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1.
Bioethics ; 36(6): 613-620, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35266579

RESUMO

"Mercy" holds a well-established place in the discourse on assisted death (AD), with mercy rhetoric used by both proponents and opponents of AD alike. In this paper, I interrogate the relationship between mercy, mercy killing and AD. Appeals to mercy introduce an ambiguity that carries implications for the enduring debate about healthcare professionals' participation in this controversial practice. The term "mercy killing" is used at different times to mean all of the following: killings that are acts of punitive leniency, killings motivated by pity, killings motivated by compassion, and acts of voluntary, involuntary and nonvoluntary euthanasia. I argue that killings that are acts of punitive leniency "track" a conceptually useful understanding of mercy and, by extension, mercy killing. However, if mercy is understood in this way, then "mercy killing" is a problematic way of characterizing physician-AD. While reference to mercy killing has been weeded out of AD legislation over time, the same cannot be said of public discourse, where the debate about physicians' character-and the locus of power with respect to who gets to decide when a life can rightly be ended-continues.


Assuntos
Eutanásia , Médicos , Suicídio Assistido , Empatia , Eutanásia Ativa , Eutanásia Ativa Voluntária , Pessoal de Saúde , Humanos
2.
Indian J Med Ethics ; VI(1): 1-11, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34081007

RESUMO

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.


Assuntos
Eutanásia , Suicídio Assistido , Assistência Terminal , Eutanásia Ativa , Eutanásia Passiva , Humanos , Índia , Estado Vegetativo Persistente , Suspensão de Tratamento
4.
CMAJ ; 193(10): E345-E346, 2021 03 08.
Artigo em Inglês | MEDLINE | ID: mdl-33685956
6.
Bioethics ; 35(2): 214-220, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32949014

RESUMO

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.


Assuntos
Eutanásia Passiva , Eutanásia , Ética , Eutanásia Ativa , Homicídio , Humanos , Próteses e Implantes
7.
Appl Nurs Res ; 52: 151245, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32199519

RESUMO

The scholarship of euthanasia indicates that in most cases, to date, non-voluntary euthanasia has been studied where euthanasia is legalized. Findings of these studies demonstrate the 'slippery slope' and reveal that non-voluntary euthanasia is pervasive in these countries. The research is aimed at answering two questions: (1) What are the common death hastening methods? (2) Is the acceptance of active non-voluntary euthanasia related to the legal status of euthanasia? A qualitative study was conducted in ICUs with 15 nurses. All of the interviewees refused to take part in the death hastening cases and did not obey any doctor's instruction that could hasten or cause death. Therefore, doctors who conducted NVE did it by themselves. The present study provides evidence of the phenomenon of illegal non-voluntary euthanasia as a routine practice by physicians in palliative care units in Israel. Interviews with 15 nurses employed in these units shed light on the means and methods used by these doctors to hasten terminal patients' death. We conclude that Nurses in various end-of-life care units persist in preserving their professional integrity and refuse to obey doctors' instructions for non-voluntary euthanasia. The slippery slope argument has been refuted in this context.


Assuntos
Atitude do Pessoal de Saúde , Eutanásia Ativa/ética , Eutanásia Ativa/psicologia , Médicos/psicologia , Assistência Terminal/ética , Assistência Terminal/psicologia , Adulto , Cristianismo/psicologia , Feminino , Humanos , Islamismo/psicologia , Israel , Judeus/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Argumento Refutável
8.
Bioethics ; 34(5): 509-518, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31943259

RESUMO

Bioethicists involved in end-of-life debates routinely distinguish between 'killing' and 'letting die'. Meanwhile, previous work in cognitive science has revealed that when people characterize behaviour as either actively 'doing' or passively 'allowing', they do so not purely on descriptive grounds, but also as a function of the behaviour's perceived morality. In the present report, we extend this line of research by examining how medical students and professionals (N = 184) and laypeople (N = 122) describe physicians' behaviour in end-of-life scenarios. We show that the distinction between 'ending' a patient's life and 'allowing' it to end arises from morally motivated causal selection. That is, when a patient wishes to die, her illness is treated as the cause of death and the doctor is seen as merely allowing her life to end. In contrast, when a patient does not wish to die, the doctor's behaviour is treated as the cause of death and, consequently, the doctor is described as ending the patient's life. This effect emerged regardless of whether the doctor's behaviour was omissive (as in withholding treatment) or commissive (as in applying a lethal injection). In other words, patient consent shapes causal selection in end-of-life situations, and in turn determines whether physicians are seen as 'killing' patients, or merely as 'enabling' their death.


