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Rev. bioét. derecho ; 54: 233-250, Mar. 2022.
Artigo em Espanhol | IBECS | ID: ibc-210224


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)

Humanos , Direito a Morrer , Eutanásia Passiva , Eutanásia , Direitos do Paciente , Cuidados Paliativos , Cuidados Paliativos na Terminalidade da Vida , Lei Orgânica , Direitos Humanos , Bioética , Princípios Morais , Ética
Dev World Bioeth ; 22(2): 105-111, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-33599371


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.

Eutanásia , Direito a Morrer , Chile , Eutanásia Passiva , Liberdade , Humanos , Autonomia Pessoal
Enferm Clin (Engl Ed) ; 31(5): 263-265, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34565499
Indian J Med Ethics ; VI(1): 1-11, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34081007


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.

Eutanásia , Suicídio Assistido , Assistência Terminal , Eutanásia Ativa , Eutanásia Passiva , Humanos , Índia , Estado Vegetativo Persistente , Suspensão de Tratamento
Aten. prim. (Barc., Ed. impr.) ; 53(5): 102058, Mayo, 2021.
Artigo em Espanhol | IBECS | ID: ibc-208119


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)

Humanos , Eutanásia , Jurisprudência , Medicina de Família e Comunidade , Direito a Morrer , Eutanásia Passiva , Determinantes Sociais da Saúde , Engajamento no Trabalho , Responsabilidade Legal , Atenção Primária à Saúde
Bioethics ; 35(2): 214-220, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-32949014


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.

Eutanásia Passiva , Eutanásia , Ética , Eutanásia Ativa , Homicídio , Humanos , Próteses e Implantes
Rev Prat ; 70(5): 485-491, 2020 May.
Artigo em Francês | MEDLINE | ID: mdl-33058632


Does the written press give a fair account of a complex medical question: "The Vincent Lambert Case"? We have studid press articles referring to Mr. Vincent Lambert's situation from 2013 to 2017. Analysis using a reading grid (including 7 questions) of press articles from four French daily newspapers (Libération, Le Monde, Le Figaro and La Croix) and a specialized medical news site (Agence de presse médicale) so that they can build their own opinion. 341 articles were analyzed (61 articles from Libération, 65 articles from Le Monde, 86 articles from Le Figaro, 82 articles from La Croix, 47 articles from the APM), writing a chronology of the main facts of the patient's history from 2013 to 2017 in order to have benchmarks to estimate the accuracy of the information reported in the various articles. Articles are rarely fully explicit. Inadequate expressions ("passive euthanasia", "end-of-life procedure") are used in the majority of newspapers. Some articles present the facts in a partisan way and contribute to mask the complexity of the patient's situation. Court decisions are often shortened and therefore simplified, which does not help the reader to understand the situation in an informed way. Reflective benchmarks are sometimes found in the various newspapers from 2013 to 2016. From 2016 onwards, we notice that the articles are shorter and that they no longer give any reference points for reflection. The daily written press in its current format does not seem to be able to help the general public to obtain accurate information on complex issues involving broad areas of reflection. The difficulty of the journalist's work in addressing this type of questioning comes partly from the constraints of brevity that are often imposed on them on the one hand and from the constant evolution of the information itself on the other.

La presse écrite rend-elle compte d'une façon juste d'une question médicale complexe : « Le Cas Vincent Lambert ¼ ? Nous avons analysé des articles de presse faisant référence à « l'affaire Vincent Lambert ¼ parus de 2013 à 2017 pour comprendre la façon dont la presse quotidienne française grand public relate les questions médicales complexes à forte tonalité éthique et interroger sa capacité à informer avec justesse ses lecteurs pour qu'ils puissent se construire leur propre opinion. À l'aide d'une grille de lecture (comportant 7 questions), 341 articles de presse de 4 quotidiens français (Libération, Le Monde, Le Figaro et La Croix) et d'un site de dépêches médicales spécialisées (Agence de presse médicale) ont été analysés. Les articles apparaissent rarement entièrement explicites. Des expressions inadaptées (« euthanasie passive ¼, « procédure de fin de vie ¼) sont utilisées dans la majorité des journaux. Certains articles exposent les faits de manière partisane et participent à maquiller la complexité de la situation du patient. Les décisions de justice sont souvent raccourcies et donc simplifiées, ce qui n'aide pas le lecteur à saisir la situation de manière éclairée. Des repères réflexifs sont parfois retrouvés dans les différents journaux de 2013 à 2016. À partir de 2016, on remarque que les articles sont plus courts et ne donnent plus aucun repère de réflexion. De nos jours, la presse écrite n'est probablement plus le premier vecteur d'information choisi par le citoyen. Les articles des titres de presse étudiés dans leur format actuel ne sont peut-être pas le meilleur moyen d'aider le grand public à s'informer de manière juste sur des questions complexes englobant de vastes champs de réflexion. La difficulté du travail du journaliste pour aborder ce type de questionnement vient en partie des contraintes de brièveté qui leur sont souvent imposées d'une part, et de l'évolution constante de l'information elle-même d'autre part.

