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The British Medical Association and some Royal Colleges have recently changed their stance on physician-assisted suicide from 'opposed' to forms of 'neutral'. The Royal College of Anaesthetists will poll members soon on whether to follow suit. Elsewhere neutrality amongst professional bodies has preceded legalisation of physician-assisted suicide. We examine the arguments relevant to the anaesthesia community and its potential impact in the UK. [ABSTRACT FROM AUTHOR]

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

This paper contributes to the ongoing discussion in the United Kingdom regarding euthanasia and assisted dying, using data specifically related to individuals with dementia. A qualitative approach was taken with data captured via a set of written questions in the form of a Mass Observation Archive Directive. The respondents, known as Observers, provided written responses; there was no limit to the length of the responses and the Observers were able to provide as much or as little detail as they chose. The data were analysed thematically utilising NVivo software. One-hundred and seven responses were received, representing a range of beliefs, and with opinions regarding euthanasia and dementia with pro, anti, and uncertain views being expressed. Five main themes emerged during our data analysis: capacity, legislation, agency and personal philosophies, disquietude, and incumbrance. Consistent with previous research capturing public views regarding euthanasia and assisted dying for people with dementia, the findings suggest policy makers may wish to consult the British public regarding legislation regarding euthanasia and dementia. [ABSTRACT FROM AUTHOR]

In this month's Policy column, Iwan Dowie explores the legality behind caring for those approaching end of life. [ABSTRACT FROM AUTHOR]

Simple Summary: This study aims to evaluate the use of ethical discussion groups for reducing moral stress in veterinary teams. The data analysis is based on focus groups and individual interviews with veterinary team members working in charity veterinary practice. Moral stress is described as an everyday experience in the lives of veterinary team members and is caused by uncertainty about their ability to fulfill their ethical obligations. Moral stress is shown to be cumulative and can interact with other forms of stress. Distinct practical and relational barriers to ethical action are identified and proposed as contributors to moral stress, whilst the potential impact of moral stress on team members' quality of life and mental health is highlighted. Results show that regular facilitated ethical group discussions may reduce moral stress in the hospital setting, particularly through familiarization with others' roles and perspectives and supporting one another's ethical decision-making. The article concludes that moral stress is an important and poorly understood problem in veterinary practice and that further development of regular facilitated ethical group discussion may be of considerable benefit to team members. This study examines experiences of veterinary moral stress in charity veterinary practice and qualitatively evaluates the role of ethical discussion in reducing veterinary moral stress. Results are drawn from a thematic data analysis of 9 focus groups and 15 individual interviews with veterinary team members from 3 UK charity veterinary hospitals. Moral stress is described as an everyday experience by participants and is caused by uncertainty about their ability to fulfill their ethical obligations. Moral stress is shown to be cumulative and can interact with other forms of stress. Distinct practical and relational barriers to ethical action are identified and proposed as contributors to moral stress, and different team members experience different barriers within their roles. The potential impact of moral stress on team members' quality of life and mental health is highlighted. Results show that regular facilitated ethical group discussions may reduce moral stress in the hospital setting, particularly through familiarization with others' roles and ethical perspectives and through supporting one another's ethical decision-making. The article concludes that moral stress is an important and poorly understood problem in veterinary practice and that further development of regular facilitated ethical group discussion may be of considerable benefit to team members. [ABSTRACT FROM AUTHOR]

Current debates about assisted dying and assisted suicide cover a series of medical, legal, moral, ethical and religious aspects. Yet, public views on the subject remain underexplored and, therefore, not always accounted for in the formation of public policy. This paper reports on empirical data from a cross-sectional study in the UK in 2019, which examines public views about the legalisation of assisted dying and assisted suicide, by means of a self-administered Qualtrics-based survey (self-devised vignettes). A combination of simple random and convenience sampling was used. Participants (n = 297) state their preference that both assisted dying and assisted suicide should be legalised in the UK (n = 70%), while doctors should be legally allowed to support such wishes of patients with an incurable and painful illness from which they will die (n = 62.22%). The paper concludes that public opinion needs to be further accounted for in policymaking and discourses regarding patient autonomy and dignity of care. [ABSTRACT FROM AUTHOR]

Some of the most common arguments against legalizing assisted dying are based on appealing to the rights of people with disabilities. This article identifies and responds to those arguments, including that people with disabilities univocally oppose assisted dying laws; that those laws harm people with disabilities, or show disrespect; and that those laws undermine other vital aspects of healthcare. Drawing on philosophical argument, as well as on evidence from jurisdictions where assisted dying is legal, the article concludes that considerations of disability do not in fact generate good arguments against assisted dying laws. In fact, the opposite is true. There are nevertheless important lessons that proponents and defenders of such laws can learn in conversation with people with disabilities, including about safeguards on assisted dying to protect their well‐being and autonomy. [ABSTRACT FROM AUTHOR]

