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Some individuals choosing physician-assisted death donate their tissue to science., Author(s): Colin Barras [sup.1] Author Affiliations: (1) Chelsea, USA In 2016, Canada became one of the few countries in the world to legalize voluntary euthanasia. Since the passage of the [...]

In many European countries there is a public debate about the acceptability and regulation of enthanasia. In 2002, Belgium became the second country after the Netherlands to enact a law on euthanasia. Although euthanasia rarely occurs, the complexity of the clinical-ethical decision making surrounding euthanasia requests and the need for adequate support reported by caregivers, means that healthcare institutions increasingly need to consider how to responsibly handle euthanasia requests. The development of written ethics policies on euthanasia may be important to guarantee and maintain the quality of care for patients requesting euthanasia. The aim of this study was to determine the prevalence, development, position, and communication of written ethics policies on euthanasia in Flemish nursing homes. Data were obtained through a cross-sectional mail survey of general directors of all Catholic nursing homes in Flanders, Belgium. Of the 737 nursing homes invited to participate, 612 (83%) completed the questionnaire. Of these, only 15% had a written ethics policy on euthanasia. Presence of an ethics committee and membership of an umbrella organization were independent predictors of whether a nursing home had such a written ethics policy. The Act on Euthanasia and euthanasia guidelines advanced by professional organizations were the most frequent reasons (76% and 56%, respectively) and reference sources (92% and 64%, respectively) for developing ethics policies on euthanasia. Development of ethics policies occurred within a multidisciplinary context. In general, Flemish nursing homes applied the Act on Euthanasia restrictively by introducing palliative procedures in addition to legal due care criteria. The policy was communicated to the consulting general practitioner and nurses in 74% and 89% of nursing homes, respectively. Although the overall prevalence of ethics policies on euthanasia was low in Flemish nursing homes, institution administrators displayed growing awareness of bearing responsibility for stimulating dialogue and reflection about how to deal with euthanasia requests within their institution. Keywords: Belgium: Ethics policy; Euthanasia; Medical end-of-life decision making; Nursing homes; Palliative care

'Code status' is a prominent feature of end-of-life discussions in U.S. hospitals. This essay analyzes how the rhetoric of code status articulates the terms of end-of-life decision-making in one hospital's 'Patient' Preferences Worksheet. The Worksheet signifies the abandonment of the technological fix as the preferred treatment for moribund patients and the transformation of a previously private moment into a matter of institutional control. Examining the Worksheet's interlocking institutional, technical, and vernacular deathbed rhetoric challenges the dominant bioethical discourse of patient autonomy and suggests a need to supplement this procedurally rational discourse with one of relational integrity. Keywords: Rhetoric of Medicine; Institutional Rhetoric; Euthanasia; End-of-Life; Death and Dying

Our project is intended to supplement and extend research that emphasizes how the rhetoric informing the euthanasia debate admits a call of conscience and how this call would have us act heroically as we acknowledge what is arguably some particular truth that is at work in the debate (e.g., only God has the right to take a life). The relationship between conscience, acknowledgment, heroism, truth and rhetoric, we submit, presupposes the workings of our metaphysical desire for perfection--a desire that is definitely on hand when debating issues of the 'good life' and the 'good death.' The relationship constitutes a rhetoric of perfection that plays an essential role in the euthanasia debate as a whole. Such a rhetoric lies at the heart of the recent and much publicized case of Terri Schiavo--a young woman who lived in a persistent vegetative state for 15 years before she was allowed to die the 'dignified' death that she supposedly wanted all along. Keywords: Rhetoric of Perfection; Euthanasia Debate; Terri Schiavo; Right to Die; Right to Life

This essay rebuts Gary Seay's efforts to show that committing euthanasia need not conflict with a physician's professional duties. First, I try to show bow his misunderstanding of the correlativity of rights and duties and his discussion of the foundation of moral rights undermine his case. Second, I show aspects of physicians' professional duties that clash with euthanasia, and that attempts to avoid this clash lead to absurdities. For professional duties are best understood as deriving from professional virtues and the commitments and purposes with which the professional as such ought to act, and there is no plausible way in which her death can be seen as advancing the patient's medical welfare. Third, I argue against Prof. Seay's assumption that apparent conflicts among professional duties must be resolved through 'balancing' and argue that, while the physician's duty to extend life is continuous with her duty to protect health, any duty to relieve pain is subordinate to these. Finally, I show that what is morally determinative here, as throughout the moral life, is the agent's intention and that Prof. Seay's implicitly preferred consequentialism threatens not only to distort moral thinking but would altogether undermine the medical (and any other) profession and its internal ethics. Keywords: Gary Seay, medical profession, euthanasia, Edmund Pellegrino, rights, double effect

[ILLUSTRATION OMITTED] The issues surrounding euthanasia have key implications for all major religions and provide one of today's most-debated ethical topics. What is euthanasia? Euthanasia is the process of killing […]

It is increasingly asserted that the disagreements of abstract principle between adversaries in the euthanasia debate fail to account for the complex, particular and ambiguous experiences of people at the end of their lives. A greater research effort into experiences, meaning, connection, vulnerability and motivation is advocated, during which the euthanasia 'question' should remain open. I argue that this is a normative strategy, which is felicitous to the status quo and further medicalises the end of life, but which masquerades as a value-neutral assertion about needing more knowledge.