Eutanásia Passiva , Jornalismo Médico , Eutanásia Passiva/legislação & jurisprudência , Humanos
Pediatrics ; 146(2)2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32732263


With increasing focus in the last decade on post-cardiac arrest care in pediatrics, return of spontaneous circulation, survival rates, and neurologic outcome have improved. As part of this postarrest care, both the American Heart Association and the American Academy of Neurology state it is reasonable to consider targeted temperature management in pediatric comatose patients, although this care is challenging and time sensitive, with many gaps in knowledge remaining. Many pediatric patients will still not survive or will suffer severe neurocognitive impairment despite the therapeutic arsenal provided. Adult guidelines suggest providing postarrest supportive care and limiting prognosis discussions with families until after 72 hours of therapy, but pediatric clinicians are advised to consider a multitude of factors given the lack of data. What, then, should clinicians do if family members of a patient who has been resuscitated request the withdrawal of all life support in the 24 hours immediately postarrest? In this Ethics Rounds, we present such a case and the responses of different clinicians and bioethicists.

Eutanásia Passiva/ética , Parada Cardíaca/terapia , Ressuscitação , Suspensão de Tratamento/ética , Tomada de Decisão Clínica/ética , Eletroencefalografia , Humanos , Hipotermia Induzida , Lactente , Prognóstico
Brain Nerve ; 72(7): 737-745, 2020 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-32641570


Although there are many ethical issues related to amyotrophic lateral sclerosis, one of the most controversial issue is the withdrawal of ventilator support. This problem has a significant impact not only on the decision to "remove", but also on the decision to "wear" it. In particular, if the withdrawal of ventilator support was to be legalized, there is a concern that its legislation may exert a 'silent pressure.' Therefore, rather than explicitly defining the withdrawal of ventilator support, as a "legal right," we prefer the installation of a policy in which the details of individual cases are carefully scrutinized, allowing for justifiable non-compliance with the law in special cases.

Esclerose Amiotrófica Lateral , Ética Clínica , Eutanásia Passiva , Esclerose Amiotrófica Lateral/terapia , Eutanásia Passiva/ética , Humanos , Respiração Artificial
New Bioeth ; 26(3): 238-252, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32449486


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.

Diretivas Antecipadas/ética , Eutanásia Passiva/ética , Legislação Médica/ética , Cuidados para Prolongar a Vida/ética , Competência Mental , Estado Vegetativo Persistente , Suspensão de Tratamento/ética , Diretivas Antecipadas/legislação & jurisprudência , Estado de Consciência/ética , Tomada de Decisões/ética , Ingestão de Líquidos , Ingestão de Alimentos , Inglaterra , Ética Médica , Eutanásia Passiva/legislação & jurisprudência , Humanos , Julgamento , Cuidados para Prolongar a Vida/legislação & jurisprudência , Princípios Morais , Ética Baseada em Princípios
BMC Med Ethics ; 21(1): 41, 2020 05 14.
Artigo em Inglês | MEDLINE | ID: mdl-32410605


BACKGROUND: Euthanasia can be thought of as being either active or passive; but the precise definition of "passive euthanasia" is not always clear. Though all passive euthanasia involves the withholding of life-sustaining treatment, there would appear to be some disagreement about whether all such withholding should be seen as passive euthanasia. MAIN TEXT: At the core of the disagreement is the question of the importance of an intention to bring about death: must one intend to bring about the death of the patient in order for withholding treatment to count as passive euthanasia, as some sources would indicate, or does withholding in which death is merely foreseen belong to that category? We may expect that this unclarity would be important in medical practice, in law, and in policy. The idea that withholding life-sustaining treatment is passive euthanasia is traced to James Rachels's arguments, which lend themselves to the claim that passive euthanasia does not require intention to end life. Yet the argument here is that Rachels's arguments are flawed, and we have good reasons to think that intention is important in understanding the moral nature of actions. As such, we should reject any understanding of passive euthanasia that does not pay attention to intent. SHORT CONCLUSION: James Rachels's work on active and passive euthanasia has been immensely influential; but this is an influence that we ought to resist.