Assuntos
Ética Médica , Eutanásia/ética , Papel do Médico/psicologia , Causalidade , Eutanásia Ativa , Eutanásia Passiva , Feminino , Humanos , Masculino , Espanha/epidemiologia , Suspensão de Tratamento
9.
Perspect Biol Med ; 63(3): 544-548, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33416631

RESUMO

Pope Francis's Address to the participants of the conference "Yes to Life! Taking Care of the Precious Gift of Life in Its Frailty" powerfully touches on multiple important aspects of the care of children experiencing "extreme frailty." It is a deeply moral account of the challenges that health-care providers, families, and patients confront in the technologically sophisticated and confusing world of modern medicine. This commentary draws upon a clinical case to contextualize the Pope's words in the hope of achieving a nuanced understanding of what pediatric palliative care offers to children experiencing extreme frailty. In his Address, the Pope asks health-care providers to consider an approach to frailty and suffering that allows for the opportunity to experience transcendent meaning and transpersonal value, and recognizes that it would be difficult to achieve these goals without the comprehensive and capable care offered by pediatric palliative care specialists.


Assuntos
Fragilidade/psicologia , Cuidados Paliativos/organização & administração , Cuidados Paliativos/psicologia , Pediatria/organização & administração , Catolicismo/psicologia , Congressos como Assunto , Eutanásia Ativa/ética , Eutanásia Ativa/psicologia , Feminino , Humanos , Relações Médico-Paciente , Gravidez
11.
Pers. bioet ; 23(2): 207-223, jul.-dic. 2019. tab
Artigo em Espanhol | LILACS, BDENF - Enfermagem, COLNAL | ID: biblio-1115066

RESUMO

Resumen El propósito de este artículo es desambiguar el concepto de "eutanasia", describir las conductas que equivocadamente son asociadas a ella, y diferenciar aquellas que no son eutanasia de aquella única que sí lo es. Además, se hacen las consideraciones bioéticas mínimas en relación con los términos de "eutanasia", "matar" y "dejar morir", y se discuten en pacientes conscientes e inconscientes.


Abstract The purpose of this original paper is to clarify the term "euthanasia", describing the varied conducts wrongly associated with it and distinguishing those that are not euthanasia from the only one that certainly is. Additionally, basic bioethical considerations are presented regarding the terms "euthanasia," "killing" and "letting die," and discussed in relation to conscious and unconscious patients.


Resumo O objetivo deste artigo é desambiguar o conceito de eutanásia, descrever as condutas que, de forma equivocada, são associadas a ele e diferenciar as que não são eutanásia daquela única que realmente é. Além disso, são feitas considerações bioéticas mínimas quanto aos termos "eutanásia", "matar" e "deixar morrer", os quais são discutidos com relação a pacientes conscientes e inconscientes.


Assuntos
Humanos , Eutanásia , Eutanásia Ativa , Valor da Vida , Ética , Jurisprudência
12.
J Am Med Dir Assoc ; 20(11): 1362-1366, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31588024

RESUMO

The Ethics Subcommittee of AMDA-The Society for Post-Acute and Long-Term Care Medicine ("The Society") presents arguments for and against Stopping Eating and Drinking by Advance Directives (SED by AD). SED by AD is a type of advance directive in which a proxy is instructed to stop offering food and fluids to a person when they reach a certain stage of dementia. Although most conversations regarding SED by AD focus on patient autonomy and the right to determine one's care, we propose that the ethical principle of justice-the obligation to treat all individuals equally regardless of race, gender, and physical or cognitive ability-is the decisive principle in this controversy. We also suggest that implementing SED by AD can violate a physician's obligation to beneficence and nonmaleficence. On the other hand, we identify with the families of our patients who see the refusal to follow an advance directive as an injustice of the highest order. In the end, The Society is convinced that no choice can be made here without practicing an injustice: if one refuses to implement SED by AD, one violates the autonomy of the person who drew up the advance directive. If, on the other hand, one refuses food and fluid to a resident who still accepts food, one risks practicing an injustice against that person as they are now. Recognizing that we have the greatest responsibility to our patients as they present to us in the residential setting, The Society recommends against implementing SED by AD in residents who still accept food and fluids, implementing instead, a policy of comfort feeding for those with advanced dementia.


