Rogelberg, Steven G; Reeve, Charlie L; Spitzmüller, Christiane; DiGiacomo, Natalie; Clark, Olga L; Teeter, Lisa; Walker, Alan G; Starling, Paula G; Carter, Nathan T
To examine the effects of euthanasia rates, euthanasia practices, and human resource practices on the turnover rate among employees with euthanasia responsibilities at animal shelters. Cross-sectional original study. 36 shelters across the United States that employed at least 5 full-time employees and performed euthanasia on site. By mail, 1 survey was sent to each shelter. Surveys were completed by a senior member of management and were returned by mail. Questions assessed characteristics (eg, euthanasia rates) and practices of the animal shelter, along with employee turnover rates. By use of correlation coefficients and stepwise regression analyses, key predictors of turnover rates among employees with euthanasia responsibilities were investigated. Employee turnover rates were positively related to euthanasia rate. Practices that were associated with decreased turnover rates included provision of a designated euthanasia room, exclusion of other live animals from vicinity during euthanasia, and removal of euthanized animals from a room prior to entry of another animal to be euthanized. Making decisions regarding euthanasia of animals on the basis of factors other than behavior and health reasons was related to increased personnel turnover. With regard to human resources practices, shelters that used a systematic personnel selection procedure (eg, standardized testing) had comparatively lower employee turnover. Data obtained may suggest several specific avenues that can be pursued to mitigate turnover among employees with euthanasia responsibilities at animal shelters and animal control or veterinary medical organizations.
Ogden, U; Kinnison, T; May, S A
Several reasons have been suggested for the elevated risk of suicide experienced by those in the veterinary profession. The current study aimed to investigate possible links between veterinarians' attitudes to 'convenience' or non-justified animal euthanasia and attitudes towards human euthanasia and suicide. Veterinary students and graduates had a negative attitude towards convenience animal euthanasia, but their attitudes changed over time (pre-clinical studies, clinical studies and recently graduated). A greater tolerance to euthanasia was displayed in the later years of study and post qualification - primarily by males. Attitudes towards both human euthanasia and suicide, however, remained stable over time and indicated on average a neutral stance. No correlations were found between attitudes to convenience euthanasia and either human euthanasia or suicide, suggesting a tolerance to convenience euthanasia of animals does not lead to desensitisation in valuing human life and a changed attitude to human euthanasia or suicide, or vice versa. Attitudes to human euthanasia and suicide were predictably correlated, perhaps suggesting an overarching attitude towards control over human death. The results of the current study throw into question the argument that it is the changes in attitudes to animal life that affect veterinarian's attitudes to human life and contribute to the high suicide rate.
Caffrey, Niamh; Mounchili, Aboubakar; McConkey, Sandra; Cockram, Michael S
Questionnaires on methods of euthanasia used in Canadian animal shelters were sent to 196 Canadian animal shelters yielding 67 responses. Sodium pentobarbital injection was the only method of euthanasia used by 61% of establishments that euthanized dogs and 53% of the establishments that euthanized cats. Many of these establishments used pre-medication. Sodium pentobarbital was mostly administered intravenously but some establishments also used intracardiac and intraperitoneal routes, and some only used intracardiac administration for cats. T-61 injection was the only method of euthanasia used by 23% of the establishments that euthanized dogs and 35% of the establishments that euthanized cats. All of these establishments used pre-medication, but the percentages of establishments that only used the intravenous route for administration of T-61 in dogs and cats were 45% and 7%, respectively. Further studies on the use of T-61, and the training and provision of counselling services for staff are recommended.
Caffrey, Niamh; Mounchili, Aboubakar; McConkey, Sandra; Cockram, Michael S.
Questionnaires on methods of euthanasia used in Canadian animal shelters were sent to 196 Canadian animal shelters yielding 67 responses. Sodium pentobarbital injection was the only method of euthanasia used by 61% of establishments that euthanized dogs and 53% of the establishments that euthanized cats. Many of these establishments used pre-medication. Sodium pentobarbital was mostly administered intravenously but some establishments also used intracardiac and intraperitoneal routes, and some only used intracardiac administration for cats. T-61 injection was the only method of euthanasia used by 23% of the establishments that euthanized dogs and 35% of the establishments that euthanized cats. All of these establishments used pre-medication, but the percentages of establishments that only used the intravenous route for administration of T-61 in dogs and cats were 45% and 7%, respectively. Further studies on the use of T-61, and the training and provision of counselling services for staff are recommended. PMID:21461208
Background and Objective: Globally, millions of rodents are used for various researches annually. These animals must be euthanised with a minimum of physical and mental suffering. We describe intramedully injection of air as safe, reliable and humane method of euthanasia for rodents. Design: A prospective study of the ...
Mozes, Rachael; Pearl, David L; Niel, Lee; Weese, J Scott
Objectives The objective was to evaluate factors associated with euthanasia in an animal shelter in Kitchener-Waterloo, Ontario, Canada. Methods Shelter data from 3737 cats admitted to the shelter between January and December 2011 were evaluated. Results Overall, 1989/3737 (53%) of admitted cats were euthanized. Male cats had greater odds of being euthanized than females (odds ratio [OR] 1.63, 95% confidence interval [CI] 1.29-2.05; P 5 days in the shelter were more likely to be euthanized than those that spent 20 days in the shelter were less likely to be euthanized than those that spent 50% of the cats admitted to the shelter in 2011 euthanized, it is important to understand the contributing risk factors that predispose shelter cats to euthanasia and what changes can be made to the shelter system and in owner education to lower the incidence of euthanasia.
Full Text Available Laboratory animals are used in several fields of science research, especially in biology, medicine and veterinary medicine. The majority of laboratory animals used in research are experimental models that replace the human body in study regarding pharmacological or biological safety products, studies conducted for a betterunderstanding of oncologic processes, toxicology, genetic studies or even new surgical techniques. Experimental protocols include a stage in which animals are euthanized in order to remove organs and tissues,or for no unnecessary pain and suffering of animals (humane endpoints or to mark the end of research. The result of euthanasia techniques is a rapid loss of consciousness followed by cardiac arrest, respiratory arrest and disruption of brain activity. Nowadays, the accepted euthanasia techniques can use chemicals (inhalant agents like: carbon dioxide, nitrogen or argon, overdoses of injectable anesthetics or physical methods (decapitation, cervical spine dislocation, stunning, gunshot, pitching.
The problem of euthanasia emerges again and again in today's Europe. The Dutch type of regulation of euthanasia could be introduced into the Hungarian legal system. Today, in Hungary, the ethical guidelines of the chamber of medicine, the criminal law and the administrative health law also forbid active euthanasia. In Hungary, the criminal code reform of 2012 missed to liberalise the regulation of euthanasia. Such liberalisation awaits bottom-up support from the part of the society. In Europe, active euthanasia is legal only in the Netherlands, Belgium, Luxemburg and Switzerland. In Hungary, a passive form of euthanasia is legal, i.e. a dying patient may, under strict procedural circumstances, refuse medical treatment. The patient is not allowed to refuse medical treatment, if she is pregnant and foreseeably capable to give birth to her child.
Brock, D W
The principles of self-determination and individual well-being support the use of voluntary euthanasia by those who do not have moral or professional objections to it. Opponents of this posture cite the ethical wrongness of the act itself and the folly of any public or legal policy permitting euthanasia. Positive consequences of making euthanasia legally permissible respect the autonomy of competent patients desiring it, expand the population of patients who can choose the option, and release...
Brock, D W
The principles of self-determination and individual well-being support the use of voluntary euthanasia by those who do not have moral or professional objections to it. Opponents of this posture cite the ethical wrongness of the act itself and the folly of any public or legal policy permitting euthanasia. Positive consequences of making euthanasia legally permissible respect the autonomy of competent patients desiring it, expand the population of patients who can choose the option, and release the dying patient from otherwise prolonged suffering and agony. Potentially bad consequences of permitting euthanasia include the undermining of the "moral center" of medicine by allowing physicians to kill, the weakening of society's commitment to provide optimal care for dying patients, and, of greatest concern, the "slippery slope" argument. The evaluation of the arguments leads to support for euthanasia, with its performance not incompatible with a physician's professional commitment.
Hartnack, Sonja; Springer, Svenja; Pittavino, Marta; Grimm, Herwig
Euthanasia of pets has been described by veterinarians as "the best and the worst" of the profession. The most commonly mentioned ethical dilemmas veterinarians face in small animal practice are: limited treatment options due to financial constraints, euthanizing of healthy animals and owners wishing to continue treatment of terminally ill animals. The aim of the study was to gain insight into the attitudes of Austrian veterinarians towards euthanasia of small animals. This included assessing their agreement with euthanasia in exemplified case scenarios, potentially predicted by demographic variables (e.g. gender, age, working in small animal practice, employment, working in a team, numbers of performed euthanasia). Further describing the veterinarians' agreement with a number of different normative and descriptive statements, including coping strategies. A questionnaire with nine euthanasia scenarios, 26 normative and descriptive statements, and demographic data were sent to all members of the Austrian Chamber of Veterinary Surgeons (n = 2478). In total, 486 veterinarians answered sufficiently completely to enable analyses. Responses were first explored descriptively before being formally analysed using linear regression and additive Bayesian networks - a multivariate regression methodology - in order to identify joint relationships between the demographic variables, the statements and each of the nine euthanasia scenarios. Mutual dependencies between the demographic variables were found, i.e. female compared to male veterinarians worked mostly in small animal practice, and working mostly in small animal practice was linked to performing more euthanasia per month. Gender and age were found to be associated with views on euthanasia: female veterinarians and veterinarians having worked for less years were more likely to disagree with euthanasia in at least some of the convenience euthanasia scenarios. The number of veterinarians working together was found to be
In the introduction the author defines different kinds of euthanasia (active, passive, indirect, assisted suicide etc). Some concepts were discussed: value of human life, humanity and the autonomy of a person. In the next chapter the author presents the standpoints on the forced end of life in different societies, from ancient Greece and medieval opinions to recent results of research in the USA, England, Germany, the Netherlands and Australia. In the third chapter – Legislation related to th...