In this article, we consider the arguments for and against physician-assisted suicide (AS) and physician-assisted euthanasia (Eu). We assess the evidence around law and practice in three jurisdictions where one or both are legal, with emphasis on data from Oregon. We compare the eligibility criteria in these different regions and review the range of approved disorders. Cancer is the most common cause for which requests are granted, with neurodegenerative diseases, mostly motor neurone disease, ranking second. We review the issues that may drive requests for a physician-assisted death, such as concerns around loss of autonomy and the possible role of depression. We also review the effectiveness and tolerability of some of the life- ending medications used. We highlight significant variation in regulatory oversight across the different models. A large amount of data are missing or unavailable. We explore physician-AS and physician-assisted Eu within the wider context of end-of-life practice. [ABSTRACT FROM AUTHOR]

Background: Many patients at the end of life require analgesia to relieve pain. Additionally, up to 1/5 of patients in the UK receive sedation for refractory symptoms at the end of life. The use of sedation in end-of-life care (EOLC) remains controversial. While gradual sedation to alleviate intractable suffering is generally accepted, there is more opposition towards deliberate and rapid sedation to unconsciousness (so-called "terminal anaesthesia", TA). However, the general public's views about sedation in EOLC are not known. We sought to investigate the general public's views to inform policy and practice in the UK. Methods: We performed two anonymous online surveys of members of the UK public, sampled to be representative for key demographic characteristics (n = 509). Participants were given a scenario of a hypothetical terminally ill patient with one week of life left. We sought views on the acceptability of providing titrated analgesia, gradual sedation, terminal anaesthesia, and euthanasia. We asked participants about the intentions of doctors, what risks of sedation would be acceptable, and the equivalence of terminal anaesthesia and euthanasia. Findings: Of the 509 total participants, 84% and 72% indicated that it is permissible to offer titrated analgesia and gradual sedation (respectively); 75% believed it is ethical to offer TA. Eighty-eight percent of participants indicated that they would like to have the option of TA available in their EOLC (compared with 79% for euthanasia); 64% indicated that they would potentially wish for TA at the end of life (52% for euthanasia). Two-thirds indicated that doctors should be allowed to make a dying patient completely unconscious. More than 50% of participants believed that TA and euthanasia were non-equivalent; a third believed they were. Interpretation: These novel findings demonstrate substantial support from the UK general public for the use of sedation and TA in EOLC. More discussion is needed about the range of options that should be offered for dying patients. [ABSTRACT FROM AUTHOR]

Objectives : To explore attitudes towards assisted dying in dementia (ADID) and the rationales underlying these attitudes, among younger and older adults. Method : We conducted separate focus groups with younger ( n = 11) and older adults ( n = 14) in the United Kingdom with personal or professional experience of dementia. Discussions were prompted by two vignettes depicting scenarios of ADID. The data were transcribed and analysed using thematic analysis. Results : Though sometimes stronger in the older adults, many of the attitudes and underlying rationales were common across the age groups. Analysis generated four themes: 'Perceptions of the disease', 'A case for empowerment', 'The morality of killing' and 'Logistical complexities'. Conclusions : For some, ADID was a hopeful alternative to the challenges they had witnessed in dementia. For others, the logistical problems surrounding ADID were insurmountable. Discussions were informed and insightful, highlighting the importance of including the general public in this ongoing debate., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: The purpose of this study was to evaluate views and attitudes concerning the legality of assisted death and euthanasia in the UK and to identify the circumstances in which individuals would or would not consider assisted death. Materials and methods: The views of a sample of the general population in the UK were sought through the use of a mixed methods questionnaire open to the public for 3 weeks. Results: The responses of 117 participants were analysed using an SPSS MANOVA statistical test for quantitative data and an in-depth content coding analysis for qualitative responses. Discussion: The majority of respondents, 85·5%, believed that Physician-Assisted Death (PAD) should be legalised in the UK and that individuals should be able to choose when, 88%, and where, 88·9%, they die. Qualitative analysis revealed that more people would consider a PAD for a severe physical terminal illness over mental illness. There was no statistical significance for variables for quantitative data when considering overall demographics, professional and educational backgrounds of the respondents. Conclusion: The majority of respondents in this study indicated that they believe assisted suicide should be made legal and that the option should be available for those who are terminally ill. Views indicated that if assisted dying was legal, it would allow terminally ill patients to die with dignity and without prolonging pain. [ABSTRACT FROM AUTHOR]

