Search

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

The authors comment on the increase in eligibility criteria for physician-assisted suicide (PAS) or euthanasia under jurisdiction in the U.S. Topics discussed include the controversy surrounding PAS, arguments by proponents about PAS, the expansion of this eligibility criteria in other countries, the introduction of California Senate Bill 1196, and example of cases of PAS in Colorado.

There is a pressing debate in the United States concerning the implied physicians' obligation to do no harm and the status of legalizing physician-assisted suicide (PAS). Key issues that underpin the debate are important to consider. These include: (1) foundational medical beginnings; (2) euthanasia's historical and legal background context; and (3) the key arguments held by those for and against legalization of PAS. This paper reviews the major claims made by proponents for the legalization of PAS and the associated complexities and concerns that help underscore the importance of conscience freedoms. Relief of suffering, respect for patient autonomy, and public policy arguments are discussed in these contexts. We argue here that the emphasis by healthcare providers should be on high quality and compassionate care for those at the end of life's journey who are questioning whether to prematurely end their lives. If medicine loses its chief focus on the quality of caring—even when a cure is not possible—it betrays its objective and purpose. In this backdrop, legalization of PAS harms not only healthcare professionals, but also the medical profession's mission itself. Medicine's foundation is grounded in the concept of never intentionally to inflict harm. Inflicting death by any means is not professional or proper, and is not trustworthy medicine. [ABSTRACT FROM AUTHOR]

Nine states and the District of Columbia have statutes which legalize physician-assisted death (PAD), the process by which a "physician provid[es], at the patient's request, a prescription for a lethal dose of medication that the patient can self-administer by ingestion, with the explicit intention of ending life." In the United States, this practice is confined to patients suffering from terminal illnesses4 who are "mentally competent." Despite some guidance on what the word "competent" means, however, the term has proved incredibly difficult to understand in practice. This Note argues that states' PAD laws should statutorily create medical committees which research and, from time to time, promulgate clinical criteria in order to guide physicians who choose to participate in PAD. Part I will trace PAD's historical background in the United States; Part II will offer some insight into the current problem that a patient competency evaluation might entail; and Part III will outline how and why medical committees could help physicians administer aid in an environment rife with uncertainty. Although this Note takes no side in the moral debates over PAD, it recognizes that states either have PAD statutes on the books or are considering such statutes in the future. As such, this Note serves to suggest necessary safeguards for a burgeoning medical-legal landscape. [ABSTRACT FROM AUTHOR]

We asked whether and how generations vary in their perceptions on moral matters ranging from their justifications of crime and questions concerning bodily autonomy. In our exploratory study using data from the World Values Survey, we found that Generations Y and Z are more likely than their older counterparts to justify crimes, such as cheating on taxes or stealing property, and to favor greater bodily autonomy in issues such as suicide and abortion. They also rank lower the importance of God and national pride. Implications are offered for employers who wish to motivate and incentivize a multi-generational workforce. [ABSTRACT FROM AUTHOR]

Sodium pentobarbital and pentobarbital combination products are commonly used by veterinarians throughout the US for euthanasia of their animal patients. The AVMA Guidelines for the Euthanasia of Animals: 2020 Edition lists barbiturate acid derivatives (pentobarbital) and pentobarbital combination products as an acceptable method of euthanasia for all species when circumstances permit their use. When using pentobarbital products, a veterinarian must consider appropriate handling and disposal of animal remains to avoid the potential for environmental contamination, relay toxicosis in wildlife or domestic animals, and contamination of the animal food supply. Failure to appropriately consider these facets of pentobarbital euthanasia can result in legal and ethical consequences. Despite these concerns, to the authors’ knowledge no comprehensive literature review has been published concerning pentobarbital euthanasia or handling and disposal of animal remains following pentobarbital euthanasia. The literature review that follows aims to give a descriptive narrative of the most recent information available on the knowledge, use, challenges, and issues surrounding pentobarbital euthanasia and disposal of animal remains within the US. [ABSTRACT FROM AUTHOR]

The author comments on an article by Daryl Pullman which raises some reasonable worries about the use of medical assistance in dying (MAiD) in Canada and outlines a plausible proposal to require patients who request MAiD but do not meet the reasonably foreseeable natural death (RFND) criteria to pursue the oral protocol. Topics include questions that are intended to determine the harms and benefits of medicalization and basis of his characterization of a slippery slope for MAiD.

