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Dealing with dementia raises agonising ethical dilemmas A FEW MONTHS before Vera mistook her grandson for a coconut, her son came by with someone she did not recognise. He was [...]

The slippery slope argument has been the mainstay of many of those opposed to the legalisation of physician-assisted suicide and euthanasia. In this paper I re-examine the slippery slope in the light of two recent studies that examined the prevalence of medical decisions concerning the end of life in the Netherlands and in Australia. I argue that these two studies have robbed the slippery slope of the source of its power - its intuitive obviousness. Finally I propose that, contrary to the warnings of the slippery slope, the available evidence suggests that the legalisation of physician-assisted suicide might actually decrease the prevalence of non-voluntary and involuntary euthanasia. Keywords: Suicide - assisted; ethics - medical; euthanasia; legislation; jurisprudence

Objectives - Life-sustaining treatment at the end of life gives rise to many ethical problems in Japan. Recent surveys of Japanese physicians suggested that they tend to treat terminally ill patients aggressively. We studied why Japanese physicians were reluctant to withhold or withdraw life-support from terminally ill patients and what affected their decisions. Design and participants - A qualitative study design was employed, using a focus group interview with seven physicians, to gain an in-depth understanding of attitudes and rationales in Japan regarding medical care at the end of life. Results - Analysis revealed that physicians and patients 'family members usually make decisions about life-sustaining treatment, while the patients' wishes are unavailable or not taken into account. Both physicians and family members tend to consider withholding or withdrawing life-sustaining treatment as abandonment or even killing. The strongest reason to start cardiopulmonary resuscitation - and to continue it until patients' family members arrive - seems to be the family members' desire w be at the bedside at the time of death. All physicians participating in our study regarded advance directives that provide information as to patients' wishes about life-sustaining treatment desirable. All expressed concern, however, that it would be difficult to forgo or discontinue life-support based on a patient's advance directive, particularly when the patient's family opposed the directive. Conclusion - Our group interview suggested several possible barriers to death with dignity and the appropriate use of advance directives in Japan. Further qualitative and quantitative research in this regard is needed. Key words: Life-sustaining treatment; advance directives; Japan; qualitative study.

It is widely accepted now that a patient's right to refuse treatment extends to circumstances in which the exercise of that right may lead to the patient's death. However, it is also often effectively assumed, without argument, that this implies a patient's right to request another agent to intervene so as to bring about his or her death, in a way which would render that agent guilty of murder in the absence of such a request. But the fight to refuse treatment can, logically, have no such implication, and the mistaken supposition that it does conflates a right to die with a fight to be killed. Confusion over this issue is brought out by an examination of conflicting opinion concerning the permissible termination of ventilation for mentally competent patients. A wider lesson may be drawn regarding the need for the ethical assessment of new forms of life-sustaining medical technology. Key words: Patients' rights; consent; euthanasia; life-sustaining technology; termination of treatment; acts and omissions.

Nursing is multidimensional, interactive, interdisciplinary, and complex. Almost anything that can be said about nursing can be said another way. Some things worth being said and heard will not follow the norms of journal presentation. A forum accommodates the emerging voice, the new format, the innovative approach. Nursing Forum, in an effort to honor the 'independent voice' in nursing, presents here the voice who elects to enter the dialogue, but who does so 'in another way.' Key words: Assisted suicide, ethics, euthanasia, intentionality, The nursing community should not rely on the ambiguous American Nurses Association's 'Position Statement on Assisted Suicide.' Language in the statement does not offer a clear interpretation of the Association's ethical position and confuses the differences and issues concerning legal assisted suicide and illegal euthanasia. A clear and strong statement addressing reasons nurses believe both assisted suicide and euthanasia is ethically wrong can provide the nursing community a strong and organized voice in the debates surrounding this issue.

Medical ethics question the severity and the practice of euthanasia of a voluntary nature by challenging its legalization. If legalized, there is the fear that voluntary euthanasia would gradually be practiced more frequently, resulting in a degradation of medicine's practices and a display of genocidal tendencies. Euthanasia is a means to relieve the sufferings of a person while genocide is a method of relieving the sufferings of a social group of people or a community afflicted by disease.

Data from the Netherlands on voluntary euthanasia indicates that the risk of abuse from legalized euthanasia may be slight. Euthanasia is illegal in the Netherlands although the courts do not prosecute for it. Policies to prevent abuses could include psychological evaluation and counseling to protect patient choice. Professional and institutional abuse could be prevented by policies including prohibition of fees, documentation, reporting requirements and retrospective data for indices of abuse.

