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* Pediatric euthanasia is currently practiced in the Netherlands on newborns, infants, children, and adolescents, although exact numbers are not known. Euthanasia in the Netherlands is generally assumed to be active and voluntary, but some cases of pediatric euthanasia would have to be characterized as nonvoluntary. Much of the motivation behind the euthanasia movement and the performance of pediatric euthanasia in the Netherlands is a genuine, compassionate desire to alleviate pain and suffering. In this study, we review the Dutch experience, with particular attention to the current practice of euthanasia on newborns, infants, children, and adolescents. We discuss pediatric euthanasia from an ethical point of view. We assert that more effective pain control, better symptom management, and psychosocial support of the dying and their families would alleviate the perception of suffering and reduce the perceived need to resort to euthanasia. (AJDC 1992;146:1440-1446)

For some patients, a right to receive euthanasia will not enhance autonomy in the morally relevant sense. Even if these patients choose wisely whether to exercise their right to die, they will still be harmed by having been given it. Perhaps, then, physicians should have permission to administer voluntary euthanasia, but patients should not have a right to receive it.

Several scholars have recently criticized the dominant emphasis upon mid-level principles in bioethics best exemplified by Beauchamp and Childress's Principles of Biomedical Ethics. In Part I of this essay, I assess the fairness and cogency of three broad criticisms raised against 'principlism' as an approach: (1) that principlism, as an exercise in applied ethics, is insufficiently attentive to the dialectical relations between ethical theory and moral practice; (2) that principlism fails to offer a systematic account of the principles of non-maleficence, beneficence, respect for autonomy, and justice; and (3) that principlism, as a version of moral pluralism, is fatally flawed by its theoretical agnosticism. While acknowledging that Beauchamp and Childress's reliance upon Ross's version of intuitionism is problematic, I conclude that the critics of principlism have failed to make a compelling case against its theoretical or practical adequacy as an ethical approach. In Part II, I assess the moral theory developed by Bernard Gert in Morality: A New Justification of the Moral Rules, because Gert has recommended his approach as a systematic alternative to principlism. I judge Gert's theory to be seriously incomplete and, in contrast to principlism, unable to generate coherent conclusions about cases of active euthanasia and paternalism.

The debate on the ethical permissibility of euthanasia in medicine has a corollary in the ethical application of drugs. The overall moral limits of medical treatment apply evenly to the moral acceptability of the pharmacological aspect of the act of euthanasia. The pharmacological aspect of the act is of ethical importance not only for the person requesting an active ending of his or her life, but also for the grieving family.

The legalization of euthanasia, both in the Netherlands and in other countries is usually justified in reference to the right to autonomy of patients. Utilizing recent Dutch jurisprudence, this article intends to show that the judicial proceedings on euthanasia in the Netherlands have not so much enhanced the autonomy of patients, as the autonomy of the medical profession.

The American public increasingly is beginning to perceive that assisted suicide is moral. This is symptomatic of a culture that tends to deny death. Institutional change promoting compassionate treatment to the dying is a better path than assisted suicide.

The arguments of Jack Kevorkian are unethical and dangerous. The concept of 'rational' suicide is contradictory. Societies in which suicide was tolerated were rife with suicides and tended to trivialize life. Tolerance towards suicide would lead to a vast increase in suicide that would hurt society.

Discussion of a public policy supporting assisted suicide must concern itself with safeguards. The primary issues for debate are whether assisted suicide fosters the dignity of the patient, whether the patient's request is an act of self-determination, and whether an assisted suicide shows compassion.

The case of Janet Adkins, who committed suicide with the aid of Jack Kevorkian and his suicide machine, raises troubling questions. Kevorkian's suicide machine heightens the power of physicians and severely limits the autonomy of the patient in the name of the freedom to commit suicide.

Advocates of assisted suicide such as Jack Kevorkian typically discourage rational debate on the subject. The ideas of Kevorkian, who advocates institutionalized assisted suicide, are alarming. Issues that need to be discussed include the link between mental illness and the desire for assisted suicide.

Assisted suicide as advocated by Jack Kevorkian, the inventor of the mercitron suicide machine, transcends traditional medical ethics. There is a flaw in the medical ethics of euthanasia in that assisted suicide tends to serve the needs of society rather than those of the individual.

The American Medical Association's Council on Ethical and Judicial Affairs evaluated the role of physicians in medical decisions made by patients near the end of life. Patients who are competent have the right to refuse treatment; physicians must respect this decision. Physicians must respect the right of terminally ill patients to choose their treatment even if the outcome is death, while not providing treatment that is medically unsound or leads to undesirable consequences. Patients can decide to have life-sustaining treatment withheld or withdrawn, even if it results in death. Terminally ill patients have the right to choose a treatment that alleviates pain, even if it shortens their life. Physicians should not perform euthanasia or participate in physician-assisted suicide because they should not use their medical knowledge to cause a patient's death. The impact of policies on end-of-life decisions on both individual patients and society should be evaluated.

The Vatican Declaration on Euthanasia (1980) supports the right to refuse medical treatment but opposes suicide or euthanasia. A referendum in Washington State that would have legalized physician-assisted suicide and euthanasia was narrowly defeated in Nov 1991. The federal Patient Self-Determination Act, requiring hospitals to inform patients of their right to refuse treatment, became effective a month later. A survey of recent literature suggests that a shift in attitude toward euthanasia is occurring.

The euthanasia debate is not just another moral debate, one in a long list of arguments in our pluralistic society. It is profoundly emblematic of three important turning points in [...]

Since the case of Karen Quinlan first seized public attention fifteen years ago, no issue in biomedical ethics has been more prominent than the debate about forgoing life-sustaining treatment. Controversy [...]