Significant ethical challenges arise when mental health practitioners care for patients who seek to accelerate their own dying for rational medically valid reasons. Current and proposed laws provide for medical assistance in dying (MAiD) in several U.S. jurisdictions, all of Canada, and several other nations. Differing provisions of these laws complicate their utility for some patients who seek aid in dying. Some extant laws include roles that mental health professionals might play in assessing patients' competence or capacity to consent, mental illness, or other cognitive and behavioral factors. Practitioners who choose to accept roles in the MAiD process must consider and resolve a number of ethical challenges including potential conflicts between and among laws, ethical standards, third-party requests, personal values, and patients' wishes. These include becoming aware of patients who may wish to act independently to end their lives when MAiD laws might otherwise exclude them. Examples from actual cases and the resultant discussion will form a basis for exploration of the ethical and legal complexities confronted when psychologists become engaged in the process either intentionally or incidentally. The lead article (Koocher) is not intended to comprehensively address MAiD in all of its complexity but rather to trigger a thoughtful discussion among the accompanying commentaries. Public Significance Statement: Current and proposed laws provide for medical assistance in dying (MAiD), sometimes described as physician-assisted suicide, in several U.S. jurisdictions, all of Canada, and in several other nations. Some such laws require psychological input, usually from either a psychologist or a psychiatrist. The limited scope of existing laws may result in some patients suffering with debilitating, painful, chronic, and fatal illnesses to consider suicide without medical assistance. With or without MAiD legislation, mental health professionals will come in contact with such patients and must consider the potentially complex ethical ramifications of caring for such patients. [ABSTRACT FROM AUTHOR]

Simple Summary: In response to disease outbreaks or other urgent circumstances, an increasing number of farm animals in the United States (US) are being killed en masse by depopulation. In the past few years, depopulation methods that rely on heatstroke as the mechanism of killing have been used with increasing frequency to kill birds and pigs raised for food production. While they are defended as expedient and faster to implement, heatstroke-based methods severely compromise animal welfare and there is a prolonged period prior to the animals losing consciousness. The US veterinary profession is entrusted with an ethical responsibility to protect and advance animal welfare, yet its classification of the heatstroke-based depopulation method Ventilation Shutdown Plus is used to justify this method's widespread use. Numerous strategies are suggested for how the US veterinary profession, including the American Veterinary Medical Association, can encourage the use of more humane methods when depopulations are performed. Depopulation of food-producing animals is becoming increasingly common in response to both disease outbreaks and supply chain disruptions. In 2019, the American Veterinary Medical Association released depopulation guidelines classifying certain heatstroke-based killing methods as "permitted in constrained circumstances", when circumstances of the emergency constrain reasonable implementation of "preferred" methods. Since then, tens of millions of birds and pigs have been killed by such methods, termed ventilation shutdown (VSD) Plus Heat and VSD Plus High Temperature and Humidity. While no research using validated measures of animal welfare assessment has been performed on these methods, their pathophysiology suggests that animals are likely to experience pain, anxiety, nausea, and heat distress prior to loss of consciousness. Heatstroke-based methods may result in prolonged suffering and often do not achieve 100% mortality. Potential and available alternative depopulation methods are briefly reviewed. The veterinary profession's ethical obligation to protect animal welfare in the context of depopulations is discussed. [ABSTRACT FROM AUTHOR]

Veterinary providers experience job-specific psychological stress from their dual role in both providing medical care to pets and supporting pet-owner clients through end-of- life care and the euthanasia process, contributing to compassion fatigue and burnout in the field. COVID-19 has impacted the provision of veterinary care and affected communication between providers and pet owners. This qualitative study explores the experiences of veterinary providers who provided end-of- life care and performed euthanasia during the COVID-19 pandemic. Participants for this qualitative study were recruited and interviewed using criterion sampling from four veterinary practices in the northeastern United States. Inductive thematic analysis was used to interpret the data collected. Significant findings include: veterinary staff are overwhelmed by the spike in animal care due to increased pet ownership during COVID-19, changes in provision of care have created additional stressors in veterinary medicine, veterinary providers feel "emotionally distanced" from their clients, and veterinary providers recognize a need for increased mental health support in the field. [ABSTRACT FROM AUTHOR]

The article delves into the contentious topic of euthanasia and assisted death, primarily focusing on the U.S. and Canada. It provides a historical backdrop, tracing the evolution of laws and organizations advocating for or against these practices in both countries. It also compares the current regulatory frameworks for Aid In Dying (AID) in the U.S. and Canada, emphasizing recent changes in Canadian Medical Assistance in Dying (MAID) law.

