ABSTRACT
Consensual homicide remains a crime in jurisdictions where active voluntary euthanasia has been legalized. At the same time, both jurisdictions, in which euthanasia is legal and those in which it is not, recognize that all patients (whether severely ill or not) have the right to refuse or withdraw medical treatment (including life-saving treatment). In this paper, I focus on the tensions between these three norms (the permission of active euthanasia, the permission to reject life-saving treatment, and the prohibition of consensual homicide), assuming a justification of euthanasia based on the right to (personal) autonomy. I argue that the best way to provide a coherent account of these norms is to claim that patients have two distinct rights: the right to autonomy and the right to bodily integrity. This solution has some relevant implications for the discussion of the legalization of active euthanasia.
Subject(s)
Euthanasia , Suicide, Assisted , Humans , Homicide , Right to Die , Freedom , Personal Autonomy , Treatment Refusal , Euthanasia, Active , Euthanasia, Active, Voluntary , Euthanasia, PassiveSubject(s)
Euthanasia , Suicide, Assisted , Humans , Right to Die , Ethics, Medical , Euthanasia, Passive , Euthanasia, Active , Euthanasia, Active, VoluntaryABSTRACT
OBJECTIVES: Currently, active euthanasia is legalized in only 7 countries worldwide. These countries have encountered problems in its implementation. The study aims to summarize the practical clinical problems in the literature on active euthanasia. METHODS: A systematic literature review was conducted using 140 works consisting of 130 articles from PubMed and EthxWeb and data from 10 euthanasia laws. RESULTS: After reviewing the specific problems reported to be associated with euthanasia in each country, 5 problems were extracted: many ambiguous conditions with room for interpretation, insufficient assurance of voluntariness, response to requests for euthanasia due to psychological distress, conscientious objection, and noncompliance by medical professionals. SIGNIFICANCE OF RESULTS: Multiple ambiguous conditions that are open to interpretation can result in a "slippery slope phenomenon." An insufficient guarantee of voluntariness violates the principle of respect for autonomy, which is the underlying justification for euthanasia. In cases of euthanasia due to mental anguish, a distinction between a desire for death caused by psychological pain alone prompted by mental illness and a desire for death caused by mental symptoms prompted by physical illness is essential. Conscientious objection should remain an option because of the heavy burden placed on doctors who perform euthanasia. Noncompliance by medical professionals due to ignorance and conflicts regarding euthanasia is contrary to procedural justice.
Subject(s)
Euthanasia , Suicide, Assisted , Humans , Euthanasia/psychology , Euthanasia, Active , Euthanasia, Active, VoluntaryABSTRACT
"Mercy" holds a well-established place in the discourse on assisted death (AD), with mercy rhetoric used by both proponents and opponents of AD alike. In this paper, I interrogate the relationship between mercy, mercy killing and AD. Appeals to mercy introduce an ambiguity that carries implications for the enduring debate about healthcare professionals' participation in this controversial practice. The term "mercy killing" is used at different times to mean all of the following: killings that are acts of punitive leniency, killings motivated by pity, killings motivated by compassion, and acts of voluntary, involuntary and nonvoluntary euthanasia. I argue that killings that are acts of punitive leniency "track" a conceptually useful understanding of mercy and, by extension, mercy killing. However, if mercy is understood in this way, then "mercy killing" is a problematic way of characterizing physician-AD. While reference to mercy killing has been weeded out of AD legislation over time, the same cannot be said of public discourse, where the debate about physicians' character-and the locus of power with respect to who gets to decide when a life can rightly be ended-continues.
