202 results on '"Euthanasia"'
Search Results
2. Should euthanasia and assisted suicide for psychiatric disorders be permitted? A systematic review of reasons.
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Nicolini ME, Kim SYH, Churchill ME, and Gastmans C
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- Decision Making, Euthanasia legislation & jurisprudence, Humans, Mental Competency, Personal Autonomy, Psychiatry legislation & jurisprudence, Suicide, Assisted legislation & jurisprudence, Euthanasia ethics, Health Policy, Mental Disorders therapy, Psychiatry ethics, Suicide, Assisted ethics
- Abstract
Background: Euthanasia and assisted suicide (EAS) based on a psychiatric disorder (psychiatric EAS) continue to pose ethical and policy challenges, even in countries where the practice has been allowed for years. We conducted a systematic review of reasons, a specific type of review for bioethical questions designed to inform rational policy-making. Our aims were twofold: (1) to systematically identify all published reasons for and against the practice (2) to identify current gaps in the debate and areas for future research., Methods: Following the PRISMA guidelines, we performed a search across seven electronic databases to include publications focusing on psychiatric EAS and providing ethical reasons. Reasons were grouped into domains by qualitative content analysis., Results: We included 42 articles, most of which were written after 2013. Articles in favor and against were evenly distributed. Articles in favor were mostly full-length pieces written by non-clinicians, with articles against mostly reactive, commentary-type pieces written by clinicians. Reasons were categorized into eight domains: (1) mental and physical illness and suffering (2) decisional capacity (3) irremediability (4) goals of medicine and psychiatry (5) consequences for mental health care (6) psychiatric EAS and suicide (7) self-determination and authenticity (8) psychiatric EAS and refusal of life-sustaining treatment. Parity- (or discrimination-) based reasons were dominant across domains, mostly argued for by non-clinicians, while policy reasons were mostly pointed to by clinicians., Conclusions: The ethical debate about psychiatric EAS is relatively young, with prominent reasons of parity. More direct engagement is needed to address ethical and policy considerations.
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- 2020
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3. Medical Assistance in Dying: Alberta Approach and Policy Analysis.
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Silvius JL, Memon A, and Arain M
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- Aged, Alberta, Decision Making, Euthanasia, Active, Voluntary legislation & jurisprudence, Female, Humans, Male, Middle Aged, Patient Preference statistics & numerical data, Suicide, Assisted legislation & jurisprudence, Euthanasia, Active, Voluntary statistics & numerical data, Health Policy, Program Development methods, Suicide, Assisted statistics & numerical data
- Abstract
ABSTRACTThe legalization of medical assistance in dying (MAID) in Canada has presented an opportunity for physicians, policy makers, and patients to rethink end-of-life care. This article reviews the key features of the Alberta MAID framework and puts it in the context of other provinces and their MAID programs. We also compared policies and MAID practices in different provinces/territories of Canada. In addition, we used the Alberta MAID database to provide the current state of patient demographics and access to MAID services in Alberta in 2017-2018. Significant differences were identified between provincial/territorial MAID program processes and practices. Alberta, Ontario, and Quebec have more comprehensive frameworks. Alberta has dedicated resources to the support of MAID. The median age of those who received MAID service in Alberta from July 2017 to April 2018 was 70 years; a higher proportion were males (55%) and the majority included patients with a cancer diagnosis (70%). Approximately 39 per cent of MAID events happened in a hospital setting, and 38 per cent occurred in patients' homes. We have presented some recommendations on MAID program development, implementation, and review based on Alberta's experience with MAID over the past two years.
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- 2019
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4. Nurses and the euthanasia debate: reflections from New Zealand.
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Woods M and Bickley Asher J
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- Humans, New Zealand, Euthanasia legislation & jurisprudence, Health Policy legislation & jurisprudence, Nurse's Role, Suicide, Assisted legislation & jurisprudence
- Abstract
Aim: Through an examination of the present situation relating to legalizing euthanasia and/or physician-assisted death in New Zealand, this paper is intended to encourage nurses worldwide to ponder about their own position on the ever present topic of assisted dying and euthanasia., Background: In New Zealand, euthanasia remains illegal, but in 2012, the 'End of Life Choice Bill' was put in the ballot for potential selection for consideration by Parliament, later to be withdrawn. However, it is increasingly likely that New Zealand will follow international trends to offer people a choice about how their lives should end, and that such a Bill will be resubmitted in the near future. Undoubtedly, the passage of such legislation would have an impact on the day-to-day practices of nurses who work with dying people., Sources of Evidence: This article has been prepared following a comprehensive review of appropriate literature both in New Zealand and overseas., Discussion: This article aims to highlight the importance of nursing input into any national debates concerning proposed euthanasia or assisted dying laws. The discussion therefore covers New Zealand's experience of such proposed legislation, that is, the draft Bill itself and the implications for nurses, the history of the assisted dying debate in New Zealand, public and professional opinion, and national and international nursing responses to euthanasia., Conclusion: New Zealand nurses will eventually have an opportunity to make their views on proposed euthanasia legislation known, and what such legislation might mean for their practice. Nurses everywhere should seriously consider their own knowledge and viewpoint on this vitally important topic, and be prepared to respond as both individuals and as part of their professional bodies when the time inevitably arrives. The result will be a better informed set of policies, regulations and legislation leading to a more meaningful and dignified experience for dying people and their families., Implications for Nursing and Health Policy: Nurses need to be fully informed about, and contribute to, proposed euthanasia or assisted dying legislation. They have extensive expertise in care of the dying, and should therefore be ready to influence law, policy and future nursing practices., (© 2014 International Council of Nurses.)
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- 2015
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5. Institutional Objection to Voluntary Assisted Dying in Victoria, Australia: An Analysis of Publicly Available Policies.
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Close, Eliana, Willmott, Lindy, Keogh, Louise, and White, Ben P.
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ASSISTED suicide , *CONCEPTUAL structures , *GOVERNMENT policy , *DECISION making , *RESEARCH funding , *MANAGEMENT , *THEMATIC analysis , *POLICY sciences - Abstract
Background: Victoria was the first Australian state to legalize voluntary assisted dying (elsewhere known as physician-assisted suicide and euthanasia). Some institutions indicated they would not participate in voluntary assisted dying. The Victorian government issued policy approaches for institutions to consider Objective: To describe and analyse publicly available policy documents articulating an institutional objection to voluntary assisted dying in Victoria. Methods: Policies were identified using a range of strategies, and those disclosing and discussing the nature of an institutional objection were thematically analysed using the framework method. Results: The study identified fifteen policies from nine policymakers and developed four themes: (1) extent of refusal to participate in VAD, (2) justification for refusal to provide VAD, (3) responding to requests for VAD, and (4) appeals to state-sanctioned regulatory mechanisms. While institutional objections were stated clearly, there was very little practical detail in most documents to enable patients to effectively navigate objections in practice. Conclusion: This study demonstrates that despite having clear governance pathways developed by centralized bodies (namely, the Victorian government and Catholic Health Australia), many institutions' public-facing policies do not reflect this guidance. Since VAD is contentious, laws governing institutional objection could provide greater clarity and regulatory force than policies alone to better balance the interests of patients and non-participating institutions. [ABSTRACT FROM AUTHOR]
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- 2023
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6. Killing in the name of: A merciful death?
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Bryanna Moore
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Philosophy ,Health (social science) ,Euthanasia ,Euthanasia, Active ,Health Personnel ,Physicians ,Health Policy ,Humans ,Euthanasia, Active, Voluntary ,Empathy ,Suicide, Assisted - Abstract
"Mercy" holds a well-established place in the discourse on assisted death (AD), with mercy rhetoric used by both proponents and opponents of AD alike. In this paper, I interrogate the relationship between mercy, mercy killing and AD. Appeals to mercy introduce an ambiguity that carries implications for the enduring debate about healthcare professionals' participation in this controversial practice. The term "mercy killing" is used at different times to mean all of the following: killings that are acts of punitive leniency, killings motivated by pity, killings motivated by compassion, and acts of voluntary, involuntary and nonvoluntary euthanasia. I argue that killings that are acts of punitive leniency "track" a conceptually useful understanding of mercy and, by extension, mercy killing. However, if mercy is understood in this way, then "mercy killing" is a problematic way of characterizing physician-AD. While reference to mercy killing has been weeded out of AD legislation over time, the same cannot be said of public discourse, where the debate about physicians' character-and the locus of power with respect to who gets to decide when a life can rightly be ended-continues.
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- 2022
7. Assisted suicide for prisoners: An ethical and legal analysis from the Swiss context
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Yoann Della Croce
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assisted suicide ,Health (social science) ,Euthanasia ,Prisoners ,Health Policy ,euthanasia ,Suicide, Assisted ,Philosophy ,death ,Prisons ,ddc:320 ,rights ,Humans ,prison ,autonomy ,Switzerland - Abstract
Should prisoners be allowed to access assisted suicide? Whereas the ethical and legal issues regarding assisted suicide have now been extensively discussed in the literature, surprisingly scarce attention has been given to the pressing issue of inmates requesting assistance in dying. Through an analysis supported by the Swiss legal framework, I first argue that the principle of equivalence in prison medicine, which states that prisoners ought to receive the same level of health care as the general population does not prove a solid basis in arguing for prisoners' right to assisted suicide. Over the course of the paper, I defend the view that the right to access assisted suicide is to be understood as a liberty that cannot be removed from incarcerated individuals. I argue that removing such a liberty cannot be consistently held within a legal framework where the death penalty does not exist, for doing so necessarily forgoes the State's ability to decide on when and how prisoners' lives end, in turn necessarily leaving them the liberty to end theirs when they decide so. I finally argue against the position that the capacity for autonomous choice is lacking in inmates by disentangling the particular features of the prison-setting and show that the context of incarceration is not so substantially different from regular cases of suicide assistance that it warrants a difference in treatment. The position I propose proves important in order to both respect prisoners' rights and ensure they retain a minimum level of control over their existences.
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- 2022
8. Burdening Others
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Brent Kious
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Philosophy ,Issues, ethics and legal aspects ,Health (social science) ,Caregivers ,Euthanasia ,Health Policy ,Humans ,General Medicine ,Suicide, Assisted - Abstract
Many people are afraid they will, as they age or fall ill, become burdens to others. Some who fear this say they would be willing to hasten their own deaths-engaging in self-sacrifice through suicide, assisted suicide, or euthanasia-to avoid it. Still, some bioethicists and other critics of medical aid in dying reject the idea that fear of being a burden can be a good reason for self-sacrifice. They argue that dependency is nearly universal, emphasize that caregiving is a valuable pursuit, and raise concerns about the impact of aid-in-dying policies on vulnerable groups. After defining what it is to be a burden, articulating why being a burden is morally significant, and, crucially, distinguishing burdensomeness from what I call "mere dependency," I defend the intuition that self-sacrifice can be justified by the desire to avoid being a burden and by the concern for the well-being of one's caregivers that this choice implies.
