Physician-Assisted Suicide and Euthanasia: Emerging Issues From a Global Perspective.

Medical professional societies have traditionally opposed physician-assisted suicide and euthanasia (PAS-E), but this opposition may be shifting. We present 5 reasons why physicians shouldn't be involved in PAS-E. 1. Slippery slopes: There is evidence that safeguards in the Netherlands and Belgium are ineffective and violated, including administering lethal drugs without patient consent, absence of terminal illness, untreated psychiatric diagnoses, and nonreporting; 2. Lack of self-determination: Psychological and social motives characterize requests for PAS-E more than physical symptoms or rational choices; many requests disappear with improved symptom control and psychological support; 3. Inadequate palliative care: Better palliative care makes most patients physically comfortable. Many individuals requesting PAS-E don't want to die but to escape their suffering. Adequate treatment for depression and pain decreases the desire for death; 4. Medical professionalism: PAS-E transgresses the inviolable rule that physicians heal and palliate suffering but never intentionally inflict death; 5. Differences between means and ends: Proeuthanasia advocates look to the ends (the patient's death) and say the ends justify the means; opponents disagree and believe that killing patients to relieve suffering is different from allowing natural death and is not acceptable. CONCLUSIONS: Physicians have a duty to eliminate pain and suffering, not the person with the pain and suffering. Solutions for suffering lie in improving palliative care and social conditions and addressing the reasons for PAS-E requests. They should not include changing medical practice to allow PAS-E.

Euthanasia is not medical treatment.

INTRODUCTION OR BACKGROUND: The public assumes that if euthanasia and assisted suicide were to be legalized they would be carried out by physicians. SOURCES OF DATA: In furthering critical analysis, we supplement the discourse in the ethics and palliative care literature with that from medical education and evolving jurisprudence. AREAS OF AGREEMENT: Both proponents and opponents agree that the values of respect for human life and for individuals' autonomy are relevant to the debate. AREAS OF CONTROVERSY: Advocates of euthanasia and assisted suicide give priority to the right to personal autonomy and avoid discussions of harmful impacts of these practices on medicine, law and society. Opponents give priority to respect for life and identify such harmful effects. These both require euthanasia to remain legally prohibited. GROWING POINTS: Proposals are emerging that if society legalizes euthanasia it should not be mandated to physicians. AREAS TIMELY FOR DEVELOPING RESEARCH: The impact of characterizing euthanasia as 'medical treatment' on physicians' professional identity and on the institutions of medicine and law should be examined in jurisdictions where assisted suicide and euthanasia have been de-criminalized.

The ethics of clinical ethics services.

One function of such services is to help clinicians ask the "right" questions.

"Doing ethics" in the context of sharing patients' personal health information.

There are at present two inconsistencies with respect to the sharing of personal health information (PHI) among health care professionals caring for a patient whom the information concerns. First, there is an inconsistency between what is in theory the ethics and law governing the confidentiality and privacy of this information--it may only be disclosed with informed consent--and what is the actual practice of health care professionals--they share it without such consent. Second, there is an inconsistency between what ethics and law demand in theory and what all parties want: They all approve of the current practice. Ethics and law can be brought into line with what is needed to act in the patient's best interests and with what people want, without opening up any serious potential for abuse of privacy and confidentiality, by establishing a safeguarded, provision-of-care exception that allows co-caring health care professionals to share patients' PHI. The requirements for a system establishing such safeguards are proposed. The basic governing presumption is respect for the person and for rights to autonomy, self-determination, privacy, and confidentiality. Therefore, disclosure may only be made with the informed consent of the competent person to whom the information pertains, unless a defence of necessity applies. Where there is doubt about someone's competence, there should likewise be doubt about disclosure without that person's informed consent. Where the person is incompetent, such a disclosure can be made to the patient's substitute decision makers, most often the family, if that is necessary for the care of the patient and in the patient's best interests. To the extent possible, consistent with the best interests of the patient, the wishes of incompetent people should be respected.

"Death talk": debating euthanasia and physician-assisted suicide in Australia.

Imprecise language and deliberate confusion of important ethical and legal concepts are clouding our understanding of controversial end-of-life issues. This could affect our decision about whether or not to legalise euthanasia.

A postmodern moral tale: the ethics of research relationships.

Once upon a time, universities were ivory towers--or, at least, most people saw them as such. Academics prided themselves on not being influenced by, or answerable to, anyone except the academy, and perceived themselves as free from conflicts of interest arising from relationships with people or institutions outside the walls of the university. None of this holds true today and, as the case of Dr Nancy Olivieri illustrates, universities are facing some difficult times in adjusting to these changes.

Developing and implementing health care ethics and law

Ethics and law in health care (medicine, ethics and law), is a seamless web in many senses. The disciplines that are needed to address adequately issues in this area, must be handled within a structure that allows for their fruitful interaction, and the provision of crucial insights and responses. We have called this structure transdisciplinarity. Students and practitioners must have sufficient knowledge to be able to recognise ethical dilemmas, and to know when they need assistance in dealing with these. Appropriate structures need to be established to provide such assistance. What these will be, will depend upon the resources (human and other), that are available, and the "health care culture" within which the ethical issues arise