies around the world over the past decades.There is no consensus about the criteria or guidelines that have been set for identifying a patient eligible for euthanasia in different countries. What this paper adds?: To our knowledge, this is the first scoping review to systematically list and categorize published records of euthanasia requests around the world into five broad groups.We provide a picture of all euthanasia requests' frequencies in each broad group.This study facilitates informing scientists and researchers about the trends of euthanasia requests during different years and in different countries around the world. How this study might affect research, practice, or policy?: This review can provide information to help clinicians and health policymakers to reach a more precise decision about the acceptance or the rejection of requests made by patients.This review informs readers about all medical conditions that increase the likelihood of requesting euthanasia. Researchers should consider these conditions and conduct further research on each condition in detail. [ABSTRACT FROM AUTHOR]

This article discusses the distinction between voluntary assisted dying and advance care planning in the context of end-of-life care discussions in Australia. It highlights the importance of incorporating voluntary assisted dying into advance care planning programs and practices, as it is now legal in all Australian states. The article emphasizes the need for training health practitioners to navigate discussions about voluntary assisted dying and adapt existing policies and guidelines. It also mentions the availability of resources and services to support health practitioners in these discussions. The authors stress the importance of a patient-centered approach that respects individuals' values and preferences. [Extracted from the article]

Scholarly interest in political secularism is currently growing. Political secularism is not the absence of religious belief, membership or practice, but the conviction that politics and religion should be kept separate and that religious arguments should have no standing in political debates. Little is known about the roots of this attitude, particularly outside the United States. This is unfortunate because politically secular attitudes strongly affect citizens' views on so‐called morality policies (e.g. the regulation of abortion, assisted suicide or experiments with stem cells) which are often highly controversial. In this research note, I focus on the link between political secularism and basic human values. From Schwartz's own work and from the extant literature on religion, secularism and basic human values, I derive two hypotheses: self‐direction should be linked to higher levels, and tradition should be linked to lower levels of political secularism. Multivariate analysis of current survey data from Germany, a prototypical 'religious‐world country', supports both hypotheses. Crucially, the relationships hold when controlling for three main facets of religion, for region (east vs west), and for socio‐demographics. The results show that net of their well‐documented association with religion, basic human values contribute to our understanding of political secularism. More generally, the findings demonstrate once more the impact of basic human values on all areas of political life. [ABSTRACT FROM AUTHOR]

Objective: This paper examines neurologists' approaches to exit strategies (ESs), such as euthanasia and physician‐assisted suicide, in patients with amyotrophic lateral sclerosis (PALS) in two European countries. Methods: In a nationwide anonymous survey, we collected responses from 237 Polish and 228 German neurologists, focusing on their practices and beliefs about ESs, as well as their viewpoints on life‐sustaining measures (LSMs) (percutaneous endoscopic gastrostomy, non‐invasive, and invasive ventilation). To analyze the data, we employed statistical methods, including Mann–Whitney U, Kruskal–Wallis, chi‐square tests, Spearman's rank correlation, and multiple regression analysis. Results: One third of the neurologists initiated the discussion about ESs with PALS. Half were ready to have this conversation upon patient's request. Age, gender, religiousness, and nationality were closely associated with this approach. One in 9 neurologists received a request to terminate an LSM, whereas 1 in 10 to implement an ES. German neurologists and palliative care trainees acquired both demands more commonly. Neurologists quoted a low quality of life, decreased mood, and being a burden to the family/closest ones as primary reasons for a wish to hasten death among PALS. Although the majority expressed a willingness to terminate an LSM at a request of the patient, most opposed the legalization of euthanasia. Younger and less religious individuals were more likely to favor accepting euthanasia. Conclusion: Neurologists vary significantly in their approaches to terminal care. Complex relationships exist among personal indices, shared beliefs, and current practices. [ABSTRACT FROM AUTHOR]

According to the "discrimination argument," it would be discriminatory and hence impermissible to categorically exclude people with mental illness (PMI) from access to assisted suicide (AS) if AS is accessible to people with somatic illnesses. In objection to this, it could be argued that excluding PMI is not discriminatory, but rather based on their inability to meet certain eligibility criteria for AS. Which criteria are deemed necessary depends on the approach taken to justifying AS. In this article, we describe two distinct ethical approaches to justifying AS and the eligibility criteria they entail and examine whether PMI can fulfill these criteria. A widespread "joint" approach based on beneficence and autonomy assumes that AS is justified when it alleviates the severe and irremediable suffering of a person who autonomously requests AS. An alternative, exclusively autonomy‐based approach assumes that providing AS is justified when a person's request is autonomous, regardless of whether AS is in her best interests. The latter approach underlies an important judgment of the German Federal Constitutional Court from 2020. We argue that PMI can in principle fulfill both beneficence‐ and autonomy‐based eligibility criteria for AS, and that a blanket exclusion of all PMI from AS is thus discriminatory on either approach. However, depending on which approach is taken, there are differences regarding the subgroups of PMI that would be eligible for AS. Whether the exclusion of specific PMI is discriminatory therefore depends on how we understand and justify AS. [ABSTRACT FROM AUTHOR]