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- 2022
9. Wish for euthanasia persists for at least one year after the request was declined by Euthanasia Expertise Center
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Suzanne van de Vathorst, Eveline M Bunge, and Caroline van den Ende
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medicine.medical_specialty ,Euthanasia ,business.industry ,030503 health policy & services ,Health Policy ,Medical record ,Wish ,Suicide, Assisted ,stomatognathic diseases ,03 medical and health sciences ,0302 clinical medicine ,Physicians ,Surveys and Questionnaires ,Family medicine ,medicine ,Humans ,030212 general & internal medicine ,0305 other medical science ,Prospective cohort study ,business ,End-of-life care ,Netherlands - Abstract
Background Euthanasia Expertise Center (EEC) in the Netherlands provides euthanasia or physician-assisted suicide for patients who meet all requirements of the Dutch Euthanasia Law, but whose treating physician declined their request. Little is known about how life continues for a patient after a request for physician-assisted death (PAD) is also declined by EEC. Objective To follow-up patients whose request for PAD was declined at EEC. Methods Between December 2016 and January 2020, 66 patients were prospectively followed for one year after their request was declined. Their general well-being and health, persistence of the wish for PAD, and mortality was measured by means of a questionnaire administered after three, six and 12 months. Furthermore, information was extracted from the patient's medical record. Findings More than half (58%) of the included patients suffered from an accumulation of old-age complaints. In the year after the request was declined, 15 patients (23%) died, three of whom committed suicide. Almost all patients who were alive after one year, persisted in their wish for PAD. Moreover, they were often not doing well. Conclusions Considering that EEC is a last resort for those who were not granted PAD elsewhere, and that the wish for PAD persists, aftercare services should be provided to people whose request has been declined.
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- 2021
10. Ambivalence toward euthanasia and physician-assisted suicide has decreased among physicians in Finland
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Reetta P, Piili, Pekka, Louhiala, Jukka, Vänskä, Juho T, Lehto, Tampere University, Clinical Medicine, Department of Oncology, and Health Sciences
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Issues, ethics and legal aspects ,Health (social science) ,Attitude of Health Personnel ,Euthanasia ,Physicians ,Health Policy ,3122 Cancers ,Humans ,Finland ,3142 Public health care science, environmental and occupational health ,Suicide, Assisted - Abstract
Background Debates around euthanasia and physician-assisted suicide (PAS) are ongoing around the globe. Public support has been mounting in Western countries, while some decline has been observed in the USA and Eastern Europe. Physicians’ support for euthanasia and PAS has been lower than that of the general public, but a trend toward higher acceptance among physicians has been seen in recent years. The aim of this study was to examine the current attitudes of Finnish physicians toward euthanasia and PAS and whether there have been changes in these attitudes over three decades. Methods A questionnaire survey was conducted with all Finnish physicians of working age in 2020 and the results were compared to previous studies conducted in 1993, 2003 and 2013. Results The proportions of physicians fully agreeing and fully disagreeing with the legalization of euthanasia increased from 1993 to 2020 (from 5 to 25%, p p p p Conclusions This study shows that Finnish physicians’ ambivalence toward euthanasia and PAS has decreased. The ongoing debate has probably forced physicians to form more solid opinions on these matters. Our study highlights that attitudes toward euthanasia and PAS are still divided within the medical profession.
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- 2022
11. Making a case for the inclusion of refractory and severe mental illness as a sole criterion for Canadians requesting medical assistance in dying (MAiD): a review
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Nicholas J. Delva and Anees Bahji
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Canada ,medicine.medical_specialty ,Health (social science) ,Inclusion (disability rights) ,Persistent mental illness ,Legislation ,0603 philosophy, ethics and religion ,Suicide, Assisted ,03 medical and health sciences ,0302 clinical medicine ,Arts and Humanities (miscellaneous) ,medicine ,Humans ,030212 general & internal medicine ,Assisted suicide ,Psychiatry ,Medical Assistance ,Euthanasia ,Mental Disorders ,Health Policy ,Legislature ,06 humanities and the arts ,Voluntariness ,Mental illness ,medicine.disease ,Issues, ethics and legal aspects ,Chronic Disease ,060301 applied ethics ,Public support ,Psychology - Abstract
BackgroundFollowing several landmark rulings and increasing public support for physician-assisted death, in 2016, Canada became one of a handful of countries legalising medical assistance in dying (MAiD) with Bill C-14. However, the revised Bill C-7 proposes the specific exclusion of MAiD where a mental disorder is the sole underlying medical condition (MAiD MD-SUMC).AimThis review explores how some persons with serious and persistent mental illness (SPMI) could meet sensible and just criteria for MAiD under the Canadian legislative framework.MethodsWe review the proposed Bill C-7 criteria (capacity, voluntariness, irremediability and suffering) as well as the nuances involved in separating a well-reasoned request for assisted suicide from what might be solely a manifestation of a SPMI.FindingsIn this paper, we argue against the absolute exclusion of patients with SPMIs from accessing MAiD. Instead, we propose that in some circumstances, MAiD MD-SUMC may be justifiable while remaining the last resort. Conducting MAiD eligibility assessments removes the need to introduce diagnosis-specific language into MAiD legislation. Competent psychiatric patients who request MAiD should not be treated any differently from other eligible candidates. Many individuals with psychiatric disorders will be incapable of consenting to MAiD. The only ethical option is to assess eligibility for MAiD on an individual basis and include as legitimate candidates those who suffer solely from psychiatric illness who have the decisional capacity to consent to MAiD.
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- 2021
12. Why Death Need Not Be 'Reasonably Foreseeable'—The Proposed Legislative Response to Truchon and Gladu v Attorney General (Canada) and Attorney General (Quebec) [2019] QCCS 3792
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Michaela E. Okninski
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Canada ,Health (social science) ,Euthanasia ,Health Policy ,Physician assisted suicide ,Quebec ,Legislature ,Medical law ,Suicide, Assisted ,Supreme court ,Lawyers ,Political science ,Law ,Humans ,Recent Developments - Abstract
Medical Assistance in Dying (MAID) has become an inescapable reality in Canada since the Supreme Court of Canada (SCC) declared in Carter v Canada (Attorney General) ([2015] 1 S.C.R. 331) (Carter) that the blanket prohibition on physician assisted dying was unconstitutional. Instead of prescribing the regulatory criteria to control the provision of MAID, the SCC invited the respective federal and provincial governments to establish the legislative framework (Carter, [127]).
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- 2021
13. The Final Act: An Ethical Analysis of Pia Dijkstra’s Euthanasia for a Completed Life
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T. J. Holzman
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Health (social science) ,media_common.quotation_subject ,Completed life ,Medical law ,Morals ,Suicide, Assisted ,03 medical and health sciences ,0302 clinical medicine ,Physicians ,Humans ,030212 general & internal medicine ,Sociology ,Set (psychology) ,Autonomy ,Netherlands ,Original Research ,media_common ,Euthanasia ,030503 health policy & services ,Health Policy ,Foundation (evidence) ,Existential suffering ,Bioethics ,Law ,Dying with dignity ,0305 other medical science ,Dijkstra's algorithm ,Ethical Analysis ,Ethical analysis ,End-of-life - Abstract
Amongst other countries, the Netherlands currently allows euthanasia, provided the physician performing the procedure adheres to a strict set of requirements. In 2016, Second Chamber member Pia Dijkstra submitted a law proposal which would also allow euthanasia without the reason necessarily having any medical foundation; euthanasia on the basis of a completed life. The debate on this topic has been ongoing for over two decades, but this law proposal has made the discussion much more immediate and concrete. This paper considers the moral permissibility of Pia Dijkstra’s law proposal, focusing on the ethics of the implementation Dijkstra describes in her proposal. I argue that, at present, Dijkstra’s law proposal is unsuitable for implementation, due to a number of as of yet unaddressed problems, including the possible development of an ageist stigma and undue pressure on the profession of end-of-life coordinator. Perhaps adequate responses can be conceived to address these issues. However, the existence of a radically different, yet currently equally unacceptable position regarding the implementation of euthanasia for a completed life as proposed by fellow party member Paul Schnabel suggests it may be difficult to formulate an ethically acceptable implementation for this, in principle, ethically acceptable concept.
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- 2021
14. Alzheimer’s disease: history, ethics and medical humanities in the context of assisted suicide
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Braun, Birgit, Demling, Joachim, and Loew, Thomas Horst
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ddc:610 ,Alzheimer dementia, Dignity, Ethics, Assisted suicide, Integrative dementia therapy model ,Euthanasia ,Health Policy ,610 Medizin ,General Medicine ,Suicide, Assisted ,Issues, ethics and legal aspects ,History and Philosophy of Science ,Alzheimer Disease ,Quality of Life ,Humans ,Dementia - Abstract
Introduction Dementia diseases, especially Alzheimer’s disease (AD), are of considerable importance in terms of social policy and health economics. Moreover, against the background of the current Karlsruhe judgement on the legalisation of assisted suicide, there are also questions to be asked about medical humanities in AD. Methodology Relevant literature on complementary forms of therapy and prognosis was included and discussed. Results Creative sociotherapeutic approaches (art, music, dance) and validating psychotherapeutic approaches show promise for suitability and efficiency in the treatment of dementia, but in some cases still need to be scientifically tested. Biomarker-based early diagnosis of dementia diseases is increasingly becoming a subject of debate against the background of the Karlsruhe ruling. Discussion Needs-oriented and resource-enhancing approaches can make a significant contribution to improving the quality of life of people with dementia. The discussion on the issue of “assisted suicide” should include questions of the dignity and value of a life with dementia. Outlook The integrative dementia therapy model can be complemented by a religion- and spirituality-based approach. Appropriate forms of psychotherapy should be scientifically evaluated.
