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A follow-up study of euthanasia, physician-assisted suicide and other end-of-life practices in the Netherlands is performed under the Dutch Euthanasia Act. The Dutch Euthanasia Act is followed by a modest decrease in the rates of euthanasia and physician-assisted suicide due to increased application of other-end-of-life care interventions, such as palliative sedation.

This study used retrospective interviews with 87 relatives to describe the experiences of patients who died by euthanasia or physician-assisted suicide (EAS) in the Netherlands. Most of the patients suffered from cancer (85%). The relatives were most often a partner (63%) or a child (28%) of the patient. Before explicitly requesting EAS most patients (79%) had spoken about their wishes concerning medical end-of-life decisions to be made at a later date. Hopeless suffering, loss of dignity, and no prospect of recovery were the most prevalent reasons for explicitly requesting EAS. According to the relative, in 92% of patients EAS had contributed favourably to the quality of the end of life, mainly by preventing or ending suffering.

Belgium's policy of not permitting Catholic hospitals to refuse euthanasia services rests on ethical presuppositions concerning the secular justification of political power which reveal the paradoxical character of European liberalism: In endorsing freedom as a value (rather than as a side constraint), liberalism prioritizes first-order intentions, thus discouraging lasting moral commitments and the authority of moral communities in supporting such commitments. The state itself is thus transformed into a moral community of its own. Alternative policies (such as an explicit moral diversification of public healthcare or the greater tolerance for Christian institutions in the Netherlands) are shown to be incompatible with Europe's liberal concern with securing social and material freedom resources, as well as the concern with equality of opportunity, as embodied in the European Union's anti-discrimination labor law. The essay's argument for the preferability of a libertarian solution closes with the challenge that only if the provision of public healthcare can be shown to be rationally indispensable for a morally justified polity, could the exposed incoherence of modern European liberalism be generously discounted. Keywords: discrimination, libertarianism, moral justification of power, public healthcare

Public opinion polls conducted from 1936 to 2002 found that Americans support both euthanasia and physician-assisted suicide. Although public opinion regarding end-of-life decisions appears to have been influenced by the [...]

The present study tests the applicability of the consensus versus the conflict model of criminal law in the case of homicide, and euthanasia, in particular. Although most criminal statutes consider euthanasia to be a serious homicide, many studies have revealed increasing public support for it. A survey of a national sample of Israeli respondents, based on a factorial design methodology, was conducted to determine the extent to which the criminal law reflects general or particular public attitudes toward euthanasia. The findings revealed that although social groups varied in their views on the seriousness of euthanasia, the public at large perceived it as significantly less serious than any other type of homicide. These findings are compatible with calls for reassessment of the criminal law with regard to euthanasia.

In this paper I explore just a few of the issues that are raised by what seem to be some rather serious shifts presently occurring in the modern order of death. My main focus is on the particular disturbances caused by the recently renewed demand for the legalisation of assisted suicide and euthanasia in much of the West; disturbances which I attempt to put into some kind of historical perspective. I argue that aspects of a new order of death are emerging around, and through, these debates: aspects that look back to the distant past as much as they look forward. Keywords: suicide; euthanasia; death; medicine; historical perspectives.

Euthanasia is legal only in the Netherlands and Belgium, but it is on occasion performed by physicians elsewhere. We recruited in France two convenience samples of 221 lay people and of 189 professionals (36 physicians, 92 nurses, 48 nurse's aides, and 13 psychologists) and asked them how acceptable it would be for a patient's physician to perform euthanasia in each of 72 scenarios. The scenarios were all combinations of three levels of the patient's life expectancy (3 days, 10 days, or 1 month), four levels of the patient's request for euthanasia (no request, unable to formulate a request because in a coma, some form of request, repeated formal requests), three of the family's attitude (do not uselessly prolong care, no opinion, try to keep the patient alive to the very end), and two of the patient's willingness to undergo organ donation (willing or not willing). We found that most lay people and health care professionals structure the factors in the patient scenarios in the same way: they assign most importance to the extent of requests for euthanasia by the patient and least importance (the lay people) or none (the health professionals) to the patient's willingness to donate organs. They also integrate the information from the different factors in the same way: the factors of patient request, patient life expectancy, and (for the lay people) organ donation are combined additively, and the family's attitude toward prolonging care interacts with patient request (playing a larger role when the patient can make no request). Thus we demonstrate a common cognitive foundation for future discussions, at the levels of both clinical care and public policy, of the conditions under which physician-performed euthanasia might be acceptable. Keywords: Euthanasia: Patient autonomy: Information integration: The Functional Theory of Cognition; France

This article reports the findings of a cross-sectional study that compared the attitudes of 618 respondents of a general household survey and a random sample of l,197 physicians toward different types of euthanasia in Hong Kong. The general public was found to agree with active euthanasia and non-voluntary euthanasia and was neutral about passive euthanasia. On the other hand, physicians agreed with passive euthanasia, were neutral about non-voluntary euthanasia, and disagreed with active euthanasia. Factors affecting the respondents' attitudes were also explored. The article ends with policy and research implications of the findings.