The article explores the potential extension of voluntary assisted dying (VAD) laws in Victoria, Australia to include people with dementia. It discusses the ethical, philosophical, and social questions raised by this extension, such as defining eligibility criteria and assessing suffering in individuals with impaired decision-making capacity. The article emphasizes the importance of maintaining the legitimacy and social consensus of the existing VAD framework and highlights the need for a balanced approach to avoid exacerbating social divisions. It suggests that a renewed social debate and a harmonized national legislative framework are necessary to address the challenges associated with VAD in dementia. [Extracted from the article]

Objectives: Multifocal renal masses and large central‐endophytic tumors can be challenging for partial nephrectomy (PN) due to the paucity of capsule remaining after tumor removal. Our objective was to develop a neocapsule to provide tamponade and test its feasibility/safety in a porcine model. Methods: Eight live pigs (50–70 kg) underwent unclamped open right flank PN. Renal defects were 1 cm deep and had moderate ongoing venous bleeding. A 6 × 9 inch sheet of Nu‐knit® was used for neocapsular reconstruction with Fibrillar™ packing to provide modest tamponade and preclude ongoing bleeding. Blood chemistry and hemoglobin (Hb) levels were drawn preoperatively and postoperative Days 3/5/8. On postoperative Day 8, euthanasia was performed, and both kidneys were inspected and analyzed for histologic changes. Results: PN defects ranged from 1 × 1 × 1 cm to 4 × 2 × 1 cm; four pigs had PN performed in both poles and four in one pole. Neocapsular reconstruction was successful (n = 8), with no perioperative complications. Median baseline Hb was 10.4 g/dL, and median Hb postoperative Days 3/5/8 were 10.0/10.8/10.6 g/dL, respectively. Median baseline serum creatinine (SCr) was 1.9 mg/dL, and median SCr postoperative Days 3/5/8 were 1.5/1.4/1.5 mg/dL, respectively. At sacrifice, no significant hematomas were observed. Other than adjacent to the PN site, there were no significant histologic changes in the parenchyma for operative kidneys versus controls. Based on our experience, we recently performed neocapsular reconstruction safely/effectively after extensive PN for multifocal tumors and for an allograft with difficult‐to‐manage subcapsular hematoma. Conclusions: Neocapsular reconstruction after PN or capsular trauma appears feasible and safe and may be considered to reduce the risk of perioperative bleeding. However, further study will be needed to confirm the utility/efficacy of this approach. [ABSTRACT FROM AUTHOR]

Introduction: Voluntary assisted dying (VAD) is increasingly being legalised internationally. In Australia, all six states have now passed such laws, with Victoria being the first in 2019. However, early research in Victoria on the patient experience of seeking VAD shows that finding a connection to the VAD system is challenging. This study analyses the causes of this 'point of access' barrier. Methods: We conducted semi‐structured qualitative interviews with family caregivers and a person seeking VAD, with participants recruited via social media and patient interest groups. Data were thematically analysed. We also undertook documentary analysis (content and thematic) of publicly available reports from the oversight body, the Voluntary Assisted Dying Review Board. Results: We interviewed 32 family caregivers and one patient across 28 interviews and analysed six Board reports. Finding a point of access to the VAD system was reported as challenging in both interviews and reports. Four specific barriers to connecting with the system were identified: (1) not knowing VAD exists as a legal option; (2) not recognising a person is potentially eligible for VAD; (3) not knowing next steps or not being able to achieve them in practice; and (4) challenges with patients being required to raise the topic of VAD because doctors are legally prohibited from doing so. Conclusion: Legal, policy and practice changes are needed to facilitate patients being able to find a connection to the VAD system. The legal prohibition on doctors raising the topic of VAD should be repealed, and doctors and institutions who do not wish to be involved in VAD should be required to connect patients with appropriate contacts within the system. Community awareness initiatives are needed to enhance awareness of VAD, especially given it is relatively new in Victoria. Patient or Public Contribution: Families and a patient were the focus of this research and interviews with them about the experience of seeking VAD were the primary source of data analysed. This article includes their solutions to address the identified point of access barriers. Patient interest groups also supported the recruitment of participants. [ABSTRACT FROM AUTHOR]