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- 2022
15. Attitudes about withholding or withdrawing life-prolonging treatment, euthanasia, assisted suicide, and physician assisted suicide: a cross-sectional survey among the general public in Croatia
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Ana Borovecki, Marko Curkovic, Krunoslav Nikodem, Stjepan Oreskovic, Milivoj Novak, Filip Rubic, Jurica Vukovic, Diana Spoljar, Bert Gordijn, and Chris Gastmans
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Adult ,Medical Ethics ,Health (social science) ,Croatia ,NETHERLANDS ,Physician assisted suicide ,Social Sciences ,ETHICAL-ISSUES ,Suicide, Assisted ,Surveys and Questionnaires ,SUPPORT ,Social Sciences - Other Topics ,DECISIONS ,Humans ,Assisted suicide ,Withdrawing ,Ethics ,Science & Technology ,Euthanasia ,Health Policy ,Withholding ,ACCEPTANCE ,Middle Aged ,End-of-life decision-making ,end-of-life decision-making ,euthanasia ,assisted suicide ,physician assisted suicide ,withholding ,withdrawing ,attitudes ,TRENDS ,humanities ,Biomedical Social Sciences ,Social Sciences, Biomedical ,Death ,Issues, ethics and legal aspects ,Cross-Sectional Studies ,OPINION ,Attitude ,STATES ,Attitudes ,TRUST ,Life Sciences & Biomedicine ,EUROPEAN COUNTRIES - Abstract
BackgroundThere has been no in-depth research of public attitudes on withholding or withdrawing life-prolonging treatment, euthanasia, assisted suicide and physician assisted suicide in Croatia. The aim of this study was to examine these attitudes and their correlation with sociodemographic characteristics, religion, political orientation, tolerance of personal choice, trust in physicians, health status, experiences with death and caring for the seriously ill, and attitudes towards death and dying.MethodsA cross-sectional study was conducted on a three-stage random sample of adult citizens of the Republic of Croatia, stratified by regions, counties, and locations within those counties (N = 1203). In addition to descriptive statistics, ANOVA and Chi-square tests were used to determine differences, and factor analysis (component model, varimax rotation and GK dimensionality reduction criterion), correlation analysis (Bivariate correlation, Pearson’s coefficient) and multiple regression analysis for data analysis.Results38.1% of the respondents agree with granting the wishes of dying people experiencing extreme and unbearable suffering, and withholding life-prolonging treatment, and 37.8% agree with respecting the wishes of such people, and withdrawing life-prolonging treatment. 77% of respondents think that withholding and withdrawing procedures should be regulated by law because of the fear of abuse. Opinions about the practice and regulation of euthanasia are divided. Those who are younger and middle-aged, with higher levels of education, living in big cities, and who have a more liberal worldview are more open to euthanasia. Assisted suicide is not considered to be an acceptable practice, with only 18.6% of respondents agreeing with it. However, 40.1% think that physician assisted suicide should be legalised. 51.6% would support the dying person’s autonomous decisions regarding end-of-life procedures.ConclusionsThe study found low levels of acceptance of withholding or withdrawing life-prolonging treatment, euthanasia, assisted suicide and physician assisted suicide in Croatia. In addition, it found evidence that age, level of education, political orientation, and place of residence have an impact on people’s views on euthanasia. There is a need for further research into attitudes on different end-of-life practices in Croatia.
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- 2022
16. Requests for euthanasia or assisted suicide of people without (severe) illness
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Vera E van den Berg, Margot L Zomers, Ghislaine JMW van Thiel, Carlo JW Leget, Johannes JM van Delden, Els J van Wijngaarden, Care Ethics, and A meaningful life in a just and caring society
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Aged, 80 and over ,Male ,Euthanasia ,Health Policy ,Decision Making ,Humans ,Pain ,Female ,Aged ,Netherlands ,Suicide, Assisted ,Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18] - Abstract
Some people request euthanasia or assisted suicide (EAS) even though they are not (severely) ill. In the Netherlands the presence of sufficient medical ground for the suffering is a strict prerequisite for EAS. The desirability of this 'medical ground'-boundary is currently questioned. Legislation has been proposed to facilitate EAS for older persons with "completed life" or "tiredness of life" in the absence of (severe) illness.To describe the characteristics and motivations of persons whose requests for EAS in the absence of (severe) illness did not result in EAS and the decision-making process of medical professionals in these types of requests.Analysis of 237 applicant records of the Dutch Euthanasia Expertise Center. We studied both the perspectives of applicants and medical professionals.The majority of the applicants were women (73%) aged 75 years and older (79%). Applicants most often indicated physical suffering as element of suffering and reason for the request. Medical professionals indicated in 40% of the cases no or insufficient medical ground for the suffering.Physical suffering plays an important role in requests for EAS even for persons who are not (severely) ill. From the presence of physical suffering it does not necessarily follow that for medical professionals there is sufficient medical ground to comply with the 'medical ground'-boundary.
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- 2022
17. The Islamic perspective on physician-assisted suicide and euthanasia
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Mohammed Madadin, Ritesh G. Menezes, Houria S Al Sahwan, Sarraa A Altarouti, Zahra S Al Eswaikt, and Khadijah K Altarouti
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Attitude to Death ,Medical treatment ,Euthanasia ,Health Policy ,Perspective (graphical) ,Islam ,Suicide, Assisted ,Variety (cybernetics) ,03 medical and health sciences ,Issues, ethics and legal aspects ,0302 clinical medicine ,Withholding Treatment ,030220 oncology & carcinogenesis ,Law ,Humans ,Physician assisted suicide ,Fiqh ,Narrative review ,030212 general & internal medicine ,Psychology ,Medical ethics - Abstract
Physician-assisted suicide (PAS) and euthanasia can be debated from ethical and legal perspectives, and there are a variety of views regarding their acceptability and usefulness. Religion is considered an important factor in determining attitudes towards such practices. This narrative review aims to provide an overview of the Islamic perspective on PAS and euthanasia and explore the Islamic approach in addressing the related issues. The PubMed database was searched to retrieve relevant articles, then the references listed in the selected articles were checked for additional relevant publications. Additionally, religious books (Quran and hadith) and legal codes of selected countries were also consulted from appropriate websites. The Islamic code of law discusses many issues regarding life and death, as it considers any act of taking one’s life to be forbidden. Islam sanctifies life and depicts it as a gift from God ( Allah). It consistently emphasises the importance of preserving life and well-being. Therefore Muslims, the followers of Islam, have no right to end their life. All Islamic doctrines consider PAS and euthanasia to be forbidden. However, if the patient has an imminently fatal illness, withholding or withdrawing a futile medical treatment is considered permissible. From a legal perspective, Islamic countries have not legalised PAS and euthanasia. Such practices are therefore considered suicides when patients consent to the procedure, and homicides when physicians execute the procedure.
- Published
- 2020
18. A citizens' jury on euthanasia/assisted dying: Does informed deliberation change people's views?
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Richard Egan, Chrystal Jaye, Simon Walker, Christopher Jackson, and Jessica E. Young
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International debate ,Consensus ,media_common.quotation_subject ,Decision Making ,111799 Public Health and Health Services not elsewhere classified ,170199 Psychology not elsewhere classified ,Citizens' jury ,FOS: Health sciences ,Suicide, Assisted ,citizens' deliberation ,Social group ,111099 Nursing not elsewhere classified ,03 medical and health sciences ,0302 clinical medicine ,Jury ,Political science ,Humans ,030212 general & internal medicine ,Health policy ,media_common ,lcsh:R5-920 ,business.industry ,lcsh:Public aspects of medicine ,030503 health policy & services ,Public Health, Environmental and Occupational Health ,health policy ,lcsh:RA1-1270 ,euthanasia ,Public relations ,Deliberation ,citizens' jury ,Original Research Paper ,FOS: Psychology ,assisted dying ,Framing (social sciences) ,Personal priorities ,lcsh:Medicine (General) ,0305 other medical science ,business ,Original Research Papers ,New Zealand - Abstract
Euthanasia or assisted dying (EAD) remains a highly contentious issue internationally. Although polls report that a majority New Zealanders support EAD, there are concerns about the framing of the polling questions, and that those responding to the questions do not know enough about the situations described, the options available and the potential implications of EAD policy. One way to address these concerns is through a citizens' jury, which is a method of learning how a group of people view an issue following informed deliberation. This citizens' jury was conducted to learn whether a group of 15 New Zealanders thought the law should be changed to allow some form of EAD and the reasons for their view, having been informed about the issue, heard arguments for and against, and having deliberated together. The jury met for two and a half days. They did not reach a consensus, but become polarized in their positions, with several changing their positions to either strong opposition or strong support. The reasons why people support or oppose EAD were not reducible to particular principles or arguments, but reflected an integrated assessment of a range of considerations, informed by personal priorities and experiences. These results suggest that views on EAD may change in response to informed deliberation that the EAD debate involves a range of value judgments and is not likely to be resolved through deliberation alone. These results may inform international debate on EAD policy.
- Published
- 2020
19. Agency, Autonomy and Euthanasia
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George L. Mendz and David W. Kissane
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Family Conflict ,media_common.quotation_subject ,Decision Making ,Dysfunctional family ,Personal autonomy ,Psychological Distress ,Affect (psychology) ,Suicide, Assisted ,03 medical and health sciences ,0302 clinical medicine ,Agency (sociology) ,Humans ,030212 general & internal medicine ,Assisted suicide ,media_common ,Motivation ,Depression ,Euthanasia ,Existential distress ,Health Policy ,Psychological distress ,General Medicine ,Issues, ethics and legal aspects ,Demoralization ,030220 oncology & carcinogenesis ,Personal Autonomy ,Psychology ,Social psychology ,Autonomy - Abstract
Agency is the human capacity to freely choose one’s thoughts, motivations and actions without undue internal or external influences; it is distinguished from decisional capacity. Four well-known conditions that can deeply affect agency are depression, demoralization, existential distress, and family dysfunction. The study reviews how they may diminish agency in persons whose circumstances may lead them to consider or request euthanasia or assisted suicide. Since agency has been a relatively neglected dimension of autonomous choice at the end of life, it is argued that to respect the autonomy of individuals, it is essential to establish their agency.
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- 2020
20. First prosecution of a Dutch doctor since the Euthanasia Act of 2002: what does the verdict mean?
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Suzanne van de Vathorst, Eva C. A. Asscher, General practice, APH - Personalized Medicine, APH - Quality of Care, APH - Aging & Later Life, and Public Health
- Subjects
Legislation, Medical ,Health (social science) ,Advisory Committees ,Clinical Decision-Making ,Decision Making ,Judgement ,Legal Case ,Euthanasia (Active voluntary) ,Suicide, Assisted ,Cognition ,Arts and Humanities (miscellaneous) ,Physicians ,Humans ,Cognitive Dysfunction ,Ethics, Medical ,Euthanasia, Active, Voluntary ,Mental Competency ,Review process ,Current Controversy ,Assisted suicide ,Legal case ,Netherlands ,Informed Consent ,Euthanasia ,Communication ,Health Policy ,Review Committees ,Directive ,Issues, ethics and legal aspects ,Law ,Verdict ,Criminal court ,Dementia ,Advance Directives ,Psychology - Abstract
On 11 September 2019, the verdict was read in the first prosecution of a doctor for euthanasia since the Termination of Life on Request and Assisted Suicide (Review Procedures) Act of 2002 was installed in the Netherlands. The case concerned euthanasia on the basis of an advance euthanasia directive (AED) for a patient with severe dementia. In this paper we describe the review process for euthanasia cases in the Netherlands. Then we describe the case in detail, the judgement of the Regional Review Committees for Termination of Life on Request and Euthanasia (RTE) and the judgement of the medical disciplinary court. Both the review committees and the disciplinary court came to the conclusion there were concerns with this case, which mainly hinged on the wording of the AED. They also addressed the lack of communication with the patient, the absence of oral confirmation of the wish to die and the fact that the euthanasia was performed without the patient being aware of this. However, the doctor was acquitted by the criminal court as the court found she had in fact met all due care criteria laid down in the act. We then describe what this judgement means for euthanasia in the Netherlands. It clarifies the power and reach of AEDs, it allows taking conversations with physicians and the testimony of the family into account when interpreting the AED. However, as a practical consequence the prosecution of this physician has led to fear among doctors about prosecution after euthanasia.