Since the 1973 Leeuwarden trial of a doctor who killed a patient requesting euthanasia, public debate on euthanasia in the Netherlands has become come more intense. Despite the fact that, [...]

At the Maastricht meeting our Dutch hosts opened a window on their society and invited us to take a look at euthanasia practices in the Netherlands. As Maurice de Wachter [...]

The November defeat of Initiative 119 in Washington state promises only a pause in the public efforts to legalize physician-assisted suicide and active euthanasia. The news reports, while analyzing the [...]

In November 1991, residents of Washington State will vote on Initiative 119, which permits physicians to legally assist in the death of mentally competent and terminally ill patients. Regardless of how any individual physician might feel about euthanasia, the proponents of the bill have done a service by bringing the topic into public debate. The right of a patient to refuse treatment, even when this would mean his death, is well established. Furthermore, physicians have often withheld treatment that would only serve to prolong incurable illness. However, many people feel that withholding treatment is fundamentally different from taking an action that would end life. There are many facets of euthanasia, and a survey of important questions is presented. For example, would the legalization of euthanasia make some terminally ill patients feel compelled to die to avoid prolonging the expense and hardship for their families? Conversely, might the option of euthanasia compel physicians to provide better care for the terminally ill patient so he does not take the option? Some argue that permitting euthanasia, even for patients in great pain, would represent an erosion of respect for life, which may then result in abuses. It seems clear that individual physicians who do not condone euthanasia would be put into the uncomfortable position of seeing some patients travel to another state in search of a physician who does, and who will help them end their life. For many religions, taking a life cannot be condoned under any circumstances. However, some religions will condone treatment that shortens life, provided the purpose of the treatment is good. For example, high-doses of morphine may shorten a patient's life, but may be given if needed to alleviate pain. Some believe that the view of any particular religion should not guide the decisions of lawmakers. These and other questions need to be addressed. (Consumer Summary produced by Reliance Medical Information, Inc.)

The Doctrine of Double Effect and the Principle of Do No Harm raise important theoretical and practical issues, some of which are discussed by Boyle, Donagan, and Quinn. I argue that neither principle is correct, and some revisionist, and probably nonabsolutist, analysis of constraints on action and omission is necessary. In making these points, I examine several approaches to deflection of threat cases, discuss an argument for the permissibility of voluntary euthanasia, and present arguments relevant to medical contexts which justify intentionally harming some to aid others, with and without the consent of those harmed.

Euthanasia in China is gaining increasing acceptance among physicians, intellectuals, and even the people. This paper surveys current attitudes towards euthanasia and suggests why it should be legalized.

A physician's account is presented of the death of one of his patients, a woman named Diane whom he had treated for eight years prior to the illness that prompted the report. Diane had struggled with depression, alcoholism, and, earlier in life, cancer: now, from a position of personal strength and improved personal relationships, she was struck with the news that she had acute myelomonocytic leukemia, a rapidly progressing malignancy that is fatal if untreated. Upon hearing that her chances of survival, even with debilitating, painful treatment, were no better than 25 percent, she elected to forego chemotherapy. During the three months before she died, the physician met with his patient frequently, and discussed her options. She also held ongoing, honest discussions with her family. Diane was a strong believer in the importance of maintaining her dignity; she wanted to avoid excess pain and to die as comfortably as possible. Her request of the physician to write a prescription for sufficient barbiturates to commit suicide raised many significant issues for him; after he wrote it, they continued to meet regularly. Diane used her remaining weeks to deepen her relationships with her son, husband, and friends, but there came a time when the symptoms of her disease issued an imperative. After requesting an hour of solitude, her family returned to the room to find her lying at peace. The physician gave the cause of death as 'acute leukemia'; listing it as 'suicide' would have made Diane a coroner's case, subject to autopsy. The possibility existed that the family and physician would have been prosecuted. It is likely that suffering patients are often helped to die by family members and physicians; easing pain is not really the same as ending suffering. Profound questions are raised in the final paragraph of the report. (Consumer Summary produced by Reliance Medical Information, Inc.)

Bioethical Decisions to End Life examines such well-known questions as artificial nutrition and hydration, direct euthanasia, etc. in the light of 'ordinary' and 'extraordinary' means, of direct and indirect intention, and of the implications of the 'preferential option for the poor.'

Patients who have extensive brain damage and are in a state of chronic unconsciousness for more than a few weeks are considered to be in a persistent vegetative state (PVS). While body functions may continue with the help of life support equipment, the patient is mentally unaware. The decision of when to withdraw life support measures for these patients has become a controversial issue that has been debated publicly and in the courts. Several judges have allowed family members to refuse or to end life support measures when there was no reasonable hope of recovery. While the legal considerations are important, the ultimate responsibility rests with the physician, who must decide when there is virtually no chance of recovery for the patient. The physician must help the family decide what form of treatment is in the best interest of the patient. In this report, the American Medical Association provides a definition of permanent unconsciousness and clinical criteria for diagnosing PVS. Patients with PVS are typically awake, but not aware; they may open their eyes, smile briefly, and make unintelligible sounds. They may respond to loud noises, but make no purposeful movements or meaningful communication. The higher brain functions involved in pain perception are lost, therefore the patient does not suffer if breathing or feeding equipment is removed. Determining what the patient would have wanted may be a means of avoiding litigation or ethical dilemmas. The legal history of this issue also suggests that in cases where the physician and caretakers agree on a course of action, legal repercussions are quite unlikely. (Consumer Summary produced by Reliance Medical Information, Inc.)

The author expresses her helplessness at a time when queried by a terminally ill patient about euthanasia while safeguarding her professional ethics.