Palliative care is routinely offered to humans in the United Kingdom, while euthanasia remains illegal. The converse is true for nonhuman animals (henceforth animals). Indeed, euthanasia is widely accepted as the appropriate course of action for "suffering" animals, and for those whose behaviors or suspected ill health are thought to pose a threat to others. This article details examples of nonhuman death at a multi-faith ashram whose members vehemently oppose all forms of killing on religious grounds. Through exploring their efforts in palliative care for animals, and their emphasis on natural death as a means of respecting the sanctity of life, the practical, emotional, and theoretical viability of caring for, instead of killing, other animals at the ends of their lives is considered. In the process, normative distinctions between different categories of animals, (including humans), and different approaches to end of life care (palliative care, euthanasia, natural death) are called into question. Indeed, paying mindful attention to the diverse ways in which individual animals are cared for as they die reveals the potential violence inherent in both palliative care leading to natural death, and euthanasia, blurring perceptions of good and bad death in both veterinary and human medicine. [ABSTRACT FROM AUTHOR]

The purpose of this research is to determine the status of dying, death and bereavement within the curricula of veterinary medicine schools in the United States and the United Kingdom. Data were obtained via a mailed questionnaire (80% US and 86% UK return rates). Results revealed that over 96% of schools have offerings related to end-of-life (eol) issues, with nearly 100% of students exposed to these offerings. The average number of hours spent on eol issues is 7 (US) and 21 (UK). Topics covered most often are 'euthanasia', 'analgesics for chronic pain', and 'communication with owners of dying animals'. Veterinary schools overwhelmingly note that dying, death and bereavement are important topics. It might be helpful to veterinary medicine students if their own feelings regarding dying and death were addressed early in the curriculum and throughout class activities and clinical work. [ABSTRACT FROM AUTHOR]

This article examines press portrayals of and public reactions to a ‘mercy killing’ in 1930s England. May Brownhill, sixty-two, killed her ‘invalid’ adult son by giving him an overdose of aspirin and poisoning him with coal gas. Through the conventions of melodrama, May was portrayed in the press as a respectable, devoted and self-sacrificial mother deserving of sympathy. The case also resonated with contemporary debates about euthanasia. It is an historical example of popular leniency, whereby although guilty of a crime, an individual is not seen as deserving of punishment. The case contributes to our understanding of how popular leniency was shaped by gender, class and age, and by contemporary views on ‘mercy killing’. [ABSTRACT FROM AUTHOR]

In 2002, The Netherlands continued its leadership in developing rules and jurisdiction regarding euthanasia and end-of-life decisions by implementing the Euthanasia Act, which allows euthanasia for patients 12 years of age and older. Subsequently, in 2005, the regulation on active ending of life for newborns was issued. However, more and more physicians and parents have stated that the age gap between these two regulations—children between 1 and 12 years old—is undesirable. These children should have the same right to end their suffering as adults and newborn infants. An extended debate on pediatric euthanasia ensued, and currently the debate is ongoing as to whether legislation should be altered in order to allow pediatric euthanasia. An emerging major question regards the active ending of life in the context of palliative care: How does a request for active ending of life relate to the care that is given to children in the palliative phase? Until now, the distinction between palliative care and end-of-life decisions continues to remain unclear, making any discussion about their mutual in- and exclusiveness hazardous at best. In this report, therefore, we aim to provide insight into the relationship between pediatric palliative care and end-of-life decisions, as understood in the Netherlands. We do so by first providing an overview of the (legal) rules and regulations regarding euthanasia and active ending of life, followed by an analysis of the relationship between these two, using the Dutch National Guidelines for Palliative Care for Children. The results of this analysis revealed two major and related features of palliative care and end-of-life decisions for children: (1) palliative care and end-of-life decisions are part of the same process, one that focuses both on quality of living and quality of dying, and (2) although physicians are seen as ultimately responsible for making end-of-life decisions, the involvement of parents and children in this decision is of the utmost importance and should be regarded as such. [ABSTRACT FROM AUTHOR]