Baran, Benjamin E; Allen, Joseph A; Rogelberg, Steven G; Spitzmüller, Christiane; Digiacomo, Natalie A; Webb, Jennifer B; Carter, Nathan T; Clark, Olga L; Teeter, Lisa A; Walker, Alan G
To identify and evaluate coping strategies advocated by experienced animal shelter workers who directly engaged in euthanizing animals. Cross-sectional study. Animal shelters across the United States in which euthanasia was conducted (5 to 100 employees/shelter). With the assistance of experts associated with the Humane Society of the United States, the authors identified 88 animal shelters throughout the United States in which animal euthanasia was actively conducted and for which contact information regarding the shelter director was available. Staff at 62 animal shelters agreed to participate in the survey. Survey packets were mailed to the 62 shelter directors, who then distributed them to employees. The survey included questions regarding respondent age, level of education, and role and asked those directly involved in the euthanasia of animals to provide advice on strategies for new euthanasia technicians to deal with the related stress. Employees completed the survey and returned it by mail. Content analysis techniques were used to summarize survey responses. Coping strategies suggested by 242 euthanasia technicians were summarized into 26 distinct coping recommendations in 8 categories: competence or skills strategies, euthanasia behavioral strategies, cognitive or self-talk strategies, emotional regulation strategies, separation strategies, get-help strategies, seek long-term solution strategies, and withdrawal strategies. Euthanizing animals is a major stressor for many animal shelter workers. Information regarding the coping strategies identified in this study may be useful for training new euthanasia technicians.
In this practice the portion of euthanasias amounts to 0.5 per cent of all veterinary services of one year. In spite of this apparantly low numerical value the performance of euthanasia is an enourmously demanding job for the veterinarian and his practice team. It is essential to save the animal from a serious deterioration of its general condition with suffering and pain, often occuring with the foreseeable oncoming death. Here the viewpoint of the pet owner and the veterinarian is mostly a ...
Powell, David M; Ardaiolo, Matthew
The humane euthanasia of animals for population management, or culling, has been suggested as one possible tool for managing animal populations for sustainability, and recent, highly publicized euthanasia of zoo animals in Copenhagen has stimulated global conversation about population management in zoos. We conducted a nationwide survey of U.S. zoo and aquarium personnel, including keepers, managers, and leaders of AZA animal programs, to assess their overall attitudes regarding population management euthanasia. The surveyed populations were generally very aware of the concept of population management euthanasia. Managers and animal program leaders were more supportive of euthanasia than keepers. We found that regardless of role, men were more supportive of euthanasia than women. Those personnel who were aware of instances of population management euthanasia at their institutions before were more supportive of it than those who were not. Support for culling varied with the kind of animal being considered for it, with three general taxon acceptability groupings emerging. Education, tenure in the profession, taxonomic expertise, and whether or not the responder took the survey before or after the Copenhagen events were not strong predictors of attitudes. Overall, the surveyed populations were approximately evenly split in terms of being in favor of euthanasia, not supporting euthanasia, or being unsure. Most responders indicated that they would be more likely to accept culling if more information was provided on its rationale. These results will form the basis for further discussions on the role of humane euthanasia for population management. Zoo Biol. 35:187-200, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.
Arbe Montoya, A I; Rand, J S; Greer, R M; Alberthsen, C; Vankan, D
Approximately 140,000 unwanted dogs and cats are culled in Australia annually. There is a paucity of information linking sources of pet acquisition with subsequent euthanasia, which may inform evidence-based strategies to reduce euthanasia rates. This pilot study aimed to determine whether there is a higher risk of euthanasia related to the source of acquisition for pets surrendered to an animal shelter. Data for 5391 dogs and 5581 cats surrendered to one Queensland shelter between January 2006 and December 2009 were analysed. The main sources of acquisition for owner-surrendered dogs were 'shelter' and 'pet shop' and for owner-surrendered cats were 'own litter' and 'shelter'. Euthanasia rates for different sources varied. For adult dogs, acquisition through newspaper advertisements was associated with the highest euthanasia rate. Adult cats obtained as gifts (from friend or family member) had the highest euthanasia rate. For junior cats, the overwhelming source was the owner's own litter (68% of intake) and only kittens acquired as strays were at significantly higher risk of euthanasia. For both dogs and cats, animals acquired from shelters had lower rates of euthanasia than most other sources, which suggests that shelter-sourced animals may be considered a preferred source for pet acquisition to assist in reducing the number of adoptable pets euthanased. There was evidence from the study animal shelter that the risk of euthanasia was related to acquisition source. These findings should be confirmed by prospective studies, which should also investigate the interaction between acquisition source and other factors, using larger data sets from a variety of shelters. © 2017 Australian Veterinary Association.
Weng, Hsin-Yi; Hart, Lynette A
This study investigated how the current economic recession (since December 2007) has affected dog and cat relinquishment, adoption, and euthanasia at the Anti-Cruelty Society animal shelter in Chicago, Illinois. The study compared temporal patterns of the investigated statistics before (2000-2007) the start of the current recession with the patterns after the start of the recession (2008-2010). The results showed that once the guardianship (ownership) of a nonhuman animal had been established, the recession did not greatly affect the owner's decision on relinquishment-except for the relinquishment of senior dogs, which may be associated with increased costs of care. However, an unfavorable economic environment may have reduced adoption of animals. The consequences of a decline in adoptions might be reflected in an increase in the proportion or number of sheltered animals euthanized. This study demonstrated how monitoring changes in temporal patterns in these shelter statistics can help guide animal shelters to better prepare for the current recession.
Nogueira Borden, Leandra J; Adams, Cindy L; Bonnett, Brenda N; Shaw, Jane R; Ribble, Carl S
To characterize veterinarian-client communication with undisclosed standardized clients (USCs) during discussions regarding euthanasia of a pet. Descriptive study. 32 companion animal veterinarians (16 males and 16 females) in southern Ontario. During 2 clinic visits, 2 cases (a geriatric dog with worsening arthritis and a cat with inappropriate urination) designed to stimulate discussion regarding euthanasia of a pet were presented by different USCs (individuals trained to consistently present a particular case to veterinarians without disclosing their identity). Discussions were audio recorded and analyzed by use of the measure of patient-centered communication (MPCC [a tool to assess and score physician communication behaviors]). Veterinarian and client statements were classified by means of 3 patient-centered components: exploring both the disease and the illness experience, understanding the whole person, and finding common ground. 60 usable recorded discussions were obtained (31 veterinarians; 30 discussions/case). Overall, MPCC scores were significantly lower for the geriatric dog case. For both cases, veterinarians scored highest on finding common ground and lowest on exploring both the disease and the illness experience. Lack of exploration of client feelings, ideas, and expectations and the effect of the illness on the animal's function resulted in low scores among veterinarians. Results indicated that the use of USCs and the MPCC are feasible methods for analysis of veterinarian-client communication during companion animal euthanasia discussions. Findings suggested that some veterinarians do not fully explore client concerns or facilitate client involvement in euthanasia decision making.
Hawkins, Penny; Prescott, Mark J.; Carbone, Larry; Dennison, Ngaire; Johnson, Craig; Makowska, I. Joanna; Marquardt, Nicole; Readman, Gareth; Weary, Daniel M.; Golledge, Huw D. R.
