Uninformed consent: Who knows what Ivan Ilyich would have thought?

ABSTRACT: In the modern era, when prolonging life is not an option, the end-of-life discussions are unavoidably influenced by Neuroethics. Despite this, it is interestingly evident how the sentiments of a terminal patient of 1885 and a physician of 2020, are still comparable. This paper pre-sents the arguments behind the so-called "Therapeutic Misconception" and the aim of palliative care to provide dying patients support. It is essential to address priorities of informed consent, signed before any remedy is provided. A key component of the newest Neuroscience research is the analysis of motivation and free will. So, it is necessary to comprehend if the patient struggles to feel at peace with these aspects of his "right to die": Is he free to choose or is he influenced by the doctors? Is this confusion an example of "Therapeutic Misconception"? Is his Informed Consent totally "Informed"? In order to broaden our understanding, we account for many critical situations, such as the mentally impaired Psychiatric patients or the famous Italian case of Eluana Englaro. In addition, we suggested some current approaches such as Artificial Intelligence, useful in preserving some cognitive functions the patient may have lost. Furthermore, research in this field is very critical and in some Catholic countries like Italy, people faced difficulties accepting the idea of the "Anticipated directives". In general, whatever the mental status and whatever the terminal state, the patients seem still far from handling their own auto-determination and their Consent, even if the ultimate goal is to die with dignity.

Physician-Assisted Death in Canada.

The Criminal Code of Canada prohibits persons from aiding or abetting suicide and consenting to have death inflicted on them. Together, these provisions have prohibited physicians from assisting patients to die. On February 6, 2015, the Supreme Court of Canada declared void these provisions insofar as they "prohibit physician-assisted death for a competent adult person who (1) clearly consents to the termination of life and (2) has a grievous and irremediable medical condition (including an illness, disease or disability) that causes enduring suffering that is intolerable to the individual in the circumstances of his or her condition." This declaration of invalidity was scheduled to take effect one year (later extended by six months) after the ruling, to give the government time to put legislation in place. We trace the history of this decision, discuss how it has forever changed the debate on physician-assisted dying, and identify the issues that must be resolved to write the legislation. Of special importance here are the topics of access, safeguards, and conscientious objection.

[The birth of the international conference "Biology and the future of man", Paris, 18-24 September 1974]. / La naissance de la conférence internationale « Biologie et devenir de l'homme ¼, Paris, 18-24 septembre 1974.

In 1974, a symposium was organized in Paris entitled "Biology and the future of man". It was focused on the analysis of "new powers of science and new duties of man" in the field of medically assisted procreation, agriculture, demography, and environmental issues. This small introductory text begins by describing the circumstances that led to the organization of this prestigious conference. Then, in order to go further than the silent framework of the presentation of the themes, we will focus on the report of Dr. Robert Edwards on medically assisted procreation, we will recall the duel between Jacques Monod and Jérôme Lejeune on abortion, then we will give center stage to physicians like Jean Bernard and Alexandre Minkowski about the right to die, and finally we will remind the conclusion brought to the conference by Georges Canguilhem.

Introduction to special issue: Robert Jay Kastenbaum (1932-2013).

The three pieces in this section introduce the Festschrift celebrating the works and influence of Omega: Journal of Death and Dying's founding editor, Robert Kastenbaum. Robert Fulton, an early Associate Editor of the Journal begins with some personal reflections on Kastenbaum. Klass and Doka then describe the nature of the Festschrift. A closing coda by Robert Kastenbaum's wife, Beatrice Kastenbaum, reminds us of the person behind the work.

[Legal issues of physician-assisted euthanasia part I--terminology and historical overview]. / Rechtsfragen zur ärztlichen Sterbehilfe Teil I--Terminologie und historischer Uberblick.

Under German criminal law, euthanasia assisted by the attending physician involves the risk of criminal prosecution. However, in the absence of clear legal provisions, the law concerning euthanasia has been primarily developed by court rulings and jurisprudential literature in the last 30 years. According to a traditional classification there are four categories of euthanasia: help in the dying process, direct active euthanasia, indirect active euthanasia and passive euthanasia. However, there is still no generally accepted definition for the general term "euthanasia". The development of the law on the permissibility of euthanasia was strongly influenced by the conflict between the right of self-determination of every human being guaranteed by the Constitution and the constitutional mandate of the state to protect and maintain human life. The decisions of the German Federal Court of Justice on euthanasia in the criminal trials "Wittig" (1984), "Kempten" (1994) and "Putz" (2010) as well as the ruling of the 12th Division for Civil Matters of the Federal Court of Justice (2003) are of special importance. Some of these decisions were significantly influenced by the discussions in the jurisprudential literature. However, the German Bundestag became active for the first time as late as in 2009 when it adopted the 3rd Guardianship Amendment Act, which also contains provisions on the legal validity of a living will independent of the nature and stage of an illness. In spite of the new law, an analysis of the "Putz" case makes it especially clear that the criminal aspects of legal issues at the end of a person's life still remain controversial. It is to be expected that this issue will remain the subject of intensive discussion also in the next few years.

Cuidados paliativos e ortotanásia

1. A morte e o processo do morrer são fontes de reflexões desde os primórdios da civilização. 2. A morte instaura-se como problemática pessoal, social e, exatamente por isso, torna-se, pelo fato irrefutável de acontecer, objeto de ampla discussão. 3. O paciente terminal tem direito à verdade, à proporcionalidade terapêutica, à prevenção de complicações e sofrimentos, ao não abandono e ao tratamento da dor.