Millions of poultry are farmed intensively every year across the United Kingdom (UK) to produce both meat and eggs. There are inevitable situations that require birds to be emergency killed on farm to alleviate pain and suffering. In Europe and the UK, emergency methods are regulated by the European Council Regulation (EC) No. 1099/2009 and The Welfare of Animals at the Time of Killing Regulations (England 2015; Scotland 2012; Wales and Northern Ireland 2014). Cervical dislocation has been reported to be the most widely used method prior to these legislative changes which took place from 1 January 2013. Based on limited scientific evidence and concern for bird welfare, these legislative changes incorporated restrictions based on bird weight for both manual (≤3 kg) and mechanical (≤5 kg) cervical dislocation, and introduced an upper limit in the number of applications for manual cervical dislocation (up to 70 birds per person per day). Furthermore, it removed methods which showed evidence of crushing injury to the neck. However, since legal reform new scientific evidence surrounding the welfare consequences of cervical dislocation and the development of novel methods for killing poultry in small numbers on farm have become available. Whether the UK poultry industry have adopted these novel methods, and whether legislative reform resulted in a change in the use of cervical dislocation in the UK remains unknown. Responses from 215 respondents working across the UK poultry industry were obtained. Despite legal reform, manual cervical dislocation remains the most prevalent method used across the UK for killing poultry on farm (used by 100% of farms) and remains the preferred method amongst respondents (81.9%). The use of alternative methods such as Livetec Nex® and captive bolt guns were available to less than half of individuals and were not frequently employed for broilers and laying hens. Our data suggests there is a lack of a clear alternative to manual cervical dislocation for individuals working with larger species and a lack of gold standard methodology. This risks bird welfare at killing and contributes to inconsistency across the industry. We suggest providing stakeholders with practical alternatives prior to imposing legislative changes and effective knowledge transfer between the scientific community and stakeholders to promote positive change and protect bird welfare. [ABSTRACT FROM AUTHOR]

This article explores at least two dominant critiques of assisted dying from a disability rights perspective. In spite of these critiques, I conclude that assisted dying ought to be permissible. I arrive at the conclusion that if we respect and value people with disabilities, we ought to permit assisted dying. I do so in the following manner. First, I examine recent changes in legislation that have occurred since the Royal Society of Canada Expert Panel on End-of-Life Decision-Making report, published in this journal. I suggest that these changes are likely to only strengthen opposition to assisted dying from disability rights activists and people with disabilities. Second, I focus on respect for people with disabilities and in particular, respect for their autonomy and decision-making abilities. Third, I explore the opposition to assisted dying that focuses on risk and the vulnerability of people with disabilities. Here I suggest that this risk ought not to be of special concern. Ultimately, I conclude that upholding respect for the disabled requires the legalization of assisted dying, rather than the denial of access in a misguided effort to protect people with disabilities. [ABSTRACT FROM AUTHOR]

Should assisted suicide be legalised? This is a topic of debate in the UK once again. The House of Lords and the Judiciary indicate that legislation must be enacted by the Government to make assisted suicide a reality. This article highlights some important historical cases involving assisted suicide, and explores the ethical, legal and professional issues assisted suicide presents for nurse prescribers. [ABSTRACT FROM AUTHOR]

Withdrawal of artificially delivered nutrition and hydration (ANH) from patients in a permanent vegetative state (PVS) requires judicial approval in England and Wales, even when families and healthcare professionals agree that withdrawal is in the patient's best interests. Part of the rationale underpinning the original recommendation for such court approval was the reassurance of patients' families, but there has been no research as to whether or not family members are reassured by the requirement for court proceedings or how they experience the process. The research reported here draws on in-depth narrative interviews with 10 family members (from five different families) of PVS patients who have been the subject of court proceedings for ANH-withdrawal. We analyse the empirical evidence to understand how family members perceive and experience the process of applying to the courts for ANH-withdrawal and consider the ethical and practice implications of our findings. Our analysis of family experience supports arguments grounded in economic and legal analysis that court approval should no longer be required. We conclude with some suggestions for how we might develop other more efficient, just and humane mechanisms for reviewing best interests decisions about ANH-withdrawal from these patients. [ABSTRACT FROM AUTHOR]

This is an allegorical analysis of the currently topical developments in the UK judiciary's approach to human rights law, in the context of inter alia private autonomy versus the public interest as per Articles 3, 6 and 8 of the European Convention on Human Rights (ECHR). The article is written as a pastiche of a UK Supreme Court judgment in a hypothetical case on euthanasia, which purports to illustrate the UK judiciary's seemingly erred and repeated omission of the fact that legalized euthanasia is prevented by the ECHR. Irrespective of the reader's philosophical perspective, a more transparent alternative is offered, safeguarding the fundamentally important principle of justice through certainty. The approach and analysis of the emerging competing jurisprudential perspectives is both practical and insightful in the resulting solutions offered. [ABSTRACT FROM AUTHOR]