Simple Summary Millions of laboratory animals are killed each year worldwide. However, there is a lack of consensus regarding what methods of killing are humane for many species and stages of development. This report summarises research findings and discussions from an international meeting of experts and stakeholders, with recommendations to inform good practice for humane killing of mice, rats and zebrafish. It provides additional guidance and perspectives for researchers designing projects that involve euthanasing animals, researchers studying aspects of humane killing, euthanasia device manufacturers, regulators, and institutional ethics or animal care and use committees that wish to review local practice. Abstract Millions of laboratory animals are killed each year worldwide. There is an ethical, and in many countries also a legal, imperative to ensure those deaths cause minimal suffering. However, there is a lack of consensus regarding what methods of killing are humane for many species and stages of development. In 2013, an international group of researchers and stakeholders met at Newcastle University, United Kingdom to discuss the latest research and which methods could currently be considered most humane for the most commonly used laboratory species (mice, rats and zebrafish). They also discussed factors to consider when making decisions about appropriate techniques for particular species and projects, and priorities for further research. This report summarises the research findings and discussions, with recommendations to help inform good practice for humane killing. PMID:27563926
Scotney, Rebekah L; McLaughlin, Deirdre; Keates, Helen L
The study of occupational stress and compassion fatigue in personnel working in animal-related occupations has gained momentum over the last decade. However, there remains incongruence in understanding what is currently termed compassion fatigue and the associated unique contributory factors. Furthermore, there is minimal established evidence of the likely influence of these conditions on the health and well-being of individuals working in various animal-related occupations. To assess currently available evidence and terminology regarding occupational stress and compassion fatigue in personnel working in animal shelters, veterinary clinics, and biomedical research facilities. Studies were identified by searching the following electronic databases with no publication date restrictions: ProQuest Research Library, ProQuest Social Science Journals, PsycARTICLES, Web of Science, Science Direct, Scopus, PsychINFO databases, and Google Scholar. Search terms included (euthanasia AND animals) OR (compassion fatigue AND animals) OR (occupational stress AND animals). Only articles published in English in peer-reviewed journals that included use of quantitative or qualitative techniques to investigate the incidence of occupational stress or compassion fatigue in the veterinary profession or animal-related occupations were included. On the basis of predefined criteria, 1 author extracted articles, and the data set was then independently reviewed by the other 2 authors. 12 articles met the selection criteria and included a variety of study designs and methods of data analysis. Seven studies evaluated animal shelter personnel, with the remainder evaluating veterinary nurses and technicians (2), biomedical research technicians (1), and personnel in multiple animal-related occupations (2). There was a lack of consistent terminology and agreed definitions for the articles reviewed. Personnel directly engaged in euthanasia reported significantly higher levels of work stress and lower
Ezequiel Cardoso Saraiva de Almeida
Full Text Available Euthanasia is a procedure frequently utilized in small animals with the objective to minimize suffering. In this way, it was realized the survey about reasons that leave the practitioner to realize the procedure and who are these animals. It was analyzed 17406 medical records. It was observed 166 euthanasia corresponding to 0.95%. The percentage of the euthanazied dogs were 97.59% and 2.41% felines. In relation to breed 26.10% were mongrel dogs, 20.48% German sheepherd, 9.04% Brazilian fila, 7.23% Pekinese and 36.75% other breeds. In relation to age, it was observed that 60.84% have 0 – 3 year, 15.06% 3 – 6 year, 4.82% 6 – 9 year, 4.22% 9 – 12 year, 1.2% above 12 year and 13.86% unknown age. About the reason of the euthanasia, 64.60% was sacrificed due to visceral leishmaniosis (calazar, 12.65% due to distemper and 22.89% due to other diseases. It was concluded that the most animals submitted to euthanasia were young, differently of the other countries. Among principal death reasons, it was included also infectious diseases that can be prevented by adequate vaccination.A eutanásia é um procedimento utilizado com freqüência em pequenos animais, com o objetivo principal de aliviar o sofrimento. Desta forma, realizou-se um levantamento sobre os motivos que levam um veterinário a indicá-la e quais são estes animais. Foram analisadas 17406 fichas, onde se observaram 166 eutanásias o que corresponde a 0,95%. A percentagem de cães eutanasiados foi de 97,59% e a de felinos 2,41%. Em relação à raça, 26,10% dos animais era sem raça definida, 20,48% pastor alemão, 9,04% fila brasileiro, 7,23% pequinês e 36, 75% outras raças. Com respeito à idade, registrou-se que 60,84% tinham entre 0 e 3 anos, 15,06% 3 e 6 anos, 4,82% 6 e 9 anos, 4,22% 9 e 12 anos, 1,20% acima de 12 anos e 13,86% idade desconhecida. Sobre o motivo da eutanásia, 64,60% dos animais foram eutanasiados devido à Leishmaniose Visceral Canina (calazar, 12,65% devido a
Garrard, E; Wilkinson, S
The idea of passive euthanasia has recently been attacked in a particularly clear and explicit way by an "Ethics Task Force" established by the European Association of Palliative Care (EAPC) in February 2001. It claims that the expression "passive euthanasia" is a contradiction in terms and hence that there can be no such thing. This paper critically assesses the main arguments for the Task Force's view. Three arguments are considered. Firstly, an argument based on the (supposed) wrongness of euthanasia and the (supposed) permissibility of what is often called passive euthanasia. Secondly, the claim that passive euthanasia (so-called) cannot really be euthanasia because it does not cause death. And finally, a consequence based argument which appeals to the (alleged) bad consequences of accepting the category of passive euthanasia.We conclude that although healthcare professionals' nervousness about the concept of passive euthanasia is understandable, there is really no reason to abandon the category provided that it is properly and narrowly understand and provided that "euthanasia reasons" for withdrawing or withholding life-prolonging treatment are carefully distinguished from other reasons.
Full Text Available Millions of laboratory animals are killed each year worldwide. There is an ethical, and in many countries also a legal, imperative to ensure those deaths cause minimal suffering. However, there is a lack of consensus regarding what methods of killing are humane for many species and stages of development. In 2013, an international group of researchers and stakeholders met at Newcastle University, United Kingdom to discuss the latest research and which methods could currently be considered most humane for the most commonly used laboratory species (mice, rats and zebrafish. They also discussed factors to consider when making decisions about appropriate techniques for particular species and projects, and priorities for further research. This report summarises the research findings and discussions, with recommendations to help inform good practice for humane killing.
E. Garrard; S. Wilkinson
The idea of passive euthanasia has recently been attacked in a particularly clear and explicit way by an "Ethics Task Force" established by the European Association of Palliative Care (EAPC) in February 2001...
Garrard, E; Wilkinson, S
The idea of passive euthanasia has recently been attacked in a particularly clear and explicit way by an "Ethics Task Force" established by the European Association of Palliative Care (EAPC) in February 2001. It claims that the expression "passive euthanasia" is a contradiction in terms and hence that there can be no such thing. This paper critically assesses the main arguments for the Task Force's view. Three arguments are considered. Firstly, an argument based on the (supposed) wrongness of...
Scarlett, Janet; Johnston, Naomi
Reducing the number of homeless, nonhuman animals entering and being euthanatized in community shelters is the principal motivation for most spay/neuter (S/N) programs in the United States. This study evaluated the impact of a subsidized S/N clinic opened in 2005 in Transylvania County, North Carolina, on the numbers of impoundments (and euthanasia) of dogs and cats and on the number of animal-related service and complaint calls at the community's only animal shelter. Before opening the local S/N clinic, a significant linear decline in the shelter's dog-intake rate per 1,000 human population was evident. This decline did not accelerate after the S/N clinic opened in 2005. The rate of decline in euthanasia did level off after the clinic opened, but the proportion of impounded dogs euthanatized did not change significantly. The median number of cats impounded and euthanatized yearly in the Transylvania County Animal Services shelter decreased significantly after the S/N clinic opened; the proportion of cats euthanatized did not change. The median annual number of service calls and complaints decreased or leveled off. Unfortunately, data regarding many factors essential for conclusively interpreting these results were not available.
Rault, J-L; Holyoake, T; Coleman, G
Euthanasia is a necessary act for any facility keeping live animals. Nevertheless, the crucial role and responsibility of the stockperson in deciding and conducting on-farm euthanasia has been overlooked. Stockperson characteristics and knowledge that lead to appropriate decision-making and the skills to competently perform the procedure remain to be identified. An important component of the stockperson's characteristics that predict behavior is the stockperson's attitudes. This preliminary study investigated the factors that influence stockperson attitudes toward the practice of on-farm euthanasia in the pork industry. A total of 120 stockpeople from 10 Australian pig farms (ranging in size from 50 to 4,754 sows and from 2 to 32 employees) completed a questionnaire based on focus group input to assess their attitudes toward euthanasia and decision processes. Factors identified included stockperson attitudes and attributes (empathy affect, empathy attribution, feeling bad about euthanizing, and negative attitudes to pigs), beliefs about the working environment (perceived time constraints and relying on others), and factors related to decision-making (comfortable with euthanasia, trouble deciding and avoid if possible, confidence, insufficient knowledge, seeking knowledge, and using sources to get advice). Numerous significant correlations were found between these variables. Furthermore, regression analyses showed confidence as the only significant predictor of being comfortable with euthanasia (12.5% of the variance; euthanasia ( euthanasia, which comprises both a decision-making process and the act itself, can adversely affect stockpeople. This preliminary study offers insights for implementation of successful practical and humane pig euthanasia protocols on farm. This will benefit stockperson well-being and animal well-being alike.
Kon, Alexander A
Despite advances in the care of infants, there remain many newborns whose medical conditions are incompatible with sustained life. At times, healthcare providers and parents may agree that prolonging life is not an appropriate goal of care, and they may redirect treatment to alleviate suffering. While pediatric palliative treatment protocols are gaining greater acceptance, there remain some children whose suffering is unrelenting despite maximal efforts. Due to the realization that some infants suffer unbearably (ie, the burdens of suffering outweigh the benefits of life), the Dutch have developed a protocol for euthanizing these newborns. In this review, I examine the ethical aspects of 6 forms of end of life care, explain the ethical arguments in support of euthanasia, review the history and verbiage of the United States regulations governing limiting and withdrawing life-prolonging interventions in infants, describe the 3 categories of neonates for whom the Dutch provide euthanasia, review the published analyses of the Dutch protocol, and finally present some practical considerations should some form of euthanasia ever be deemed appropriate.
C. R. Gherardi
Full Text Available Los avances de la medicina en el área tecnológica respecto de la aplicación de métodos de soporte vital en el paciente crítico y las modificaciones culturales que se han operado en la sociedad contemporánea con relación al derecho de los pacientes a decidir sobre el final de sus vidas, hacen imprescindible disponer de una definición de eutanasia que atienda la vigencia de este nuevo escenario. La exclusión de las llamadas formas pasivas y en general de la omisión como procedimiento o conducta posible para la provocación de la muerte y la necesidad de la voluntariedad explícita del paciente delimitarían muy concretamente el concepto de eutanasia. Del mismo modo, una referencia concreta sobre el modo de provocar la muerte debería integrar obligatoriamente su definición. Así, la eutanasia significaría básicamente provocar la muerte de un paciente portador de una enfermedad mortal, a su requerimiento y en su propio beneficio, por medio de la administración de un tóxico o veneno en dosis mortal. Esta definición muy restrictiva separaría la eutanasia de los casos de rechazo de tratamiento, aunque se produjera la muerte como resultado del mismo, y también de las situaciones en que la abstención o el retiro de un soporte vital en el paciente crítico permite la llegada de la muerte.Technological progress in medicine regarding the application of life-sustaining treatment in the critical patient and the cultural changes that have taken place in contemporary society with respect to the patients' right to decide over the end of their lives, demand the existence of a definition of euthanasia that will acknowledge this new scenario. The concept of euthanasia would be very specifically limited by the exclusion of so-called passive forms of euthanasia and of omission as a possible procedure to cause death and the need for the explicit request of the patient involved. Likewise, the definition of euthanasia should include a specific
Several circumstances may require the euthanasia of a cetacean: stranding, entanglement in fishing gear, entrapment in ice, significant injury of a free-swimming cetacean from ship-strike, or a terminally ill animal in a captive situation...