Eutanásia Passiva , Eutanásia , Eutanásia Ativa , Eutanásia Ativa Voluntária , Humanos , Intenção , Suspensão de Tratamento
Riv Psichiatr ; 55(2): 119-128, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32202550


Euthanasia and medical assistance in dying entail daunting ethical and moral challenges, in addition to a host of medical and clinical issues, which are further complicated in cases of patients whose decision-making skills have been negatively affected or even impaired by psychiatric disorders. The authors closely focus on clinical depression and relevant European laws that have over the years set firm standards in such a complex field. Pertaining to the mental health realm specifically, patients are required to undergo a mental competence assessment in order to request aid in dying. The way psychiatrists deal and interact with decisionally capable patients who have decided to end their own lives, on account of sufferings which they find to be unbearable, may be influenced by subjective elements such as ethical and cultural biases on the part of the doctors involved. Moreover, critics of medical aid in dying claim that acceptance of such practices might gradually lead to the acceptance or practice of involuntary euthanasia for those deemed to be nothing more than a burden to society, a concept currently unacceptable to the vast majority of observers. Ultimately, the authors conclude, the key role of clinicians should be to provide alternatives to those who feel so hopeless as to request assistance in dying, through palliative care and effective social and health care policies for the weakest among patients: lonely, depressed or ill-advised people.

Depressão/psicologia , Eutanásia/ética , Suicídio Assistido/ética , Cultura , Tomada de Decisões , Ética Médica , Europa (Continente) , Eutanásia/legislação & jurisprudência , Eutanásia Ativa Voluntária/ética , Eutanásia Ativa Voluntária/legislação & jurisprudência , Eutanásia Ativa Voluntária/estatística & dados numéricos , Eutanásia Passiva/ética , Humanos , Itália , Competência Mental , Psiquiatria/ética , Suicídio Assistido/legislação & jurisprudência
Rev. bioét. derecho ; (48): 177-191, mar. 2020.
Artigo em Português | IBECS | ID: ibc-192086


Os recentes casos envolvendo a morte de crianças em razão da suspensão do suporte vital, mesmo com a oposição dos pais, demonstram a necessidade de um debate transdisciplinar sobre o conteúdo do princípio do melhor interesse da criança e a extensão dos poderes-deveres decorrentes da autoridade parental. Poderia a morte, em determinadas situações, representar o melhor interesse da criança? Partindo dos casos de Charlie Gard e Alfie Evans, este artigo tem por objetivo a busca de parâmetros para a tomada de decisões voltadas à terminalidade da vida infantil. Por meio de uma revisão bibliográfica interdisciplinar, buscam-se fundamentos para confirmar ou refutar a hipótese de que a morte pode ser configurada como o melhor interesse da criança em contextos específicos

Los recientes casos que involucran la muerte de niños en razón de la suspensión del soporte vital, incluso con la incisiva oposición de los padres, demuestran la necesidad de un debate transdisciplinario sobre el contenido del principio del mejor interés del niño y la extensión de los poderes-deberes derivados de la autoridad parental. ¿Podría la muerte, en determinadas situaciones, representar el mejor interés del niño? A partir de los casos Charlie Gard y Alfie Evans, este artículo objetiva la búsqueda de parámetros para la toma de decisiones dirigidas a la terminalidad de la vida infantil. Por medio de una revisión bibliográfica interdisciplinaria, se buscan fundamentos para confirmar o refutar la hipótesis de que la muerte puede ser configurada como el mejor interés del niño en contextos específicos

The recent cases involving the death of children due to the suspension of life support, even with the strong opposition of their parents, demonstrate the need for a transdisciplinary debate on the content of the principle of the best interests of the child and the extension of the powers-duties arising from the parental authority. Could death, in certain situations, represent the best interest of the child? Based on the cases of Charlie Gard and Alfie Evans, this article aims to search for parameters for the decision-making in situations of terminally ill infants. Through an interdisciplinary bibliographical review, it is sought the confirmation or refutation of the hypothesis that death can be configured as the best interest of the child in specific contexts

Els recents casos que involucren la mort de nens a causa de la suspensió del suport vital, fins i tot amb l'enèrgica oposició dels pares, demostren la necessitat d'un debat transdisciplinar sobre el contingut del principi del millor interès del nen i l'extensió dels poders-deures derivats de l'autoritat parental. Podria la mort, en determinades situacions, suposar el millor interès del nen? A partir dels casos Charlie Gard i Alfie Evans, aquest article objectiva la recerca de paràmetres per a la presa de decisions dirigides al final de vida infantil. Per mitjà d'una revisió bibliogràfica interdisciplinària, es pretèn confirmar o refutar la hipòtesi que la mort pot ser configurada com el millor interès del nen en contextos específics

Humanos , Masculino , Lactente , Direito a Morrer/ética , Suspensão de Tratamento/ética , Futilidade Médica/ética , Assistência Terminal/ética , Cuidados Paliativos na Terminalidade da Vida/ética , Tomada de Decisão Clínica/ética , Direito a Morrer/legislação & jurisprudência , Eutanásia Passiva/legislação & jurisprudência , Doente Terminal , Morte , Direitos do Paciente/ética , Suspensão de Tratamento/legislação & jurisprudência , Assistência Terminal/legislação & jurisprudência , Poder Familiar , Direitos Humanos/legislação & jurisprudência , Cuidados Paliativos na Terminalidade da Vida/legislação & jurisprudência