Background: Despite media and academic interest on assisted dying in dementia, little is known of the views of those directly affected. Aim: This study explored the views of former carers on assisted dying in dementia. Design: This was a qualitative study using thematic analysis. Setting/participants: A total of 16 former carers of people with dementia were recruited through national dementia charities and participated in semi-structured interviews. Results: While many supported the individual’s right to die, the complexity of assisted dying in dementia was emphasized. Existential, physical, psychological and psychosocial aspects of suffering were identified as potential reasons to desire an assisted death. Most believed it would help to talk with a trained health professional if contemplating an assisted death. Conclusion: Health workers should be mindful of the holistic experience of dementia at the end of life. The psychological and existential aspects of suffering should be addressed, as well as relief of physical pain. Further research is required. [ABSTRACT FROM AUTHOR]

The application of ethically controversial medical procedures may differ from one place to another. Drawing on a keyword and text-mining analysis of 156 interviews with doctors and nurses involved in end-of-life care ('care providers'), differences between countries in care providers' ethical rationales for the use of sedation are reported. In the United Kingdom, an emphasis on titrating doses proportionately against symptoms is more likely, maintaining consciousness where possible. The potential harms of sedation are perceived to be the potential hastening of social as well as biological death. In Belgium and the Netherlands, although there is concern to distinguish the practice from euthanasia, rapid inducement of deep unconsciousness is more acceptable to care providers. This is often perceived to be a proportionate response to unbearable suffering in a context where there is also greater pressure to hasten dying from relatives and others. This means that sedation is more likely to be organised like euthanasia, as the end 'moment' is reached, and family farewells are organised before the patient is made unconscious for ever. Medical and nursing practices are partly responses to factors outside the place of care, such as legislation and public sentiment. Dutch guidelines for sedation largely tally with the practices prevalent in the Netherlands and Belgium, in contrast with those produced by the more international European Association for Palliative Care whose authors describe an ethical framework closer to that reportedly used by UK care providers. [ABSTRACT FROM AUTHOR]

Hastening the death of another whether through assisted suicide or euthanasia is the subject of intense debate in the UK and elsewhere. In this paper we use a nationally representative survey of public attitudes – the British Social Attitudes survey – to examine changes in attitudes to the legalisation of physician provided euthanasia (PPE) over almost 30 years (1983–2012) and the role of religious beliefs and religiosity in attitudes over time. Compatible questions about attitudes to euthanasia were available in the six years of 1983, 1984, 1989, 1994, 2005, and 2012. We study the trends in the support for legalisation through these time points and the relationship between attitudes, religious denomination and religiosity, controlling for a series of covariates. In total, 8099 individuals provided answers to the question about PPE in the six years of the study. The support for legalisation rose from around 76.95% in 1983 to 83.86% in 2012. This coincided with an increase in secularisation exhibited in the survey: the percentage of people with no religious affiliation increasing from 31% to 45.4% and those who do not attend a religious institution (e.g. church) increasing from 55.7% to 65.03%. The multivariate analysis demonstrates that religious affiliation and religiosity as measured by religious institution attendance frequency are the main contributors to attitudes towards euthanasia, and that the main increase in support happened among the group with least religious affiliation. Other socio-demographic characteristics do not seem to alter these attitudes systematically across the years. Our study demonstrates an increase in the support of euthanasia legalisation in Britain in the last 30 years coincided with increased secularisation. It does not follow, however, that trends in public support are immutable nor that a change in the law would improve on the current pragmatic approach toward hastening death by a physician adopted in England and Wales in terms of the balance between compassion and safeguards against abuse offered. [ABSTRACT FROM AUTHOR]

The article discusses the consistency of the manner of the death of feminist and psychologist Sandra Bem by suicide with the originality and quality of her life and work. Topics include the meaning of euthanasia, the development of feminist ethics in 1970 as a reaction of Cartesian model, and the resolution of the debate over voluntary euthanasia and physician-assisted suicide.

This article analyses domestic and foreign reactions to a 2008 report in the British Medical Journal on the complementary and, as argued, synergistic relationship between palliative care and euthanasia in Belgium. The earliest initiators of palliative care in Belgium in the late 1970s held the view that access to proper palliative care was a precondition for euthanasia to be acceptable and that euthanasia and palliative care could, and should, develop together. Advocates of euthanasia including author Jan Bernheim, independent from but together with British expatriates, were among the founders of what was probably the first palliative care service in Europe outside of the United Kingdom. In what has become known as the Belgian model of integral end-of-life care, euthanasia is an available option, also at the end of a palliative care pathway. This approach became the majority view among the wider Belgian public, palliative care workers, other health professionals, and legislators. The legal regulation of euthanasia in 2002 was preceded and followed by a considerable expansion of palliative care services. It is argued that this synergistic development was made possible by public confidence in the health care system and widespread progressive social attitudes that gave rise to a high level of community support for both palliative care and euthanasia. The Belgian model of so-called integral end-of-life care is continuing to evolve, with constant scrutiny of practice and improvements to procedures. It still exhibits several imperfections, for which some solutions are being developed. This article analyses this model by way of answers to a series of questions posed by Journal of Bioethical Inquiry consulting editor Michael Ashby to the Belgian authors. [ABSTRACT FROM AUTHOR]