71 8. Summary- Euthanasia and criminal law Euthanasia is often regarded as a controversial topic that is being discussed all around the world. The legislative rules differ among the countries to various extent. The scope of this work is to offer a summary of legal regulations in euthanasia, particulary in the area of criminal law and a several examples of these regulations in Europe, USA and Australia. In the first chapter, the term of euthanasia is defined which is necessary for the purpose ...
Brigham, J C; Pfeifer, J E
It has been argued that euthanasia is one of the most pressing social concerns of our times. A review of current scientific and legal materials, however, indicates that this issue is a complex and contentious one that crosses numerous perspectives and theoretical orientations. In order to provide background for the other articles in this collection, we present a brief history of attitudes toward euthanasia. In addition, various terms that are associated with the concept of euthanasia are defined. Finally, this paper provides a framework for the articles that follow by suggesting that three central issues must be addressed in order to resolve the controversies surrounding euthanasia. These are (1) the establishment of standardized criteria of euthanasia eligibility, (2) the investigation of public attitudes regarding acceptable means for engaging in euthanasia, and (3) the evaluation of the roles of professionals who are directly involved in euthanasia decisions. We hope that the following articles will provide insight into these issues.
Rathwell-Deault, Dominick; Godard, Béatrice; Frank, Diane; Doizé, Béatrice
In companion animal practice, convenience euthanasia (euthanasia of a physically and psychologically healthy animal) is recognized as one of the most difficult situations. There is little published on veterinary perceptions of the consequences of convenience euthanasia. A qualitative study on the subject based on interviews with 14 veterinarians was undertaken. The animal's interests in the dilemma of convenience euthanasia was taken into consideration, strictly from the point of view of the physical suffering and stress related to the procedure. The veterinarian's goal was to respect the animal's interests by controlling physical pain. Most often, veterinarians made their own interests and those of the owners a priority when considering the consequences of their decision to perform or refuse convenience euthanasia.
R. S. Magnusson
The key to the euthanasia debate lies in how best to regulate what doctors do. Opponents of euthanasia frequently warn of the possible negative consequences of legalising physician assisted suicide and active euthanasia (PAS/AE...
ten Have, H A
Over the past 30 years, euthanasia has been under continuous debate in The Netherlands. This contribution aims to provide a moral assessment of this debate. It is argued that euthanasia should be understood within a historical context, as a protest against medical power and as a way to bring about good death. Within the euthanasia debate, two paradoxes are identified which make the issue inherently complex and hard to regulate. The first paradox results from the dialectical relation between individual autonomy and relief of suffering as the major justifications of euthanasia. Although euthanasia represents an ultimate effort to give the individual patient control over his dying, the result of the debate is an increase of medical power. The second paradox is that although euthanasia emerged from a commitment to good death, it is resulting in a reduced range of options to bring about good death.
Valentim, A M; Guedes, S R; Pereira, A M; Antunes, L M
Several questions have been raised in recent years about the euthanasia of laboratory rodents. Euthanasia using inhaled agents is considered to be a suitable aesthetic method for use with a large number of animals simultaneously. Nevertheless, its aversive potential has been criticized in terms of animal welfare. The data available regarding the use of carbon dioxide (CO2), inhaled anaesthetics (such as isoflurane, sevoflurane, halothane and enflurane), as well as carbon monoxide and inert gases are discussed throughout this review. Euthanasia of fetuses and neonates is also addressed. A table listing currently available information to ease access to data regarding euthanasia techniques using gaseous agents in laboratory rodents was compiled. Regarding better animal welfare, there is currently insufficient evidence to advocate banning or replacing CO2 in the euthanasia of rodents; however, there are hints that alternative gases are more humane. The exposure to a volatile anaesthetic gas before loss of consciousness has been proposed by some scientific studies to minimize distress; however, the impact of such a measure is not clear. Areas of inconsistency within the euthanasia literature have been highlighted recently and stem from insufficient knowledge, especially regarding the advantages of the administration of isoflurane or sevoflurane over CO2, or other methods, before loss of consciousness. Alternative methods to minimize distress may include the development of techniques aimed at inducing death in the home cage of animals. Scientific outcomes have to be considered before choosing the most suitable euthanasia method to obtain the best results and accomplish the 3Rs (replacement, reduction and refinement). © The Author(s) 2015.
Chaloner, C; Sanders, K
The legal status of euthanasia is frequently deliberated. It remains unlawful in Britain and advocates for a change in the law are vigorously opposed by those who argue that it should remain unchanged. An objective account, in which current law and arguments for and against change are exposed, is essential to inform the euthanasia debate. In this article the legal issues concerning euthanasia are examined and arguments raised by proposed changes in the law are considered.
Minerva, Francesca; Sandberg, Anders
In this article we discuss the moral and legal aspects of causing the death of a terminal patient in the hope of extending their life in the future. We call this theoretical procedure cryothanasia. We argue that administering cryothanasia is ethically different from administering euthanasia. Consequently, objections to euthanasia should not apply to cryothanasia, and cryothanasia could also be considered a legal option where euthanasia is illegal. © 2017 John Wiley & Sons Ltd.
Pu, S D
Euthanasia in China is gaining increasing acceptance among physicians, intellectuals, and even the people. This paper surveys current attitudes towards euthanasia and suggests why it should be legalized.
Several sections of the Criminal Code of Canada which are relevant to the issue of euthanasia are discussed. In addition, the value placed on the sanctity of life by the law, the failure to recognize motive in cases of euthanasia, and disparate legal and medical definitions of death are also considered. (Author)
Carrasco M, Víctor Hugo; Crispi, Francisca
Euthanasia is a complex medical procedure. Even though end of life decisions are common situations in health practice, there is a lack of consensus about their terminology. In this manuscript, the main concepts about this issue are defined and delimited; including active and passive euthanasia and limitation of therapeutic effort. Then, a revision is made about the international experience on euthanasia, to then go through the Chiles history in euthanasia and the populations opinion. In Chile, euthanasia is an act that has been removed from the social dialogue and legislation. In order to have an open discussion in our population about the issue, the debate has to be opened to the citizens, accompanied by clear medical information about the procedure.
Rathwell-Deault, Dominick; Godard, Béatrice; Frank, Diane; Doizé, Béatrice
In companion animal practice, convenience euthanasia (euthanasia of a physically and psychologically healthy animal) is recognized as one of the most difficult situations. There is little published on veterinary perceptions of the consequences of convenience euthanasia. A qualitative study on the subject based on interviews with 14 veterinarians was undertaken. The animal’s interests in the dilemma of convenience euthanasia was taken into consideration, strictly from the point of view of the physical suffering and stress related to the procedure. The veterinarian’s goal was to respect the animal’s interests by controlling physical pain. Most often, veterinarians made their own interests and those of the owners a priority when considering the consequences of their decision to perform or refuse convenience euthanasia. PMID:28698691
Bollen, Peter; Saxtorph, Henrik
Euthanasia of laboratory animals should be quick, painless and with a minimum of distress to the animal. Methods of euthanasia are the topic of an ongoing discussion, especially with respect to the degree of pain and distress associated with different methods. A common method of euthanasia of rats...... a reduced nociception, in the spine of rats receiving a mixture of pentobarbital and lidocaine, compared to rats receiving pentobarbital alone. However, it is our experience that visible signs of pain are not always observable during euthanasia. For this reason we performed a study comparing two...... concentrations of pentobarbitone (50 mg/ml vs. 200 mg/ml) for euthanasia in rats (n=12). The time point of loss of balance, immobility and respiratory stop were registered, and the behaviour was assessed from video recordings of the procedure. Our study revealed no differences between the two concentrations...
Stoyles, Byron J; Costreie, Sorin
Our goal in this article is to explicate the way, and the extent to which, euthanasia can be voluntary from both the perspective of the patient and the perspective of the health care providers involved in the patient's care. More significantly, we aim to challenge the way in which those engaged in ongoing philosophical debates regarding the morality of euthanasia draw distinctions between voluntary, involuntary, and nonvoluntary euthanasia on the grounds that drawing the distinctions in the traditional manner (1) fails to reflect what is important from the patient's perspective and (2) fails to reflect the significance of health care providers' interests, including their autonomy and integrity.
Daoust, P Y; Ortenburger, A I
A stranded juvenile fin whale was successfully euthanized with an intravenous injection of sedative and cardioplegic drugs. Veterinarians may face a number of serious difficulties if called to perform this task, and advance preparation is required for successful euthanasia of these animals.
Parakh, Jal S.; Slesnick, Irwin L.