Medical technology has made tremendous strides in extending the lives of patients who have suffered organ failure. Machines can now replace the function of the kidneys, the heart, and other vital organs. Much has been written about a patient's right to refuse or direct the withdrawal of medical treatment, especially at the end of life, under the guise of "death with dignity." However, little attention has been paid to the situation where a patient elects to deactivate their life‐sustaining medical device without a physician's involvement. This raises the challenging question of whether the patient's manner of death should be classified as suicide or natural. Surprisingly, common law, statutes, medical ethics, and public health practice are not in alignment on the answer. This article will explore the ramifications and far‐reaching impact that such divergence has on the survivors and the medical community, as well as recommend corrective actions and practical approaches for the medical and legal practitioner. [ABSTRACT FROM AUTHOR]

Background: With over 1060 species reported and a considerable number of these kept in captivity, theraphosid spiders, also known as tarantulas, have become a significant part of private and zoological collections, hence necessitating a greater demand for veterinary expertise. Aim of the article: This comprehensive review addresses the unique challenges in tarantula care. It delves into the application of diagnostic tools like histology, radiography, haematology and microbiology in tarantulas, and discusses how to gather clinically relevant data for effective treatment planning of common conditions. It also outlines adaptations to cater treatments to tarantulas' unique anatomy, and offers guidance on drug selection and veterinary procedures, as well as covering humane euthanasia methods. [ABSTRACT FROM AUTHOR]

Canadian nursing practice has been profoundly influenced by the legalization of medical assistance in dying in 2016, requiring that nurses navigate new and sometimes highly challenging experiences. Findings from our longitudinal studies of nurses' experiences suggest that these include deep emotional responses to medical assistance in dying, an urgency in orchestrating the perfect death, and a high degree of relational impact, both professionally and personally. Here we propose a theoretical explanation for these experiences based upon a relational ontology. Drawing upon the work of Wildman, we understand a relational ontology to be one in which relationships are more fundamentally central than the conceptual entities that provide the context to practice. It is in a relationship that conceptual entities, and their affiliated values, are created and recreated. Seen as causal, relationships have ontological status, with important implications for how we consider the concepts of death, suffering, and time in this context. From a conceptual perspective, suffering is primarily self‐defined based upon personal histories, time reflects the potential remaining until death, and death is primarily biological and amoral, although social discourses of a good and bad death surround the death trajectory. However, within a relational ontology of medical assistance in dying, these understandings shift. Death becomes primarily social rather than biological, suffering is shared, and time until death is now clearly delimited. Accordingly, nurses assume a profound responsibility for influencing outcomes that are authentically person‐centered. These understandings provide important insights into nurses' experiences, enabling us to recognize the causal effects, both intended and unintended, of nurses' relational practices amidst the complexities of assisted death. Drawing on such a perspective, we find implications for how we provide spaces for nurses to reflect on, and have conversations about, their experiences with some of the greatest mysteries of life—death, suffering, and time. [ABSTRACT FROM AUTHOR]

Introduction: This study explores the assessments of mental health clinicians working with suicidal patients who requested access to medical assistance in dying (MAiD). Methods: A sample of convenience completed an online questionnaire about their experiences with suicidal patients. Respondents described their encounters with 227 suicidal patients: 44 requested access to MAiD, and 183 did not. Data were analyzed using chi‐squared and simple t‐test to identify differences between the respondents' descriptions of the two groups. Results: Results noted differences between patients who experience suicide ideation and request MAiD (SPM), and those who experience suicide ideation and do not (SP). Overall, the SPM group was older, more physical health concerns, chronic pain, existential distress, and less hope. Many had experienced several episodes of mental health care and medication trials, though unlike the SP group, they had a split between accessing a little care and a lot of care. They also engaged in less suicide planning, and some had no history of suicide attempts. Conclusion: It is important that mental health clinicians learn to differentiate between MAiD requests due to an ongoing and irremediable mental disorder, and MAiD requests in response to circumscribed psychological suffering that could be relieved via a change in circumstances and/or access to different treatment options amenable to the patient. [ABSTRACT FROM AUTHOR]

Although the domestic cat Felis catus is implicated in multiple faunal extinctions and threatens many extant species, there is widespread, well‐funded advocacy for desexing unowned cats near human habitation and returning them to site to be fed by volunteers, arguing that this prevents euthanasia, is unlikely to be hazardous to wildlife or a public health risk, and controls non‐native rodents. To the contrary, we present unequivocal evidence that this approach harms cat welfare, does threaten wildlife and public health, and exacerbates rather than controls rodent problems. We argue instead that unowned cats near human habitation can be controlled effectively by intensive adoption and responsible euthanasia when necessary, supported by licensing and containment of adopted/owned cats. [ABSTRACT FROM AUTHOR]

