Organ donation after euthanasia starting with anesthesia at home is legal in The Netherlands, Belgium, Canada and Spain.

We would like to respond to the article "Organ donation after euthanasia starting at home in a patient with multiple system atrophy Tajaâte et al., [2021] 22:120" on organ donation after euthanasia from home [ODEH]. Although we welcome the performance of ODEH, we would like to make some critical comments regarding the article, both in relation to factual inaccuracies and in terms of the vision expressed on this subject. In this letter we stress the protection of autonomy of vulnerable euthanasia patients, we contradict the assumption of illegality, we question if the anesthesia method utilized is optimal and correct a mistake in regard to an article to which is referred of ourselves.

[Euthanasia in cases of advanced dementia remains a disquieting problem]. / Euthanasie bij gevorderde dementie: het ongemak blijft.

The practice of euthanasia in The Netherlands shows a gradual widening of patient categories who are considered to be eligible. The latest addition to this list consists of patients with dementia who are no longer mentally competent. They too may obtain euthanasia if they provided an Advance Euthanasia Directive stating their wish, at a time when they still were mentally competent. This possibility is explicitly mentioned in the law. A recent judgment by the Dutch Supreme Court upheld the action of a doctor who performed euthanasia under such circumstances. Dutch doctors tended to ignore this possibility, because it would lead to euthanasing persons who do not realize what is being done to them. The issue was explored in a survey amongst 422 Dutch GP's. A surprising 45,7% of doctors thinks it is acceptable if midazolam is administered in order to forego unworthy scenes at the time of the actual euthanasia. The author disapproves of these developments.

The End of Life Choice Act: a proposed implementation and research agenda.

AIM: This article outlines the End of Life Choice Act 2019. It highlights some of the key implementation issues to ensure the system operates safely and equitably after the Act comes into force. It also identifies priorities for research to ensure issues are detected and provision of assisted dying (AD) is monitored. METHOD: We reviewed the End of Life Choice Act, assisted dying implementation literature and governmental reports. RESULTS: Effective system implementation depends on infrastructure, oversight and funding. In terms of service provision, we make recommendations about training for all health practitioners and providing practitioners; the nuances of discussing the "wish to hasten death"; conscientious objection; cultural safety for Maori; and minimising the complexity of delivering assisted dying practice. Structured research is needed to understand how the assisted dying system is operating. CONCLUSION: This article contributes by identifying core issues for practitioners, patients and policymakers. Implementation is an ongoing process that continues after the Act starts. Data are required to know whether access is equitable, who is choosing to make use of the law, whether providers are well informed and whether the safeguards are working as intended. The implications of how the Act is implemented are significant for patients, whanau, health professionals and society.

The ongoing discussion on termination of life on request. A review from a German/European perspective.

BACKGROUND: Interest in the topic of termination of life has been growing for 2 decades. After legalisation of active euthanasia and assisted suicide (EAS) in the Netherlands in 2002, movements to implement similar laws started in other European countries. However, many people objected to legalisation on the basis of the experiences in the Netherlands and as a matter of principal. METHODS: This selected and focussed review presents the theoretical discussions about EAS and describes the respective parliamentary discussions in Germany and the data and experiences in the Netherlands. It also considers people with mental disorders in the context of termination-of-life services. RESULTS: So far, only a few European countries have introduced legislation on EAS. Legalisation of EAS in the Netherlands resulted in an unexpectedly large increase in cases. The number of people with mental disorders who terminate their lives on request remains low. CONCLUSIONS: Experience from the Netherlands shows that widening criteria for EAS has problematic consequences.KEY POINTSTermination of life on request, which a subgroup of people support, is a matter of ongoing debate.Because of several problematic aspects, including ethical considerations, only a few countries in the world allow active euthanasia or assisted suicide.Even if euthanasia is well regulated, legalising it can have problematic consequences that are difficult to control, such as an unwanted excessive increase in euthanasia cases.The well-documented experiences with the euthanasia law in the Netherlands serve as an example of what is to be expected when euthanasia is legalised.We need to pay close attention to the relationship between suicide and suicide prevention on the one hand and euthanasia acts and promotion of euthanasia on the other.Further ethical, psychological and legal research is needed. In particular, the role of palliative medicine in societies' approach to end-of-life care must be explored in much more detail.

