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.

EUTHANASIA IN THE DIGITAL AGE: MEDICAL AND LEGAL ISSUES AND CHALLENGES.

The purpose of this article is to analyze the main medical, legal, and ethical issues and challenges of euthanasia in the digital age. The methods that were used in this study are historical, logical, empirical, as well as comparative legal method for comparison of laws and practices of the EU and post-Soviet countries, including Ukraine. This choice determined by the fact that both groups of countries have common features and relations, while the features of their development affect approaches to regulating such sensitive and potentially open to abuse problems as euthanasia. There is no final legal answer as to whether to legalize, decriminalize or prohibit euthanasia in any of its forms. The features and legal terms of active and passive, voluntary and non-voluntary euthanasia and assisted suicide, especially for psychiatric and minor patients were researched, as well as conflicting arguments, which include individual autonomy, right to choose, the opportunity to get rid of suffering, as well as undermining the practice of palliative care, abuse in cases of vulnerable and dependent patients, moral burden on the doctors. The issue of control of the practice of euthanasia is complicated, given the extent to which it is possible to obtain informed consent, establish criteria for suffering and hopelessness, check the persistence, conviction and validity of requests for euthanasia, especially in the digital era. The potential legislation and judicial practice should provide for strict and effective guarantees, respect for the beliefs of each person and the right not to participate in any contentious practices, the balance of human rights and social values.

Commonalities and differences in legal euthanasia and physician-assisted suicide in three countries: a population-level comparison.

OBJECTIVES: To describe and compare euthanasia and physician-assisted suicide (EAS) practice in Flanders, Belgium (BE), the Netherlands (NL) and Switzerland (CH). METHODS: Mortality follow-back surveys among attending physicians of a random sample of death certificates. RESULTS: We studied 349 EAS deaths in BE (4.6% of all deaths), 851 in NL (4.6% of all deaths) and 65 in CH (1.4% of all deaths). People who died by EAS were mostly aged 65 or older (BE: 81%, NL: 77% and CH: 71%) and were mostly diagnosed with cancer (BE: 57% and NL: 66%). Home was the most common place of death in NL (79%), while in BE and CH, more variation was found regarding to place of death. The decision to perform EAS was more frequently discussed with a colleague physician in BE (93%) and NL (90%) than in CH (60%). CONCLUSIONS: EAS practice characteristics vary considerably in the studied countries with legal EAS. In addition to the legal context, cultural factors as well as the manner in which legislation is implemented play a role in how EAS legislation translates into practice.

[Social Aspects of Euthanasia]. / Aspectos Sociales de la Eutanasia.

This article analyzes the issue of euthanasia, but under a concrete point of view, that of its social implications. It is defended here that euthanasia is not exclusively an individual decision, but has, above all, an important social repercussion. If euthanasia were accepted and legalized, the very nature of the medicine and the physician's own identity would undergo a profound transformation. The doctor-patient relationship based on trust would be broken. Also, if euthanasia were endorsed, it would be encouraged that the human being was not valued for his / her being, but for his capacity to produce. Now, vulnerable, fragile and weak people (dependent, old, sick ...) keep their dignity intact, because we have this because of the simple fact of being born as human beings. All human lives are worth living, however sick and deteriorated their bodies are. To admit the opposite is to enter a spiral where the dignity of the human being would become an object of weighting with respect to another value, which, in a hypothetical conflict could be postponed by another. However, Palliative Care takes into account the social dimension of the end of life of the human being. They take care of the sick human being in its entirety. That is why they are the option most in line with the dignity of the human being at the end of his life.

[Knowledge and preferences on end-of-life resources in a sample of professionals of the Community of Madrid]. / Conocimientos y preferencias sobre los recursos existentes al final de la vida en una muestra de la Comunidad de Madrid.