- Published
- 2019
21. Assessing attitudes towards medical assisted dying in Canadian family medicine residents: a cross-sectional study
- Author
-
Amy T Hsu, Aaron Wong, and Peter Tanuseputro
- Subjects
Adult ,Male ,Medical education ,medicine.medical_specialty ,Canada ,Health (social science) ,Palliative care ,assisted suicide ,Cross-sectional study ,Attitude of Health Personnel ,0603 philosophy, ethics and religion ,Suicide, Assisted ,Physician hastened death ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Terminally Ill ,030212 general & internal medicine ,Medical prescription ,Assisted suicide ,Response rate (survey) ,lcsh:R723-726 ,palliative care ,Descriptive statistics ,business.industry ,Euthanasia ,Health Policy ,Internship and Residency ,06 humanities and the arts ,Issues, ethics and legal aspects ,Cross-Sectional Studies ,Philosophy of medicine ,Family medicine ,Health Care Surveys ,residents ,Female ,060301 applied ethics ,Death certificate ,Medical assistance in dying ,business ,Family Practice ,lcsh:Medical philosophy. Medical ethics ,Research Article ,End-of-life - Abstract
Background Medical Assistance in Dying (MAID) in Canada came into effect in 2016 with the passing of Bill C-14. As patient interest and requests for MAID continue to evolve in Canada, it is important to understand the attitudes of future providers and the factors that may influence their participation. Attitudes towards physician hastened death (PHD) in general and the specific provision of MAID (e.g., causing death by lethal prescription or injection) are unknown among Canadian residents. This study examined residents’ attitudes towards PHD and MAID, and identified factors (e.g., demographics, clinical exposure to death and dying) that may influence their decision to participate in PHD and provide MAID. Methods A cross-sectional survey was adapted from prior established surveys on MAID to reflect the Canadian setting. All Canadian family medicine programs were invited to participate. The survey was distributed between December 2016 and April 2017. Analysis of the results included descriptive statistics to characterize the survey participants and multivariable logistic regressions to identify factors that may influence residents’ attitudes towards PHD and MAID. Results Overall, 247 residents from 6 family medicine training programs in Canada participated (response rate of 27%). While residents were most willing to participate in treatment withdrawal (52%), active participation in PHD (41%) and MAID by prescription of a lethal drug (31%) and lethal injection (24%) were less acceptable. Logistic regressions identified religion as a consistent and significant factor impacting residents’ willingness to participate in PHD and MAID. Residents who were not strictly practicing a religion were more likely to be willing to participate in PHD (OR = 17.38, p p p Conclusions Residents are hesitant to provide MAID themselves, with religious faith being a major factor impacting their decision.
- Published
- 2019
22. Autonomy, voluntariness and assisted dying
- Author
-
Colburn, Ben
- Subjects
Health (social science) ,media_common.quotation_subject ,Morals ,Suicide, Assisted ,03 medical and health sciences ,0302 clinical medicine ,Arts and Humanities (miscellaneous) ,030502 gerontology ,Argument ,Humans ,030212 general & internal medicine ,Sociology ,Assisted suicide ,media_common ,Law and economics ,Choice set ,Euthanasia ,Health Policy ,Legislature ,Voluntariness ,Dissent and Disputes ,Issues, ethics and legal aspects ,Personal Autonomy ,Position (finance) ,0305 other medical science ,Autonomy - Abstract
Ethical arguments about assisted dying often focus on whether or not respect for an individual’s autonomy gives a reason to offer them an assisted death if they want it. In this paper, I present an argument for legalising assisted dying which appeals to the autonomy of people who don’t want to die. Adding that option can transform the nature of someone’s choice set, enabling them to pursue other options voluntarily where that would otherwise be harder or impossible. This does not contradict the more familiar arguments for legalising assisted dying based on the autonomy of those who seek to die. But it does suggest that a wider constituency of support for that legislative change might be created by emphasising that one need not be in that position to be benefited by the change.
- Published
- 2019
23. Attitudes toward withholding antibiotics from people with dementia lacking decisional capacity: findings from a survey of Canadian stakeholders
- Author
-
Lise Trottier, Marcel Arcand, Jocelyn Downie, Lieve Van den Block, Gina Bravo, Family Medicine and Chronic Care, and End-of-life Care Research Group
- Subjects
PNEUMONIA ,Continuous deep sedation ,medicine.medical_specialty ,Canada ,Health (social science) ,LIFE-SUSTAINING ,Medical philosophy. Medical ethics ,Attitude of Health Personnel ,Psychological intervention ,UNTIL DEATH ,Suicide, Assisted ,Religiosity ,Antibiotics ,Medicine and Health Sciences ,medicine ,Dementia ,Humans ,Decisional incapacity ,Medical assistance in dying (MAID) ,dying (MAID) ,Survey ,TREATMENTS ,Response rate (survey) ,AFFECTING PHYSICIANS DECISIONS ,R723-726 ,Family caregivers ,Euthanasia ,Health Policy ,Research ,Stakeholder ,Advance directive ,NURSING-HOME RESIDENTS ,CARE ,medicine.disease ,Anti-Bacterial Agents ,Issues, ethics and legal aspects ,Vignette ,Philosophy of medicine ,Family medicine ,END ,Medical assistance in ,Female ,FAMILY BOOKLET ,ANTIMICROBIAL USE ,Psychology ,Infection - Abstract
Background Healthcare professionals and surrogate decision-makers often face the difficult decision of whether to initiate or withhold antibiotics from people with dementia who have developed a life-threatening infection after losing decisional capacity. Methods We conducted a vignette-based survey among 1050 Quebec stakeholders (senior citizens, family caregivers, nurses and physicians; response rate 49.4%) to (1) assess their attitudes toward withholding antibiotics from people with dementia lacking decisional capacity; (2) compare attitudes between dementia stages and stakeholder groups; and (3) investigate other correlates of attitudes, including support for continuous deep sedation (CDS) and medical assistance in dying (MAID). The vignettes feature a woman moving along the dementia trajectory, who has refused in writing all life-prolonging interventions and explicitly requested that a doctor end her life when she no longer recognizes her loved ones. Two stages were considered after she had lost capacity: the advanced stage, where she likely has several more years to live, and the terminal stage, where she is close to death. Results Support for withholding antibiotics ranged from 75% among seniors and caregivers at the advanced stage, to 98% among physicians at the terminal stage. Using the generalized estimating equation approach, we found stakeholder group, religiosity, and support for CDS and MAID, to be associated with attitudes toward antibiotics. Conclusions Findings underscore the importance for healthcare professionals of discussing underlying values and treatment goals with people at an early stage of dementia and their relatives, to help them anticipate future care decisions and better prepare surrogates for their role. Findings also have implications for the scope of MAID laws, in particular in Canada where the extension of MAID to persons lacking decisional capacity is currently being considered.
- Published
- 2021
24. Attitudes on euthanasia among medical students and doctors in Sri Lanka: a cross sectional study
- Author
-
H. M. M. T. B. Herath, K. W. S. M. Wijayawardhana, U. I. Wickramarachchi, and Chaturaka Rodrigo
- Subjects
Male ,Health (social science) ,Students, Medical ,R723-726 ,Medical philosophy. Medical ethics ,Cross sectional study ,Attitude of Health Personnel ,Euthanasia ,Health Policy ,health care facilities, manpower, and services ,Research ,Physician assisted suicide ,social sciences ,humanities ,Suicide, Assisted ,Issues, ethics and legal aspects ,Cross-Sectional Studies ,Surveys and Questionnaires ,Humans ,Sri Lanka - Abstract
Background Euthanasia is a topic of intense ethical debate and it is illegal in most countries at present, including Sri Lanka. The aim of this descriptive cross-sectional study of medical students and practicing doctors was to explore the acceptance of euthanasia and physician assisted suicide (PAS), and factors influencing this opinion. Methods A customised online questionnaire which explored opinions on euthanasia was administered to first and final year medical undergraduates in University of Colombo and practicing doctors with more than 5 years of work experience at The National Hospital of Sri Lanka. Attitudes on euthanasia and PAS were also assessed with the attitudes towards euthanasia (ATE) Scale, which is a 10-item questionnaire. Results A total of 425 individuals responded (males: 178, 42%, age: median – 27 years), which included 143 (33.6%) first-year medical undergraduates, 141 (33.2%) final-year medical undergraduates and 141 (33.2%) practicing doctors. More participants (200, 47.1%) favoured legalizing euthanasia than those directly opposing it (110, 25.9%), but a significant proportion (27%) remained undecided. The mean scores of ATE questionnaire from the whole sample were generally unfavourable towards euthanasia/PAS. Accepting euthanasia as an option for oneself (p = Conclusion In this cross-sectional survey, more respondents supported legalisation of euthanasia in Sri Lanka than those openly opposing it. Yet, a significant minority that responded as “undecided” for legalisation, were more likely to have unfavourable ATE.
- Published
- 2021
25. Regulating voluntary assisted dying practice: A policy analysis from Victoria, Australia
- Author
-
Lindy Willmott, Ben White, and Eliana Close
- Subjects
Value (ethics) ,Policy development ,Terminal Care ,Victoria ,Euthanasia ,030503 health policy & services ,Health Policy ,media_common.quotation_subject ,Conscientious objector ,Public policy ,Public administration ,Policy analysis ,Suicide, Assisted ,03 medical and health sciences ,0302 clinical medicine ,State (polity) ,Turnover ,Political science ,Humans ,030212 general & internal medicine ,0305 other medical science ,Policy Making ,media_common - Abstract
Background Victoria is the first state in Australia to legalise voluntary assisted dying (elsewhere known as physician-assisted suicide and euthanasia). The Victorian law took effect in 2019 after an 18-month implementation period designed to facilitate policy development and other regulatory infrastructure. Objective To study publicly available policy documents regarding voluntary assisted dying in Victoria and the issues they seek to regulate. Methods Policies were identified using a combination of search strategies to capture documents aimed at a broad range of stakeholders including health practitioners, patients, and families. The policies were thematically analysed using the Framework Method. Results The study identified 60 policies and five themes: 1) conceptions of policy purpose; 2) degree of support for VAD; 3) guidance about process; 4) navigating conscientious objection; and 5) conceptualising voluntary assisted dying and its relationship with other aspects of end-of-life care. Outside of the detailed Victorian Government policies, there was little practical guidance for voluntary assisted dying provision. Instead, the non-governmental policies tended to focus on positioning regarding VAD and entry into the process. Conclusion The study demonstrates the value of a planned implementation period for jurisdictions contemplating voluntary assisted dying reform and highlights the challenges in policymaking for a practice that is contentious for some.
