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.

First Do No Harm: Euthanasia of Patients with Dementia in Belgium.

In Memory of Ed Pellegrino. Euthanasia in Belgium is not limited to terminally ill patients. It may be applied to patients with chronic degenerative diseases. Currently, people in Belgium wish to make it possible to euthanize incompetent patients who suffer from dementia. This article explains the Belgian law and then explores arguments for and against euthanasia of patients with dementia. It probes the dementia paradox by elucidating Dworkin's distinction between critical and experiential interests, arguing that at the end-of-life this distinction is not clearcut. It argues against euthanasia for patients with dementia, for respecting patients' humanity and for providing them with more care, compassion, and good doctoring.

First do no harm: intentionally shortening lives of patients without their explicit request in Belgium.

The aim of this article is to provide a critical review of one of the most worrying aspects of the euthanasia policy and practice in Belgium--the deliberate shortening of lives of some patients without their explicit voluntary request. Some suggestions designed to improve the situation and prevent abuse are offered.

Press self-regulation in Britain: a critique.

This article reviews the history of press self-regulation in Britain, from the 1947 Ross Commission to the 2012 Leveson Inquiry Commission. It considers the history of the Press Council and the Press Complaints Commission, analysing the ways they developed, their work, and how they have reached their current non-status. It is argued that the existing situation in Britain is far from satisfactory, and that the press should advance more elaborate mechanisms of self-control, establishing a new regulatory body called the Public and Press Council that will be anchored in law, empowering the new regulator with greater and unprecedented authority, and equipping it with substantive sanctioning abilities. The Public and Press Council should be independent and effective, with transparent policies, processes and responsibilities. Its adjudication should be made in accordance with a written, detailed Code of Practice.

Expert Views on Medical Involvement in the Swiss Assisted Dying Practice: "We Want to Have Our Cake and Eat It Too"?

BACKGROUND: Most jurisdictions that allow euthanasia and assisted suicide (AS) regulate it through the medical profession. However, the extent and nature of how medicine should be involved are debated. Swiss AS practice is unusual in that it is managed by lay AS organizations that rely on a law that permits AS when done for nonselfish reasons. Physicians are not mentioned in the law but are usually called upon to prescribe the lethal medications and perform capacity evaluations. METHODS: We analyzed in-depth interviews of 23 Swiss AS experts including ethicists, lawyers, medical practitioners, and senior officials of AS organizations for their views on AS. RESULTS: Although there was agreement on some issues (e.g., need for better end-of-life care), the interviewees' preferred model for AS, and the nature of preferred medical involvement, varied, which we categorized into five types: preference for AS practice as it occurred prior to lay AS organizations; preference for the current lay model; preference for a modified lay model to increase autonomy protections while limiting medical AS normalization; preference for various types of more medicalized models of AS; and, ambivalence about any specific model of medical involvement. The rationales given for each type of model reflected varying opinions on how medicine's role would likely impact AS practice and demonstrated the experts' attitudes toward those impacts. CONCLUSION: The dynamics within the Swiss AS regime, as reflected in the varying views of Swiss AS experts, shed light on the dilemmas inherent to medical scope and involvement in AS, which may have implications for debates in other jurisdictions.

Fatal choices and flawed decisions at the end of life: lessons from Israel.

This article presents a recent disconcerting event that took place at a rehabilitative nursing home in Tel Aviv in light of Israel's Dying Patient Law, which came into effect in 2005. It probes the double effect doctrine as it is relevant to the case at hand and the role of the medical profession and of the family in making decisions at the end of life, and it argues that patients who express a wish to die should receive a comprehensive care assessment that addresses their physical and mental condition before rushing to provide lethal medication. The article concludes by offering some guidelines to help practitioners address the intricate questions they face when patients ask to die.

Euthanasia policy and practice in Belgium: critical observations and suggestions for improvement.

The essay opens with some background information about the context of euthanasia in Belgium. It proceeds by discussing the Belgian law on euthanasia and concerns about the law, its interpretations and implementation. Finally, the major developments and controversies since the law came into effect are discussed. Suggestions as to how to improve the Belgian law and circumscribe the practice of euthanasia are made, urging Belgian legislators and the medical establishment to reflect and study so as to prevent potential abuse of vulnerable patients.

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.

Balancing Freedom of Expression and Social Responsibility on the Internet.

This paper reflects on the articles submitted for the Symposium Confronting the Internet's Dark Side. I discuss some of the criticisms of the book's theory and my treatment of hate speech. The responsibilities of Internet Service Providers (ISPs) and Web-Hosting Services (WHSs) are in the fore, arguing that as they are the gatekeepers, they need to be proactive far more than they are now. This paper, like my book, strives to suggest an approach that harnesses the strengths and capabilities of the public and the private sectors in offering practical solutions to pressing problems.