Subject(s)
Euthanasia , Physicians , Suicide, Assisted , Empathy , Euthanasia, Active , Euthanasia, Active, Voluntary , Health Personnel , HumansSubject(s)
Euthanasia , Ethics , Ethics Committees , Euthanasia, Active , Euthanasia, Active, Voluntary , Euthanasia, Passive , Humans , IntentionABSTRACT
The 2011 Shanbaug case has proved to be very important in shaping the debates about end-of-life care and assisted dying in India. Ostensibly dealing with the question of whether it was permissible to withdraw treatment from a patient in a persistent vegetative state, it became a case about the legality of passive euthanasia, which is how it was treated by the Law Commission of India in 2012, and by the Supreme Court bench considering the Common Cause case in 2018. However, questions about the legality of passive euthanasia depend on whether we have a coherent definition of "passive euthanasia". In this paper, I argue that such a definition was absent from both the Shanbaug and the Common Cause rulings. As a result, they are highly unreliable.
Subject(s)
Euthanasia , Suicide, Assisted , Terminal Care , Euthanasia, Active , Euthanasia, Passive , Humans , India , Persistent Vegetative State , Withholding TreatmentSubject(s)
Euthanasia, Active , Terminally Ill , Attitude of Health Personnel , Canada , Humans , Palliative CareABSTRACT
Disconnecting a patient from artificial life support, on their request, is often if not always a matter of letting them die, not killing them-and sometimes, permissibly doing so. Stopping a patient's heart on request, by contrast, is a kind of killing, and rarely if ever a permissible one. The difference seems to be that procedures of the first kind remove an unwanted external support for bodily functioning, rather than intervening in the body itself. What should we say, however, about cases at the boundary-procedures involving items that seem bodily in some respects, but not others? When, for instance, does deactivating an implanted device like a pacemaker count as killing, and when as letting die? Contra existing proposals, I argue that the boundaries of the body for this purpose are not drawn at the boundaries of the self, or (if this is different) the human organism. Nor should we determine when we are killing and when we are letting die by deferring to existing practices for distinguishing ongoing from completed treatment. Rather, I argue that whether something (organic or inorganic) counts as body part for purposes of this distinction depends on the results of a normative analysis of the particular character of our rights in it-particularly, whether and in what way these rights ought to be alienable. I conclude by arguing that there are likely good reasons to recognize distinctively "bodily" rights and restrictions in at least some implantable devices.
Subject(s)
Euthanasia, Passive , Euthanasia , Ethics , Euthanasia, Active , Homicide , Humans , Prostheses and ImplantsABSTRACT
BACKGROUND: Euthanasia can be thought of as being either active or passive; but the precise definition of "passive euthanasia" is not always clear. Though all passive euthanasia involves the withholding of life-sustaining treatment, there would appear to be some disagreement about whether all such withholding should be seen as passive euthanasia. MAIN TEXT: At the core of the disagreement is the question of the importance of an intention to bring about death: must one intend to bring about the death of the patient in order for withholding treatment to count as passive euthanasia, as some sources would indicate, or does withholding in which death is merely foreseen belong to that category? We may expect that this unclarity would be important in medical practice, in law, and in policy. The idea that withholding life-sustaining treatment is passive euthanasia is traced to James Rachels's arguments, which lend themselves to the claim that passive euthanasia does not require intention to end life. Yet the argument here is that Rachels's arguments are flawed, and we have good reasons to think that intention is important in understanding the moral nature of actions. As such, we should reject any understanding of passive euthanasia that does not pay attention to intent. SHORT CONCLUSION: James Rachels's work on active and passive euthanasia has been immensely influential; but this is an influence that we ought to resist.
Subject(s)
Euthanasia, Passive , Euthanasia , Euthanasia, Active , Euthanasia, Active, Voluntary , Humans , Intention , Withholding TreatmentABSTRACT
The scholarship of euthanasia indicates that in most cases, to date, non-voluntary euthanasia has been studied where euthanasia is legalized. Findings of these studies demonstrate the 'slippery slope' and reveal that non-voluntary euthanasia is pervasive in these countries. The research is aimed at answering two questions: (1) What are the common death hastening methods? (2) Is the acceptance of active non-voluntary euthanasia related to the legal status of euthanasia? A qualitative study was conducted in ICUs with 15 nurses. All of the interviewees refused to take part in the death hastening cases and did not obey any doctor's instruction that could hasten or cause death. Therefore, doctors who conducted NVE did it by themselves. The present study provides evidence of the phenomenon of illegal non-voluntary euthanasia as a routine practice by physicians in palliative care units in Israel. Interviews with 15 nurses employed in these units shed light on the means and methods used by these doctors to hasten terminal patients' death. We conclude that Nurses in various end-of-life care units persist in preserving their professional integrity and refuse to obey doctors' instructions for non-voluntary euthanasia. The slippery slope argument has been refuted in this context.