- Published
- 2021
26. Novel beings and assisted nonexistence
- Author
-
Isra Black
- Subjects
050502 law ,Male ,Health (social science) ,Computer science ,Euthanasia ,Health Policy ,05 social sciences ,06 humanities and the arts ,0603 philosophy, ethics and religion ,Universal model ,Suicide, Assisted ,Issues, ethics and legal aspects ,Prima facie ,Extant taxon ,Block (programming) ,Humans ,060301 applied ethics ,Assisted suicide ,0505 law ,Law and economics - Abstract
This article engages with the legal regulation of end-of-existence decisionmaking for novel beings, specifically assisted nonexistence for such entities. The author explains the concept of a legal model for assisted death by reference to the substantive features of legal regimes in three jurisdictions in which assisted suicide or euthanasia is lawful. He considers how these models might fit novel beings who may require or prefer assistance to end their own existence by reference to the constituent features—abstract legal ingredients—that models for assisted death share. The author argues that extant models may block some novel beings’ access to end-of-existence assistance or fail to track what matters to them. He then examines the merits of adopting a universal model for assisted nonexistence, that is, a legal framework whose substantive features capture the end-of-existence concerns of both human and novel beings. Consideration of a unified legal framework may illuminate the discussion of assisted nonexistence for humans and novel beings. However, the paper proposes that whereas novel beings may have similar interests to humans, they may be relevantly different also. The prima facie case for adopting a one regime to rule us all approach to assisted nonexistence may be defeated by reasons for divergent regulation.
- Published
- 2021
27. Euthanasia and organ donation still firmly connected: reply to Bollen
- Author
-
Zeljka Buturovic
- Subjects
Study groups ,Health (social science) ,Tissue and Organ Procurement ,Adolescent ,media_common.quotation_subject ,0603 philosophy, ethics and religion ,Suicide, Assisted ,03 medical and health sciences ,0302 clinical medicine ,Arts and Humanities (miscellaneous) ,Intensive care ,Humans ,030212 general & internal medicine ,Organ donation ,Assisted suicide ,Situational ethics ,media_common ,Netherlands ,Commitment device ,Euthanasia ,Health Policy ,Timeline ,06 humanities and the arts ,Organ Transplantation ,3. Good health ,Issues, ethics and legal aspects ,Law ,060301 applied ethics ,Psychology ,Autonomy - Abstract
Bollen et al, replying to my own article, describe, in great detail, administrative and logistical aspects of euthanasia approval and organ donation in the Netherlands. They seem to believe that no useful lessons can be drawn from experiences of related groups such as euthanasia patients (typically patients with cancer) who cannot donate organs; patients who chose assisted suicide as opposed to euthanasia; patients in intensive care units and their relatives and suicidal young people as if we can only learn about organ donation in euthanasia patients by studying this exact group and no other, no matter how closely related and obviously relevant. However, it is not only permissible but also absolutely essential to gather evidence that goes beyond immediate point of interest and carefully study groups that share important features with it. Also, groups eligible for euthanasia are constantly expanding, theoretically, legally and practically, and it would be irresponsible to not foresee what are likely future developments. Finally, myopic focus on the technicalities of the procedure misses psychological reality that drives decisions and behaviours and which rarely mimics administrative timelines. Patients proceeding through euthanasia pipeline already face substantial situational pressure and adding organ donation on top of it can make the whole process work as a commitment device. By allowing euthanasia patients to donate their organs, we are giving them additional reason to end their lives, thus creating an unbreakable connection between the two.
- Published
- 2021
28. Doctor’s Criminal Liability and Medically Assisted Death – The Portuguese Case
- Author
-
Vera Lúcia Raposo
- Subjects
Parliament ,media_common.quotation_subject ,Suicide, Assisted ,Homicide ,Criminal Law ,Humans ,Relevance (law) ,Assisted suicide ,media_common ,Informed Consent ,Portugal ,Euthanasia ,Health Policy ,Interpretation (philosophy) ,Liability, Legal ,language.human_language ,Causality ,Criminal Behavior ,Law ,language ,Health law ,Portuguese ,Psychology ,Medical Futility ,Culpability - Abstract
Recently, the Portuguese Parliament discussed four proposals aimed at allowing some forms of medically assisted death. However, all of them were rejected by the majority. Therefore, doctors who in some way accelerate a patient’s death risk being convicted of the crime of homicide. Portuguese law provides some legal mechanisms that can exempt a doctor from criminal liability, such as causes excluding the conduct’s wrongfulness, and causes excluding the doctor’s culpability. Other elements to take into consideration are a proper interpretation of homicide crimes, thereby excluding conducts without the intent to kill; the relevance of patient consent; and the rejection of medical futility. This article explains how a doctor may not be held criminally accountable for medically assisted death, even in restrictive jurisdictions such as the Portuguese one.
- Published
- 2019
29. Ways of Debating Assisted Suicide and Euthanasia: Implications for Psychiatry
- Author
-
Scott Y. H. Kim
- Subjects
Psychiatry ,medicine.medical_specialty ,Scope (project management) ,Euthanasia ,Health Policy ,media_common.quotation_subject ,Context (language use) ,General Medicine ,Suicide, Assisted ,Issues, ethics and legal aspects ,History and Philosophy of Science ,Physicians ,medicine ,Humans ,Sociology ,Assisted suicide ,Autonomy ,Prerogative ,media_common ,Netherlands - Abstract
Euthanasia or assisted suicide (EAS) is permitted in a handful of jurisdictions. But its scope (ranging from being restricted to the end of life to no restrictions save those of autonomy) and its legal basis (ranging from a necessary prerogative of physicians to a human right) vary greatly. The debate over psychiatric EAS (pEAS) needs to be understood within this complex context. This essay addresses one specific aspect: can pEAS be grounded on a basic human right? The author argues against pEAS as grounded on a basic human right by showing that such a view has several implications we ought not accept.
- Published
- 2021
30. Trends in hastened death decision criteria: A review of official reports
- Author
-
Sílvia Marina, Tony Wainwright, Helena P. Pereira, and Miguel Ricou
- Subjects
Aged, 80 and over ,Male ,Euthanasia ,Health Policy ,Neoplasms ,Humans ,Euthanasia, Active, Voluntary ,Female ,Aged ,Netherlands ,Suicide, Assisted - Abstract
Voluntary euthanasia and physician assisted suicide has been legally performed in several countries. However, little is known about how decision-making occurs. We undertook this study to describe trends in officially reported cases of voluntary euthanasia or physician assisted suicide and to explore the decision-making procedures and understand relevant criteria. Thematic analysis of the official reports from several countries was performed. Differences in the number of reported deaths from hasten death practices between countries was found, with higher numbers in countries who performed voluntary euthanasia. Patients profiles follow the trends in the literature (the majority is aged between 70 and 89 years old, men die more often than women in most countries, most prevalent underlying disease is cancer, most people died at home). Despite there being little detail in the reports, decision is explored in the majority of countries and states (exploration of acceptable alternatives and verification of the voluntariness of the request). The importance of collecting data on this topic around the world and establishing a firm evidence-base to support professionals' practice is highlighted.
- Published
- 2021
31. The Judgment of the German Federal Constitutional Court regarding assisted suicide: a template for pluralistic states?
- Author
-
Urban Wiesing
- Subjects
Health (social science) ,Human Rights ,media_common.quotation_subject ,0603 philosophy, ethics and religion ,Suicide, Assisted ,German ,03 medical and health sciences ,Dignity ,Judgment ,0302 clinical medicine ,Arts and Humanities (miscellaneous) ,State (polity) ,Political science ,Humans ,030212 general & internal medicine ,Constitutional court ,Assisted suicide ,media_common ,Human rights ,Euthanasia ,Health Policy ,Interpretation (philosophy) ,06 humanities and the arts ,language.human_language ,United States ,Issues, ethics and legal aspects ,Law ,language ,060301 applied ethics ,Autonomy - Abstract
The article presents the judgment of the German Federal Constitutional Court from 26 February 2020 on assisted suicide. The statements regarding human dignity, human rights and the relationship between citizens and the state are examined. Furthermore, the consequences resulting from this interpretation of human dignity for states that are pluralistic and based on human rights will be laid out. The court’s judgment limits the power of parliaments and poses a challenge to many laws in states that see themselves as pluralistic, human rights-based states.
- Published
- 2021
32. Navigating medical assistance in dying from Bill C-14 to Bill C-7 : a qualitative study
- Author
-
Sally Thorne, Barbara Pesut, David Kenneth Wright, Gloria Puurveen, Madison Huggins, Kenneth Chambaere, Catharine J. Schiller, Family Medicine and Chronic Care, and End-of-life Care Research Group
- Subjects
Palliative care ,NETHERLANDS ,Population ,Legislation ,Nursing ,Health informatics ,Health administration ,Suicide, Assisted ,PALLIATIVE CARE ,03 medical and health sciences ,0302 clinical medicine ,030502 gerontology ,Medicine and Health Sciences ,Medicine ,Humans ,030212 general & internal medicine ,Assisted suicide ,education ,EUTHANASIA ,Qualitative Research ,Medicine(all) ,education.field_of_study ,Terminal Care ,Medical Assistance ,business.industry ,Health Policy ,Nursing research ,Research ,Public Health, Environmental and Occupational Health ,Healthcare systems ,TRENDS ,3. Good health ,Cross-Sectional Studies ,End of life ,Public aspects of medicine ,RA1-1270 ,Medical assistance in dying ,0305 other medical science ,business ,Qualitative ,Qualitative research - Abstract
Background Even as healthcare providers and systems were settling into the processes required for Medical Assistance in Dying (MAID) under Bill C-14, new legislation was introduced (Bill C-7) that extended assisted death to persons whose natural death is not reasonably foreseeable. The purpose of this paper is to describe the experiences of nurses and nurse practitioners with the implementation and ongoing development of this transition. Methods This qualitative longitudinal descriptive study gathered data through semi-structured telephone interviews with nurses from across Canada; cross sectional data from 2020 to 2021 is reported here. The study received ethical approval and all participants provided written consent. Findings Participants included nurses (n = 34) and nurse practitioners (n = 16) with significant experience with MAID. Participants described how MAID had transitioned from a new, secretive, and anxiety-producing procedure to one that was increasingly visible and normalized, although this normalization did not necessarily mitigate the emotional impact. MAID was becoming more accessible, and participants were learning to trust the process. However, the work was becoming increasingly complex, labour intensive, and often poorly remunerated. Although many participants described a degree of integration between MAID and palliative care services, there remained ongoing tensions around equitable access to both. Participants described an evolving gestalt of determining persons’ eligibility for MAID that required a high degree of clinical judgement. Deeming someone ineligible was intensely stressful for all involved and so participants had learned to be resourceful in avoiding this possibility. The required 10-day waiting period was difficult emotionally, particularly if persons worried about losing capacity to give final consent. The implementation of C-7 was perceived to be particularly challenging due to the nature of the population that would seek MAID and the resultant complexity of trying to address the origins of their suffering within a resource-strapped system. Conclusions Significant social and system calibration must occur to accommodate assisted death as an end-of-life option. The transition to offering MAID for those whose natural death is not reasonably foreseeable will require intensive navigation of a sometimes siloed and inaccessible system. High quality MAID care should be both relational and dialogical and those who provide such care require expert communication skills and knowledge of the healthcare system.