Focuses on the moral arguments for and against the controversial topic of voluntary active euthanasia. Discusses the question of legalization and decriminalization of the practice. Provides a student worksheet with questions to stimulate discussion on the issue. (MDH)
Harris, N M
Debates about the moral dilemmas of euthanasia date back to ancient times. Many of the historical arguments used for and against the practice remain valid today. Indeed, any form of discussion on the subject often provokes emotive responses, both from members of the medical profession and the general public. For this reason alone, the issue will continue to be debated at all levels of society. There are, however, other factors that ensure euthanasia will remain a subject of major controversy within medical, legal and governmental bodies. Firstly, the act of euthanasia itself is illegal, yet in its passive form occurs on a daily basis in many of our hospitals (1). Secondly, medical advances have made it possible to artificially prolong the life of an increasing number of patients far beyond what was possible only a few years ago. Furthermore, we must all contend with the reality that financial constraints are an important consideration in modern health care provision. Finally, there is an ethical difficulty in interpreting the concept of a patient's right, or autonomy, versus the rights and duty of a doctor. Before attempting to answer the questions posed by these issues, it is important to have some accurate definitions of both euthanasia and of the concept of morality. According to the House of Lords Select Committee on Medical Ethics, the precise definition of euthanasia is "a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering" (2). The term can be further divided into voluntary and involuntary euthanasia. The former is said to occur if a competent patient makes an informed request for a life terminating event and the latter can be used if a patient does not give informed and specific consent for such treatment. It is the occurrence of involuntary euthanasia which forms one of the main arguments against legalisation. This is discussed in greater detail below. Euthanasia is frequently separated into
Sveinsson, Olafur Arni
Euthanasia has been heatedly discussed in Western countries over the last years. Only a few nations have legalized euthanasia or physician assisted suicide with the Dutch at the forefront of that field...
Johnson, Reid Rucker
The objective of this dissertation is to examine the moral arguments commonly presented in the current debate on active and passive euthanasia in the United States. I claim the belief that there is a moral permissibility difference between active and passive euthanasia, which is that active euthanasia is impermissible and passive euthanasia is permissible, is unable to be supported by the arguments given in its defense. I first clarify what types of medical conditions commonly associated with...
Simón Lorda, Pablo; Barrio Cantalejo, Inés M
The experience of the Netherlands in relation with the legalization and practice of euthanasia is better known in Spain than the Belgian experience in this matter. But the historical process of social debate in Belgium has many specific details which should be known by Spanish healthcare professionals, bioethicists, politicians and lawyers. This paper begins with a comparative analysis of both countries: Spain and Belgium and follows with a description of the milestones of the historical process of debating and, finally, passing the Belgian Law on Euthanasia in 2002. The next chapter consists of a description of the main contents of this important Law. The paper continues then with an approach to the epidemiology of the practice of euthanasia in Belgium and finishes with a description of the different positions of the actors of the process. Two positions are described more in depth: the opinion of the specialists in palliative care, and the opinion of the Catholic Church. The paper ends underlining the reason for the incorporation of the Belgian experience on euthanasia to the debate about the possibility of legalizing euthanasia in Spain.
The passive form of euthanasia is legalized almost in every civilized country. Its active form is not a generally accepted legal institution. In Europe, active euthanasia is legalized only in The Netherlands, Belgium, Luxembourg and Switzerland. In Australia, the Act on the Rights of the Terminally Ill of 1995 legalized the institution of assisted suicide, which is not identical to active euthanasia. The difference lies in the fact that legalized active euthanasia means that the author of a murder is not punishable (under certain circumstances), whilst assisted suicide is not about murder, rather about suicide. In the first case, the patient is killed on his or her request by someone else. In the second case, the patient himself or herself executes the act of self-killing (by the assistance of a healthcare worker). In Australia, the institution of assisted suicide was repealed in 1997. Assisted suicide is legal in four USA member states: in Vermont, Washington, Montana and Oregon. In Uruguay, the active form of euthanasia has been legal since 1932.
If a physician accepts to conduct an act of euthanasia or assisted suicide, would it be possible for him to be charged with homicide or even, is patient consent or motivation of the physician, susceptible to change the nature of the criminal act? Since the 1990s, a transformation has occurred in the way of dealing with these questions and figures from the world of philosophy, ethics and law can now be found in favor of euthanasia and assisted suicide. In certain countries, legislation has even been modified to follow this pattern. In consequence, besides the philosophical and ethical dimensions of this issue, it has become necessary to reexamine, even to revise, the notion of responsibility concerning euthanasia in Muslim law from new bases constituted by the doctrine of the Ulemas.
Right to life -as the prohibition of intentionally and arbitrarily taking life, even with authorization of the concerned one- is an internationally recognized right. In many countries, debate regarding euthanasia is more centered in its convenience, social acceptability and how it is regulated, than in its substantial legitimacy. Some argue that euthanasia should be included as part of clinical practice of health professionals, grounded on individual's autonomy claims-everyone having the liberty to choose how to live and how to die. Against this, others sustain that life has a higher value than autonomy, exercising autonomy without respecting the right to life would become a serious moral and social problem. Likewise, euthanasia supporters some-times claim a 'right to live with dignity', which must be understood as a personal obligation, referred more to the ethical than to the strictly legal sphere. In countries where it is already legalized, euthanasia practice has extended to cases where it is not the patient who requests this but the family or some healthcare professional, or even the legal system-when they think that the patient is living in a condition which is not worthy to live. Generalization of euthanasia possibly will end in affecting those who need more care, such as elder, chronically ill or dying people, damaging severely personal basic rights. Nature, purpose and tradition of medicine rule out the practice of euthanasia, which ought not be considered a medical act or legitimately compulsory for physicians. Today's medicine counts with effective treatments for pain and suffering, such as palliative care, including sedative therapy, which best preserves persons dignity and keeps safe the ethos of the medical profession.
Aghababaei, Naser; Farahani, Hojjatollah; Hatami, Javad
The main purposes of the present study were to see how the term ?euthanasia? influences people?s support for or opposition to euthanasia; and to see how euthanasia attitude relates to religious orientation and personality factors. In this study two different euthanasia attitude scales were compared. 197 students were selected to fill out either the Euthanasia Attitude Scale (EAS) or Wasserman?s Attitude Towards Euthanasia scale (ATE scale). The former scale includes the term ?euthanasia?, the...
Full Text Available Euthanasia is an attempt to end someone life when he/she has an uncurable illness, euthanasia will be done in order to release his/her from suffering his/her illness. In Indonesia, euthanasia can not be done and it is classified as an illegal act. Both in the positive law and the ethics code regulate that performing an euthanasia is not allowed. Regarded to the perspective of Islamic law, also regulated that an active euthanasia is an act that is forbidden and punishable by God with a punishment of hell for those who did.
Norum, J; Leknes, M
Euthanasia is clinical practice in several countries world-wide. Cancer patients' attitude in this field was focused through a review of case reports and questionnaire-based studies on Medline (1992-97). A total of nine publications including 459 cancer patients from USA, Canada and Holland were found. The majority of patients had poor performance status and advanced disease. At least one third reported themselves positive to euthanasia. Patients below 50 years of age, having superior performance status and not considering themselves religious, more frequently supported euthanasia. Psychological factors seem to be more significant than physical factors for support of euthanasia. Loss of control, being a burden on one's family and loss of dignity are the psychological factors most frequently reported. A "help to live" approach aimed at avoiding patient requests for help to die will mean that health care workers must allocate more of their time to these patients. Overcrowded hospitals with several patients in corridors and lack of nursing-homebeds do not make this situation easier to handle.
Full Text Available The right to live is a right guaranteed by the constitution as well as international legal acts in force in a country, and is based on the moral of a society. But does the right to live imply a parallel individual right to die? Or should the state protect the right to life of a person who does not want to live anymore, going like this against the will of that person? Albanian anthropology, as a post-communist society lacks the tradition of freedom, as in this case of the freedom that belongs to a man affected by an incurable disease. For this reason, in Albania not only we do not have a law on euthanasia, but the issue of euthanasia is not raised as an issue nor by the legislator nor by civil society. The purpose of this paper is to give an overview of euthanasia in Albania, as well as on some specific problems facing the Albanian reality. The methodology used in the paper consists with the combination of comparing legal provisions of euthanasia (or the lack of them in a vertical historical continuity.
In the Judeo-Christian tradition, human life is held to be sacred, a semblance of the divine and a gift from God which the individual cannot dispose of at his or her own will. Hence, these monotheistic religions have made of the crime of murder a transgression of God's own commandment not to kill and have extended the applicability of this commandment to the practice of euthanasia and suicide. On the other hand, some non-religious traditions offer plausible reasons favoring euthanasia. This is a delicate matter for physicians, since the Hippocratic tradition forbids euthanasia and because as care-givers they must also bear the psychological, moral and emotional burden of carrying it out. Physicians are trained to preserve life but not to bring it to an end. As human beings, they must always respect the principle of nonmaleficence, and as physicians they must always respect as well the principle of beneficence. It is difficult to accept the fact that ending a human life can be an act of beneficence. In order to differentiate between passive and active euthanasia, the concept of proportionality of medical acts must be brought into consideration. For instance, using high doses of opiates to alleviate pain or withholding the use of an extraordinary method of treatment are not passive acts aimed at ending the life of a terminally ill patient, but medical acts that are reasonable, judicious and proportionate to the condition and irreversibility of a patient's illness. Therefore, so-called passive euthanasia cannot be considered the same as euthanasia. On the other hand, medically assisted suicide is a deceitful form of active euthanasia. The aim of this act is to cause death and the physician is morally responsible for such a death, since he is providing the means for bringing a human life to an end. Many times the desire to die expressed by terminally ill elderly and helpless patients is a request for help and an expression of reproach against a society that allows for
Sveinsson, Olafur Arni
Euthanasia has been heatedly discussed in Western countries over the last years. Only a few nations have legalized euthanasia or physician assisted suicide with the Dutch at the forefront of that field. Proponents of euthanasia mostly argue for euthanasia on two grounds. Firstly, that the patient has a right to die and secondly, that there is no substantial difference between euthanasia and palliative care. In this paper I will argue against both of the above. I discuss the arguments against euthanasia which are in principle four. Firstly, it is held by many that taking a human life is wrong under all circumstances. Secondly, that it is an unjustifiable demand to ask a person to take another person's life. In relation to that argument, euthanasia is not in accordance with the basic principles of medicine and nursing as they have evolved over the years and could therefore easily disrupt the therapeutic relationship. Thirdly, as shown from Holland there is empirical evidence that euthanasia is not under good enough surveillance and therefore invites misuse. Fourthly, even though euthanasia might possibly be justifiable under certain circumstances, legalisation might well invite abuse because of the message and pressure that the option places on both patients and professionals in terminal care. My answer to the euthanasia demand is palliative care, where dialogue between the patient and doctor is central. But the dialogue cannot be effective, unless both partners are willing and able to engage in sincere and frank conversations.
