James Rachels and the morality of euthanasia.

My fundamental thesis is that Rachels dismisses the traditional Western account of the morality of killing without offering a viable replacement. In this regard, I will argue that the substitute account he offers is deficient in at least eight regards: (1) he fails to justify the foundational principle of utilitarianism, (2) he exposes preference utilitarianism to the same criticisms he lodges against classical utilitarianism, (3) he neglects to explain how precisely one performs the maximization procedure which preference utilitarianism requires, (4) his account of the sanctity of life is subject to the very criticism he levels against the traditional position, (5) he cannot justify the exceptions he makes to his interpretation of the sanctity of life, (6) his account could easily be used to justify murder, (7) his embrace of autonomy as an ethical principle undermines his preference utilitarianism, and (8) he cannot maintain the moral identification of acts of killing and letting die.

Euthanasia, consensual homicide, and refusal of treatment.

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.

Self-destruction or surrender? Religiosity and active versus passive euthanasia.

Previous research suggests that people, especially religious people, are more opposed to active euthanasia, such as a lethal injection, than to passive euthanasia, such as withdrawing life support. The current research proposes a possible explanation for this finding-that active euthanasia is viewed as interfering with the natural course of life and death, but passive euthanasia is viewed as allowing it to take place. Two studies yielded results consistent with this hypothesis and found that how people think about the natural course of life and death substantially explained the greater opposition to active euthanasia among more religious people.

What does the Chilean Constitution say about euthanasia?

What does the Chilean Constitution say about euthanasia? When we read the Chilean Constitution we cannot find the word "euthanasia" in the text, and there is no such thing as a right to die, therefore the answer should apparently be that the Constitution does not say anything about euthanasia and, in short, euthanasia is not allowed. However, on a second reading we can find out some statements from which we can infer another answer. My aim is to show that there is room for the acceptance of euthanasia in the Chilean Constitution, and in other similar Constitutions and international regulations in which freedom of conscience is granted.

How not to talk about passive euthanasia: A lesson from India.

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.

Vital prostheses: Killing, letting die, and the ethics of de-implantation.

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.

[Does the written press give a fair account of a complex medical question: «the Vincent Lambert case¼?] / La presse écrite rend-elle compte d'une façon juste d'une question médicale complexe : « le cas Vincent Lambert ¼ ?

Does the written press give a fair account of a complex medical question: "The Vincent Lambert Case"? We have studid press articles referring to Mr. Vincent Lambert's situation from 2013 to 2017. Analysis using a reading grid (including 7 questions) of press articles from four French daily newspapers (Libération, Le Monde, Le Figaro and La Croix) and a specialized medical news site (Agence de presse médicale) so that they can build their own opinion. 341 articles were analyzed (61 articles from Libération, 65 articles from Le Monde, 86 articles from Le Figaro, 82 articles from La Croix, 47 articles from the APM), writing a chronology of the main facts of the patient's history from 2013 to 2017 in order to have benchmarks to estimate the accuracy of the information reported in the various articles. Articles are rarely fully explicit. Inadequate expressions ("passive euthanasia", "end-of-life procedure") are used in the majority of newspapers. Some articles present the facts in a partisan way and contribute to mask the complexity of the patient's situation. Court decisions are often shortened and therefore simplified, which does not help the reader to understand the situation in an informed way. Reflective benchmarks are sometimes found in the various newspapers from 2013 to 2016. From 2016 onwards, we notice that the articles are shorter and that they no longer give any reference points for reflection. The daily written press in its current format does not seem to be able to help the general public to obtain accurate information on complex issues involving broad areas of reflection. The difficulty of the journalist's work in addressing this type of questioning comes partly from the constraints of brevity that are often imposed on them on the one hand and from the constant evolution of the information itself on the other.