- Published
- 2021
33. From Reciprocity to Autonomy in Physician-Assisted Death: An Ethical Analysis of the Dutch Supreme Court Ruling in the Albert Heringa Case
- Author
-
Barend W. Florijn
- Subjects
Physician-Patient Relations ,Euthanasia ,Health Policy ,media_common.quotation_subject ,Personal autonomy ,humanities ,Supreme court ,Suicide, Assisted ,Issues, ethics and legal aspects ,Political science ,Law ,Physicians ,Personal Autonomy ,Humans ,Physician patient relationship ,Assisted suicide ,Autonomy ,Ethical analysis ,Ethical Analysis ,Reciprocity (international relations) ,media_common - Abstract
In 2002, the Dutch Euthanasia Act was put in place to regulate the ending of one's life, permitting a physician to provide assistance in dying to a patient whose suffering the physician assesses as unbearable. Currently, a debate in the Netherlands concerns whether healthy (older) people who value their life as completed should have access to assistance in dying based on their autonomous decision making. Although in European law a right to self-determination ensues from everyone's right to private life, the Dutch Supreme Court recently adopted a position on whether the Dutch Euthanasia Act lacks adequate attention to a patient's autonomous decision making. Specifically, in the
- Published
- 2020
34. US medical and surgical society position statements on physician-assisted suicide and euthanasia: a review
- Author
-
Joseph G. Barsness, C. Christopher Hook, Paul S. Mueller, and Casey R. Regnier
- Subjects
Health (social science) ,Palliative care ,Attitude of Health Personnel ,education ,Poison control ,Suicide prevention ,Suicide, Assisted ,03 medical and health sciences ,0302 clinical medicine ,Physician-assisted suicide ,Humans ,030212 general & internal medicine ,Assisted suicide ,Legalization ,lcsh:R723-726 ,Euthanasia ,Health Policy ,Palliative Care ,PAD ,Assisted death ,Issues, ethics and legal aspects ,Philosophy of medicine ,Professional association ,Neutrality ,lcsh:Medical philosophy. Medical ethics ,Societies ,Psychology ,Social psychology ,PAS ,030217 neurology & neurosurgery ,Research Article - Abstract
BackgroundAn analysis of the position statements of secular US medical and surgical professional societies on physician-assisted suicide (PAS) and euthanasia have not been published recently. Available statements were evaluated for position, content, and sentiment.MethodsIn order to create a comprehensive list of secular medical and surgical societies, the results of a systematic search using Google were cross-referenced with a list of societies that have a seat on the American Medical Association House of Delegates. Societies with position statements were identified. These statements were divided into 5 categories: opposed to PAS and/or euthanasia, studied neutrality, supportive, acknowledgement without statement, and no statement. Linguistic analysis was performed using RapidMinder in order to determine word frequency and sentiment respective to individual statements. To ensure accuracy, only statements with word counts > 100 were analyzed. A 2-tailed independentttest was used to test for variance among sentiment scores of opposing and studied neutrality statements.ResultsOf 150 societies, only 12 (8%) have position statements on PAS and euthanasia: 11 for PAS (5 opposing and 4 studied neutrality) and 9 for euthanasia (6 opposing and 2 studied neutrality). Although the most popular words used in opposing and studied neutrality statements are similar, notable exceptions exist (suicide,medicine, andtreatmentappear frequently in opposing statements, but not in studied neutrality statements, whereaspsychologists,law, andindividualsappear frequently in studied neutrality statements, but not in opposing statements). Sentiment scores for opposing and studied neutrality statements do not differ (mean, 0.094 vs. 0.104;P = 0.90).ConclusionsFew US medical and surgical societies have position statements on PAS and euthanasia. Among them, opposing and studied neutrality statements share similar linguistic sentiment. Opposing and studied neutrality statements have clear differences, but share recommendations. Both opposing and studied neutrality statements cite potential risks of PAS legalization and suggest that good palliative care might diminish a patient’s desire for PAS.
- Published
- 2020
35. Counting Cases of Termination of Life without Request: New Dances with Data
- Author
-
Govert den Hartogh and ASCA (FGw)
- Subjects
Health (social science) ,Euthanasia ,Computer science ,Health Policy ,06 humanities and the arts ,0603 philosophy, ethics and religion ,Suicide, Assisted ,Connection (mathematics) ,03 medical and health sciences ,Issues, ethics and legal aspects ,0302 clinical medicine ,Argument ,030220 oncology & carcinogenesis ,Humans ,060301 applied ethics ,Law and economics ,Legalization - Abstract
This paper explores the common argument proposed by opponents of the legalization of euthanasia that permitting ending a patient’s life at their request will lead to the eventual legalization of terminating life without request. The author’s examination of data does not support the conclusion that a causal connection exists between legalizing ending of life on request and an increase in the number of cases without request.
- Published
- 2020
36. Ethical arguments against coercing provider participation in MAiD (medical assistance in dying) in Ontario, Canada
- Author
-
Lucas Vivas and Travis Carpenter
- Subjects
Conscientious objection ,Canada ,Health (social science) ,Debate ,media_common.quotation_subject ,Right to die ,0603 philosophy, ethics and religion ,Assisted dying ,Suicide, Assisted ,Political science ,Health care ,Humans ,Conscience ,media_common ,Ontario ,lcsh:R723-726 ,Medical Assistance ,Euthanasia ,business.industry ,Health Policy ,Conscientious objector ,06 humanities and the arts ,Dissent and Disputes ,Supreme court ,Issues, ethics and legal aspects ,Economic sanctions ,Harm ,Philosophy of medicine ,Law ,060301 applied ethics ,Medical assistance in dying ,lcsh:Medical philosophy. Medical ethics ,business ,Conscience rights - Abstract
It has historically been a crime in Canada to provide assistance to someone in ending their own life, however, this paradigm was inverted in 2015 when the Supreme Court of Canada (SCC) ruled that restrictions on this practice, within certain defined parameters, violated the right to life, liberty, and security of the person. Subsequently, recent legal and policy decisions have highlighted the issue of how to balance the rights of individuals to access MAiD with the rights of care providers to exercise conscience-based objections to participation in this process. We argue that there is significant harm and ethical hazard in disregarding individual and institutional rights to conscientious objection and since measures less coercive than the threat of regulatory or economic sanctions do exist, there should be no justification for such threats in Canada’s health care systems.
- Published
- 2020
37. Should euthanasia and assisted suicide for psychiatric disorders be permitted? A systematic review of reasons
- Author
-
Madison E Churchill, Scott Y H Kim, Chris Gastmans, and Marie E Nicolini
- Subjects
medicine.medical_specialty ,Decision Making ,Poison control ,Suicide prevention ,Occupational safety and health ,Suicide, Assisted ,03 medical and health sciences ,0302 clinical medicine ,Injury prevention ,medicine ,Humans ,Mental Competency ,030212 general & internal medicine ,Assisted suicide ,Psychiatry ,Applied Psychology ,Euthanasia ,Health Policy ,Mental Disorders ,Human factors and ergonomics ,Bioethics ,Mental health ,030227 psychiatry ,Psychiatry and Mental health ,Personal Autonomy ,Psychology - Abstract
BackgroundEuthanasia and assisted suicide (EAS) based on a psychiatric disorder (psychiatric EAS) continue to pose ethical and policy challenges, even in countries where the practice has been allowed for years. We conducted a systematic review of reasons, a specific type of review for bioethical questions designed to inform rational policy-making. Our aims were twofold: (1) to systematically identify all published reasons for and against the practice (2) to identify current gaps in the debate and areas for future research.MethodsFollowing the PRISMA guidelines, we performed a search across seven electronic databases to include publications focusing on psychiatric EAS and providing ethical reasons. Reasons were grouped into domains by qualitative content analysis.ResultsWe included 42 articles, most of which were written after 2013. Articles in favor and against were evenly distributed. Articles in favor were mostly full-length pieces written by non-clinicians, with articles against mostly reactive, commentary-type pieces written by clinicians. Reasons were categorized into eight domains: (1) mental and physical illness and suffering (2) decisional capacity (3) irremediability (4) goals of medicine and psychiatry (5) consequences for mental health care (6) psychiatric EAS and suicide (7) self-determination and authenticity (8) psychiatric EAS and refusal of life-sustaining treatment. Parity- (or discrimination-) based reasons were dominant across domains, mostly argued for by non-clinicians, while policy reasons were mostly pointed to by clinicians.ConclusionsThe ethical debate about psychiatric EAS is relatively young, with prominent reasons of parity. More direct engagement is needed to address ethical and policy considerations.
- Published
- 2020
38. Polices and guidance on euthanasia and assisted suicide
- Author
-
Alan Glasper
- Subjects
Medical education ,030504 nursing ,Euthanasia ,Health Policy ,MEDLINE ,Media coverage ,State Medicine ,United Kingdom ,Suicide, Assisted ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Political science ,Practice Guidelines as Topic ,Humans ,Assisted suicide ,0305 other medical science ,General Nursing - Abstract
In light of recent media coverage, Emeritus Professor Alan Glasper, from the University of Southampton, discusses polices and guidance that relate to euthanasia and assisted suicide
- Published
- 2020
39. The right to a self-determined death as expression of the right to freedom of personal development: The German Constitutional Court takes a clear stand on assisted suicide
- Author
-
Horn, R
- Subjects
Freedom ,Health (social science) ,media_common.quotation_subject ,Context (language use) ,0603 philosophy, ethics and religion ,Suicide, Assisted ,German ,03 medical and health sciences ,Dignity ,0302 clinical medicine ,Arts and Humanities (miscellaneous) ,Political science ,Humans ,ddc:610 ,030212 general & internal medicine ,Constitutional court ,Assisted suicide ,media_common ,business.industry ,Constitution ,Euthanasia ,Health Policy ,Right to Die ,06 humanities and the arts ,16. Peace & justice ,language.human_language ,Personal development ,Issues, ethics and legal aspects ,Law ,Personal Autonomy ,language ,060301 applied ethics ,business ,Autonomy - Abstract
On 26 February 2020, the German Constitutional Court rejected a law from 2015 that prohibited any form of ‘business-like’ assisted suicide as unconstitutional. The landmark ruling of the highest federal court emphasised the high priority given to the rights of autonomy and free personal development, both of which constitute the principle of human dignity, the first principle of the German constitution. The ruling echoes particularities of post-war Germany’s end-of-life debate focusing on patient self-determination while rejecting any discussion of active assistance to die through a lethal injection administered by a doctor. This brief report discusses the ruling in the light of the broader sociopolitical and historical context of the German end-of-life debate.