OBJECTIVE: The Law (4/2017) on rights and guarantees of persons in the process of dying in Community of Madrid regulates the exercise of the rights of the person during this process. The main objective of this study was to determine the knowledge and preferences about palliative sedation (PS), euthanasia, physician-assisted suicide (PAS), and adequacy of the therapeutic effort (ATE). MATERIALS AND METHODS: A questionnaire was designed to collect knowledge about definition and legality of detailed resources, and disposition for themselves or for a relative. The questionnaire was completed by a total of 192 palliative care Conference attendees (October 2017). RESULTS: Of those that completed the questionnaire, 160 (83.3%) were women, and the mean age was of 39 years (SD=15.8). More than two-thirds (131; 68.2%) did not know that the law existed. The definition with the highest rate of knowledge was on PS (89.1%; 171) and the lowest was ATE (50.5%; 97). On legality, the most successful was euthanasia (94.8%; 182) and the lowest was ATE (63.5%; 122). PS was considered the most appropriate resource (93.2%; 179), and the greater willingness of use in both relatives (91.7%; 176) as well as by themselves (90.6%; 174). PAS was the least suitable (34.4%; 66), and that less might resort in case of end-of-life of a relative (29.7%; 57), and themselves (33.3%; 64). CONCLUSIONS: There is a greater awareness of the condition of legality or illegality of each resource than of the definition of the terms. The use of the PAS and euthanasia is disapproved. It is important to clarify the meaning of ATE, and clarify its confusion with other measures such as PS and PAS.

Should the Euthanasia Act in Belgium Include Minors?

In 2014, Belgium became the first country in the world to legislate euthanasia for children. The decision evoked questions and criticisms in Belgium and in the world at large: should children have the right to ask to die? Are children able to make reasoned and independent choices on such an important matter? Does maturity matter? Are children as autonomous as adults? Is it a logical move to grant terminally ill children who are in intolerable pain this right? What happens if there is a conflict of wishes between the child and parents? This article argues that these questions should be addressed while legislators are fully aware of the relevant medical data regarding child development. The article weighs arguments for and against euthanasia for children, dis cussing patients' autonomy, competence, age and maturity, pressure and abuse, and palliative care. It is suggested that the option of pediatric palliative care should be exhausted before proceeding to euthanasia, and that psychological counselling be made available to both children and guardians. It is further argued that the law should explicate the age of children, and that it should insist on consensus between children and parents.

A Phronetic Inquiry into the Australian Euthanasia Experience: Challenging Paternalistic Medical Culture and Unrepresentative Health Policy.

Australia's intermittent attempts to legalise euthanasia are typically fraught with brief, polarised, and often sensationalised, public debate. Yet beyond the sensitive arguments in favour and in opposition of reform, the practical antecedents of change that may determine Australia's genuine aptitude to enact reforms have been largely neglected. Phronetic legal inquiry thus offers insights into the euthanasia law reform experience, using Australian and international case comparisons to examine covert power dynamics, cultural discourses, and social and institutional structures that affect the practices of the legislature. On this basis, it is argued that Australia's medical profession, and particularly its dominant providers of palliative care, are hampered by an entrenched culture of medicalisation and paternalism, within which patient autonomy provides only a veneer of self-determination. This can be strikingly contrasted with the Dutch approach of patient-centred care, which seeks to produce collaborative, respectful dialogue between physician and patient and to integrate the principles of autonomy and beneficence. Furthermore, these contrasting medical cultures represent issues in the broader policymaking context, as Australia's health policy remains unduly subject to the pressure of unrepresentative yet influential conservative interest groups, most prominently including the Australian Medical Association. This pressure serves to suppress public opinion on the issue of euthanasia in a parliamentary climate that remains stifled by bipartisan alliances and political inertia. It is therefore argued that Australia's prospects for successful voluntary euthanasia law reform rest on the dual pillars of developing a more patient-centred medical culture and challenging the prevailing paternalistic approach to health policymaking in Australia's currently unrepresentative political landscape.