As more and more American states legalize medical aid in dying (MAID), Consultation-Liaison Psychiatrists will increasingly be asked to assist medical and surgical colleagues in differentiating this end-of-life practice from suicide. Where suicide is traditionally understood as an act clouded by depression, desperation, or both, MAID represents a terminally medically ill patient's effort to take control of their dying process when death is imminent, likely to occur within 6 months, and inevitable. Rendering opinions on patient suicidality in the setting of a complex co-occurring medical illness is a Consultation-Liaison Psychiatrist's bread and butter. This paper seeks to elucidate 4 points that distinguish MAID from suicide: (1) Hastening death when the end of natural life is approaching is not synonymous with suicide in the vernacular American usage of the term. (2) Unlike suicide, MAID is a highly collaborative process in which dying, mentally capable adults involve their doctors and loved ones in legally recognized decisions to hasten death. (3) The clinical presentation of patients requesting MAID differs from that of individuals whose suicidality is driven by psychopathology. (4) Certain behavioral traits differentiate such MAID patients from suicidal ones. Understanding and applying these distinctions in the consultation-liaison arena will help remove the stigma of suicide from end-of-life care deliberations where it does not belong while ensuring appropriate end-of-life care for dying individuals for whom MAID is the culmination of a carefully considered process of self-determination rather than suicide., (Copyright © 2024 Academy of Consultation-Liaison Psychiatry. Published by Elsevier Inc. All rights reserved.)

Background: Rapid implementation of Medical Assistance in Dying (MAiD) across care settings has challenged providers and organizations, including hospices, to develop and implement new modes of practice. The aim of this study was to examine the effects that legalization of MAiD has had on hospice care provider roles within the non-provider context. Methods: Eight in-depth semi-structured interviews were conducted and a qualitative descriptive approach used to examine hospice care providers experiences in a small western Canadian city. In the study context, patients who choose MAiD are cared for until immediately prior to the procedure when they are transferred off-site to undergo MAiD. Inductive and thematic analyses were undertaken. Results: Participants experienced practical, philosophical, and professional challenges. Despite the overwhelming desire to support patient autonomy and decision-making, some interpreted patient choice for MAiD as rejection of the natural death experience at the hospice. Patient choice for MAiD initiated a new and different pathway of end-of-life care. While participants felt uncertain how best to support patients undergoing MAiD, they shared mixed optimism on how their care provider roles were evolving as their level of experience broadened. While implementation of MAiD was rapid, the introduction of practical and professional supports has remained slow to materialize, leaving many providers to navigate their own personal and professional positions and practices. Conclusion: Care providers require a multi-faceted range of clinical, legal, and logistical supports at the practice, organizational, and health system levels, to facilitate care delivery to those requesting and undergoing MAiD and to promote coordinated and holistic patient-centered care. The different pathway for those who chose MAiD may lead care providers to struggle with relational challenges and interpersonal unease. Further research may address how to support those undergoing MAiD within the hospice context. [ABSTRACT FROM AUTHOR]

The avemge age of individuals in the United States and worldwide is steadily increasing, resulting in an increase in the number of older, terininally ill adults who may seek counseling for end-of-life decisions. Euthaimsia is one such end-of-life option that is emerging iii the United States. Physicicm-assisted dying, currently the only legal form of active euthanasia in eight states and the District of Columbia, is a relatively new and often misuitderstood eitd-oflife option. Although arguments continue about this issue, the American Mental Health Counselors Association has developed ethical codes to guide mental health counselors working with terminally ill clients making end-of-life decisions. The core moral and ethical principles of autonomy, betteficence, nonmaleficence, justice,/idelity, and veracity provide guidance/6r helping tenninally ill clients explore end-o/-life options that could include physician-assisted dying when it is a legally viable option. Additional recommendations are made for increasing intellectual and emotional competence regarding euthanasia. [ABSTRACT FROM AUTHOR]