- Published
- 2020
40. To die well : the phenomenology of suffering and end of life ethics
- Author
-
Fredrik Svenaeus
- Subjects
Medical Ethics ,Value of Life ,Dying ,Health (social science) ,Palliative care ,Pain ,Medical law ,0603 philosophy, ethics and religion ,Medicinsk etik ,Respect ,GeneralLiterature_MISCELLANEOUS ,Suicide, Assisted ,Education ,Phenomenology (philosophy) ,03 medical and health sciences ,0302 clinical medicine ,Narrative ,Phenomenon ,Humans ,030212 general & internal medicine ,Philosophy, Medical ,Terminal Care ,Euthanasia ,Health Policy ,Politics ,Right to Die ,06 humanities and the arts ,Scientific Contribution ,Epistemology ,Death ,Affect ,Philosophy of biology ,Suffering ,Mood ,Philosophy of medicine ,Personal Autonomy ,Quality of Life ,Phenomenology ,060301 applied ethics ,Psychology ,Stress, Psychological ,Medical ethics - Abstract
The paper presents an account of suffering as a multi-level phenomenon based on concepts such as mood, being-in-the-world and core life value. This phenomenological account will better allow us to evaluate the hardships associated with dying and thereby assist health care professionals in helping persons to die in the best possible manner. Suffering consists not only in physical pain but in being unable to do basic things that are considered to bestow meaning on one’s life. The suffering can also be related to no longer being able to be the person one wants to be in the eyes of others, to losing one’s dignity and identity. These three types of suffering become articulated by a narrative that holds together and bestows meaning on the whole life and identity of the dying person. In the encounter with the patient, the health-care professional attempts to understand the suffering-experience of the patient in an empathic and dialogic manner, in addition to exploring what has gone wrong in the patient’s body. Matters of physician assisted suicide and/or euthanasia—if it should be legalized and if so under which conditions—need to be addressed by understanding the different levels of human suffering and its positive counterpart, human flourishing, rather than stressing the respect for patient autonomy and no-harm principles, only. In this phenomenological analysis the notions of vulnerability and togetherness, ultimately connecting to the political-philosophical issues of how we live together and take care of each other in a community, need to be scrutinized.
- Published
- 2020
41. Public reasoning about voluntary assisted dying: An analysis of submissions to the Queensland Parliament, Australia
- Author
-
Chi-Wai Lui and David G. Kirchhoffer
- Subjects
Health (social science) ,assisted suicide ,Parliament ,media_common.quotation_subject ,Suicide, Assisted ,Rhetorical question ,Humans ,Euthanasia, Active, Voluntary ,Sociology ,Assisted suicide ,Everyday life ,Problem Solving ,media_common ,Law reform ,business.industry ,Euthanasia ,Health Policy ,public ,Australia ,Original Articles ,voluntary assisted dying ,Public relations ,Philosophy ,Normative reasoning ,reasoning ,reasons ,Original Article ,Queensland ,Thematic analysis ,business - Abstract
The use of voluntary assisted dying as an end‐of‐life option has stimulated concerns and debates over the past decades. Although public attitudes towards voluntary assisted dying (including euthanasia and physician‐assisted suicide) are well researched, there has been relatively little study of the different reasons, normative reasoning and rhetorical strategies that people invoke in supporting or contesting voluntary assisted dying in everyday life. Using a mix of computational textual mining techniques, keyword study and qualitative thematic coding to analyse public submissions to a parliamentary inquiry into voluntary assisted dying in Australia, this study critically examines the different reasons, normative reasoning and rhetorical strategies that people invoke in supporting or contesting voluntary assisted dying in everyday life. The analysis identified complex and potentially contradictory ethical principles being invoked on both sides of the debate. These findings deepen our understanding of the moral basis of public reasoning about end‐of‐life matters and will help to inform future discussions on policy and law reform. The findings underscore the importance of sound normative reasoning and the use of caution when interpreting opinion polls to inform policy.
- Published
- 2019
42. A Life Fulfilled: Should There Be Assisted Suicide for Those Who Are Done with Living?
- Author
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Martin Buijsen, Corporate and Financial Law, and Health Law
- Subjects
Health (social science) ,media_common.quotation_subject ,Common law ,Fundamental rights ,Legislation ,0603 philosophy, ethics and religion ,Suicide, Assisted ,03 medical and health sciences ,0302 clinical medicine ,SDG 3 - Good Health and Well-being ,Political science ,Humans ,Terminally Ill ,030212 general & internal medicine ,Obligation ,Assisted suicide ,Aged ,Netherlands ,media_common ,Human rights ,Euthanasia ,Constitution ,Health Policy ,Right to Die ,06 humanities and the arts ,Issues, ethics and legal aspects ,Law ,The Right to Privacy ,060301 applied ethics - Abstract
The issue of assisted suicide for those with a “fulfilled life” is being hotly debated in the Netherlands. A large number of Dutch people feel that elderly people (i.e., people who have reached the age of 70) with a “fulfilled life” should have access to assisted suicide. Citizens have therefore requested Parliament to expand the existing legislation that governs euthanasia and physician-assisted suicide. The Dutch constitution does not permit national legislation to be incompatible with higher international (human rights) law. An analysis of the case law of the European Court of Human Rights shows that a person’s right to decide on the time and manner of his or her death should be regarded as an aspect of the right to privacy. Although no positive obligation has been imposed on parties to the European Convention for the Protection of Human Rights and Fundamental Freedoms to facilitate suicide, they may do so, provided that certain conditions are met.
- Published
- 2018
43. Fear of Life, Fear of Death, and Fear of Causing Death How Legislative Changes on Assisted Dying Are Doomed to Fail
- Author
-
Matti Häyry
- Subjects
end of life ,life ,Attitude to Death ,Legislation, Medical ,Health (social science) ,assisted suicide ,media_common.quotation_subject ,Decision Making ,Appeal ,Legislation ,0603 philosophy, ethics and religion ,legislation ,medical ,Suicide, Assisted ,03 medical and health sciences ,0302 clinical medicine ,Physicians ,death ,Humans ,030212 general & internal medicine ,Assisted suicide ,law ,ta512 ,Finland ,media_common ,Health Policy ,healthcare ,Legislature ,06 humanities and the arts ,euthanasia ,Voluntariness ,causing death ,ethics ,Issues, ethics and legal aspects ,Professionalism ,Withholding Treatment ,Personal Autonomy ,Professional ethics ,Normative ,fear ,060301 applied ethics ,professional ethics ,Psychology ,Delivery of Health Care ,Social psychology ,Autonomy - Abstract
Fear of life, fear of death, and fear of causing death form a combination that prevents reasoned changes in laws concerning end-of-life situations. This is shown systematically in this article using the methods of conceptual analysis. Prevalent fears are explicated and interpreted to see how their meanings differ depending on the chosen normative stance. When the meanings have been clarified, the impact of the fears on the motivations and justifications of potential legislative reforms are assessed. Two main normative stances are evoked. The first makes an appeal to individual self-determination, or autonomy, and the second to the traditional professional ethics of physicians. These views partly share qualifying elements, including incurability and irreversibility of the patient’s medical condition, proximity of death, the unbearable nature of suffering, and issues of voluntariness further shade the matter. The conclusion is that although many motives to change end-of-life laws are admirable, they are partly contradictory, as are calls for autonomy and appeals to professional ethics; to a degree that good, principled legislative solutions remain improbable in the foreseeable future.
- Published
- 2018
44. Secularity, abortion, assisted dying and the future of conscientious objection: modelling the relationship between attitudes
- Author
-
Magne Supphellen, Morten Magelssen, and Nhat Quang Le
- Subjects
Adult ,Male ,Conscientious objection ,Health (social science) ,Attitude of Health Personnel ,media_common.quotation_subject ,Abortion ,0603 philosophy, ethics and religion ,Morals ,Assisted dying ,Suicide, Assisted ,Religiosity ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Health care ,Public attitudes ,Humans ,030212 general & internal medicine ,health care economics and organizations ,media_common ,lcsh:R723-726 ,business.industry ,Euthanasia ,Norway ,Health Policy ,Conscientious objector ,Religion and Medicine ,Abortion, Induced ,Refusal to Treat ,06 humanities and the arts ,Bioethics ,Toleration ,Middle Aged ,Secularity ,Issues, ethics and legal aspects ,Philosophy of medicine ,Female ,060301 applied ethics ,lcsh:Medical philosophy. Medical ethics ,business ,Psychology ,Social psychology ,Conscience ,Research Article - Abstract
Background Controversies arise over abortion, assisted dying and conscientious objection (CO) in healthcare. The purpose of the study was to examine the relationship between attitudes towards these bioethical dilemmas, and secularity and religiosity. Method Data were drawn from a 2017 web-based survey of a representative sample of 1615 Norwegian adults. Latent moderated structural equations modelling was used to develop a model of the relationship between attitudes. Results The resulting model indicates that support for abortion rights is associated with pro-secular attitudes and is a main “driver” for support for assisted dying and opposition to conscientious objection. Conclusions This finding should be regarded as a hypothesis which ought to be tested in other populations. If the relationship is robust and reproduced elsewhere, there are important consequences for CO advocates who would then have an interest in disentangling the debate about CO from abortion; and for health systems who ought to consider carefully how a sound policy on CO can safeguard both patient trust in the services and the moral integrity of professionals. It is suggested that if religiosity wanes and pro-secular and pro-abortion attitudes become more widespread, support for CO might decline, putting into question whether present policies of toleration of conscientious refusals will remain acceptable to the majority.
- Published
- 2019
45. The Case for an Autonomy-Centred View of Physician-Assisted Death
- Author
-
Eric Mathison and Jeremy Davis
- Subjects
Health (social science) ,Philosophical literature ,Scope (project management) ,Euthanasia ,Health Policy ,media_common.quotation_subject ,Medical law ,Suicide, Assisted ,Physicians ,Personal Autonomy ,Humans ,Assisted suicide ,Psychology ,Welfare ,Autonomy ,Law and economics ,media_common - Abstract
Most people who defend physician-assisted death (PAD) endorse the Joint View, which holds that two conditions-autonomy and welfare-must be satisfied for PAD to be justified. In this paper, we defend an Autonomy Only view. We argue that the welfare condition is either otiose on the most plausible account of the autonomy condition or else is implausibly restrictive, particularly once we account for the broad range of reasons patients cite for desiring PAD, such as "tired of life" cases. Moreover, many of the common objections to an autonomy only view fail once we understand the extent of the autonomy condition's requirements-in particular, the importance of one's values for autonomous choices. If our view is correct, then the scope of permissible PAD is broader than is currently accepted in both the philosophical literature and the law and therefore poses an important challenge to the current consensus on justified PAD.