Assuntos
Diretivas Antecipadas/ética , Demência/psicologia , Eutanásia Ativa/ética , Comportamento Alimentar/ética , Casas de Saúde/ética , Suspensão de Tratamento/ética , Diretivas Antecipadas/psicologia , Cuidadores/psicologia , Tomada de Decisões/ética , Comportamento Alimentar/psicologia , Humanos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Autonomia Pessoal
13.
Ned Tijdschr Geneeskd ; 1632019 05 09.
Artigo em Holandês | MEDLINE | ID: mdl-31140766

RESUMO

To act or not to act? Developments in prenatal and postnatal care for children with spina bifida aperta Until the middle of the twentieth century, newborns with spina bifida aperta had low chances of survival. Advances in the treatment of hydrocephalus, among other conditions, led to increased chances of survival during the 1960s. This also revealed the downsides of the treatment of spina bifida patients since some considered the quality of life of a number of these patients to be unacceptable. But withholding treatment also had negative consequences, leading to an ethical deadlock. Over the past thirty years - besides postnatal closure of the neural tube defect - more emphasis has been put on selective pregnancy termination and sporadic active termination of life in newborns with very severe forms of spina bifida. At the same time, new treatment strategies, such as foetal surgery, are being developed. With this historical overview, we illustrate the way in which technological developments and ethical dilemmas are constantly affecting each other.


Assuntos
Aborto Eugênico , Eutanásia Ativa , Terapias Fetais , Espinha Bífida Cística/terapia , Aborto Eugênico/ética , Eutanásia Ativa/ética , Terapias Fetais/ética , Humanos , Recém-Nascido , Cuidado Pós-Natal , Cuidado Pré-Natal , Qualidade de Vida
14.
Psicooncología (Pozuelo de Alarcón) ; 16(1): 143-160, mar. 2019. graf, ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-184804

RESUMO

Objective: to analyze the perception about dignified death and orthothanasia in the view of health professionals who provide curative and palliative care in oncology. Method: this is a research with exploratory, qualitative approach. Saturation criteria included the participation of eight health professionals from the Cancer Institute of Ceará, Brazil: a physician, a nurse, a social worker and a psychologist of the palliative care team, and an oncologist, a nurse, a social worker and a psychologist of the curative care team. Three instruments were used: semi-structured interview; Free Word Association Test (WAT) with "cancer" and "orthothanasia" as inductive stimulus; and a Photo Projection Test (PPT) using five images. A textual analysis was carried out using the Iramuteq software to analyze the interviews. For the analysis of the WAT, the frequencies of the words of each stimulus were counted; then they were submitted to the word reduction technique and understood through simple frequency analysis. For the analysis of the PPT, the frequencies were counted, followed by analysis of meanings. Results: cancer is perceived by professionals as synonymous with death, pain and suffering, and orthothanasia as a practice of care and affection. The importance of the transition from curative care to exclusive palliative care is evident when there is no prognosis of cure, so as to offer quality of death and pain relief. This process can be facilitated by the acceptance of death and participation on the part of the family. The family must also receive care. Conclusion: health professionals recognize the importance and challenges of orthothanasia


Objetivo: el presente artículo objetivó analizar la percepción sobre la muerte digna y la ortotanasia para los profesionales de salud de cuidado curativo y paliativo en oncología. Método: se realizó una investigación descriptiva y exploratoria de abordaje cualitativo. Se contó con la participación de ocho profesionales de salud del Instituto del Cáncer de Ceará, en Brasil: médico, enfermera, asistente social y psicóloga del equipo de cuidados paliativos, y médico oncólogo, enfermera, asistente social y psicóloga del equipo de cuidados curativos. Se utilizaron tres instrumentos: entrevista semiestructurada, Prueba de Asociación Libre de Palabras (TALP) y Prueba de Proyección sobre Fotos (TPF). Las entrevistas fueron analizadas a través del software Iramuteq. Para el análisis del TALP, las palabras de cada estímulo fueron analizadas y contabilizadas las frecuencias; a continuación, fueron sometidas a la técnica de reducción de palabras y comprendidas por medio de análisis simple de frecuencia. Para el análisis del TPF, se contabilizaron las frecuencias, seguidas de sus análisis de significados. Resultados: los resultados muestran que el cáncer se percibe como sinónimo de muerte, dolor y sufrimiento; y ortotanasia como cuidado y afecto. Se evidencia la necesidad de la aceptación de la muerte y del cambio de enfoque de cuidado de pacientes en proceso de finitud, y que por medio de los cuidados paliativos es posible ofrecer calidad de muerte y alivio del dolor. Conclusión: se concluye que los profesionales de la salud reconocen la importancia y los desafíos de la ortotanasia