This article makes important contributions to governance research by studying the implementation of policies with high potential for goal incongruence between intermediaries and regulators. Building on a regulatory intermediation framework and prevailing theories from organizational institutionalism, we propose an original typology that classifies intermediaries' strategies for coping with challenging regulations. Furthermore, we explain the choice of these strategies based on intermediaries' value systems, the degree of interdependency with the regulator, and policy ambiguity. The empirical strategy is based on the case of Catholic, Protestant, and Muslim religious organizations engaged in the implementation of abortion and euthanasia policies in Belgium. These latter constitute a typical case of policy implementation that prompts value conflicts between permissive official regulations and intermediaries' conservative values on life‐and‐death issues. [ABSTRACT FROM AUTHOR]

Empirical assessment of cetacean welfare to inform stranding interventions is lacking. Here, potential welfare indicators are described for two stranded pygmy killer whales (Feresa attenuata), along with euthanasia procedures and pathology of potential relevance. The animals were filmed for 3.5 and 1.5 hr, respectively, allowing assessment of 19 indicators, including animal behaviors and human interventions. Eight interventions and 19 animal behaviors were identified; 17 and 11 behaviors were displayed by animal 1 and 2, respectively. Examination of ballistics euthanasia revealed atypical projectile placement and characterized animal behavioral responses, but welfare implications could not be assessed as insensibility was not verified in-field. Pulmonary edema and renal degeneration were documented in both animals; differential etiologies include ischemia-reperfusion, shock, and/or myopathy. Potential relationships among histopathology and welfare indicators are explored to infer affective experiences. For example, simultaneous head-lifting with respiration increased over time which, alongside pulmonary edema, suggests these animals experienced breathlessness. Other likely affective states include fatigue and discomfort; there are insufficient data to estimate the intensity or duration of these experiences or to provide an overall welfare grade/score. Further data are required to validate the proposed welfare indicators and to progress development of holistic approaches to welfare assessment at cetacean strandings. [ABSTRACT FROM AUTHOR]

Many healthcare providers think withholding food and fluids from advance dementia patients, even if those patients requested that when competent, is immoral. This means such patients suffer unnecessarily long. Patients have the ethical right when capacitated to specify that they want assistance with food and drink stopped when they have advanced dementia. Physicians should implement these patient choices when advance dementia patients can no longer feed themselves. In some states there may be legal barriers to this practice. The perpetual placement of food and drink within reach of patients who are unable to feed themselves is futile, so there is no need for it. The best way for persons concerned about suffering in advanced dementia is to add a supplement to one's advance directive specifying under what circumstances one wants food and fluids assistance stopped. [ABSTRACT FROM AUTHOR]

Objectives: To investigate barriers to and facilitators of access to voluntary assisted dying in Victoria under the Voluntary Assisted Dying Act 2017 (Vic). Design, setting, participants: Qualitative study; semi‐structured interviews with people who had applied for voluntary assisted dying or their family caregivers, recruited via social media and interested advocacy groups; interviews conducted 17 August – 26 November 2021. Main outcome measures: Barriers to and facilitators of access to voluntary assisted dying. Results: We interviewed 33 participants about 28 people who had applied for voluntary assisted dying; all but one of the interviews were with family caregivers after their relatives' deaths, and all but three were conducted via Zoom. The major barriers to access identified by participants were finding trained and willing doctors to assess eligibility for voluntary assisted dying; the time required for the application process (especially given how ill the applicants were); the prohibition of telehealth consultations; institutional objections to voluntary assisted dying; and the prohibition of health practitioners raising voluntary assisted dying with their patients. The major facilitators mentioned were care navigators (both the Statewide service and local navigators); finding a supportive coordinating practitioner; the Statewide Pharmacy Service; and system flow once the process had been initiated (although not during the early days of voluntary assisted dying in Victoria). Access was particularly difficult for people in regional areas or with neurodegenerative conditions. Conclusions: Access to voluntary assisted dying has improved in Victoria, and people generally felt supported while navigating the application process once they found a coordinating practitioner or a navigator. But this step, and other barriers, often still made patient access difficult. Adequate support for doctors, navigators and other facilitators of access is vital for the effective functioning of the overall process. [ABSTRACT FROM AUTHOR]