Background: End‐of‐life decision making for animals happens daily in veterinary practice. However, access to such discussions as they happen is difficult, in view of the highly emotional circumstances of end‐of‐life consultations. Despite the expanding literature on euthanasia, few studies have explored the circumstances of euthanasia disagreement or delay. Methods: To explore euthanasia discussions in veterinary practice, consultations recorded in electronic health records in a UK veterinary surveillance database (SAVSNET) were examined. From a sample of 2000 identified consultations, 69 canine and 76 feline consultations were purposively sampled for detailed thematic analysis. Specifically, consultations were selected if they involved a decision to delay euthanasia, including disagreement about the timing of euthanasia. Results: Reasons identified for euthanasia refusal or delay included client‐related factors (e.g., allowing other family members to say goodbye, differing opinions on the quality of life) and veterinary surgeon‐related factors (eg, the wish to carry out further investigations or to try a new treatment). In the instance of refusal or delay, palliative treatment was commonly provided to preserve animal welfare. Conclusion: This study illustrates some of the processes used to negotiate end‐of‐life decision making in dogs and cats. Its findings shed light on the importance of palliative care in providing owners with time to decide. [ABSTRACT FROM AUTHOR]

Public and healthcare professionals differ in their attitudes towards euthanasia and physician-assisted suicide (PAS), the legal status of which is currently in the spotlight in the UK. In addition to medical training and experience, religiosity, locus of control and patient characteristics (eg, patient age, pain levels, number of euthanasia requests) are known influencing factors. Previous research tends toward basic designs reporting on attitudes in the context of just one or two potentially influencing factors; we aimed to test the comparative importance of a larger range of variables in a sample of nursing trainees and non-nursing controls. One hundred and fifty-one undergraduate students (early-stage nursing training, late-stage nursing training and non-nursing controls) were approached on a UK university campus and asked to complete a self-report questionnaire. Participants were of mixed gender and were on average 25.5 years old. No significant differences in attitude were found between nursing and non-nursing students. There was a significant positive correlation between higher religiosity and positive attitude toward euthanasia (r=0.19, p<0.05) and a significant negative relationship between internal locus of control and positive attitude toward PAS (r=-0.263, p<0.01). Multivariate analyses revealed differing predictor models for attitudes towards euthanasia and PAS, and confirm the importance of individual differences in determining these attitudes. The unexpected direction of association between religiosity and attitudes may reflect a broader cultural shift in attitudes since earlier research in this area. Furthermore, these findings suggest it possible that experience, more than training itself, may be a bigger influence on attitudinal differences in healthcare professionals. [ABSTRACT FROM AUTHOR]

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

The evaluation of whether an animal has a life worth living (LWL) has been suggested as a useful concept for farm animal policymaking. But there are a number of different ways in which the concept could be applied. This paper attempts to identify and evaluate candidate ethical principles based on the concept. It suggests that an appropriate principle by which to apply the concept is one that (1) is framed in terms of preventing an animal having a life worth avoiding (LWA), rather than ensuring they have LWL, (2) is based on a prospective, rather than retrospective, concept of a life's worth, and (3) relates to both the perpetuation and creation of an animal at all times during its life. The paper concludes by endorsing an overarching principle that no animal should be unreasonably caused to be, or allowed to remain, in a position of having a prospective LWA. [ABSTRACT FROM AUTHOR]

The article discusses the legal aspects of euthanasia in regards to medicine and ethics in various countries as of March 2012, focusing on British physician-assisted deaths and an investigation by the police and health officials into the deaths of several elderly hospital patients in Great Britain. An inquiry into the reported deliberate starvation and dehydration of nursing home patients in the Netherlands is mentioned, along with right to die laws and assisted suicide in the U.S.