Issues pertaining to euthanasia, assisted suicide, and cessation of life support continue to be a subject of worldwide interest. Euthanasia- particularly 'active' euthanasia- is not considered legally or socially acceptable in most countries. In Japan, the first judgment of a case involving euthanasia took place in 1949. Since then there have been another five cases that reached the point of sentencing in 1990. All six cases were examples of so called 'active euthanasia', in which the termination of life was performed by family members. However, the focus of discussion has been changed dramatically in recent years, owing to two prominent cases of mercy killing in 1995 (Yokohama) and 1996 (Kyoto), respectively. Medical doctors were involved in both of these cases, and euthanasia moved from being a theoretical problem to a practical dilemma. These cases also drew attention to the fact that assisted suicide could be distinguished from euthanasia. The first part of this paper will summarize the current status of euthanasia and the cessation of life support in Japan, focusing on its historical background and policy. The second part will briefly sketch the characteristics of Japanese law and then will examine the two recent cases of mercy killing mentioned above to try and determine the roles of whistle blowing in the medical practice arena, with particular reference to Japanese culture. This analysis is a challenge to elucidate how ethics and the law interact, and influence medical practice in a specific cultural context. Keywords: Euthanasia; Assisted suicide; Cessation of life support; Mercy killing; Japan; Whistle blowing

There has been much public debate on assisted suicide and euthanasia. One potential 'slippery slope' issue is the effect of euthanasia on the incidence of suicide, a question on which there has been a paucity of empirical research. The present paper explores the relationship between the growing legal acceptance of euthanasia and physician-assisted suicide on the suicide rate in the Netherlands. Methods. Yule-Walker time series techniques are applied to annual data on suicide rates in the Netherlands from 1950 to 1990. Controls are introduced for the covariates of legal change. Results. There was a significant bivariate relationship between euthanasia and suicide. However, controlling for the sociodemographic covariates of legal change, suicide is not significantly related to euthanasia. Conclusion. The results provide the first time series evidence on the nature of legal change, euthanasia, and suicide.

These are the results of two surveys of relatives, and others who knew people who had died, describing events in the year before death and their views on the time of the person's death. Those surveyed were identified from death certificates in England. The main focus is on a sample of 3696 people dying in 1990 in 20 health authorities, with supporting analysis from an earlier national sample of 639 people dying in 1987. Variation in peoples' views about whether an earlier death would have been better is reported, in the context of debate about euthanasia. Spouses were less likely than others to feel that it would have been better if the person had died earlier, and this held true even when controlling for the deceaseds' levels of pain, distress, dependency and age. Spouses were more likely than others to say that a later death would have been better, though not in cases where the deceased was reported as having said they wanted to die sooner. Spouses were influenced by the loss which the death of the person represented for them, being more likely than others to say they missed the person who died a great deal, and feel loneliness was a big problem. Non spouses (children and other relatives of the deceased, friends, neighbours and a few officials) on the other hand were more likely than spouses to say an earlier death would have been better, even when levels of pain, distress, dependency and age were controlled for. They were also more likely than spouses to say this when the deceased was not said to have wanted to die earlier. This was influenced by the fact that they experienced care as more burdensome than spouses, finding that it restricted their lives. The consequences of all this is that the very old were more likely to be cared for by people who, in retrospect, felt that it would have been better if the old person had died earlier. The views of the very old, particularly of women, suggest that they themselves often take on the view that they are 'too old'. Key words - death, euthanasia, age, caring

The results from two surveys in England of relatives and others who knew people in samples drawn from death certificates are reported. The main focus is on a sample of 3696 people dying in 1990 in 20 health authorities, with supporting analysis from an earlier national sample of 639 people dying in 1987. The argument that good care and, in particular, hospice care is effective in reducing the desire for euthanasia has been proposed as an argument against the legalization of voluntary euthanasia. The findings suggest that the picture is in fact more complex. People who received hospice care were, if anything, more likely to have respondents who felt that it would have been better if they had died earlier. The latter held when controlling for other variables found to influence respondents' views, such as the level of distress and dependency experienced by the dying person. It appears possible that the same may apply to the dying peoples' own wishes, although here the time order of events could not be controlled for in the data. It is suggested that this may be due to hospice care being geared to helping patients express their fears and exercise choice. The wish for euthanasia may then be an assertion of personal control, rather than an act of surrender. Alternatively, people (and their relatives) who accept hospice care may be predisposed to consider the benefits of an earlier death. Measures of the quality of care and, where appropriate, symptom relief, from general practitioners, nursing and other domiciliary services, and care in other institutions such as old peoples' homes and hospitals showed only a few and weak associations with the wish to die earlier or requests for euthanasia. Several measures of unmet need for domiciliary services and for treatment for symptoms were associated with the dependent variables. It is suggested that care that is judged to be good may only do a little to counteract peoples' fear of dependency, and indeed might serve to increase feelings of lost autonomy. Key words - death, euthanasia, hospice, cancer

A secondary analysis explores the influence of age on attitudes toward euthanasia. Previously published research suggests that as individuals get older their attitudes will be less favorable. This study differs in two major ways. More recent data are used and a cohort design was employed that used nine cohorts whose members ranged in age from 45 to 85. Data from 10 separate years across a 15-year period, from 1977 through 1991, were analyzed. The conclusion reached is contrary to earlier studies: Older persons do not become less supportive of euthanasia as they age. In general, little change is noted as cohort members grow older. Chronological age did not emerge as a strong predictor among an extensive list of independent variables tested using multivariate models. Attendance at church services was the most predictive variable.