Subject(s)
Attitude of Health Personnel , Euthanasia, Active/ethics , Euthanasia, Active/psychology , Physicians/psychology , Terminal Care/ethics , Terminal Care/psychology , Adult , Christianity/psychology , Female , Humans , Islam/psychology , Israel , Jews/statistics & numerical data , Male , Middle Aged , Qualitative Research , Wedge ArgumentABSTRACT
Bioethicists involved in end-of-life debates routinely distinguish between 'killing' and 'letting die'. Meanwhile, previous work in cognitive science has revealed that when people characterize behaviour as either actively 'doing' or passively 'allowing', they do so not purely on descriptive grounds, but also as a function of the behaviour's perceived morality. In the present report, we extend this line of research by examining how medical students and professionals (N = 184) and laypeople (N = 122) describe physicians' behaviour in end-of-life scenarios. We show that the distinction between 'ending' a patient's life and 'allowing' it to end arises from morally motivated causal selection. That is, when a patient wishes to die, her illness is treated as the cause of death and the doctor is seen as merely allowing her life to end. In contrast, when a patient does not wish to die, the doctor's behaviour is treated as the cause of death and, consequently, the doctor is described as ending the patient's life. This effect emerged regardless of whether the doctor's behaviour was omissive (as in withholding treatment) or commissive (as in applying a lethal injection). In other words, patient consent shapes causal selection in end-of-life situations, and in turn determines whether physicians are seen as 'killing' patients, or merely as 'enabling' their death.
Subject(s)
Ethics, Medical , Euthanasia/ethics , Physician's Role/psychology , Causality , Euthanasia, Active , Euthanasia, Passive , Female , Humans , Male , Spain/epidemiology , Withholding TreatmentABSTRACT
Pope Francis's Address to the participants of the conference "Yes to Life! Taking Care of the Precious Gift of Life in Its Frailty" powerfully touches on multiple important aspects of the care of children experiencing "extreme frailty." It is a deeply moral account of the challenges that health-care providers, families, and patients confront in the technologically sophisticated and confusing world of modern medicine. This commentary draws upon a clinical case to contextualize the Pope's words in the hope of achieving a nuanced understanding of what pediatric palliative care offers to children experiencing extreme frailty. In his Address, the Pope asks health-care providers to consider an approach to frailty and suffering that allows for the opportunity to experience transcendent meaning and transpersonal value, and recognizes that it would be difficult to achieve these goals without the comprehensive and capable care offered by pediatric palliative care specialists.
Subject(s)
Frailty/psychology , Palliative Care/organization & administration , Palliative Care/psychology , Pediatrics/organization & administration , Catholicism/psychology , Congresses as Topic , Euthanasia, Active/ethics , Euthanasia, Active/psychology , Female , Humans , Physician-Patient Relations , PregnancyABSTRACT
Resumen El propósito de este artículo es desambiguar el concepto de "eutanasia", describir las conductas que equivocadamente son asociadas a ella, y diferenciar aquellas que no son eutanasia de aquella única que sí lo es. Además, se hacen las consideraciones bioéticas mínimas en relación con los términos de "eutanasia", "matar" y "dejar morir", y se discuten en pacientes conscientes e inconscientes.
Abstract The purpose of this original paper is to clarify the term "euthanasia", describing the varied conducts wrongly associated with it and distinguishing those that are not euthanasia from the only one that certainly is. Additionally, basic bioethical considerations are presented regarding the terms "euthanasia," "killing" and "letting die," and discussed in relation to conscious and unconscious patients.