The Commission on Assisted Dying was an unofficial body set up to investigate the legal position on assisted dying in the UK in the autumn of 2010. Its report was published to some degree of media attention in the first week of January 2012; its most headline-grabbing suggestion provided a framework setting out how British law might be reformed to allow assisted dying for the terminally ill. In this paper, I analyse some of the key points of the report and argue that it adds little that could settle - or even add to - the assisted dying debate. [ABSTRACT FROM AUTHOR]

There have been a number of attempts to legalise euthanasia and physician assisted suicide (PAS) in the UK over the past decade. The potential impact of legalising euthanasia and PAS in the UK on the training of medical students, the next generation of doctors, is examined in this discussion paper. [ABSTRACT FROM AUTHOR]

Objectives: To review studies over a 20-year period that assess the attitudes of UK doctors concerning active, voluntary euthanasia (AVE) and physician-assisted suicide (PAS), assess efforts to minimise bias in included studies, determine the effect of subgroup variables (e.g. age, gender) on doctors’ attitudes, and make recommendations for future research.Data sources: Three electronic databases, four pertinent journals, reference lists of included studies.Review methods: Literature search of English articles between January 1990 and April 2010. Studies were excluded if they did not present independent data (e.g. commentaries) or if they related to doctors outside the UK, patients younger than 18 years old, terminal sedation, withdrawing or withholding treatment, or double-effect. Quantitative and qualitative data were extracted.Results: Following study selection and data extraction, 15 studies were included. UK doctors oppose the introduction of both AVE and PAS in the majority of studies. Degree of religiosity appeared as a statistically significant factor in influencing doctors’ attitudes. The top three themes in the qualitative analysis were the provision of palliative care, adequate safeguards in the event of AVE or PAS being introduced, and a profession to facilitate AVE or PAS that does not include doctors.Conclusions: UK doctors appear to oppose the introduction of AVE and PAS, even when one considers the methodological limitations of included studies. Attempts to minimise bias in included studies varied. Further studies are necessary to establish if subgroup variables other than degree of religiosity influence attitudes, and to thoroughly explore the qualitative themes that appeared. [ABSTRACT FROM PUBLISHER]

This module was designed to equip UK medical students to respond ethically and sensitively to requests encountered as qualified doctors regarding euthanasia and assisted dying. The aim was to expose students to relevant opinions and experiences and provide opportunities to explore and justify their own views and rehearse ethical decision making in a safe learning environment.The module is delivered by a multidisciplinary team, providing students with the working knowledge to actively discuss cases, articulate their own views and practice ethical reasoning. Visits to intensive care units, palliative care wards and hospices are integrated with theory. Student assessment comprises a dissertation, debate and reflection. Module impact was evaluated by analysis of student coursework and a questionnaire.Students greatly appreciated the clinical context provided by the visits and opportunities to apply ethical reasoning to cases and debate issues with peers. They reported increased discernment of the ethical and legal position and practical considerations and greater awareness of the range of professional and lay viewpoints held. Many participants were less strongly in favor of euthanasia and assisted dying on module completion than at the outset, but all of them believed they were better equipped to justify their own viewpoint and respond to patient requests. The multi-disciplinary nature of this course helps to prepare students to deal effectively and sensitively with ethical dilemmas they will encounter in their medical career. Use of an integrated, learner-centred approach equips students to actively engage with their peers in discussion of such issues and to formulate and defend their own position. [ABSTRACT FROM AUTHOR]

Abstract: Geriatric horses (aged≥15 years) now represent a substantial proportion of the equine population, yet mortality rates for aged horses in the UK have not previously been described. Although post-mortem studies have provided some data regarding specific causes of death, “old age” is a common owner-reported reason for euthanasia of adult horses, indicating further elucidation of reasons for death or euthanasia is required for the geriatric equine population. The objective of this cohort study was to describe mortality rates, causes of death or euthanasia and factors associated with mortality in geriatric horses and ponies. Veterinary registered horses randomly selected for a cross-sectional questionnaire survey on geriatric health were enrolled in the cohort study (n =908). Follow-up information was obtained over an 18-month period via telephone questionnaires and mortality questionnaires, providing data regarding reasons for death or euthanasia, were completed for 118 cases of mortality. Overall and stratified mortality rates were calculated and Cox proportional hazards models were used to investigate risk factors associated with mortality. The majority (94%) of mortalities were euthanised, most frequently due to lameness (24%) and colic (21%). Veterinary advice was important in owner decision making regarding euthanasia of cases of colic or other acute illnesses, while poor quality of life was considered an important factor where euthanasia was due to chronic diseases or lameness. Overall mortality rate was 11.1 (95% C.I. 9.2–13.2) per 100 horse-years at risk, with the mortality rate of animals >30 years of age over five times the rate in horses aged 15–19 years. On multivariable analysis, increasing age was associated with increasing mortality and Cob/Cob crossbreeds and Thoroughbred/Thoroughbred crossbreeds had an increased risk of mortality. Horses considered to be underweight had a greater risk of mortality than those in good condition. Increasing number of owner-reported clinical signs and the degree to which pain was reported to limit normal daily activities were associated with increased risk of mortality. The results of this study provide useful information about rates and factors associated with mortality in geriatric horses in the UK, which should be relevant to veterinary surgeons involved in the treatment of aged horses. [Copyright &y& Elsevier]