- Published
- 2019
46. The involvement of family in the Dutch practice of euthanasia and physician assisted suicide: a systematic mixed studies review
- Author
-
Roest, Bernadette, Trappenburg, M.J., Leget, Carlo, Politiek en bestuur, UU LEG Research USG Public Matters Public Governance and Management, UU LEG Research USG Public Matters, Citizenship and Humanisation of the Public Sector, Care Ethics, A meaningful life in a just and caring society, University of Humanistic Studies, Politiek en bestuur, UU LEG Research USG Public Matters Public Governance and Management, and UU LEG Research USG Public Matters
- Subjects
Health (social science) ,family ,media_common.quotation_subject ,Decision Making ,Guidelines as Topic ,end-of-life ,PsycINFO ,0603 philosophy, ethics and religion ,Suicide, Assisted ,03 medical and health sciences ,0302 clinical medicine ,Empirical research ,Humans ,Terminally Ill ,030212 general & internal medicine ,Qualitative Research ,Netherlands ,media_common ,lcsh:R723-726 ,Physician-Patient Relations ,Medical education ,Physician-assisted dying ,Health Policy ,Social environment ,06 humanities and the arts ,euthanasia ,decision-making ,Issues, ethics and legal aspects ,Philosophy of medicine ,Grief ,Guideline Adherence ,060301 applied ethics ,Thematic analysis ,lcsh:Medical philosophy. Medical ethics ,Psychology ,Autonomy ,Research Article ,Qualitative research - Abstract
Background Family members do not have an official position in the practice of euthanasia and physician assisted suicide (EAS) in the Netherlands according to statutory regulations and related guidelines. However, recent empirical findings on the influence of family members on EAS decision-making raise practical and ethical questions. Therefore, the aim of this review is to explore how family members are involved in the Dutch practice of EAS according to empirical research, and to map out themes that could serve as a starting point for further empirical and ethical inquiry. Methods A systematic mixed studies review was performed. The databases Pubmed, Embase, PsycInfo, and Emcare were searched to identify empirical studies describing any aspect of the involvement of family members before, during and after EAS in the Netherlands from 1980 till 2018. Thematic analysis was chosen as method to synthesize the quantitative and qualitative studies. Results Sixty-six studies were identified. Only 14 studies had family members themselves as study participants. Four themes emerged from the thematic analysis. 1) Family-related reasons (not) to request EAS. 2) Roles and responsibilities of family members during EAS decision-making and performance. 3) Families’ experiences and grief after EAS. 4) Family and ‘the good euthanasia death’ according to Dutch physicians. Conclusion Family members seem to be active participants in EAS decision-making, which goes hand in hand with ambivalent feelings and experiences. Considerations about family members and the social context appear to be very important for patients and physicians when they request or grant a request for EAS. Although further empirical research is needed to assess the depth and generalizability of the results, this review provides a new perspective on EAS decision-making and challenges the Dutch ethical-legal framework of EAS. Euthanasia decision-making is typically framed in the patient-physician dyad, while a patient-physician-family triad seems more appropriate to describe what happens in clinical practice. This perspective raises questions about the interpretation of autonomy, the origins of suffering underlying requests for EAS, and the responsibilities of physicians during EAS decision-making.
- Published
- 2019
47. To die, to sleep, perchance to dream? A response to DeMichelis, Shaul and Rapoport
- Author
-
Joel L Gamble, Nathan K. Gamble, and Michal Pruski
- Subjects
Warrant ,Health (social science) ,Palliative care ,Euthanasia ,Health Policy ,education ,Palliative Care ,Poison control ,Commit ,Hospitals, Pediatric ,humanities ,Suicide, Assisted ,Issues, ethics and legal aspects ,Arts and Humanities (miscellaneous) ,Dismissal ,Argument ,Law ,Humans ,Ethics, Medical ,Psychology ,Child ,End-of-life care ,health care economics and organizations ,Medical ethics - Abstract
In developing their policy on paediatric medical assistance in dying (MAID), DeMichelis, Shaul and Rapoport decide to treat euthanasia and physician-assisted suicide as ethically and practically equivalent to other end-of-life interventions, particularly palliative sedation and withdrawal of care (WOC). We highlight several flaws in the authors’ reasoning. Their argument depends on too cursory a dismissal of intention, which remains fundamental to medical ethics and law. Furthermore, they have not fairly presented the ethical analyses justifying other end-of-life decisions, analyses and decisions that were generally accepted long before MAID was legal or considered ethical. Forgetting or misunderstanding the analyses would naturally lead one to think MAID and other end-of-life decisions are morally equivalent. Yet as we recall these well-developed analyses, it becomes clear that approving of some forms of sedation and WOC does not commit one to MAID. Paediatric patients and their families can rationally and coherently reject MAID while choosing palliative care and WOC. Finally, the authors do not substantiate their claim that MAID is like palliative care in that it alleviates suffering. It is thus unreasonable to use this supposition as a warrant for their proposed policy.
- Published
- 2019
48. Educational needs of healthcare professionals and members of the general public in Alberta Canada, 2 years after the implementation of medical assistance in dying
- Author
-
Jean Triscott, Donna M Wilson, Rod MacLeod, Joachim Cohen, Family Medicine and Chronic Care, and End-of-life Care Research Group
- Subjects
Adult ,Male ,medicine.medical_specialty ,Canada ,Sociology and Political Science ,Attitude of Health Personnel ,Health Personnel ,Clinical Decision-Making ,Alberta ,Suicide, Assisted ,03 medical and health sciences ,0302 clinical medicine ,Surveys and Questionnaires ,medicine ,Humans ,survey ,Euthanasia, Active, Voluntary ,030212 general & internal medicine ,Assisted suicide ,education ,educational needs ,Medicine(all) ,education.field_of_study ,Terminal Care ,Health professionals ,Euthanasia ,030503 health policy & services ,Health Policy ,Public Health, Environmental and Occupational Health ,Survey tool ,Alberta canada ,Work experience ,Animal euthanasia ,Family medicine ,Female ,0305 other medical science ,Psychology ,Healthcare providers ,Social Sciences (miscellaneous) ,Dying care - Abstract
Medical assistance in dying (MAID) was implemented across Canada in June of 2016, after each Canadian province and territory had developed their own MAID processes. Over the first 2 years, just under 300 Alberta citizens received MAID services, a very small proportion (
- Published
- 2018
49. Changes in attitudes towards hastened death among Finnish physicians over the past sixteen years
- Author
-
Heikki Hinkka, Reetta P. Piili, Riina Metsänoja, Juho T. Lehto, Pirkko-Liisa Kellokumpu-Lehtinen, Lääketieteen ja biotieteiden tiedekunta - Faculty of Medicine and Life Sciences, and University of Tampere
- Subjects
Male ,Health (social science) ,Younger age ,medicine.medical_treatment ,Medical Oncology ,0302 clinical medicine ,Neurologia ja psykiatria - Neurology and psychiatry ,Surveys and Questionnaires ,030212 general & internal medicine ,Assisted suicide ,Finland ,Resuscitation Orders ,Response rate (survey) ,lcsh:R723-726 ,Morphine ,Health Policy ,Religion and Medicine ,clinical ethics ,Age Factors ,Middle Aged ,Death ,End-of-life care ,030220 oncology & carcinogenesis ,Female ,Specialization ,Research Article ,Adult ,medicine.medical_specialty ,Attitude to Death ,Attitude of Health Personnel ,Specialty ,Background factors ,Suicide, Assisted ,03 medical and health sciences ,Sex Factors ,Clinical ethics ,Physicians ,medicine ,Humans ,Cardiopulmonary resuscitation ,end-of-life care ,Aged ,Euthanasia ,business.industry ,decision-making ,euthanasia ,Issues, ethics and legal aspects ,Philosophy of medicine ,Family medicine ,lcsh:Medical philosophy. Medical ethics ,business ,Decision-making - Abstract
Background The ethics of hastened death are complex. Studies on physicians’ opinions about assisted dying (euthanasia or assisted suicide) exist, but changes in physicians’ attitudes towards hastened death in clinical decision-making and the background factors explaining this remain unclear. The aim of this study was to explore the changes in these attitudes among Finnish physicians. Methods A questionnaire including hypothetical patient scenarios was sent to 1182 and 1258 Finnish physicians in 1999 and 2015, respectively. Two scenarios of patients with advanced cancer were presented: one requesting an increase in his morphine dose to a potentially lethal level and another suffering a cardiac arrest. Physicians’ attitudes towards assisted death, life values and other background factors were queried as well. The response rate was 56%. Results The morphine dose was increased by 25% and 34% of the physicians in 1999 and 2015, respectively (p
- Published
- 2018
50. End-of-life decision-making across cancer types
- Author
-
Mariëtte N. Verkissen, Dirk Houttekier, Kenneth Chambaere, Luc Deliens, Joachim Cohen, Rik Schots, End-of-life Care Research Group, Faculty of Medicine and Pharmacy, Family Medicine and Chronic Care, Immunology and Microbiology, Laboratory of Molecullar and Cellular Therapy, Clinical sciences, and Hematology
- Subjects
Male ,medicine.medical_specialty ,Cancer Research ,Palliative care ,Clinical Decision-Making ,MEDLINE ,Article ,Suicide, Assisted ,03 medical and health sciences ,0302 clinical medicine ,Belgium ,Retrospective survey ,Neoplasms ,Surveys and Questionnaires ,Medicine ,Humans ,030212 general & internal medicine ,Assisted suicide ,Health policy ,Response rate (survey) ,Terminal Care ,business.industry ,Euthanasia ,Cancer ,Middle Aged ,medicine.disease ,3. Good health ,030220 oncology & carcinogenesis ,Family medicine ,oncology ,Female ,Death certificate ,business - Abstract
BACKGROUND: The treatment of advanced cancer often involves potentially life-shortening end-of-life decisions (ELDs). This study aimed to examine the prevalence and characteristics of ELDs in different cancer types. METHODS: A nationwide death certificate study was conducted based on a large random sample of all deaths in Flanders, Belgium, between 1 January and 30 June 2013. All cancer deaths were selected (n = 2392). Attending physicians were sent a questionnaire about ELDs and the preceding decision-making process. RESULTS: The response rate was 58.3%. Across cancer types, a non-treatment decision occurred in 7.6-14.0%, intensified pain and symptom alleviation in 37.5-41.7%, euthanasia or physician-assisted suicide in 8.7-12.6%, and life shortening without explicit patient request in 1.0-2.4%. ELD prevalence did not differ significantly by cancer type. Reasons for ELDs were most frequently patient's physical suffering and lack of prospect of improvement. 'Anticipated further suffering' and 'unbearable situation for relatives' were reasons more often reported in haematological cancer than in other cancer types. Patient, family, and caregiver involvement in decision-making did not differ across cancer types. CONCLUSIONS: Euthanasia or physician-assisted suicide rates were relatively high in all cancer types. Neither the prevalence of ELDs nor characteristics of the decision-making process differed substantially between cancer types. This indicates a uniform approach to end-of-life care, including palliative care, across oncological settings.
- Published
- 2018
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