Belgium legalised voluntary euthanasia in 2002, thus ending the long isolation of the Netherlands as the only country in which doctors could openly give lethal injections to patients who have requested help in dying. Meanwhile in Oregon, in the United States, doctors may prescribe drugs for terminally ill patients, who can use them to end their life u if they are able to swallow and digest them. But despite President Bush's oft-repeated statements that his philosophy is to 'trust individuals to make the right decisions' and his opposition to 'distant bureaucracies', his administration is doing its best to prevent Oregonians acting in accordance with a law that its voters have twice ratified. The situation regarding voluntary euthanasia around the world is therefore very much in flux. This essay reviews ethical arguments regarding voluntary euthanasia and physician-assisted suicide from a utilitarian perspective. I shall begin by asking why it is normally wrong to kill an innocent person, and whether these reasons apply to aiding a person who, when rational and competent, asks to be killed or given the means to commit suicide. Then I shall consider more specific utilitarian arguments for and against permitting voluntary euthanasia.

The Netherlands is currently the only country in the world in which euthanasia is legally permissible. More specifically, Dutch law (briefly explained) allows that a doctor terminates the life of a patient of hers on his voluntary, well-considered and sustained request, if he is suffering unbearably and hopelessly. The aim of this paper is to reconstruct the Dutch debate on the moral permissibility of euthanasia so as to clarify and strengthen the various views that can be advanced in support of euthanasia. On the one view, The Pure Autonomy View (TPAV), the justification of euthanasia rests solely on the principle of respect for autonomy. That is, the reason for performing and permitting euthanasia is the patient's voluntary, well-considered and sustained, in one word: autonomous, request for euthanasia. On the alternative view, The Joint View (TJV), the principle of respect for autonomy and the principle of beneficence morally justify euthanasia together. That is, euthanasia is ethical if and partly because, since the patient is suffering unbearably and hopelessly, euthanasia is in his interest. According to this paper, there is no easy argument for one of these views rather than the other. Instead, as yet both TPAV and TJV seem inherently problematic. TPAV is unable to give a doctor a reason for performing euthanasia that appeals to her in her capacity as a doctor, such as relief of suffering. And TJV begs the question -- for example, if a state were to legalize euthanasia on grounds of TJV, it would force the view upon its citizens that it may be in a person's interest to die.

It started with a headache. It ended with a shocking death, a devastated family, a tarnished reputation for a hospital, and growing concern about the state of ethics in Catholic [...]

Issues concerning the use of drowning as an acceptable form of euthanasia for wildlife are discussed.

The philosophers' tendency to characterize euthanasia in terms of either the right or the responsibility to die is, in some ways, problematic. Stepping outside of the analytic framework, the author draws out the implications of the ethics of Emmanuel Levinas for the euthanasia debate, tracing the way Levinas's position differs not only from the philosophical consensus but also from the theological one. The article shows that, according to Levinas, there is no ethical case for suicide or assisted suicide. Death cannot be assumed or chosen--not only because suicide is a logically and metaphysically contradictory concept but also because in the choice of death ethical responsibility turns into irresponsibility. However, since Levinas holds that one must be responsible to the point of expiation, he can be said to approve certain actions that may have the consequence of hastening death. KEY WORDS: death, dying, ethics, euthanasia, Levinas, responsibility, suicide

Emmanuel Levinas writes of how the 'call of conscience' is a 'primordial discourse' that 'interrupts' the routines and language-games that help organize and give meaning to a person's everyday existence. Levinas thus provides a way of thinking about the relationship between the call of conscience and rhetoric that advances what rhetorical theorists have so far claimed about this relationship. This essay develops the position that the call of conscience is a rhetorical interruption in its purest form. A case study is offered to illustrate how such an interruption manifests itself in the debate over the justifiability and social acceptability of physician-assisted suicide. The specific rhetorical transaction in question occurred in cyberspace and lasted five months; it began when members of a disability civil rights group known as 'Not Dead Yet!' conducted what their opponents described as an 'invasion' of an electronic mailing list operated by the Euthanasia Research and Guidance Organization. KEY WORDS: conscience, Levinas, rhetorical interruptions, euthanasia, physician-assisted suicide, Not Dead Yet, right to life, right to die.

Humanist readers will be familiar with the many terms used by the news media concerning the provision of compassionate choice to those who are terminally ill. A partial list includes [...]

A number of philosophers in recent times have employed arguments to show that there is no morally relevant difference between killing a patient and allowing that patient to die in those circumstances where the outcome is virtually identical and where death is preventable, at least for a significant time. From his perspective as both a philosopher and a clinician, Grant Gillett has rejected such general and abstract arguments in the light of the intuitions and moral perceptions available to clinicians and those who care for the terminally ill. I argue that his strategy fails, is massively question-begging, and that his appeal to the notion of 'moral particularism', far from being an alternative to cogent philosophical argument, actually supports the very position he has attempted to discredit.