Right-to-die societies represent a new social movement driven by societal change. They reflect concerns about the impact of advances in medicine, about the quality of care available for people at the end of life and the consequences of demographic changes that lead to the prolongation of dying with high degrees of disability and distress. More generally, the growth of individualism and the obligation towards exercising personal autonomy leads to desires to control events near the end of life. This paper reports a survey of the membership of a UK right-to-die society Friends at the End (FATE). A questionnaire answered by 41% (162) of the members of this society provided insight into motives and experiences that had led to a decision to join. Members were more likely to be female, older and of higher social standing than the general population. A high proportion were religious and found no conflict between this and their membership, and a high proportion had backgrounds in health and social care. Motives for membership included the desire for practical assistance with dying, past involvement with deaths that involved high levels of dependency and distress, and commitment to ‘right’ to die ideology. The concerns of members about the distress of dying mirror what is known about the reasons why people approaching death request an assisted death. [ABSTRACT FROM AUTHOR]

Abstract: The issue of whether it is right to be concerned about the accuracy with which mass media report social scientific research is explored through a detailed case study of media reporting of two surveys of UK doctors’ end-of-life decision-making. Data include press releases, emails and field notes taken during periods of media interest supplemented by a collection of print and broadcast media reports. The case study contributes to existing knowledge about the ways in which mass media establish, exaggerate and otherwise distort the meaning of statistical findings. Journalists ignored findings that did not fit into existing media interest in the ‘assisted dying’ story and were subject to pressure from interest groups concerned to promote their own interpretations and viewpoints. Rogue statistics mutated as they were set loose from their original research report context and were ‘laundered’ as they passed from one media report to another. Yet media accounts of the research, fuelling an already heated public debate about ethical issues in end-of-life care, arguably acted as a conduit for introducing new considerations into this debate, such as the role played by sedation at the end of life, the extent to which euthanasia is practiced outside the law, and the extent of medical opposition to the legalisation of assisted dying. The expectation that accuracy and comprehensiveness should be the sole criteria for judging journalists’ reports is, finally, considered to be unrealistic and it is argued that social scientists need to understand and adapted to the conditions under which mass media reporting operates if they are to succeed in introducing the findings of social research into public debates. [Copyright &y& Elsevier]

A recent inquest in South Wales heard of the tragic case of a husband who killed himself and his wife through carbon monoxide poisoning because he could not bear to see her continued suffering. His wife had spent two years in a persistent vegetative state and attempts to obtain a court order allowing the withholding of her artificial nutrition and hydration had been subject to lengthy delays. This article discusses how this case highlights the importance of making preparations for possible future incapacity by creating an advance decision refusing treatment and a health and welfare power of attorney under the Mental Capacity Act 2005. These provisions will ensure that the wishes of the patient are respected without the need to go to court and so avoid delay. [ABSTRACT FROM AUTHOR]

In this paper, we consider three arguments for the irrelevance of the doctrine of double effect in end-of-life decision making. The third argument is our own and, to that extent, we seek to defend it. The first argument is that end-of-life decisions do not in fact shorten lives and that therefore there is no need for the doctrine in justification of these decisions. We reject this argument; some end-of-life decisions clearly shorten lives. The second is that the doctrine of double effect is not recognized in UK law (and similar jurisdictions); therefore, clinicians cannot use it as the basis for justification of their decisions. Against this we suggest that while the doctrine might have dubious legal grounds, it could be of relevance in some ways, e.g. in marking the boundary between acceptable and unacceptable practice in relation to the clinician's duty to relieve pain and suffering. The third is that the doctrine is irrelevant because it requires there to be a bad effect that needs justification. This is not the case in end-of-life care for patients diagnosed as dying. Here, bringing about a satisfactory dying process for a patient is a good effect, not a bad one. What matters is that patients die without pain and suffering. This marks a crucial departure from the double-effect doctrine; if the patient's death is not a bad effect then the doctrine is clearly irrelevant. A diagnosis of dying allows clinicians to focus on good dying and not to worry about whether their intervention affects the time of death. For a patient diagnosed as dying, time of death is rarely important. In our conclusion we suggest that acceptance of our argument might be problematic for opponents of physician-assisted death. We suggest one way in which these opponents might argue for a distinction between such practice and palliative care; this relies on the double-effect doctrine's distinction between foresight and intention. [ABSTRACT FROM AUTHOR]