Objectives: Medical Assistance in Dying (MAiD) has been legal in Canada since June 2016. A person can receive MAiD if their suffering cannot be relieved under conditions that they consider acceptable. Informed consent requires that the person requesting MAiD has received all the information needed to make their decision; that is, medical diagnosis and prognosis, available treatments including palliative care. The evaluation of unbearable suffering is known to be challenging as suffering is often psychological, existential, and social in nature. While interventions to relieve suffering exist, it is unclear how suffering is assessed and addressed in the literature on MAiD practice. No scoping review exists on the topic in Canada. The aim of this study was to understand how the concept of suffering was approached within the Canadian MAiD grey (GL) and scientific (peer‐reviewed) literature (SL), specifically: 1‐ How suffering is defined and assessed in the context of MAiD in Canada and 2‐ Which interventions in response to suffering are recommended within the process of obtaining informed consent for MAiD and throughout the process of MAiD itself. Methods: A scoping review was conducted based on PRISMA‐SR guidelines. SL articles (N = 1027) were identified from a review of 6 databases and GL documents (N = 537) were obtained from the provinces of Quebec, Ontario and British Columbia. Documents were analyzed using NVivo with coding by two‐raters and continuous team discussions. Results: A multidimensional definition of suffering, akin to the concept of total pain, is used. The assessment of suffering is based upon patients' reports. Tools to aid in the assessment are not comprehensively covered. Specific interventions to address suffering were often focused on active listening and the management of physical symptoms. No specific interventions were mentioned and there was no reference to clinical practice guidelines in the grey literature to address other components of suffering. The use of a multidisciplinary approach is suggested without specifying the nature of involvement. Conclusions: Our review indicates that published guidelines of MAID assessments could include clearer structure around the assessment and management of suffering, with suggestions of tools that may help clarify types of suffering and reference to clinical practice guidelines and interventions to holistically attend to patient suffering with an attention on non‐physical symptoms. Guidelines would benefit from clearer explanations of how members of an interdisciplinary teams could be coherently coordinated. [ABSTRACT FROM AUTHOR]

Magnesium chloride in high concentration is used for euthanasia of jellyfish to limit overpopulation and for predatory species consumption, but its use could lead to magnesium bioaccumulation and subsequent negative effects in consumers. Two species of scyphozoan jellyfish (Cassiopea andromeda and Aurelia aurita) were subjected to freezing (control), or magnesium chloride baths (144 g/L), with subsequent 30 min baths (one or two) in fresh artificial saltwater and submitted for inductively coupled plasma analysis to determine tissue concentration. Frozen jellyfish consistently yielded the lowest magnesium concentrations, while magnesium chloride euthanized individuals contained the highest concentrations in both species. C. andromeda displayed a significantly higher (p <.05) magnesium absorption capacity than A. aurita in both trials. Single and double baths significantly decreased magnesium concentrations (p <.05) in both species, however, magnesium remained consistently elevated compared to frozen specimens. This study demonstrated species‐specific magnesium accumulation in jellyfish posteuthanasia and that rinsing was an effective method to limit excessive magnesium that could be deleterious to animals in public display aquaria. Magnesium concentrations of tissue and receiving water should be tested if magnesium chloride euthanasia is utilized for dietary supplementation in small bodies of water. [ABSTRACT FROM AUTHOR]

Objective: To assess how families are involved in situations of euthanasia or physician assisted suicide (PAS) in dementia. Design: Systematic review searching literature in nine databases from inception up to October 2021. We included studies on family involvement in euthanasia from the perspective of persons with dementia and family caregivers. Themes were formulated through thematic analysis. The design was registered at Prospero (CRD42022298215). Results: We assessed 215 of 4038 studies in full text; 19 met the inclusion criteria of which 13 empirical studies. Themes included for people with dementia: being a burden; stage of dementia, and permissibility of euthanasia/PAS. Themes for family were the burden of care, responsibility toward the euthanasia or PAS wish, permissibility of euthanasia/PAS. Conclusion: The wish for euthanasia/PAS arises in situations of burdensome care and fear of future deterioration. The family feels entrusted with the responsibility to enact upon the death wish. In shaping this responsibility, four roles of family can be distinguished: carer, advocate, supporter, and performer. Family as in need of support themselves is understudied. [ABSTRACT FROM AUTHOR]

The article offers insights from an open medical education form on generative artificial intelligence (GenAI). Topics covered include GenAI's creation of new content like text, codes and audio and visual materials, and large language models' (LLM) support of active recall, improvement of understanding, and knowledge application and analysis. Also noted is the beneficial collaboration of students and junior staff with senior educators to keep abreast of technological advancements.

We study whether the work capacity of the older working population responds to improved pain management therapy access. We use the adoption of state recreational marijuana laws (RMLs) as a large policy shock to access to a non‐pharmaceutical pain management option. We focus on workers' compensation cash benefit receipt as a measure of work capacity, finding that receipt declines in response to RML adoption. Workers' compensation cash benefits are awarded to workers who require time away from work to recover from an injury, which arguably captures a policy‐relevant aspect of work capacity. We observe similar shifts in complementary proxies for work capacity, including work‐limiting disability rates. After considering a range of alternative mechanisms, the evidence suggests that the primary driver of the reductions in workers' compensation benefits is improvements in work capacity. [ABSTRACT FROM AUTHOR]

Organ donation after voluntary assisted dying (VAD) in Australia may potentially increase organ transplant rates. Despite significant international experience with donation after VAD, there has been little discussion of this in Australia. We review potential ethical and practical concerns relating to donation after VAD and advocate action to establish programmes in Australia that ensure safe, ethical and effective donation after VAD. [ABSTRACT FROM AUTHOR]