Euthanasia and surgeons: an overview of the Victorian Voluntary Assisted Dying Act 2017 and its relevance to surgical practice in Australia.

Surgeons play a significant role in the treatment of patients with many types of cancer, including the management of advanced and recurrent disease after long periods of apparent remission. The recently introduced Victorian Voluntary Assisted Dying (VAD) Act represents a shift in paradigm in Australian medical practice. To be eligible for VAD, the new legislation requires patient assessment by a physician with at least 5 years post-fellowship experience and relevant expertise in the patient's condition. Given many specialist surgeons' experience in managing advanced and often incurable malignancy, it is likely that many will receive referrals for assessment for VAD. It is foreseeable that other states and territories in Australia will follow suit with similar legislation. It is imperative that surgeons receiving referrals to assess patients seeking access to VAD are familiar with the legislation and assessment process. This article summarizes the current regulation of VAD in Australia, including the patient application and assessment process, briefly reviews world-wide assisted dying practices and discusses the relevance to surgeons practicing in Australia.

Euthanasia and palliative sedation in Belgium.

The aim of this article is to use data from Belgium to analyse distinctions between palliative sedation and euthanasia. There is a need to reduce confusion and improve communication related to patient management at the end of life specifically regarding the rapidly expanding area of patient care that incorporates a spectrum of nuanced yet overlapping terms such as palliative care, sedation, palliative sedation, continued sedation, continued sedation until death, terminal sedation, voluntary euthanasia and involuntary euthanasia. Some physicians and nurses mistakenly think that relieving suffering at the end of life by heavily sedating patients is a form of euthanasia, when indeed it is merely responding to the ordinary and proportionate needs of the patient. Concerns are raised about abuse in the form of deliberate involuntary euthanasia, obfuscation and disregard for the processes sustaining the management of refractory suffering at the end of life. Some suggestions designed to improve patient management and prevent potential abuse are offered.

Physician-Assisted Suicide and the New York State Constitution.

On September 7, 2017, the New York State Court of Appeals ruled on the most significant state constitutional case that it had been presented in several years. In Myers v. Schneiderman, the Court unanimously rejected a request to legalize physician-assisted suicide ("PAS"). This article will examine the background and the legal grounds of that historic ruling, as well as some reflections on our involvement in the case.

Involvement of palliative care in euthanasia practice in a context of legalized euthanasia: A population-based mortality follow-back study.

BACKGROUND: In the international debate about assisted dying, it is commonly stated that euthanasia is incompatible with palliative care. In Belgium, where euthanasia was legalized in 2002, the Federation for Palliative Care Flanders has endorsed the viewpoint that euthanasia can be embedded in palliative care. AIM: To examine the involvement of palliative care services in euthanasia practice in a context of legalized euthanasia. DESIGN: Population-based mortality follow-back survey. SETTING/PARTICIPANTS: Physicians attending a random sample of 6871 deaths in Flanders, Belgium, in 2013. RESULTS: People requesting euthanasia were more likely to have received palliative care (70.9%) than other people dying non-suddenly (45.2%) (odds ratio = 2.1 (95% confidence interval, 1.5-2.9)). The most frequently indicated reasons for non-referral to a palliative care service in those requesting euthanasia were that existing care already sufficiently addressed the patient's palliative and supportive care needs (56.5%) and that the patient did not want to be referred (26.1%). The likelihood of a request being granted did not differ between cases with or without palliative care involvement. Palliative care professionals were involved in the decision-making process and/or performance of euthanasia in 59.8% of all euthanasia deaths; this involvement was higher in hospitals (76.0%) than at home (47.0%) or in nursing homes (49.5%). CONCLUSION: In Flanders, in a context of legalized euthanasia, euthanasia and palliative care do not seem to be contradictory practices. A substantial proportion of people who make a euthanasia request are seen by palliative care services, and for a majority of these, the request is granted.