Resumo O objetivo deste artigo é desambiguar o conceito de eutanásia, descrever as condutas que, de forma equivocada, são associadas a ele e diferenciar as que não são eutanásia daquela única que realmente é. Além disso, são feitas considerações bioéticas mínimas quanto aos termos "eutanásia", "matar" e "deixar morrer", os quais são discutidos com relação a pacientes conscientes e inconscientes.
Subject(s)
Humans , Euthanasia , Euthanasia, Active , Value of Life , Ethics , JurisprudenceABSTRACT
The Ethics Subcommittee of AMDA-The Society for Post-Acute and Long-Term Care Medicine ("The Society") presents arguments for and against Stopping Eating and Drinking by Advance Directives (SED by AD). SED by AD is a type of advance directive in which a proxy is instructed to stop offering food and fluids to a person when they reach a certain stage of dementia. Although most conversations regarding SED by AD focus on patient autonomy and the right to determine one's care, we propose that the ethical principle of justice-the obligation to treat all individuals equally regardless of race, gender, and physical or cognitive ability-is the decisive principle in this controversy. We also suggest that implementing SED by AD can violate a physician's obligation to beneficence and nonmaleficence. On the other hand, we identify with the families of our patients who see the refusal to follow an advance directive as an injustice of the highest order. In the end, The Society is convinced that no choice can be made here without practicing an injustice: if one refuses to implement SED by AD, one violates the autonomy of the person who drew up the advance directive. If, on the other hand, one refuses food and fluid to a resident who still accepts food, one risks practicing an injustice against that person as they are now. Recognizing that we have the greatest responsibility to our patients as they present to us in the residential setting, The Society recommends against implementing SED by AD in residents who still accept food and fluids, implementing instead, a policy of comfort feeding for those with advanced dementia.
Subject(s)
Advance Directives/ethics , Dementia/psychology , Euthanasia, Active/ethics , Feeding Behavior/ethics , Nursing Homes/ethics , Withholding Treatment/ethics , Advance Directives/psychology , Caregivers/psychology , Decision Making/ethics , Feeding Behavior/psychology , Humans , Patient Acceptance of Health Care/psychology , Personal AutonomyABSTRACT
To act or not to act? Developments in prenatal and postnatal care for children with spina bifida aperta Until the middle of the twentieth century, newborns with spina bifida aperta had low chances of survival. Advances in the treatment of hydrocephalus, among other conditions, led to increased chances of survival during the 1960s. This also revealed the downsides of the treatment of spina bifida patients since some considered the quality of life of a number of these patients to be unacceptable. But withholding treatment also had negative consequences, leading to an ethical deadlock. Over the past thirty years - besides postnatal closure of the neural tube defect - more emphasis has been put on selective pregnancy termination and sporadic active termination of life in newborns with very severe forms of spina bifida. At the same time, new treatment strategies, such as foetal surgery, are being developed. With this historical overview, we illustrate the way in which technological developments and ethical dilemmas are constantly affecting each other.
Subject(s)
Abortion, Eugenic , Euthanasia, Active , Fetal Therapies , Spina Bifida Cystica/therapy , Abortion, Eugenic/ethics , Euthanasia, Active/ethics , Fetal Therapies/ethics , Humans , Infant, Newborn , Postnatal Care , Prenatal Care , Quality of LifeABSTRACT
In the debate surrounding the morality and legality of the practices of physician-assisted death and euthanasia, a common logical argument regularly employed against these practices is the "slippery slope argument." One formulation of this argument claims that acceptance of physician-assisted death will eventually lead down a "slippery slope" into acceptance of active euthanasia, including its voluntary, non-voluntary, and/or involuntary forms, through psychological and social processes that warp a society's values and moral perspective of a practice over an extended period of time. This formulation is known as the psychological slippery slope argument. This paper analyzes the psychological slippery slope argument as it is applied to the practice of physician-assisted death, and utilizing recent empirical evidence from various nations around the world that practice physician-assisted death and/or euthanasia, the paper argues that (1) employing the psychological slippery slope argument against physician-assisted death is logically fallacious, (2) this kind of slippery slope is unfounded in practice, and thus (3) the psychological slippery slope argument is insufficient on its own to justify continued legal prohibition of physician-assisted death.
