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.

New York State Creates New Governance of Commercial Gestational Surrogacy.

United States law recognizes adult reproductive liberty and many states view surrogacy services through that lens. During the COVID-19 pandemic in March, 2020, New York State enacted the Child-Parent Surrogacy Act (CPSA) into law, after feminists and their allies had caused its defeat in 2019. Just before approval of the CPSA, a group of legislators introduced the Alternative Surrogacy Bill (ASB). This article is a case study that examines how the CPSA and not the ASB became law, examining surrogate rights, the best interests of the child, and the ethical issues related to adult donor-conceived and surrogacy born children's rights to information about their ancestry.

Ethical framework for adult social care in COVID-19.

In March 2020, the Government produced a document entitled "Responding to COVID-19: The Ethical Framework for Adult Social Care" ('The Ethical Framework'). In this article, we summarise the key features of the proposed ethical framework and subject it to critical analysis. We highlight three primary issues. First, the emphasis placed on autonomy as the primary ethical principle. We argue if ever there was a context in which autonomy should dominate the ethical analysis, this is not it. Second, we examine the interface between ethics and law which is largely overlooked in the document. Finally, we explore the surprising lack of attention paid to the concept of responsibility and communal obligations within the framework.

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.

When Are Vaccine Mandates Appropriate?

Vaccine refusal is a serious public health problem, especially in the context of diseases with potential to spark global pandemics, such as Ebola virus disease in the Democratic Republic of the Congo. This article examines whether and when compelling vaccination through mandates and criminalization, for example, are appropriate. It argues that some legal approaches are ethical when they preserve social stability, trust in government, therapeutic research opportunities, or when they diminish disease severity.

La criogenización: el vencimiento de la muerte, los derechos del "ser criónico" renacido / Cryogenization: the expiration of death, the rights of the reborn "cryonic being"

El debate se nos manifiesta intenso, extenso y complejo en los interrogantes jurídicos y éticos que el problema suscita y concita a cualquier atento observador de una realidad social tan impactante y sobrecogedora. En fin, un debate apasionante pero todavía teórico entre la Bioética y la legalidad. La reflexión está abierta, y la experimentación en relación con la "medicina regenerativa" irá avanzando al compás de los logros (entendemos que, en este caso, dilatados en el tiempo) con la investigación biotecnológica. Hoy por hoy, esta técnica es una "quimera" y los expertos creen que pasarán muchos años antes de que esta experimentación pueda vislumbrarse que obtenga una ejecución viable. La práctica de la criogenia consiste en preservar un cuerpo mediante su congelamiento con la finalidad de resucitarlo en el futuro. Legalmente, debe llevarse a cabo inmediatamente después que una persona ha sido declarada muerta para evitar así lesiones cerebrales que suceden rápidamente pasados los cinco a diez minutos aproximadamente luego de la muerte. El objetivo de esto es suspender la vida amenazada por una enfermedad incurable hasta tanto se logre obtener la cura a la misma. La criogenia debe ser llevada a cabo luego que una persona ha sido declarada muerta, sin embargo, el cese de latidos y respiración no es equivalente a muerte biológica. Legalmente una persona es declarada muerta cuando ha ocurrido muerte cerebral diagnosticada por falta de actividad cerebral evidenciada mediante electroencefalograma

The debate presents itself as intense, extensive and complex in terms of the legal and ethical questions that the problem poses to any alert observer of this arresting and moving social reality. All in all, it is a fascinating -albeit still theoretical- debate between bio-ethics and lawfulness. The issue is open to reflection, and all the while experimentation in relation to 'regenerative medicine' will keep on progressing in step with the advances in bio-technology research (which in this case we may suppose to be drawn out over a long period of time). Currently this technique is no more than a chimaera, and experts believe that it will be many years before this form of experimentation will be seen to offer a viable outcome. In practical terms, cryonics consists of preserving a body by freezing it, with the aim of resuscitation at a later date. Legally, it must be carried out immediately after someone is pronounced dead so as to avoid injury to the brain which will occur rapidly after five to ten minutes following death. The aim is to suspend life when it is threatened by an incurable disease until such time as it becomes curable. Cryopreservation must be carried out after someone has been pronounced dead, although the cessation of a heartbeat and breathing is not the same as biological death. Legally, someone is pronounced dead when brain death has occurred, determined by a lack of brain activity established by way of an EEG

Medical Assistance in Dying (MAiD) in Canada: A Critical Analysis of the Exclusion of Vulnerable Populations.