The Chabot case: analysis and account of Dutch perspectives.

The aims of this essay are twofold: to point out the main problems of the Chabot precedent and to report the findings of a fieldwork in the Netherlands during which some experts were asked to voice an opinion regarding the psychiatrist's conduct and the legal precedent. During the summer of 1999, twenty-eight interviews with some of the leading authorities on the euthanasia policy were conducted in the Netherlands. Multiple reasons were mentioned to either condone or condemn Chabot's practice.

Non-voluntary and involuntary euthanasia in The Netherlands: Dutch perspectives.

During the summer of 1999, twenty-eight interviews with some of the leading authorities on euthanasia policy were conducted in the Netherlands. They were asked about cases of non-voluntary (when patients are incompetent) and involuntary euthanasia (when patients are competent and made no request to die). This study reports the main findings, showing that most respondents are quite complacent with regard to breaches of the guideline that require the patient's consent as a prerequisite to performance of euthanasia.

Dutch perspectives on palliative care in the Netherlands.

This study reports data gathered via extensive interviews with some of the leading authorities on the euthanasia policy that were conducted in the Netherlands. They were asked: It has been argued that the policy and practice of euthanasia in the Netherlands is the result of undeveloped palliative care. What do you think? I also mentioned the fact that there are only a few hospices in the Netherlands. The responses were different and contradictory. Many interviewees agreed with the statement. Almost all of those agreeing with it said that only during the late 1990s were people beginning to admit that there was a need to improve palliative care. Some interviewees insisted that doctors first need to explore other options for helping the patient prior to choosing the course of euthanasia. Other interviewees thought that palliative care is well developed in the Netherlands and that euthanasia has actually paved the way for calling more attention to palliative care.

A critique of Callahan's utilitarian approach to resource allocation in health care.

The rationale of this article is grounded in the liberal tradition. It places the individual at the center of concern, and attempts to fortify the individual's basic right to health care. Attention is focused on the writings of Daniel Callahan, arguing that his approach is too cold and detached, and that age should not serve as the decisive criterion. The criticism of his views on older patients and on patients in post-coma unawareness (PCU) stems from two different lines of reasoning: the medical and the moral-contractual. From the medical perspective, while age is an important variable in determining a patient's medical condition, there are other--no less important--factors that influence one's health. From the moral-contractual line of reasoning, liberal society should not desert its citizens at the time they need its help most. The age criterion is too simple, too general, too sweeping. It provides too convenient an answer to a tough and troubling question. Similarly, the argument with regard to PCU patients should be qualified, taking into account the age of the patient, the cause of the condition, and the length of time in state of unawareness.

First do no harm: pressing concerns regarding euthanasia in Belgium.

This article is concerned with the practice of euthanasia in Belgium. Background information is provided; then major developments that have taken place since the enactment of the Belgian Act on Euthanasia are analysed. Concerns are raised about (1) the changing role of physicians and imposition on nurses to perform euthanasia; (2) the physicians' confusion and lack of understanding of the Act on Euthanasia; (3) inadequate consultation with an independent expert; (4) lack of notification of euthanasia cases, and (5) organ transplantations of euthanized patients. Some suggestions designed to improve the situation and prevent abuse are offered.

Euthanasia and law in the Netherlands: reflections on Dutch perspectives.

During the summer of 1999, twenty-eight interviews with some of the leading authorities on the euthanasia policy were conducted in the Netherlands. The discussion begins with providing some background information on the guidelines for conducting euthanasia. Next, I explain the research methodology and move on to discuss the interviewees' responses to the question whether it is preferable to legislate euthanasia. The interviewees exhibited split views on the issue. Some were in favor of legislation for instrumental and symbolic reasons. Others utilized different instrumental and symbolic reasons to argue against legislation. Three interviewees preferred to wait for some years before changing the law.

Should doctors suggest euthanasia to their patients? Reflections on Dutch perspectives.

During the summer of 1999 and in April 2002 I went to The Netherlands in order to meet some of the leading authorities on the euthanasia policy. They were asked multiple questions. This study reports the main findings to the question: should doctors suggest euthanasia to their patients? Some interviewees did not observe any significant ethical concerns involved in suggesting euthanasia. For various reasons they thought physicians should offer euthanasia as an option. Two interviewees asserted that doctors don't propose euthanasia to their patients. Five interviewees objected to physician's initiative.