The consideration of laypeople's views of conditions under which euthanasia is justifiable is important for policy decisions. In an online survey of US respondents, we examined how patient's symptoms influence justifiability of euthanasia. Euthanasia was judged more justifiable for conditions associated with physical suffering and negative impact on other people. The weight given to physical suffering and negative impact on others in evaluation of justifiability of euthanasia also differed based on personal characteristics. The results suggest that public discourse about medical assistance in dying should take into account differences in its perceived justifiability for patients with different conditions. [ABSTRACT FROM AUTHOR]

This study examines the impact of the level of religious observance on the attitudes toward end‐of‐life (EOL) decisions and euthanasia of Jews in Israel—where euthanasia is illegal—as compared to Jews living in the USA, in the states where euthanasia is legal. A self‐reporting questionnaire on religiosity and personal beliefs and attitudes regarding EOL care and euthanasia was distributed, using a convenience sample of 271 participants from Israel and the USA. Findings show that significant differences were found in attitudes between Jews of different levels of religious observance with respect to patient autonomy, right to die with dignity, and dying in familiar and supportive surroundings. The USA and Israeli Jews have similar knowledge regarding EOL care and expressed similar attitudes and perceptions toward the issues of authority of medical staff and religious figures and patient's autonomy. Findings indicate that the level of religious observance has more potency in shaping their attitudes and perceptions of EOL decisions than the state law. We conclude by discussing the implications of our findings with regard to multicultural health systems and providing practical recommendations. [ABSTRACT FROM AUTHOR]

This article is an analysis of the relationship between US hospice structure and the feeling of being a burden to others (FBO). A goal of US hospice care is to reduce the FBO. But in America, hospice is limited in its ability to do so because of the high caregiver burden it places on family members of dying people. Through a historical study, I show that this burden was excessive when the hospice system was created and has worsened over time. Through three ethnographic vignettes, I demonstrate how this burden inculcates in dying people the FBO. I then examine the bioethical implications of this finding for the existing US debate about physician-assisted suicide (PAS). The presence of FBO due to insufficient hospice care supports arguments made by PAS opponents about the social pressure placed on dying people. This finding is not itself sufficient to resolve the "right to die" debate. But it provides the ground for a compromise, across the debate, to reduce the FBO by changing US hospice structure. The resulting consensus will further the goals of both PAS proponents and opponents. [ABSTRACT FROM AUTHOR]

West Nile Virus (WNV), an emerging and re-emerging RNA virus, is the leading source of arboviral encephalitic morbidity and mortality in the United States. WNV infections are acutely controlled by innate immunity in peripheral tissues outside of the central nervous system (CNS) but WNV can evade the actions of interferon (IFN) to facilitate CNS invasion, causing encephalitis, encephalomyelitis, and death. Recent studies indicate that STimulator of INterferon Gene (STING), canonically known for initiating a type I IFN production and innate immune response to cytosolic DNA, is required for host defense against neurotropic RNA viruses. We evaluated the role of STING in host defense to control WNV infection and pathology in a murine model of infection. When challenged with WNV, STING knock out (-/-) mice displayed increased morbidity and mortality compared to wild type (WT) mice. Virologic analysis and assessment of STING activation revealed that STING signaling was not required for control of WNV in the spleen nor was WNV sufficient to mediate canonical STING activation in vitro. However, STING-/- mice exhibited a clear trend of increased viral load and virus dissemination in the CNS. We found that STING-/- mice exhibited increased and prolonged neurological signs compared to WT mice. Pathological examination revealed increased lesions, mononuclear cellular infiltration and neuronal death in the CNS of STING-/- mice, with sustained pathology after viral clearance. We found that STING was required in bone marrow derived macrophages for early control of WNV replication and innate immune activation. In vivo, STING-/- mice developed an aberrant T cell response in both the spleen and brain during WNV infection that linked with increased and sustained CNS pathology compared to WT mice. Our findings demonstrate that STING plays a critical role in immune programming for the control of neurotropic WNV infection and CNS disease. [ABSTRACT FROM AUTHOR]