Assuntos
Humanos , Masculino , Feminino , Eutanásia Ativa/métodos , Eutanásia Ativa/psicologia , Neoplasias , Percepção , Atitude do Pessoal de Saúde , Entrevistas como Assunto , 25783 , Cuidados Paliativos
15.
Med Health Care Philos ; 22(2): 239-244, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30145689

RESUMO

In the debate surrounding the morality and legality of the practices of physician-assisted death and euthanasia, a common logical argument regularly employed against these practices is the "slippery slope argument." One formulation of this argument claims that acceptance of physician-assisted death will eventually lead down a "slippery slope" into acceptance of active euthanasia, including its voluntary, non-voluntary, and/or involuntary forms, through psychological and social processes that warp a society's values and moral perspective of a practice over an extended period of time. This formulation is known as the psychological slippery slope argument. This paper analyzes the psychological slippery slope argument as it is applied to the practice of physician-assisted death, and utilizing recent empirical evidence from various nations around the world that practice physician-assisted death and/or euthanasia, the paper argues that (1) employing the psychological slippery slope argument against physician-assisted death is logically fallacious, (2) this kind of slippery slope is unfounded in practice, and thus (3) the psychological slippery slope argument is insufficient on its own to justify continued legal prohibition of physician-assisted death.


Assuntos
Eutanásia Ativa/psicologia , Suicídio Assistido/psicologia , Argumento Refutável , Eutanásia Ativa/ética , Humanos , Princípios Morais , Filosofia Médica , Suicídio Assistido/ética , Assistência Terminal/ética , Assistência Terminal/psicologia
16.
J R Soc Med ; 111(11): 407-413, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30427291

RESUMO

Assisted dying is a highly controversial moral issue incorporating both physician-assisted dying (PAD) and voluntary active euthanasia. End-of-life practices are debated in many countries, with assisted dying receiving different consideration across various jurisdictions. In this paper, we provide an analytic framework of the current position and the main arguments related to the rights and moral principles concerning assisted dying. Assisted dying proponents focus on the respect of autonomy, self-determination and forestalling suffering. On the other hand, concerns are raised regarding the interpretation of the constitutional right to life and balancing this with the premise of assisted dying, alongside the impacts of assisted dying on the doctor-patient relationship, which is fundamentally based on trust, mutual respect and the premise of 'first do no harm'. Our review is underpinning the interpretation of constitutional rights and the Hippocratic Oath with the premise of assisted dying, alongside the impacts of assisted dying on the doctor-patient relationship. Most clinicians remain untrained in such decision making, with fears against crossing key ethical divides. Due to the increasing number of cases of assisted dying and lack of consensus, our review enables the integration of ethical and legal aspects and facilitates decision making.


Assuntos
Atitude Frente a Morte , Cultura , Dissidências e Disputas , Eutanásia Ativa , Direitos Humanos , Relações Médico-Paciente , Suicídio Assistido , Ética Médica , Eutanásia Ativa/ética , Eutanásia Ativa/legislação & jurisprudência , Humanos , Legislação Médica , Cuidados Paliativos , Autonomia Pessoal , Relações Médico-Paciente/ética , Suicídio Assistido/ética , Suicídio Assistido/legislação & jurisprudência , Assistência Terminal
17.
BMJ Open ; 8(9): e020519, 2018 09 11.
Artigo em Inglês | MEDLINE | ID: mdl-30206075

RESUMO

OBJECTIVES: This study determined attitudes of four groups-Korean patients with cancer, their family caregivers, physicians and the general Korean population-towards five critical end-of-life (EOL) interventions-active pain control, withdrawal of futile life-sustaining treatment (LST), passive euthanasia, active euthanasia and physician-assisted suicide. DESIGN AND SETTING: We enrolled 1001 patients with cancer and 1006 caregivers from 12 large hospitals in Korea, 1241 members of the general population and 928 physicians from each of the 12 hospitals and the Korean Medical Association. We analysed the associations of demographic factors, attitudes towards death and the important components of a 'good death' with critical interventions at EoL care. RESULTS: All participant groups strongly favoured active pain control and withdrawal of futile LST but differed in attitudes towards the other four EoL interventions. Physicians (98.9%) favoured passive euthanasia more than the other three groups. Lower proportions of the four groups favoured active euthanasia or PAS. Multiple logistic regression showed that education (adjusted OR (aOR) 1.77, 95% CI 1.33 to 2.36), caregiver role (aOR 1.67, 95% CI 1.34 to 2.08) and considering death as the ending of life (aOR 1.66, 95% CI 1.05 to 1.61) were associated with preference for active pain control. Attitudes towards death, including belief in being remembered (aOR 2.03, 95% CI 1.48 to 2.79) and feeling 'life was meaningful' (aOR 2.56, 95% CI 1.58 to 4.15) were both strong correlates of withdrawal of LST with the level of monthly income (aOR 2.56, 95% CI 1.58 to 4.15). Believing 'freedom from pain' negatively predicted preference for passive euthanasia (aOR 0.69, 95% CI 0.55 to 0.85). In addition, 'not being a burden to the family' was positively related to preferences for active euthanasia (aOR 1.62, 95% CI 1.39 to 1.90) and PAS (aOR 1.61, 95% CI 1.37 to 1.89). CONCLUSION: Groups differed in their attitudes towards the five EoL interventions, and those attitudes were significantly associated with various attitudes towards death.