Five countries now permit organ donation after euthanasia, on the basis of respecting donor autonomy. Some now openly consider performing euthanasia itself via organ extraction to better preserve organ viability, albeit in violation of the dead donor rule. Proponents argue that respect for patient autonomy requires this option; the dead donor rule is inapplicable since it fulfills donors' wishes. Other ethical arguments, not addressed herein, explore issues including dying at home, impact on clinicians, and societal faith in donation enterprise, but these concerns are not insurmountable. This paper instead solely critiques proponents' oversimplified understanding of autonomy with an autonomy‐based argument against any linkage of organ donation and euthanasia, regardless of its timing. Respect for patient autonomy does not unilaterally require fulfilling patients' every wish. Moreover, the very possibility of organ donation with euthanasia limits donor autonomy qualitatively and quantitatively substantially more than by offering it. In fact, organ donation after euthanasia violates the purpose of the dead donor rule, even if not its technicalities. [ABSTRACT FROM AUTHOR]

What makes property restitution "successful" in postwar Kosovo? How are multiple, overlapping, and conflicting property regimes folded into the process of postwar transition? And what can the implementation of rule of law illuminate about international interventionism? Daily practices at the Kosovo Property Agency (KPA, the administrative, quasi‐judicial institution that the United Nations tasked with postwar property restitution) reveal the runaway effect of the growing bureaucratization of international human rights: institutional success is measured through neoliberal "technologies of accountability," and the project itself becomes the key outcome. This is the result of a paradigm shift in global development that saw the legalization of property rights as a cornerstone of post‐conflict state‐building. A parallel shift towards managerialism and auditability in public sector management has given rise to demands for efficiency and accountability in transnational institutions. Together, these moves, which found fertile ground in Kosovo's reconstruction process and determined the mandate and institutional setup of property restitution, transform rule of law from an idealized public good to a shortsighted, box‐ticking exercise chiefly concerned with the production of measurable returns. These benchmarks sidestep the complicated historical legacies of property relations and entitlements and generate new forms of rights inequality. [ABSTRACT FROM AUTHOR]

Aim: Hans Asperger is probably best known for Asperger syndrome. However, he has been accused of knowingly and willingly participating in the National Socialist Child Euthanasia programme by referring patients to the Am Spiegelgrund children's home in Vienna. This later became notorious for euthanising disabled children. We investigated those allegations. Methods: Clinicians and historians examined original documents and transcripts related to Asperger's referrals from the Viennese Therapeutic Pedagogy Unit, and corresponding Am Spiegelgrund admissions, up to 25 March 1943, when he was drafted. Results: Asperger referred 13 children to Am Spiegelgrund. Eleven survived and apparently received adequate care that allowed them to achieve positive developments, but two girls died. Asperger referred these two girls during June and October 1941, before most of the deaths at Am Spiegelgrund occurred and before its euthanasia programme became public knowledge. Our detailed investigation of the medical records, Unit referral practices and Am Spiegelgrund provided no evidence that Asperger knew about the euthanasia programme at the time of the referrals. One death was probably due to euthanasia, but the other was less clear. Conclusion: There was no evidence that Asperger knew about the euthanasia programme when he referred two patients who died at Am Spiegelgrund. [ABSTRACT FROM AUTHOR]

Background and Aims: The core ethical perplexity is that physician‐assisted suicide and euthanasia (PAS/E) contradicts the core value of medical practice which is about the duty of care to preserve life. While most arguments for and against euthanasia emerge from other continents, no African country legalizes or decriminalizes PAS/E. The essence of this scoping review is to collate evidence and scientific voices on euthanasia in Africa by synthesizing empirical articles on the subject in Africa. Methods: In this scoping review, a systematic search of five electronic research databases—PubMed, SCOPUS, CINHAL Complete, Allied and Complementary Medicine (AMED), and APA PsycInfo—was conducted to identify relevant articles conducted in Africa on euthanasia. After deduplication with the Rayyan software, the retrieved literature were screened for eligibility, and only eligible articles were included in the review. Relevant data from these articles were extracted and analyzed using narrative synthesis. Results: Only 14 articles reporting empirical studies, conducted in Africa, and published in English, were included in the review after a rigorous screening process. The review shows a wide rejection of euthanasia, but there is not much resistance to passive euthanasia, that is, withholding/withdrawing life‐saving medical care from a terminally ill patient, mostly due to advanced age of the patient and the incurability of the illness. Many factors, such as religion, profession, and age help in shaping the way an individual view and understand PAS/E. Professionals take the patient's clinical condition and sociocultural context into consideration when making decisions about end‐of‐life care. The sociocultural context did not favor PAS/E. Conclusion: Euthanasia will continue to be a subject of controversy and debate in Africa and elsewhere. The majority of Africans hold the duty of care and preservation of life as the hallmark of medical practice, which informs the wide rejection of PAS/E. [ABSTRACT FROM AUTHOR]