Canadian medical assistance in dying (MAiD) legislation was introduced in 2016. Although Bill C-14 attempted to balance patient autonomy and the protection of the vulnerable, recent court challenges suggest that an ideal balance has not been achieved. Numerous advocacy initiatives as well as a parliamentary review currently focus on three specific populations: mature minors, patients requesting MAiD via an advance directive and patients with a mental illness as the sole underlying condition. This article approaches these issues from an ethical and legal lens. We first outline a policy review on existing MAiD legislation in 11 jurisdictions. We then use the Oakes test (a critical assessment tool in the Carter v Canada case) to determine whether the restrictions on the three above-mentioned groups are consistent with the Canadian Charter of Rights and Freedoms. Finally, we consult our literature review to propose reasonable solutions that would be more consistent with the Charter.

Mobile applications for client use: Ethical and legal considerations.

Mobile applications (apps) to support behavioral health are increasing in number and are recommended frequently by medical providers in a variety of settings. As with the use of any adjunct tool in therapy, psychologists adopting new technologies in clinical practice must comply with relevant professional ethics codes and legal standards. However, emerging technologies can outpace regulations regarding their use, presenting novel ethical considerations. Therefore, it is incumbent upon providers to extrapolate current ethical standards and laws to new technologies before they recommend them as adjuncts to face-to-face treatment. This article identifies best practices for incorporating apps into treatment, including competence in the use of smartphones in general and familiarity with the specific apps recommended. Psychologists must conduct informed consent procedures in accordance with existing evidence, as well as privacy and security concerns relating to a particular app, in order to mitigate potential liability regarding the collection of client-generated data. Psychologists also should be prepared to educate clients about how best to safeguard their data, such as through encryption, password protection, or remote deletion of data. By doing so, psychologists can balance potentially competing demands of leveraging emerging technology to improve care while simultaneously ensuring ethical and legal compliance in these new areas. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Rethinking Brain Death as a Legal Fiction: Is the Terminology the Problem?

Brain death, or the determination of death by neurological criteria, has been described as a legal fiction. Legal fictions are devices by which the law treats two analogous things (in this case, biological death and brain death) in the same way so that the law developed for one can also cover the other. Some scholars argue that brain death should be understood as a fiction for two reasons: the way brain death is determined does not actually satisfy legal criteria requiring the permanent cessation of all brain function, and brain death is not consistent with the biological conception of death as involving the irreversible cessation of the functioning of an organism as a whole. Critics counter that the idea that brain death is a legal fiction is deceptive and undemocratic. I will argue that diagnosing brain death as a hidden legal fiction is a helpful way to understand its historical development and current status. For the legal-fictions approach to be ethically justifiable, however, the fact that brain death is a legal fiction not aligned with the standard biological conception of death must be acknowledged and made transparent.

Death: An Evolving, Normative Concept.

Constantin Reliu had been working for twenty years as a cook in Turkey when he returned to his hometown of Barlad, Romania, to discover that, there, he was dead. His former wife had, unbeknownst to him, at some point during his stay in Turkey registered him as deceased in Romania. He has since been living a legal nightmare trying to prove to Romanian authorities that he is, in fact, alive. Reliu is not alone in finding out that the legal system is not as attuned to physiological activity or biological assessment by doctors in determining death as one might think. If one starts with the assumption that death is a purely biological concept, solely the province of doctors, Reliu's story seems entirely unrelated to the concept of death in the medical context. A brain scan would not lead to a reversal of his being assessed as dead. The story is a reminder, however, that how death is used is not just biological, and therefore that the standard of death even in the clinic must answer to cultural considerations. Values, the law, and custom matter a great deal in determining who is alive and who is not, whether in the courtroom, the coroner's office, or the clinic.

Fear of Life, Fear of Death, and Fear of Causing Death: How Legislative Changes on Assisted Dying Are Doomed to Fail.

Fear of life, fear of death, and fear of causing death form a combination that prevents reasoned changes in laws concerning end-of-life situations. This is shown systematically in this article using the methods of conceptual analysis. Prevalent fears are explicated and interpreted to see how their meanings differ depending on the chosen normative stance. When the meanings have been clarified, the impact of the fears on the motivations and justifications of potential legislative reforms are assessed. Two main normative stances are evoked. The first makes an appeal to individual self-determination, or autonomy, and the second to the traditional professional ethics of physicians. These views partly share qualifying elements, including incurability and irreversibility of the patient's medical condition, proximity of death, the unbearable nature of suffering, and issues of voluntariness further shade the matter. The conclusion is that although many motives to change end-of-life laws are admirable, they are partly contradictory, as are calls for autonomy and appeals to professional ethics; to a degree that good, principled legislative solutions remain improbable in the foreseeable future.

The 'French exception': the right to continuous deep sedation at the end of life.

In 2016, a law came into force in France granting terminally ill patients the right to continuous deep sedation (CDS) until death. This right was proposed as an alternative to euthanasia and presented as the 'French response' to problems at the end of life. The law draws a distinction between CDS and euthanasia and other forms of sympton control at the end of life. France is the first country in the world to legislate on CDS . This short report describes the particular context and underlying social values that led to this piece of legislation, and explores its meaning in the wider French context.