Physician-assisted suicide and voluntary euthanasia should remain illegal because hospice care is a proper alternative. Euthanasia would hinder progress to relieve the suffering of terminal patients. Hospice care helps the strongest needs of the dying including autonomy, control, lessening pain and preventing loneliness. Killing is not the solution to dying and suffering.

Where do you stand on euthanasia? Jim Bosworth developed acute lymphocytic leukemia at the age of 29. A marathon runner who'd always been in excellent health, he was determined to [...]

I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. Similarly, I will not give to a woman [...]

The slippery slope argument has been the mainstay of many of those opposed to the legalisation of physician-assisted suicide and euthanasia. In this paper I re-examine the slippery slope in the light of two recent studies that examined the prevalence of medical decisions concerning the end of life in the Netherlands and in Australia. I argue that these two studies have robbed the slippery slope of the source of its power - its intuitive obviousness. Finally I propose that, contrary to the warnings of the slippery slope, the available evidence suggests that the legalisation of physician-assisted suicide might actually decrease the prevalence of non-voluntary and involuntary euthanasia. Keywords: Suicide - assisted; ethics - medical; euthanasia; legislation; jurisprudence

Physicians' generally have three reasons for objecting to euthanasia: revulsion for the act of ending a patient's life; the social taboo against killing of any sort; and traditional ideals about medical ethics and the physician's function as a healer. These objections derive from medical training and practice and so serve the interests of physicians rather than their patients. Since society dares to use technology to keep patients alive and in pain, it should also dare to end their suffering when that is their wish. Physicians should develop ethics that accommodate this norm.

The palliative care movement in the UK has become linked to anti-euthanasia views. It has become a dominant philosophy that the principles palliative care, which involves the care of patients with diseases unresponsive to treatment, are contradictory to euthanasia. However, it is argued that this philosophy does not reflect the views of all palliative care professionals and that the availability of palliative care does not eliminate the desire of some patients to end their life.

Daniel P. Sulmasy and Jeremy Sugarman believe that withholding and withdrawing treatment are not morally equivalent but they have not succeeded in showing a moral difference between the two. Prior acquisition is a just allocation procedure which should not be altered without a powerful moral reason and this is where Sulmasy and Sugarman have confused themselves because they believe that even if an allocation was unjust, the first occupant still has a claim to continue treatment.

A panel of Dutch medical ethicists visited US hospitals and discussed issues of access to medical care and euthanasia. Dutch medicine places greater emphasis on continuing medical care than the US system. In addition, euthanasia is permitted under certain conditions. For example, it can must be carried out with the consent of both the patient and the family physician. In addition, the patient must be 'competent' and economic factors must never play a part in the decision. Additional discussion of Dutch euthanasia protocol is presented., Recent experiences of the Dutch health care community in dealing with access, financing and bioethical issues might be of use in U.S. discussions on health care reform and clinical ethics, [...]

In January 1995, the Royal College of Nursing, Australia (RCNA) took the unprecedented step of releasing for comment a discussion paper entitled Euthanasia: an issue for nurses. Responses were received [...]

In earlier publications, we had argued that Paul Ramsey is inconsistent because he simultaneously asserts that (i) |all our days and years are of equal worth' and (ii) |that it is permissible to refrain from prolonging the lives of some dying patients'. Thomas Long has suggested that we have not shown that Paul Ramsey is inconsistent. Ramsey and we, he holds, start from incommensurable metaphysical views: for Ramsey, the dying process has religious significance -- God is calling his servant home. While it is normally a good thing to keep a patient alive, it would, for Ramsey, show deafness to God's call to keep a dying patient alive. It is true we do not share Paul Ramsey's religious views. It is, however, not necessary to rely on any particular metaphysical views to refute Ramsey's position. For Ramsey's view to be internally consistent, Ramsey would have to be able to distinguish between dying and non-dying patients. We examine some of Ramsey's examples and show that his practical judgements do not allow us to draw this distinction. This means that, contra Long, we hold fast to our charge that Ramsey's view is inconsistent.

Doctors can be spared of the trouble of having to decide on a patient's request to withdraw his life support system. This can be done by providing medical equipments with automatic switch-off mechanisms which would allow patients to die without human intervention. However, clinician's actions are expected to be determined by their ethics and medical legality. Although these cases seldom occur, these give the patients a chance to voice out their wishes.