The growing acceptance of voluntary active euthanasia by the Dutch is examined in relation to the plastic cards requesting active euthanasia carried by many people in The Netherlands, public opinion polls, and support by leading medical figures of the movement to legalize euthanasia. The author draws upon his experience as a hospital doctor to condemn the practice of active euthanasia, arguing that its voluntariness is often counterfeit and always questionable, that it is inseparable from overtly involuntary forms of euthanasia, and that its promise of sparing the sick person agony is false. "Voluntary" euthanasia also brings an ominous change in society because of the message it sends to the elderly and sick, the weak and the dependent; because the fallibility of medical judgments are inconsistent with the irreversibility of the act; and because the fallacious reasoning of the philosophy threatens to cause irreparable damage to the medical profession.
Boudreau, J Donald; Somerville, Margaret A
The public assumes that if euthanasia and assisted suicide were to be legalized they would be carried out by physicians. In furthering critical analysis, we supplement the discourse in the ethics and palliative care literature with that from medical education and evolving jurisprudence. Both proponents and opponents agree that the values of respect for human life and for individuals' autonomy are relevant to the debate. Advocates of euthanasia and assisted suicide give priority to the right to personal autonomy and avoid discussions of harmful impacts of these practices on medicine, law and society. Opponents give priority to respect for life and identify such harmful effects. These both require euthanasia to remain legally prohibited. Proposals are emerging that if society legalizes euthanasia it should not be mandated to physicians. The impact of characterizing euthanasia as 'medical treatment' on physicians' professional identity and on the institutions of medicine and law should be examined in jurisdictions where assisted suicide and euthanasia have been de-criminalized.
Barone, Silvana; Unguru, Yoram
As more countries adopt laws and regulations concerning euthanasia, pediatric euthanasia has become an important topic of discussion. Conceptions of what constitutes harm to patients are fluid and highly dependent on a myriad of factors including, but not limited to, health care ethics, family values, and cultural context. Euthanasia could be viewed as iatrogenic insofar as it results in an outcome (death) that some might consider inherently negative. However, this perspective fails to acknowledge that death, the outcome of euthanasia, is not an inadvertent or preventable complication but rather the goal of the medical intervention. Conversely, the refusal to engage in the practice of euthanasia might be conceived as iatrogenic insofar as it might inadvertently prolong patient suffering. This article will explore cultural and social factors informing families', health care professionals', and society's views on pediatric euthanasia in selected countries. © 2017 American Medical Association. All Rights Reserved.
Full Text Available Dalam KUHP tidak satu pasal pun yang menjelaskan batasan atau pengertian euthanasia. Namun demikian, pengenaan terhadap euthanasia dianalogikan dengan delik-delik yang tercantum dalam pasal 338, 340, 344 KUHP. Dengan dasar itulah maka pelaksanaan euthanasia dilarang. Larangan euthanasia pasif tidak pernah efektif karena kematian sebagai akibat ketidakmampuan ilmu dan teknologi kedokteran, dipandang sebagai kematian alamiah, sedangkan terhadap kematian alamiah tentu saja tidak ditahan-tahan atau dilarang hukum pidana maupun kode etik kedokteran. Hukum pidana dan kode etik kedokteran, tidak mewajibkan dokter untuk mengobati pasien di Iuar batas kemampuan ilmu dan teknologi kedokteran. berdasarkan penerapan karakteristik delik omisionis terbukti bahwa, larangan euthanasia pasif tidak memenuhi kriteria untuk diterapkan sebagai perbuatan pidana. Dalam hal terjadinya euthanasia pasif, walaupun dokter melakukan perbuatan positif, secara logika, kematian pasien tidak dapat dihindari. Dengan demikian sulit untuk dibuktikan adanya hubungan kausal antara akibat yang dilarang timbulnya dengan kelakuan negatif dokter.
Ozcelik, Hanife; Tekir, Ozlem; Samancioglu, Sevgin; Fadiloglu, Cicek; Ozkara, Erdem
In Turkey, which is a secular, democratic nation with a majority Muslim population, euthanasia is illegal and regarded as murder. Nurses and students can be faced with ethical dilemmas and a lack of a legal basis, with a conflict of religious beliefs and social and cultural values concerning euthanasia. The aim of this study was to investigate undergraduate nursing students' attitudes towards euthanasia. The study, which had a descriptive design, was conducted with 600 students. The 1st, 2nd, 3rd, and 4th year nursing students at a school of nursing were contacted in May 2009, and 383 students (63.8% of the study population of a total of 600 students) gave informed consent. Two tools were used in accordance with questionnaire preparation rules. The majority of students were female and single (96.9%), and their mean age was 21.3 ± 1.5 years. A majority (78.9%) stated they had received no training course/education on the concept of euthanasia. Nearly one-third (32.4%) of the students were against euthanasia; 14.3% of the students in the study agreed that if their relatives had an irreversible, lethal condition, passive euthanasia could be performed. In addition, 24.8% of the students agreed that if they themselves had an irreversible, lethal condition, passive euthanasia could be performed. Less than half (42.5%) of the students thought that discussions about euthanasia could be useful. There was a significant relation between the study year and being against euthanasia (p euthanasia could be abused (p euthanasia was unethical (p euthanasia.
The bachelor thesis "Attitude of nurses to euthanasia" focuses on an understanding of dying, euthanasia and palliative care and their attitude to euthanasia. The work is devided into two parts - a theoretical one and an empirical one. The theoretical part describes the methodology and results of quantitative research by the use of questionaire comparing two specified groups of nurses - hospic care nurses and intensive care nurses. There are summarised findings from the investigation in the co...
van der Wal, G.; Dillmann, R. J.
The practice of euthanasia in the Netherlands is often used as an argument in debates outside the Netherlands--hence a clear description of the Dutch situation is important. This article summarises recent data and discusses conceptual issues and relevant characteristics of the system of health care. Special emphasis is put on regulation, including relevant data on notification and prosecution. Besides the practice of euthanasia the Dutch are confronted with the gaps in reporting of cases to the public prosecutor and the existence of cases of ending a life without an explicit request. Nevertheless, the "Dutch experiment" need not inevitably lead down the slippery slope because of the visibility and openness of this part of medical practice. This will lead to increased awareness, more safeguards, and improvement of medical decisions concerning the end of life. PMID:8019226
On 10 April last, the Dutch Senat accepted a new bill concerning voluntary active euthanasia and physician assisted suicide. This bill legally embodies a ground for exemption from punishment for physicians who conducted voluntary active euthanasia or physician assisted suicide and who complied with certain requirements. Hence, the old policy of tolerance has been transformed into a legal system of acceptance of certain forms of voluntary active euthanasia and physician assisted suicide. This contribution describes these legal changes as the final stage of a process of integration of voluntary active euthanasia and physician assisted suicide in Dutch society. In this way, it endeavours to contribute to a constructive debate.
Euthanasia and assisted suicide are not part of French laws of bioethics and lack, for the time being, definition and normative framework other than their criminal prosecution. To transform them into a right, these concepts certainly call for an ethical and legal debate. This paper aims to question the ideas to be considered, the conceptual bases and normative tools that may be useful to the discussion.
de Kort, Susanne J
A recent survey showed that less than half of Dutch physicians would find it conceivable to grant a request for euthanasia from a patient suffering from psychiatric disease or dementia, or who is tired of life. Because of a broader interpretation by the Regional Review Committees of the official criteria for due care, all recent cases of euthanasia in these specific groups of patients had been accepted. In this commentary it is argued that, following recent social developments in the Netherlands (including cuts in provision of care for the elderly and of mental health care, and a narrowed view about end-of-life issues), the official euthanasia criteria for due care are no longer suitable if we are to avoid a 'slippery slope' effect in cases such as those mentioned above. The criteria of a) a voluntary and well-considered request and b) absence of reasonable treatment alternatives are particularly under pressure. A plea is hold for a return to stricter interpretation of the criteria.
It is often accepted that we may legitimately speak about voluntary euthanasia only in cases of persons who are suffering because they are incurably injured or have an incurable disease. This article argues that when we consider the moral acceptability of voluntary euthanasia, we have no good reason to concentrate only on persons who are ill or injured and suffering.
Kelleher, M J; Chambers, D; Corcoran, P; Keeley, H S; Williamson, E
The present paper examines the occurrence of matters relating to the ending of life, including active euthanasia, which is, technically speaking, illegal worldwide. Interest in this most controversial area is drawn from many varied sources, from legal and medical practitioners to religious and moral ethicists. In some countries, public interest has been mobilized into organizations that attempt to influence legislation relating to euthanasia. Despite the obvious international importance of euthanasia, very little is known about the extent of its practice, whether passive or active, voluntary or involuntary. This examination is based on questionnaires completed by 49 national representatives of the International Association for Suicide Prevention (IASP), dealing with legal and religious aspects of euthanasia and physician-assisted suicide, as well as suicide. A dichotomy between the law and medical practices relating to the end of life was uncovered by the results of the survey. In 12 of the 49 countries active euthanasia is said to occur while a general acceptance of passive euthanasia was reported to be widespread. Clearly, definition is crucial in making the distinction between active and passive euthanasia; otherwise, the entire concept may become distorted, and legal acceptance may become more widespread with the effect of broadening the category of individuals to whom euthanasia becomes an available option. The "slippery slope" argument is briefly considered.