Individuals may support economic redistribution because of practical considerations, but also because they perceive it as morally necessary according to their personal ethical beliefs. Across three studies, we investigated whether attitudes towards reducing economic inequality can be experienced with moral conviction (i.e. perceived as rooted in one's core beliefs about right and wrong) and motivate support for redistributive government policies. In Study 1 (N = 138), reducing economic inequality moral conviction scores were comparable to other highly moralized topics (e.g. euthanasia) and higher than lowly moralized topics (e.g. tattoos). In Study 2 (N = 325) and Study 3 (N = 271), the moral conviction for reducing economic inequality positively predicted support for several redistributive government policies. Additionally, while empathic concern (Study 2 and 3) provided mixed results, structural causal attributions (Study 3) mediated this effect. Therefore, our findings highlight the importance of personal moral significance in understanding what motivates support for redistributive policies. [ABSTRACT FROM AUTHOR]

Receptor for Advanced Glycated End‐products (RAGE) is highly expressed in diabetes and impairs wound healing. We proposed that administering an antibody that blocks RAGE will hasten the healing of dorsal wounds in diabetic pigs compared with a non‐immune IgG. Two purpose‐bred diabetic (D) Yucatan minipigs (Sinclair, Auxvasse MO) each underwent 12 2 × 2 cm full thickness dorsal wounds: four wounds received decellularized porcine skin patches (Xylyx Bio, Bklyn NY): four anti‐RAGE Ab (CR‐3) infused patches, four saline infused patches and four wounds were left open. One pig received anti‐RAGE Ab (CR‐3) 1 mg/kg IM q 10 days and other received non‐immune IgG. Wounds were measured at 2 and 4 weeks followed by euthanasia and wound harvesting. At 2 weeks few of the patches appeared to be incorporated into the wound. By 4 weeks all patches in pigs treated systemically with CR‐3 were detached and the wounds almost healed. For all 24 wounds for both pigs regardless of presence of patch or type of patch, the average IgG treated pig wound size at 4 weeks was 69.2 ± 14.6% of initial size and the average CR‐3 treated pig wound size was 40.9 ± 11.3% of initial size (P = 0.0002). Quantitative immunohistology showed greater staining for collagen in the CR‐3 treated wounds compared with IgG treated. Staining was positive for RAGE, Mac, and IL‐6 in the IgG treated wounds and negative in the CR‐3 treated wounds. From these pilot experiments, we conclude that a RAGE blocking antibody given parenterally improved wound healing in a diabetic pig while patches were not effective. [ABSTRACT FROM AUTHOR]

STRENGTHS AND WEAKNESSES I Introducing Political Philosophy i teaches us how to practice political philosophy using the modern analytical approach by analyzing 15 important policy debates. I Introducing Political Philosophy: A Policy-Driven Approach i is a textbook that aims to introduce students to analytical political philosophy by theorizing about 15 prominent public policy issues. Introducing Political Philosophy: A Policy-Driven Approach. [Extracted from the article]

Background: As the primary decision‐maker for their horse's health and welfare, owners' knowledge of clinical conditions may impact their horse's health. Anecdotal evidence suggests that the emotional impact of equine illness on the owner can be severe but research is lacking. Objectives: To evaluate horse owners' self‐declared knowledge of eight common equine health conditions and perceptions of the quality of information available; to ascertain respondents' perceptions of the severity of impact on their horse of the conditions and potential emotional impact on themselves and to establish the factors of greatest concern to owners when their horse has a health condition and influential factors on end‐of‐life decisions. Study design: Online survey of horse owners. Methods: An online survey comprising three sections was created: respondent demographics; vignettes of clinical conditions; concerns and decision‐making regarding illness and euthanasia. Vignettes focused on arthritis; Pars Pituitary Intermedia Dysfunction; Equine Metabolic Syndrome (EMS); gastric ulcers; high intestinal worm burden; dermatophilosis ('mud rash'); quidding and head tossing; and equine asthma. Respondents were self‐selecting. The survey was circulated for completion by horse owners residing in Ireland and Northern Ireland obtaining 491 valid responses. Results: Respondents declared that they had the highest knowledge of mud rash, with 84.1% rating their knowledge as very good compared to 42% of respondents for EMS. There was positive correlation between the perceived impact on their horse and emotional impact on the owner for all conditions ranging from weak (arthritis 0.36, P < 0.001) to strong (EMS 0.62, P < 0.001). Pain, discomfort, and quality of life were reported as the most common concerns when their horse has a medical condition or when considering euthanasia. Main limitations: Potential bias among respondents towards computer literate owners, with good literacy and interest in equine health conditions. Conclusions: Knowledge of equine health conditions, perceived impact of conditions on the horse and emotional impact on their owners varied significantly between conditions. [ABSTRACT FROM AUTHOR]