Euthanasia: trends and opinions in Spain.

OBJECTIVE: Analyse the evolution of opinions about euthanasia by the general public and clinical physicians from 1995 to 2019 and their influence at the present time. MATERIAL AND METHOD: Bibliographical review based on relevance and quality of publications in open access and academic access platforms. Main surveys review of public and private institutions. Congress and Senate Official Journal Sessions. RESULTS: Recent surveys show that clinicians support the regulation of euthanasia. This position matches the general public's belief, which has grown steadily in recent decades. DISCUSSION: Social and clinical support for the regulation of euthanasia has been fundamental. In the last two decades political parties have changed their positions, thus creating a window of opportunity.

Agency, Autonomy and Euthanasia.

Agency is the human capacity to freely choose one's thoughts, motivations and actions without undue internal or external influences; it is distinguished from decisional capacity. Four well-known conditions that can deeply affect agency are depression, demoralization, existential distress, and family dysfunction. The study reviews how they may diminish agency in persons whose circumstances may lead them to consider or request euthanasia or assisted suicide. Since agency has been a relatively neglected dimension of autonomous choice at the end of life, it is argued that to respect the autonomy of individuals, it is essential to establish their agency.

New Zealand doctors and euthanasia-legal and practical considerations of the End of Life Choice Act.

AIM: To provide an overview of the New Zealand End of Life Choice Act in comparison with other countries, arguments for and against euthanasia, and consideration of relevant legal and practical issues. METHOD: Structured descriptive summary of criteria for medical euthanasia in various jurisdictions currently allowing the practice, compared with New Zealand legislation. Narrative review of arguments for and against euthanasia with reference to existing medical literature and legal cases. RESULTS: A strong case for medical assistance in dying, based on autonomy and quality of life arguments, is countered by a long history of medical and legal tradition protecting life. CONCLUSION: This highly contentious issue is coming before the New Zealand public as a referendum in October 2020. The results will have profound implications for medical practice as well as reflecting societal shifts in attitudes toward death and dying.

[Forensic implications of humane self-chosen death in the Netherlands]. / Zelfgekozen levenseinde: een forensisch dilemma.

Euthanasia is legal in the Netherlands. Nevertheless, some individuals decide to plan their self-chosen death without the help of a physician. 'Right-to-die' organisations provide advice about humane deaths, which include voluntary refusal of food and fluids, the helium method and use of a lethal overdose of medication. It is known that suicides are sometimes influenced by the media and internet. Since 2013, 'right-to-die' organisations have informed individuals about the use of a deadly barbiturate overdose and the helium method. A rise in suicides resulting from these methods has subsequently been observed in the Netherlands. Suicides are recorded as deaths resulting from unnatural causes and are therefore investigated by a forensic physician, forensic investigator and tactical investigator. Investigation should determine the cause of death and rule out a staged crime, 'criminal' assisted suicide or an accident.

[Euthanasia in The Netherlands: slippery slope?] / Euthanasie in Nederland: hellend vlak?

Of all medical procedures euthanasia is surely the most fearful, involving as it does the deliberate ending of a human life. Yet after 1975 there was growing unease about the medical treatment of dying patients, resulting in requests to stop useless treatments and end a patient's life as a way out of unbearable suffering. The actual practice of euthanasia went through many stages. The slippery slope question is very astute: over the years new groups of suffering persons emerged who considered themselves eligible. Next to terminal patients came patients with chronic diseases, psychiatric patients, people suffering from dementia in the early stages, and dementia in the later stages. In spite of many misgivings, there is the fact that for the first time in history people have the possibility to leave life when it has become unbearable, in open communication with their loved ones.

[Choosing for euthanasia in advanced dementia; an analysis of the decisions by the Supreme Court]. / Euthanasie bij gevorderde dementie.

For many yearsthere has been confusion in the Netherlands about the question of whether doctors are entitled to end the life of incompetent patients with advanced dementia. The euthanasia control commission, the disciplinary courts and the penal court all answered this question differently after a doctor had performed euthanasia on a 74-year-old woman with advanced dementia and an advance directive made at an earlier stage. On 21 April 2020 the Supreme Court provided clarity, at least to a certain extent. This contribution presents an analysis of the decisions made by the Supreme Court and their implications for self-chosen death in patients with advanced dementia.