Commercial captive breeding and trade in body parts of threatened wild carnivores is an issue of significant concern to conservation scientists and policy-makers. Following a 2016 decision by Parties to the Convention on International Trade in Endangered Species of Wild Fauna and Flora, South Africa must establish an annual export quota for lion skeletons from captive sources, such that threats to wild lions are mitigated. As input to the quota-setting process, South Africa’s Scientific Authority initiated interdisciplinary collaborative research on the captive lion industry and its potential links to wild lion conservation. A National Captive Lion Survey was conducted as one of the inputs to this research; the survey was launched in August 2017 and completed in May 2018. The structured semi-quantitative questionnaire elicited 117 usable responses, representing a substantial proportion of the industry. The survey results clearly illustrate the impact of a USA suspension on trophy imports from captive-bred South African lions, which affected 82% of respondents and economically destabilised the industry. Respondents are adapting in various ways, with many euthanizing lions and becoming increasingly reliant on income from skeleton export sales. With rising consumer demand for lion body parts, notably skulls, the export quota presents a further challenge to the industry, regulators and conservationists alike, with 52% of respondents indicating they would adapt by seeking ‘alternative markets’ for lion bones if the export quota allocation restricted their business. Recognizing that trade policy toward large carnivores represents a ‘wicked problem’, we anticipate that these results will inform future deliberations, which must nonetheless also be informed by challenging inclusive engagements with all relevant stakeholders. [ABSTRACT FROM AUTHOR]

A decision by a society to sanction assisted dying in any form should logically go hand-in-hand with defining the acceptable method(s). Assisted dying is legal in several countries and we have reviewed the methods commonly used, contrasting these with an analysis of capital punishment in the USA. We expected that, since a common humane aim is to achieve unconsciousness at the point of death, which then occurs rapidly without pain or distress, there might be a single technique being used. However, the considerable heterogeneity in methods suggests that an optimum method of achieving unconsciousness remains undefined. In voluntary assisted dying (in some US states and European countries), the common method to induce unconsciousness appears to be self-administered barbiturate ingestion, with death resulting slowly from asphyxia due to cardiorespiratory depression. Physician-administered injections (a combination of general anaesthetic and neuromuscular blockade) are an option in Dutch guidelines. Hypoxic methods involving helium rebreathing have also been reported. The method of capital punishment (USA) resembles the Dutch injection technique, but specific drugs, doses and monitoring employed vary. However, for all these forms of assisted dying, there appears to be a relatively high incidence of vomiting (up to 10%), prolongation of death (up to 7 days), and re-awakening from coma (up to 4%), constituting failure of unconsciousness. This raises a concern that some deaths may be inhumane, and we have used lessons from the most recent studies of accidental awareness during anaesthesia to describe an optimal means that could better achieve unconsciousness. We found that the very act of defining an 'optimum' itself has important implications for ethics and the law. [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]

Physician‐assisted death (PAD) has long been a strongly debated moral and public policy issue in the United States, and an increasing number of jurisdictions have legalized this practice under certain circumstances. In light of changing terminology, laws, public and professional attitudes, and the availability of published data about the practice, we review key concepts and terms in the ongoing PAD debate, moral arguments for and against PAD, the current legal status of PAD in the United States and in other nations, and data on the reported experience with PAD in those U.S. jurisdictions where it is a legal practice. We then identify situations in which emergency physicians (EPs) may encounter patients who request PAD or have attempted to end their lives with physician assistance and consider EP responses in those situations. Based on our analysis, we offer recommendations for emergency medical practice and professional association policy. [ABSTRACT FROM AUTHOR]

Copyright of Revista Bioetica is the property of Conselho Federal de Medicina and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article offers information about the hospital closures disrupt communities that support the patients and communities relying on them. It mentions a tale of corporate greed endangering the health of vulnerable patients. It discusses that how health care has increasingly shifted to outpatient settings, reducing demand for the inpatient care that supports higher financial margins than ambulatory care.

Many critics of the legalization of physician‐assisted death oppose it in part because they fear it will further disadvantage those who are already economically disadvantaged. This argument points to a serious problem of how economic considerations can influence medical decisions, but in the context of PAD, the concern is not borne out. We will provide empirical evidence suggesting that concerns about money influence medical decisions throughout the full course of illness, but at the end of life, financial pressure is much more likely to influence a decision to pursue or reject aggressive life‐extending care than it is to influence a request for PAD. We will also address the question of whether financial pressure as a result of being poor—particularly in the context of an inadequate social safety net—robs people of their autonomy, rendering their informed request and consent invalid. We argue that it does not. We will emphasize the impracticality and injustice of rejecting the role of poverty as a legitimate factor in decision‐making, the irrational distinction between PAD and withdrawal of life‐sustaining care, and the more appropriate focus on the great flaws in the American health care system. [ABSTRACT FROM AUTHOR]

