James Rachels and the morality of euthanasia.

My fundamental thesis is that Rachels dismisses the traditional Western account of the morality of killing without offering a viable replacement. In this regard, I will argue that the substitute account he offers is deficient in at least eight regards: (1) he fails to justify the foundational principle of utilitarianism, (2) he exposes preference utilitarianism to the same criticisms he lodges against classical utilitarianism, (3) he neglects to explain how precisely one performs the maximization procedure which preference utilitarianism requires, (4) his account of the sanctity of life is subject to the very criticism he levels against the traditional position, (5) he cannot justify the exceptions he makes to his interpretation of the sanctity of life, (6) his account could easily be used to justify murder, (7) his embrace of autonomy as an ethical principle undermines his preference utilitarianism, and (8) he cannot maintain the moral identification of acts of killing and letting die.

Euthanasia, consensual homicide, and refusal of treatment.

Consensual homicide remains a crime in jurisdictions where active voluntary euthanasia has been legalized. At the same time, both jurisdictions, in which euthanasia is legal and those in which it is not, recognize that all patients (whether severely ill or not) have the right to refuse or withdraw medical treatment (including life-saving treatment). In this paper, I focus on the tensions between these three norms (the permission of active euthanasia, the permission to reject life-saving treatment, and the prohibition of consensual homicide), assuming a justification of euthanasia based on the right to (personal) autonomy. I argue that the best way to provide a coherent account of these norms is to claim that patients have two distinct rights: the right to autonomy and the right to bodily integrity. This solution has some relevant implications for the discussion of the legalization of active euthanasia.

Self-destruction or surrender? Religiosity and active versus passive euthanasia.

Previous research suggests that people, especially religious people, are more opposed to active euthanasia, such as a lethal injection, than to passive euthanasia, such as withdrawing life support. The current research proposes a possible explanation for this finding-that active euthanasia is viewed as interfering with the natural course of life and death, but passive euthanasia is viewed as allowing it to take place. Two studies yielded results consistent with this hypothesis and found that how people think about the natural course of life and death substantially explained the greater opposition to active euthanasia among more religious people.

El derecho a solicitar la prestación de ayuda para morir: un debate desde la Bioética y el Derecho / El dret a sol·licitar la prestació d'ajuda per a morir: un debat des de la Bioètica i el Dret / The Right to request the provision of Aid to Die: A debate from Bioethics and the Law

La Ley Orgánica 3/2021, de 24 de marzo, de regulación de la eutanasia surge a través de un extenso y exaltado debate jurídico y bioético. La consecuencia deeste nuevo marco normativo regulador es la despenalización de la eutanasia activa directa y el desarrollo del derecho a solicitar la prestación de ayuda para morir. Este debate jurídico y bioético se ha sustentado en gran medida en la contraposición de dos figuras, como son la eutanasia y los cuidados paliativos, que reflejan semejanzas pero que jurídicamente son elementos que deben ser diferenciados.(AU)

Organic Law 3/2021, of March 24, on the regulation of euthanasia arises through an extensive legal and bioethical debate. The consequence of this new regulatory framework is the decriminalization of direct active euthanasia and the development of the rightto request assistance to die. This legal and bioethical debate has been based largely on the contrast of two concepts, such as euthanasia and palliative care, which reflect similarities but which are legally elements that must be differentiated.(AU)

La Llei orgànica 3/2021, de 24 de març, de regulació de l'eutanàsia sorgeix a través d'un extens i exaltat debat jurídic i bioètic. La conseqüència d'aquest nou marc normatiu regulador és la despenalització de l'eutanàsia activa directa i el desenvolupament del dret a sol·licitar la prestació d'ajuda per a morir. Aquest debat jurídic i bioètic s'ha sustentat en gran manera en la contraposició de dues figures, com són l'eutanàsia i les cures pal·liatives, que reflecteixen semblances però que jurídicament són elements que han de ser diferenciats.(AU)

What does the Chilean Constitution say about euthanasia?