Subject(s)
Euthanasia, Active/psychology , Suicide, Assisted/psychology , Wedge Argument , Euthanasia, Active/ethics , Humans , Morals , Philosophy, Medical , Suicide, Assisted/ethics , Terminal Care/ethics , Terminal Care/psychologyABSTRACT
Assisted dying is a highly controversial moral issue incorporating both physician-assisted dying (PAD) and voluntary active euthanasia. End-of-life practices are debated in many countries, with assisted dying receiving different consideration across various jurisdictions. In this paper, we provide an analytic framework of the current position and the main arguments related to the rights and moral principles concerning assisted dying. Assisted dying proponents focus on the respect of autonomy, self-determination and forestalling suffering. On the other hand, concerns are raised regarding the interpretation of the constitutional right to life and balancing this with the premise of assisted dying, alongside the impacts of assisted dying on the doctor-patient relationship, which is fundamentally based on trust, mutual respect and the premise of 'first do no harm'. Our review is underpinning the interpretation of constitutional rights and the Hippocratic Oath with the premise of assisted dying, alongside the impacts of assisted dying on the doctor-patient relationship. Most clinicians remain untrained in such decision making, with fears against crossing key ethical divides. Due to the increasing number of cases of assisted dying and lack of consensus, our review enables the integration of ethical and legal aspects and facilitates decision making.
Subject(s)
Attitude to Death , Culture , Dissent and Disputes , Euthanasia, Active , Human Rights , Physician-Patient Relations , Suicide, Assisted , Ethics, Medical , Euthanasia, Active/ethics , Euthanasia, Active/legislation & jurisprudence , Humans , Legislation, Medical , Palliative Care , Personal Autonomy , Physician-Patient Relations/ethics , Suicide, Assisted/ethics , Suicide, Assisted/legislation & jurisprudence , Terminal CareABSTRACT
OBJECTIVES: This study determined attitudes of four groups-Korean patients with cancer, their family caregivers, physicians and the general Korean population-towards five critical end-of-life (EOL) interventions-active pain control, withdrawal of futile life-sustaining treatment (LST), passive euthanasia, active euthanasia and physician-assisted suicide. DESIGN AND SETTING: We enrolled 1001 patients with cancer and 1006 caregivers from 12 large hospitals in Korea, 1241 members of the general population and 928 physicians from each of the 12 hospitals and the Korean Medical Association. We analysed the associations of demographic factors, attitudes towards death and the important components of a 'good death' with critical interventions at EoL care. RESULTS: All participant groups strongly favoured active pain control and withdrawal of futile LST but differed in attitudes towards the other four EoL interventions. Physicians (98.9%) favoured passive euthanasia more than the other three groups. Lower proportions of the four groups favoured active euthanasia or PAS. Multiple logistic regression showed that education (adjusted OR (aOR) 1.77, 95% CI 1.33 to 2.36), caregiver role (aOR 1.67, 95% CI 1.34 to 2.08) and considering death as the ending of life (aOR 1.66, 95% CI 1.05 to 1.61) were associated with preference for active pain control. Attitudes towards death, including belief in being remembered (aOR 2.03, 95% CI 1.48 to 2.79) and feeling 'life was meaningful' (aOR 2.56, 95% CI 1.58 to 4.15) were both strong correlates of withdrawal of LST with the level of monthly income (aOR 2.56, 95% CI 1.58 to 4.15). Believing 'freedom from pain' negatively predicted preference for passive euthanasia (aOR 0.69, 95% CI 0.55 to 0.85). In addition, 'not being a burden to the family' was positively related to preferences for active euthanasia (aOR 1.62, 95% CI 1.39 to 1.90) and PAS (aOR 1.61, 95% CI 1.37 to 1.89). CONCLUSION: Groups differed in their attitudes towards the five EoL interventions, and those attitudes were significantly associated with various attitudes towards death.