Assuntos
Atitude , Cuidadores/psicologia , Neoplasias/psicologia , Médicos/psicologia , Assistência Terminal/métodos , Atitude Frente a Morte , Estudos Transversais , Escolaridade , Eutanásia Ativa , Eutanásia Passiva , Feminino , Humanos , Masculino , Futilidade Médica , Pessoa de Meia-Idade , Neoplasias/terapia , Manejo da Dor , Preferência do Paciente , República da Coreia , Suicídio Assistido , Suspensão de Tratamento
18.
Camb Q Healthc Ethics ; 27(3): 376-384, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29845907

RESUMO

In 2002, The Netherlands continued its leadership in developing rules and jurisdiction regarding euthanasia and end-of-life decisions by implementing the Euthanasia Act, which allows euthanasia for patients 12 years of age and older. Subsequently, in 2005, the regulation on active ending of life for newborns was issued. However, more and more physicians and parents have stated that the age gap between these two regulations-children between 1 and 12 years old-is undesirable. These children should have the same right to end their suffering as adults and newborn infants. An extended debate on pediatric euthanasia ensued, and currently the debate is ongoing as to whether legislation should be altered in order to allow pediatric euthanasia. An emerging major question regards the active ending of life in the context of palliative care: How does a request for active ending of life relate to the care that is given to children in the palliative phase? Until now, the distinction between palliative care and end-of-life decisions continues to remain unclear, making any discussion about their mutual in- and exclusiveness hazardous at best. In this report, therefore, we aim to provide insight into the relationship between pediatric palliative care and end-of-life decisions, as understood in the Netherlands. We do so by first providing an overview of the (legal) rules and regulations regarding euthanasia and active ending of life, followed by an analysis of the relationship between these two, using the Dutch National Guidelines for Palliative Care for Children. The results of this analysis revealed two major and related features of palliative care and end-of-life decisions for children: (1) palliative care and end-of-life decisions are part of the same process, one that focuses both on quality of living and quality of dying, and (2) although physicians are seen as ultimately responsible for making end-of-life decisions, the involvement of parents and children in this decision is of the utmost importance and should be regarded as such.


Assuntos
Eutanásia Ativa/legislação & jurisprudência , Cuidados Paliativos , Enfermagem Pediátrica , Qualidade de Vida , Tomada de Decisões , Eutanásia Ativa/ética , Humanos , Recém-Nascido , Países Baixos , Doente Terminal
19.
Kennedy Inst Ethics J ; 28(1): 23-48, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29628450

RESUMO

This paper demonstrates that acceptance of voluntary euthanasia does not generate commitment to either non-voluntary euthanasia or euthanasia on request. This is accomplished through analysis of John Keown's and David Jones's slippery slope arguments, and rejection of their view that voluntary euthanasia requires physicians to judge patients as better off dead. Instead, voluntary euthanasia merely requires physicians to judge patients as within boundaries of appropriate deference. This paper develops two ways of understanding and defending voluntary euthanasia on this model, one focused on the independent value of patients' autonomy and the other on the evidence of well-being provided by patients' requests. Both avoid the purported slippery slopes and both are independently supported by an analogy to uncontroversial elements of medical practice. Moreover, the proposed analyses of voluntary euthanasia suggest parameters for the design of euthanasia legislation, both supporting and challenging elements of existing laws in Oregon and the Netherlands.


Assuntos
Eutanásia Ativa Voluntária/ética , Argumento Refutável , Atitude do Pessoal de Saúde , Viés , Eutanásia Ativa , Humanos , Autonomia Pessoal , Relações Médico-Paciente
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