Indeterminacy of identity and advance directives for death after dementia.

A persistent question in discussions of the ethics of advance directives for euthanasia is whether patients who go through deep psychological changes retain their identity. Rather than seek an account of identity that answers this question, I argue that responsible policy should directly address indeterminacy about identity directly. Three sorts of indeterminacy are distinguished. Two of these-epistemic indeterminacy and metaphysical indeterminacy-should be addressed in laws/policies regarding advance directives for euthanasia.

The Islamic perspective on physician-assisted suicide and euthanasia.

Physician-assisted suicide (PAS) and euthanasia can be debated from ethical and legal perspectives, and there are a variety of views regarding their acceptability and usefulness. Religion is considered an important factor in determining attitudes towards such practices. This narrative review aims to provide an overview of the Islamic perspective on PAS and euthanasia and explore the Islamic approach in addressing the related issues. The PubMed database was searched to retrieve relevant articles, then the references listed in the selected articles were checked for additional relevant publications. Additionally, religious books (Quran and hadith) and legal codes of selected countries were also consulted from appropriate websites. The Islamic code of law discusses many issues regarding life and death, as it considers any act of taking one's life to be forbidden. Islam sanctifies life and depicts it as a gift from God (Allah). It consistently emphasises the importance of preserving life and well-being. Therefore Muslims, the followers of Islam, have no right to end their life. All Islamic doctrines consider PAS and euthanasia to be forbidden. However, if the patient has an imminently fatal illness, withholding or withdrawing a futile medical treatment is considered permissible. From a legal perspective, Islamic countries have not legalised PAS and euthanasia. Such practices are therefore considered suicides when patients consent to the procedure, and homicides when physicians execute the procedure.

Between illness and death: "Euthanasia".

The arguments for and against euthanasia present a complex picture that will need to be discussed and decided in Mexico. This article addresses some relevant aspects such as the legal determination of death, the field of bioethics intervention, terminology related to euthanasia, its classifications, international instruments promoting human rights, as well as reflections on the importance of palliative care and the patient's right to be in a terminal situation to act in accordance with their goals, expectations and beliefs, in the context of their family and social relationships.

Los argumentos a favor y en contra de la eutanasia exponen un panorama complejo, que será necesario discutir y decidir en México. En este artículo se abordan algunos aspectos relevantes, como la determinación legal de la muerte, el campo de intervención de la bioética, la terminología relacionada con la eutanasia, sus clasificaciones, los instrumentos internacionales promotores de los derechos humanos, y reflexiones sobre la importancia de los cuidados paliativos y el derecho que tiene el paciente en situación terminal para actuar conforme a sus objetivos, expectativas y creencias, en el contexto de sus relaciones familiares y sociales.

Should euthanasia and assisted suicide for psychiatric disorders be permitted? A systematic review of reasons.

BACKGROUND: Euthanasia and assisted suicide (EAS) based on a psychiatric disorder (psychiatric EAS) continue to pose ethical and policy challenges, even in countries where the practice has been allowed for years. We conducted a systematic review of reasons, a specific type of review for bioethical questions designed to inform rational policy-making. Our aims were twofold: (1) to systematically identify all published reasons for and against the practice (2) to identify current gaps in the debate and areas for future research. METHODS: Following the PRISMA guidelines, we performed a search across seven electronic databases to include publications focusing on psychiatric EAS and providing ethical reasons. Reasons were grouped into domains by qualitative content analysis. RESULTS: We included 42 articles, most of which were written after 2013. Articles in favor and against were evenly distributed. Articles in favor were mostly full-length pieces written by non-clinicians, with articles against mostly reactive, commentary-type pieces written by clinicians. Reasons were categorized into eight domains: (1) mental and physical illness and suffering (2) decisional capacity (3) irremediability (4) goals of medicine and psychiatry (5) consequences for mental health care (6) psychiatric EAS and suicide (7) self-determination and authenticity (8) psychiatric EAS and refusal of life-sustaining treatment. Parity- (or discrimination-) based reasons were dominant across domains, mostly argued for by non-clinicians, while policy reasons were mostly pointed to by clinicians. CONCLUSIONS: The ethical debate about psychiatric EAS is relatively young, with prominent reasons of parity. More direct engagement is needed to address ethical and policy considerations.