Ward, Russell A.
Study explores relationship between age (and sex and race) and acceptance of euthanasia. Women and non-Whites were less accepting because of religiosity. Among older people less acceptance was attributable to their lesser education and greater religiosity. Results suggest that quality of life in old age affects acceptability of euthanasia. (Author)
Both active euthanasia and assisted suicide are legal in The Netherlands, Belgium, Luxemburg and, most recently, in Canada. Examination of national legislations of countries where both active euthanasia and assisted suicide are legal. The number of accomplished active euthanasia cases and that of assisted suicide cases. Analysis of national statistical data. Comparison of statistical data before and after 2010. Comparison of the related practices in the surveyed countries. The number of active euthanasia cases markedly predominates over the number of assisted suicide cases. Cancer is a main reason for active euthanasia, or assisted suicide. In countries with a larger population, the number of active euthanasia cases is higher than that in countries with a smaller population. Regarding the fact that the applicants for active euthanasia withdraw their requests in a smaller number than the applicants for assisted suicide, patients prefer the choice of active euthanasia. Since the related legislative product is too recent in Canada at present, it may be only presumed that a certain preference will also develop in the related practices in Canada. Orv. Hetil., 2016, 157(40), 1595-1600.
Hermsen, Maaike A; ten Have, Henk A M J
With the growth of palliative care services, interest in moral issues also seems to be growing. The controversial issue of euthanasia significantly provokes moral reflection on the care for dying patients. This article presents an analysis of the moral issue of euthanasia as it is discussed by the palliative care community in the professional journals of palliative care. Initially, the analysis will focus on describing the characteristics of the publications about euthanasia and the attitudes expressed in the articles towards this practice. Second, attention will be paid to the description of the uses of the term euthanasia in the various articles and also how frequently such uses occur. Third, the various arguments in support for or against a place for euthanasia in palliative care will be discussed.
In 2011, Frank Van Den Bleeken became the first detainee to request euthanasia under Belgium's Euthanasia Act of 2002. This article investigates whether it would be lawful and morally permissible for a doctor to accede to this request. Though Van Den Bleeken has not been held accountable for the crimes he committed, he has been detained in an ordinary prison, without appropriate psychiatric care, for more than 30 years. It is first established that Van Den Bleeken's euthanasia request plausibly meets the relevant conditions of the Euthanasia Act and that, consequently, a doctor could lawfully fulfill it. Next, it is argued that autonomy-based reasons for euthanizing him outweigh complicity-based reasons against doing so, and that, therefore, it is also morally permissible for a doctor to carry out the euthanasia request.
Magnusson, R S
The key to the euthanasia debate lies in how best to regulate what doctors do. Opponents of euthanasia frequently warn of the possible negative consequences of legalising physician assisted suicide and active euthanasia (PAS/AE) while ignoring the covert practice of PAS/AE by doctors and other health professionals. Against the background of survey studies suggesting that anything from 4% to 10% of doctors have intentionally assisted a patient to die, and interview evidence of the unregulated, idiosyncratic nature of underground PAS/AE, this paper assesses three alternatives to the current policy of prohibition. It argues that although legalisation may never succeed in making euthanasia perfectly safe, legalising PAS/AE may nevertheless be safer, and therefore a preferable policy alternative, to prohibition. At a minimum, debate about harm minimisation and the regulation of euthanasia needs to take account of PAS/AE wherever it is practised, both above and below ground.
van der Heide, Agnes
Several countries have adopted laws that regulate physician assistance in dying. Such assistance may consist of providing a patient with a prescription of lethal medication that is self-administered by the patient, which is usually referred to as (physician) assistance in suicide, or of administering lethal medication to a patient, which is referred to as euthanasia. The main aim of regulating physician assistance in dying is to bring these practices into the open and to provide physicians with legal certainty. A key condition in all jurisdictions that have regulated either assistance in suicide or euthanasia is that physicians are only allowed to engage in these acts upon the explicit and voluntary request of the patient. All systems that allow physician assistance in dying have also in some way included the notion that physician assistance in dying is only accepted when it is the only means to address severe suffering from an incurable medical condition. Arguments against the legal regulation of physician assistance in dying include principled arguments, such as the wrongness of hastening death, and arguments that emphasize the negative consequences of allowing physician assistance in dying, such as a devaluation of the lives of older people, or people with chronic disease or disabilities. Opinion polls show that some form of accepting and regulating euthanasia and physician assistance in suicide is increasingly supported by the general population in most western countries. Studies in countries where physician assistance in dying is regulated suggest that practices have remained rather stable in most jurisdictions and that physicians adhere to the legal criteria in the vast majority of cases. © 2013 Elsevier B.V. All rights reserved.
Sinha, Vinod K.; Basu, S.; Sarkhel, S.
In our society, the palliative care and quality of life issues in patients with terminal illnesses like advanced cancer and AIDS have become an important concern for clinicians. Parallel to this concern has arisen another controversial issue-euthanasia or “mercy –killing” of terminally ill patients. Proponents of physician-assisted suicide (PAS) feel that an individual's right to autonomy automatically entitles him to choose a painless death. The opponents feel that a physician's role in the death of an individual violates the central tenet of the medical profession. Moreover, undiagnosed depression and possibility of social ‘coercion’ in people asking for euthanasia put a further question mark on the ethical principles underlying such an act. These concerns have led to strict guidelines for implementing PAS. Assessment of the mental state of the person consenting to PAS becomes mandatory and here, the role of the psychiatrist becomes pivotal. Although considered illegal in our country, PAS has several advocates in the form of voluntary organizations like “death with dignity” foundation. This has got a fillip in the recent Honourable Supreme Court Judgment in the Aruna Shaunbag case. What remains to be seen is how long it takes before this sensitive issue rattles the Indian legislature. PMID:22988327
The ethical problems of euthanasia are evolving. After a long "silent" period, two conflicting moral codes have emerged. One, backed by most of the clergy, is based on the belief that a person's life does not belong to him/her. The other, adopted by a majority of free thinkers, maintains that each person has the right to appreciate the value of his/her own life. Underlying the controversy about rendering euthanasia legal or not, there is tension between the values of life and freedom. Surprisingly, the practices themselves do not seem to be questioned. However, the uncertain situation of the non-respect of a legal prohibition can undermine the doctor-patient relationship and also seems to have led to increase in the number of voluntary interruptions of life carried out without the patient's consent. The law cannot uphold one particular ethic over another. This is the reason why the text adopted in Belgium is based on the recognition of a person's autonomy. At the heart of the reform there is also the twofold will to bring practices into the open as much as possible and to protect practitioners who "rely" on a fundamental dialogue with their patients.
Benatar, S R
Medical progress, secularisation of life, growing acceptance of individual human rights (including the right to refuse medical treatment) and of shared decision-making in medicine have focused public attention on the ways in which life may, and perhaps even ought to, be allowed to end in our complex modern era. Intense and thoughtful bio-ethical debate over many years has 'unpacked' the many different understandings and interpretations of the word euthanasia. The consequent conceptual clarification together with recognition and acknowledgement of psychological implications has facilitated a growing rational consensus on openly accepting the withholding and withdrawing of treatment (under defined conditions) within the realm of sound medical practice. This is clearly distinct from assisted suicide and active euthanasia which are generally considered unacceptable perversions of medical practice. Given the ability to sustain life for prolonged periods, often in a permanent state of unconsciousness, the unrealistic expectations of some medical personnel and the lay public, the severe constraints on health care facilities in South Africa and the totally inadequate allocation of resources for highly effective medical treatments, it is appropriate to re-open public debate on the limits of 'striving officiously to keep alive' and on the distinction between 'allowing to die' and 'killing'. Concern that 'rational' arguments reflect moral decay rather than moral progress keeps the debate open and focuses attention on some 'slippery slope' consequences.
INTRODUCTION Euthanasia represents an ethical, social, legal and medical issue, which is being disputed more and more frequently worldwide. In Serbia, it is illegal and punishable by law and subject to a prison sentence. Euthanasia verbatim, meaning "good death", refers to the practice of ending a life in order to relieve pain and suffering. It can be voluntary, when a person knowingly declares the wish to end life, and involuntary, when relatives and family make decisions on behalf of patients in coma. It can be active, when a person applies a medical procedure to end life and passive, when medical procedures which can extend a patient's life are not applied. EUTHANASIA THROUGH HISTORY: The term was known in old Greece, and Hippocrates mentioned it in his oath, which is now taken by all doctors in the world, by which they pledge not to apply a medicine which can lead to death of the patients, nor to give such counsel. Euthanasia had its most vigorous impetus in the mid-20th century when it was being carried out deliberately in Nazi Germany. All leading religions from Christianity, over Buddhism, to Islam, are directly or indirectly against any kind of euthanasia. EUTHANASIA TODAY: At the beginning of the 21st century, euthanasia was legalized in several most developed countries in the world, among them the Netherlands, Belgium, Germany, Switzerland, Japan, India and some American and Mexican federal states. The World Medical Association from 82 countries has condemned euthanasia, and called all medical workers who practice euthanasia to reconsider their attitudes and to stop this practice.