Although abortion and euthanasia are highly contested issues at the heart of the culture war, the moral foundations underlying ideological differences on these issues are mostly unknown. Given that much of the extant debate is framed around the sanctity of life, we argued that the moral foundation of purity/sanctity—a core moral belief that emphasises adherence to the "natural order"—would mediate the negative relationship between conservatism and support for abortion and euthanasia. As hypothesised, results from a nation‐wide random sample of adults in New Zealand (N = 3360) revealed that purity/sanctity mediated the relationship between conservatism and opposition to both policies. These results demonstrate that, rather than being motivated by a desire to reduce harm, conservative opposition to pro‐choice and end‐of‐life decisions is (partly) based on the view that ending a life, even if it is one's own, violates God's natural design and, thus, stains one's spiritual purity. [ABSTRACT FROM AUTHOR]

This study explores the perceptions of Norwegian nurses who have received assisted dying requests from terminally ill patients. Assisted dying is illegal in Norway, while in some countries, it is an option. Nurses caring for terminally ill patients may experience ethical challenges by receiving requests for euthanasia and assisted suicide. We applied a qualitative research design with a phenomenological hermeneutic approach using open individual interviews. A total of 15 registered nurses employed in pulmonary and oncology wards of three university hospitals and home care in one municipality were recruited. Four themes emerged from the analysis: (1) unprepared for the request; (2) meeting direct, indirect, and nonverbal requests; (3) working in a gray zone, and (4) feeling alone and powerless. The study found that nurses were unsure how to handle such requests due to professional uncertainty about assisted dying. Working in an environment where the topic is taboo made nurses morally uncertain, and some perceived this as moral distress. The hospital chaplain played a significant role in providing support to these nurses. [ABSTRACT FROM AUTHOR]

The doctrine of the sanctity of life has traditionally been characterised as a Judeo‐Christian doctrine that has it that bodily human life is an intrinsic good and that it is always impermissible to kill an innocent human. Abortion and euthanasia are often assumed to violate the doctrine. The doctrine is usually understood as being derived from religious dogma and, as such, not amenable to debate. I show that this characterisation of the doctrine is problematic in a number of ways, and I go on to rethink the doctrine. In doing so I follow in the footsteps of Ronald Dworkin, who offered a characterisation of the doctrine in his 1993 Life's Dominion, drawing on a conceptualisation of sacredness that is radically different from standard ones and not dependent on religious dogma. I'll argue that although Dworkin's efforts have much to recommend, his conceptualisation of sacredness is inadequate. Dworkin attempted to reconceptualise sacredness 'from the armchair'. Here I explain how sacred values are thought of in anthropology and psychology and argue that the sanctity of human life should be understood in the same way. I'll explain how doing so allows us to resolve a number of conceptual problems that bedevil standard characterisations of the doctrine of the sanctity of life. I'll also consider the possibility of a compromise over the sanctity of human life, and as a consequence, compromise over the permissibility of abortion and euthanasia. I'll argue that such compromise is possible, albeit difficult to achieve. [ABSTRACT FROM AUTHOR]

The median age of voluntary assisted dying applicants is similar in Victoria and Western Australia (about 73 years).[[15]] Most had advanced cancer (Victoria: 82%; Western Australia: 68%), neurodegenerative diseases (especially motor neurone disease), or organ failure, and most were receiving palliative care (Victoria: 81%; Western Australia: 85%). Keywords: Euthanasia; Terminal care; Legislation, medical EN Euthanasia Terminal care Legislation, medical 208 210 3 09/05/23 20230904 NES 230904 Until six years ago, there were no voluntary assisted dying laws in Australia, despite strong public support and fifty attempts in parliaments around the country. During 2021-22, voluntary assisted dying was involved in 0.58% of all deaths in Victoria,[15] and 1.1% of all deaths in Western Australia.[16] It is involved in 0.59% of deaths in Oregon,[18] where self-administered assisted dying has been available since 1998 for people expected to live less than six months. 17 Sellars M, White B, Yates P, Willmott L. Medical practitioners' views and experiences of being involved in voluntary assisted dying in Victoria, Australia: a qualitative interview study among participating doctors. [Extracted from the article]

The article focuses on the challenges clinicians face with the introduction of Voluntary Assisted Dying (VAD) legislation across Australia. Topics include the need for continuous monitoring of community and practitioner concerns, the widespread but varied support for VAD among clinicians, and the ongoing ethical and cultural complexities that require sustained dialogue and evaluation.