Whether or not the practices of euthanasia and assisted suicide are viable as societal options presents a challenging dilemma for social workers in health care settings. Social workers should prepare to discuss possible requests for information about these practices in the context of patient and family decision making in end-of-life situations. Along with awareness of definitions, current debate, federal, state, professional policies, other health care professionals' attitudes and practices, social workers must examine their own values, attitudes, and practices in this highly controversial area so that the profession may continue to enhance quality of life and protect vulnerable populations, such as the elderly. Keywords: Assisted suicide, ethics, euthanasia, health care, end-of-life issues, practice

Byline: Sudesh. Prabhakar Amyotrophic lateral sclerosis (ALS) is a debilitating, degenerative neurological illness like any other chronic disease. It has a devastating effect on the psyche of the patients as [...]

Byline: Ashok. Panagariya, Parul. Dubey, Bhawna. Sharma It is a million-dollar question whether “dying good” is as important as “living good.” The concept of “good death” in general may be [...]

Researchers have consistently found that blacks are more opposed to legalizing voluntary euthanasia than are whites. Although sketchy and untested, theories for this race difference attribute it either to a difference between the two groups' levels of fundamentalism, or to a difference between the two groups' levels of fear regarding of giving others the power to end one's life. Data from the General Social Survey (GSS) and the Ohio Death and Dying Survey (DANDS) are used to examine to what extent these two variables, along with socioeconomic status and political conservatism, account for blacks' greater opposition toward legalizing voluntary euthanasia. An exploratory structural equation model of attitudes toward physician-assisted suicide, though based on limited data, suggests that all four variables are important in explaining the difference between blacks' and whites' attitudes toward legalizing voluntary euthanasia.

The development of bioethics and the debate over euthanasia is increasingly coming under federal control in Australia. Although the origins of bioethics are recent and suggest health care professionals are attempting to become self-regulating, these issues are gradually being dominated by government or its agents and are therefore being re-regulated. Euthanasia offers the possibility of de-regulation, but it is also being federally re-regulated.

An analysis of the four methods of terminating life is presented. Terminally ill patients can voluntarily stop eating and drinking, which will cause death from dehydration or some other cause. This is considered acceptable, but many family members may object to starving their relative to death. Terminal sedation is also acceptable, and involves giving patients a sedative that makes them unconscious. These patients would also die of starvation or dehydration. Physician-assisted suicide occurs when the physician gives the patient a lethal dose but the patient carries out the act, while in euthanasia, the physician does so., Palliative care is generally agreed to be the standard of care for the dying, but there remain some patients for whom intolerable suffering persists. In the face of ethical and legal controversy about the acceptability of physician-assisted suicide and voluntary active euthanasia, voluntarily stopping eating and drinking and terminal sedation have been proposed as ethically superior responses of last resort that do not require changes in professional standards or the law. The clinical and ethical differences and similarities between these 4 practices are critically compared in light of the doctrine of double effect, the active/ passive distinction, patient voluntariness, proportionality between risks and benefits, and the physician's potential conflict of duties. Terminal sedation and voluntarily stopping eating and drinking would allow clinicians to remain responsive to a wide range of patient suffering, but they are ethically and clinically more complex and closer to physician-assisted suicide and voluntary active euthanasia than is ordinarily acknowledged. Safeguards are presented for any medical action that may hasten death, including determining that palliative care is ineffective, obtaining informed consent, ensuring diagnostic and prognostic clarity, obtaining an independent second opinion, and implementing reporting and monitoring processes. Explicit public policy about which of these practices are permissible would reassure the many patients who fear a bad death in their future and allow for a predictable response for the few whose suffering becomes intolerable in spite of optimal palliative care. JAMA. 1197;278:2099-2104

The ethical guidelines of the Norwegian Medical Association strongly condemn physician participation in euthanasia and assisted suicide. A previous study on attitudes towards euthanasia in the Norwegian population, however, indicates that a substantial part of the population is quite liberal. This study explores Norwegian physicians' attitudes towards and experience with end of life dilemmas. Sixty-six percent of a representative sample of 1476 who received postal questionnaires responded. They confirmed that Norwegian physicians actually seem to hold quite restrictive attitudes towards euthanasia. Seventeen percent answered yes to a question of whether a physician should have the opportunity to actively end the life of a terminal patient in great pain who requests this help, while 4% agreed that the same could be done to a chronically ill patient with great pain and a poor quality of life who otherwise would have several more years to live. Six percent of the physicians had performed actions intended to hasten a patient's death, while 76% said that they at least once had treated patients even if they had felt that treatment should have been discontinued. A multiple logistic regression analysis showed that internal medicine specialists, surgeons and psychiatrists were significantly more restrictive than their colleagues in laboratory specialties, and that physicians educated abroad and those with negative attitudes towards patient autonomy had more liberal attitudes towards euthanasia, when gender and time since graduation from medical school were controlled for. Key words - euthanasia, physicians, patient autonomy