La presse écrite rend-elle compte d'une façon juste d'une question médicale complexe : « Le Cas Vincent Lambert ¼ ? Nous avons analysé des articles de presse faisant référence à « l'affaire Vincent Lambert ¼ parus de 2013 à 2017 pour comprendre la façon dont la presse quotidienne française grand public relate les questions médicales complexes à forte tonalité éthique et interroger sa capacité à informer avec justesse ses lecteurs pour qu'ils puissent se construire leur propre opinion. À l'aide d'une grille de lecture (comportant 7 questions), 341 articles de presse de 4 quotidiens français (Libération, Le Monde, Le Figaro et La Croix) et d'un site de dépêches médicales spécialisées (Agence de presse médicale) ont été analysés. Les articles apparaissent rarement entièrement explicites. Des expressions inadaptées (« euthanasie passive ¼, « procédure de fin de vie ¼) sont utilisées dans la majorité des journaux. Certains articles exposent les faits de manière partisane et participent à maquiller la complexité de la situation du patient. Les décisions de justice sont souvent raccourcies et donc simplifiées, ce qui n'aide pas le lecteur à saisir la situation de manière éclairée. Des repères réflexifs sont parfois retrouvés dans les différents journaux de 2013 à 2016. À partir de 2016, on remarque que les articles sont plus courts et ne donnent plus aucun repère de réflexion. De nos jours, la presse écrite n'est probablement plus le premier vecteur d'information choisi par le citoyen. Les articles des titres de presse étudiés dans leur format actuel ne sont peut-être pas le meilleur moyen d'aider le grand public à s'informer de manière juste sur des questions complexes englobant de vastes champs de réflexion. La difficulté du travail du journaliste pour aborder ce type de questionnement vient en partie des contraintes de brièveté qui leur sont souvent imposées d'une part, et de l'évolution constante de l'information elle-même d'autre part.

Controversy About Withdrawal of Postresuscitation Care After Cardiac Arrest.

With increasing focus in the last decade on post-cardiac arrest care in pediatrics, return of spontaneous circulation, survival rates, and neurologic outcome have improved. As part of this postarrest care, both the American Heart Association and the American Academy of Neurology state it is reasonable to consider targeted temperature management in pediatric comatose patients, although this care is challenging and time sensitive, with many gaps in knowledge remaining. Many pediatric patients will still not survive or will suffer severe neurocognitive impairment despite the therapeutic arsenal provided. Adult guidelines suggest providing postarrest supportive care and limiting prognosis discussions with families until after 72 hours of therapy, but pediatric clinicians are advised to consider a multitude of factors given the lack of data. What, then, should clinicians do if family members of a patient who has been resuscitated request the withdrawal of all life support in the 24 hours immediately postarrest? In this Ethics Rounds, we present such a case and the responses of different clinicians and bioethicists.

[Clinical Ethics on Amyotrophic Lateral Sclerosis: Focusing on Discussions and Future Challenges Regarding Withdrawal of Ventilator Support].

Although there are many ethical issues related to amyotrophic lateral sclerosis, one of the most controversial issue is the withdrawal of ventilator support. This problem has a significant impact not only on the decision to "remove", but also on the decision to "wear" it. In particular, if the withdrawal of ventilator support was to be legalized, there is a concern that its legislation may exert a 'silent pressure.' Therefore, rather than explicitly defining the withdrawal of ventilator support, as a "legal right," we prefer the installation of a policy in which the details of individual cases are carefully scrutinized, allowing for justifiable non-compliance with the law in special cases.

The Briggsian Heresy? Should Previously Expressed Wishes Determine Best Interests in Decisions Relating to Withdrawal of Clinically-Assisted Nutrition and Hydration?

This paper examines the Court of Protection decision in Briggs v Briggs. It considers whether the approach of the Court, which gave effective decisive weight to a patient's previously expressed wishes about whether he should be kept alive in a minimally conscious state, is a proper application of the 'best interests' test under the Mental Capacity Act 2005. It assesses whether the Briggs approach is effectively applying a 'substituted judgement' test and considers the difficulties in ascertaining what a person's actual wishes are.

What passive euthanasia is.

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.

Euthanasia and physician-assisted suicide for patients with depression: thought-provoking remarks.

Euthanasia and medical assistance in dying entail daunting ethical and moral challenges, in addition to a host of medical and clinical issues, which are further complicated in cases of patients whose decision-making skills have been negatively affected or even impaired by psychiatric disorders. The authors closely focus on clinical depression and relevant European laws that have over the years set firm standards in such a complex field. Pertaining to the mental health realm specifically, patients are required to undergo a mental competence assessment in order to request aid in dying. The way psychiatrists deal and interact with decisionally capable patients who have decided to end their own lives, on account of sufferings which they find to be unbearable, may be influenced by subjective elements such as ethical and cultural biases on the part of the doctors involved. Moreover, critics of medical aid in dying claim that acceptance of such practices might gradually lead to the acceptance or practice of involuntary euthanasia for those deemed to be nothing more than a burden to society, a concept currently unacceptable to the vast majority of observers. Ultimately, the authors conclude, the key role of clinicians should be to provide alternatives to those who feel so hopeless as to request assistance in dying, through palliative care and effective social and health care policies for the weakest among patients: lonely, depressed or ill-advised people.