What does the Chilean Constitution say about euthanasia? When we read the Chilean Constitution we cannot find the word "euthanasia" in the text, and there is no such thing as a right to die, therefore the answer should apparently be that the Constitution does not say anything about euthanasia and, in short, euthanasia is not allowed. However, on a second reading we can find out some statements from which we can infer another answer. My aim is to show that there is room for the acceptance of euthanasia in the Chilean Constitution, and in other similar Constitutions and international regulations in which freedom of conscience is granted.

How not to talk about passive euthanasia: A lesson from India.

The 2011 Shanbaug case has proved to be very important in shaping the debates about end-of-life care and assisted dying in India. Ostensibly dealing with the question of whether it was permissible to withdraw treatment from a patient in a persistent vegetative state, it became a case about the legality of passive euthanasia, which is how it was treated by the Law Commission of India in 2012, and by the Supreme Court bench considering the Common Cause case in 2018. However, questions about the legality of passive euthanasia depend on whether we have a coherent definition of "passive euthanasia". In this paper, I argue that such a definition was absent from both the Shanbaug and the Common Cause rulings. As a result, they are highly unreliable.

La Medicina de Familia ante la ley sobre la ayuda médica para morir: responsabilidad y garantías / Family Medicine in the face of the law on medical aid in dying responsibility and guarantees

La aprobación de la ley de eutanasia supone un reto para la medicina y culmina un proceso de maduración cívica de la sociedad ante el morir. Existen desafíos que la aplicación de la ley deberá solventar. Buscar una solución médica objetiva e irreversible a un sufrimiento subjetivo, donde pueden existir determinantes sociales condicionantes, implica un grave riesgo de inequidad que requiere políticas que establezcan un marco pre-decisional garantista. La eutanasia debería ser una excepción gracias a la existencia de fuertes salvaguardas clínicas, informativas y relacionales que solo pueden garantizarse en el contexto de una atención primaria solvente que acompañe a las personas a lo largo de sus vidas. En este contexto primarista y comunitario, la eutanasia puede ser el último recurso de un profesional comprometido con el no abandono de un paciente con sufrimiento grave e irreversible que la solicita.(AU)

The approval of the euthanasia law represents a challenge for medicine and culminates a process of civic maturation of society in the face of death. There are challenges that the application of the law will have to meet. Seeking an objective and irreversible medical solution to subjective suffering - where there may be conditioning social determinants - implies a serious risk of inequity that requires policies that establish a pre-decisional guaranteeing framework. Euthanasia should be an exception thanks to the existence of strong clinical, informational and relational safeguards that can only be guaranteed in the context of a solvent primary care that accompanies people throughout their lives. In this primarist and community context, euthanasia can be the last resort of a professional committed to not abandoning a patient with severe and irreversible suffering who requests it.(AU)

Vital prostheses: Killing, letting die, and the ethics of de-implantation.

Disconnecting a patient from artificial life support, on their request, is often if not always a matter of letting them die, not killing them-and sometimes, permissibly doing so. Stopping a patient's heart on request, by contrast, is a kind of killing, and rarely if ever a permissible one. The difference seems to be that procedures of the first kind remove an unwanted external support for bodily functioning, rather than intervening in the body itself. What should we say, however, about cases at the boundary-procedures involving items that seem bodily in some respects, but not others? When, for instance, does deactivating an implanted device like a pacemaker count as killing, and when as letting die? Contra existing proposals, I argue that the boundaries of the body for this purpose are not drawn at the boundaries of the self, or (if this is different) the human organism. Nor should we determine when we are killing and when we are letting die by deferring to existing practices for distinguishing ongoing from completed treatment. Rather, I argue that whether something (organic or inorganic) counts as body part for purposes of this distinction depends on the results of a normative analysis of the particular character of our rights in it-particularly, whether and in what way these rights ought to be alienable. I conclude by arguing that there are likely good reasons to recognize distinctively "bodily" rights and restrictions in at least some implantable devices.