States and nations are grappling with physician-assisted dying and its boundaries. In the United States, euthanasia is universally prohibited and a handful of states have sanctioned physician-assisted dying for competent adults with terminal illnesses. In Europe, access to physician-assisted dying is broader. The Netherlands, Belgium and Switzerland permit physician-assisted dying for competent nonterminal patients, whether the cause of the patient's suffering is psychological or somatic. Indeed, all three countries allow physician-assisted dying for psychiatric patients without an underlying somatic disorder. Still, legal scholars and bioethicists are divided over whether someone with a mental disorder should have access to physician-assisted dying. Some object to physician-assisted dying itself, while others support a right to assisted dying for people with terminal illnesses, but are unwilling to extend that right to people with mental illnesses. In this Article, I argue that when a person requests the assistance of a physician to hasten her death, our only concern should be whether she is competent to consent to physician-assisted dying. A large empirical literature has shown that mental disorder is not synonymous with incompetence. A person can be depressed and form a desire to die that we are obligated to respect. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM PUBLISHER]

Horses are a precocious species that must accomplish several milestones that are critical to survival in the immediate post-birth period for their survival. One essential milestone is the successful transition from the intrauterine unconsciousness to an extrauterine state of consciousness or awareness. This transition involves a complex withdrawal of consciousness inhibitors and an increase in neuroactivating factors that support awareness. This process involves neuroactive hormones as well as inputs related to factors such as cold, visual, olfactory, and auditory stimuli. One factor not previously considered in this birth transition is a yet unreported direct neural reflex response to labor-induced physical compression of the fetus in the birth canal (squeezing). Neonatal maladjustment syndrome (NMS) is a disorder of the newborn foal characterized by altered behavior, low affinity for the mare, poor awareness of the environment, failure to bond to the mother, abnormal sucking, and other neurologically-based abnormalities. This syndrome has been associated with altered events during birth, and was believed to be caused exclusively by hypoxia and ischemia. However, recent findings revealed an association of the NMS syndrome with the persistence of high concentrations of in utero neuromodulating hormones (neurosteroids) in the postnatal period. Anecdotal evidence demonstrated that a novel physical compression (squeeze) method that applies 20 min of sustained pressure to the thorax of some neonatal foals with this syndrome might rapidly hasten recovery. This survey provides information about outcomes and time frames to recovery comparing neonatal foals that were given this squeeze treatment to foals treated with routine medical therapy alone. Results revealed that the squeeze procedure, when applied for 20 min, resulted in a faster full recovery of some foals diagnosed with NMS. The adjunctive use of a non-invasive squeeze method may improve animal welfare by hastening recovery and foal-mare interactions that minimize health problems. This would also avoid or reduce costs arising from hospitalization associated with veterinary and nursing care that sometimes leads owners to elect for euthanasia. [ABSTRACT FROM AUTHOR]

As more countries adopt laws and regulations concerning euthanasia, pediatric euthanasia has become an important topic of discussion. Conceptions of what constitutes harm to patients are fluid and highly dependent on a myriad of factors including, but not limited to, health care ethics, family values, and cultural context. Euthanasia could be viewed as iatrogenic insofar as it results in an outcome (death) that some might consider inherently negative. However, this perspective fails to acknowledge that death, the outcome of euthanasia, is not an inadvertent or preventable complication but rather the goal of the medical intervention. Conversely, the refusal to engage in the practice of euthanasia might be conceived as iatrogenic insofar as it might inadvertently prolong patient suffering. This article will explore cultural and social factors informing families', health care professionals', and society's views on pediatric euthanasia in selected countries. [ABSTRACT FROM AUTHOR]

Background: End-of-life decision making constitutes a major challenge for bioethical deliberation and political governance in modern democracies: On the one hand, it touches upon fundamental convictions about life, death, and the human condition. On the other, it is deeply rooted in religious traditions and historical experiences and thus shows great socio-cultural diversity. The bioethical discussion of such cultural issues oscillates between liberal individualism and cultural stereotyping. Our paper confronts the bioethical expert discourse with public moral attitudes.Methods: The paper is based on a qualitative study comprising 12 focus group discussions with religious and secular persons in the USA, Germany, and Israel (n = 82). Considering the respective socio-political and legal frameworks, the thematic analysis focuses on moral attitudes towards end-of-life decision making and explores the complex interplay between individual preferences, culture, and religion.Results: Our findings draw attention to the variety and complexity of cultural and religious aspects of end-of-life decision making. Although there is local consensus that goes beyond radical individualism, positions are not neatly matched with national cultures or religious denominations. Instead, the relevance of the specific situatedness of religious beliefs and cultural communities becomes visible: Their status and role in individual situations, for example, as consensual or conflicting on the level of personal perspectives, family relationships, or broader social contexts, e.g., as a majority or minority culture within a political system.Conclusions: As the group discussions indicate, there are no clear-cut positions anchored in "nationality," "culture," or "religion." Instead, attitudes are personally decided on as part of a negotiated context representing the political, social and existential situatedness of the individual. Therefore, more complex theoretical and practical approaches to cultural diversity have to be developed. [ABSTRACT FROM AUTHOR]

The topic of physician-assisted dying has always been a controversial topic raising a strong ethical dilemma. Currently, six states in the USA (Oregon, Vermont, Washington, Montana, California, & Colorado) have developed regulations legalizing physician-assisted dying (medical euthanasia). We propose that physicians, because of their Hippocratic oath, should be exempted from participating in it. We suggest experts in professional assisted dying (Euthanasia Specialists) be ethically, and where possible, medically trained to perform such a task when deemed appropriate. [ABSTRACT FROM AUTHOR]

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

Importance: The increasing legalization of euthanasia and physician-assisted suicide worldwide makes it important to understand related attitudes and practices.Objective: To review the legal status of euthanasia and physician-assisted suicide and the available data on attitudes and practices.Evidence Review: Polling data and published surveys of the public and physicians, official state and country databases, interview studies with physicians, and death certificate studies (the Netherlands and Belgium) were reviewed for the period 1947 to 2016.Findings: Currently, euthanasia or physician-assisted suicide can be legally practiced in the Netherlands, Belgium, Luxembourg, Colombia, and Canada (Quebec since 2014, nationally as of June 2016). Physician-assisted suicide, excluding euthanasia, is legal in 5 US states (Oregon, Washington, Montana, Vermont, and California) and Switzerland. Public support for euthanasia and physician-assisted suicide in the United States has plateaued since the 1990s (range, 47%-69%). In Western Europe, an increasing and strong public support for euthanasia and physician-assisted suicide has been reported; in Central and Eastern Europe, support is decreasing. In the United States, less than 20% of physicians report having received requests for euthanasia or physician-assisted suicide, and 5% or less have complied. In Oregon and Washington state, less than 1% of licensed physicians write prescriptions for physician-assisted suicide per year. In the Netherlands and Belgium, about half or more of physicians reported ever having received a request; 60% of Dutch physicians have ever granted such requests. Between 0.3% to 4.6% of all deaths are reported as euthanasia or physician-assisted suicide in jurisdictions where they are legal. The frequency of these deaths increased after legalization. More than 70% of cases involved patients with cancer. Typical patients are older, white, and well-educated. Pain is mostly not reported as the primary motivation. A large portion of patients receiving physician-assisted suicide in Oregon and Washington reported being enrolled in hospice or palliative care, as did patients in Belgium. In no jurisdiction was there evidence that vulnerable patients have been receiving euthanasia or physician-assisted suicide at rates higher than those in the general population.Conclusions and Relevance: Euthanasia and physician-assisted suicide are increasingly being legalized, remain relatively rare, and primarily involve patients with cancer. Existing data do not indicate widespread abuse of these practices. [ABSTRACT FROM AUTHOR]

This article reports cultural differences in the relationship between personality characteristics and euthanasia attitudes using samples from Iran and the United States. Survey data from university students were analyzed using multivariate regression. Results indicate that while attitudes toward euthanasia are significantly more positive among the U.S. sample, there is significantly greater variation among the Iranian sample. Honesty-Humility and Openness to Experience are predictive factors in both samples, where Agreeableness is only significant among the Iranian group. Additionally, Chow tests of structural features of the multivariate models show significant differences between the two samples. We conclude by discussing implications of these results for understanding cultural similarities and differences in attitudes toward euthanasia, including the practical implications of this work for patient care in an increasingly globalized world. [ABSTRACT FROM AUTHOR]