Reichel, W; Dyck, A J
Responding to an increased interest in establishing active, voluntary euthanasia as a viable medical and social policy, Reichel and Dyck consider the major arguments for and against the practice. Proponents of euthanasia support a patient's right of self determination and a compassion-motivated active ending of suffering. Opponents are concerned with the problems of determining intention and motivation, the danger of involuntary euthanasia of the aged, the handicapped, and the incompetent, and the impact on the physician patient relationship. Reichel and Dyck argue that, instead of euthanasia, physicians can offer terminally ill patients the "moral choice to die well" by alleviating pain, by respecting requests to forgo burdensome, invasive treatments, by providing comfort and support, and by communicating with patients and their families.
Abdi Omar Shuriye
Full Text Available This paper is an analysis on euthanasia from ethical and religious perspectives. Historically, the classical Greek thinkers including Aristotle had categorically accepted euthanasia with the main reason of minimizing pain. However, as science develops ethical and religious isuues related to the subject have increasingly created fervent debates on euthanesia. ABSTRAK: Kertas ini mengkaji euthanasia dari perspektif agama dan etika. Sejarah telah melihat para pemikir Greek termasuk Aristotle secara kategorinya menerima Euthanasia dengan sebab utama untuk mengurangkan kesakitan. Bagaimanapun, apabila sains berkembang, perbahasan mengenai isu-isu agama dan etika tentang Euthanasia telah meningkat dengan nyata.KEYWORDS: mercy killing; religion; ethics; morality; euthanasia
Boivin, Gregory P; Bottomley, Michael A; Grobe, Nadja
The AVMA Panel on Euthanasia recommends that sensitive animals should not be present during the euthanasia of others, especially of their own species, but does not provide guidelines on how to identify a sensitive species. To determine if mice are a sensitive species we reviewed literature on empathy in mice, and measured the cardiovascular and activity response of mice observing euthanasia of conspecifics. We studied male 16-wk-old C57BL/6N mice and found no increase in cardiovascular parameters or activity in the response of the mice to observing CO2 euthanasia. Mice observing decapitation had an increase in all values, but this was paralleled by a similar increase during mock decapitations in which no animals were handled or euthanized. We conclude that CO2 euthanasia of mice does not have an impact on other mice in the room, and that euthanasia by decapitation likely only has an effect due to the noise of the guillotine. We support the conceptual idea that mice are both a sensitive species and display empathy, but under the controlled circumstances of the euthanasia procedures used in this study there was no signaling of stress to witnessing inhabitants in the room. PMID:27423146
Hickman, Debra L; Johnson, Steven W
Dissection of living brain tissue for in vitro experiments requires the use of a rapid euthanasia method. However, the method must not subject animals to unnecessary pain and must be aesthetically acceptable to experimenters. The purposes of the current study were to assess the aesthetics of 6 euthanasia methods, measure the procedure duration, and evaluate brain for pathology after each procedure. We digitally recorded euthanasia of isoflurane-anesthetized rats by 6 physical methods: anesthetic overdose, cardiac exsanguination, decapitation, closed intrathoracic transection of the great vessels and heart, thoracic percussion, and thoracotomy with rupture of great vessels. Volunteer researchers and animal caretakers watched the video and completed an associated questionnaire. Anesthetic overdose and cardiac exsanguinations were rated most aesthetically pleasing, although these procedures took the longest to complete. In contrast, decapitation and thoracic percussion were the least aesthetically pleasing, but these methods were the quickest. No demographic factor was identified that could predict whether a given euthanasia procedure would be favored for aesthetic reasons, and participants provided a wide variety of rationales for the aesthetic ratings they assigned. Although all of these euthanasia methods meet the criteria of approved methods of euthanasia of anesthetized rats as defined by the AVMA, aesthetic features and the scientific need for rapid euthanasia are both considerations in selecting a method. PMID:22330717
Abdi Omar Shuriye
This paper is an analysis on euthanasia from ethical and religious perspectives. Historically, the classical Greek thinkers including Aristotle had categorically accepted euthanasia with the main reason of minimizing pain...
Euthanasia has a wide range of classifications. Confusion exists in the application of specific concepts to various studies. To analyze the concept of voluntary active euthanasia using Walker and Avant's concept analysis method. A comprehensive literature review from various published literature and bibliographies. Clinical, ethical, and policy differences and similarities of euthanasia need to be debated openly, both within the medical profession and publicly. Awareness of the classifications about euthanasia may help nurses dealing with "end of life issues" properly.
Tur, Richard H S
Those who campaign for law reform to permit "euthanasia" may seek different things and at least some of what they seek may already be permissible under the criminal law of England and Wales. In this paper I examine one means whereby the criminal law delivers outcomes acceptable to the euthanasia lobby, that is the curious notion of "causation" deployed by the law, which adds a value override to the more usual notion of factual causation such that, for example, if medical treatment falls within the acceptable range as normal and proper, the pre-existing injury or illness is treated as exclusively the cause of death and the doctor escapes criminal liability, even where the medical treatment will shorten life to the certain knowledge, possibly even the wish, of the doctor. Thus the law may already be delivering a range of outcomes--euthanasia in a weak sense--acceptable to the euthanasia lobby. If so, it achieves this by stealth. That is inappropriate to the doctor-patient relationship, which is one of trust. So there is a strong case for greater transparency. Moreover, there are limits to the acceptable outcomes which an unreformed criminal law can deliver and in a range of cases the criminal law condemns the doctor to impotence and the patient to a prolonged, miserable and undignified death. So there is also a case for going beyond the current law and legalising euthanasia in a strong sense.
Full Text Available In this study, after the definition and short historical development of Euthanasia, a questionnaire was given to 510 medical staff; 208 of whom are medical students who are in the 5th form and 302 of whom are physcians. In this questionnaire 6 multiple choice questions were asked about the knowledge level, social groups to comment and argue on the subject, the right of person to decide about his/her own life, opinions about current applications of euthanasia, whether he/she would agree on the application of the process and whether he would accept to get a responsibility in it or not. It was determined that among the people who attended the questionnaire, one third didn't have enough knowledge about the subject while 325 (63.72 % of them supported the application, still 351 (68.82 % of them refused to get a responsibility in the application of euthanasia, even if the process becomes legal. Opinions of the people who are with and against the idea were collected and summarized, it was determined that although passive euthanasia is not legal it is currently being applied when it is necessary and that physcians are biased to the legalization of the subject while they refuse to take a role in the application. Keywords : Euthanasia, Self Deliverance, Right to Life, Mercy Killing, Informed Consent
Full Text Available ohn Arras argues against the legalization of physician- assisted suicide and active euthanasia on the basis of social costs that he anticipates will result from legalization. Arras believes that the legalization of highly restricted physician-assisted suicide will result in the legalization of active euthanasia without special restrictions, a prediction I grant for the sake of argument. Arras further anticipates that the practices of physician-assisted suicide and euthanasia will be abused, so that many patients who engage in these practices will lose out as a result. He refers to these losses as social costs to legalization. But the social costs at play in typical public policy debates are borne by individuals other than the agent who engages in the controversial activity, specifically by people who cannot be held responsible for enduring those costs. Even if plausible interpretations of Arras’ predictions about the abuse of the practice are granted, legalization of physician-assisted suicide or euthanasia brings no social costs of this latter sort. For this reason, and also because a ban on euthanasia is unfair to those who would profit from it, the losses in utility brought about by legalization would have to be very great to justify a ban.
In view of the continuing debate on euthanasia, the restrictions and safeguards which were introduced into the Voluntary Euthanasia (Legislation) Bill 1936 are discussed. Proposals for a new Terminal Care and Euthanasia Bill are suggested, based on some of the principles of the Mental Health Act 1983. PMID:2033626
In 2002 the Dutch Euthanasia Act came into force. This Act is the result of a lengthy developmental process. It codifies the requirements that have evolved in case law and medical ethics since 1973. Empirical data indicate that the Dutch euthanasia practice is stabilising. Euthanasia and assisted
Aghababaei, Naser; Farahani, Hojjatollah; Hatami, Javad
The main purposes of the present study were to see how the term "euthanasia" influences people's support for or opposition to euthanasia; and to see how euthanasia attitude relates to religious orientation and personality factors. In this study two different euthanasia attitude scales were compared. 197 students were selected to fill out either the Euthanasia Attitude Scale (EAS) or Wasserman's Attitude Towards Euthanasia scale (ATE scale). The former scale includes the term "euthanasia", the latter does not. All participants filled out 50 items of International Personality Item Pool, 16 items of the the HEXACO openness, and 14 items of Religious Orientation Scale-Revised. Results indicated that even though the two groups were not different in terms of gender, age, education, religiosity and personality, mean score on the ATE scale was significantly higher than that of the EAS. Euthanasia attitude was negatively correlated with religiosity and conscientiousness and it was positively correlated with psychoticism and openness. It can be concluded that analyzing the attitude towards euthanasia with the use of EAS rather than the ATE scale results in lower levels of opposition against euthanasia. This study raises the question of whether euthanasia attitude scales should contain definitions and concepts of euthanasia or they should describe cases of it.
... 21 Food and Drugs 6 2010-04-01 2010-04-01 false Euthanasia solution. 522.900 Section 522.900 Food... Euthanasia solution. (a) Specifications. Each milliliter (mL) of solution contains: (1) 390 milligrams (mg.... For humane, painless, and rapid euthanasia. (2) Amount. One mL per 10 pounds of body weight. (3...
Some background information about the context of euthanasia in Belgium is presented, and Belgian law on euthanasia and concerns about the law are discussed. Suggestions as to how to improve the Belgian law and practice of euthanasia are made, and Belgian legislators and medical establishment are urged to reflect and ponder so as to prevent potential abuse.
Rathwell-Deault, Dominick; Godard, Béatrice; Frank, Diane; Doizé, Béatrice
Companion animal welfare in our society has become increasingly important, yet many healthy animals are euthanized in veterinary facilities. How is it possible to explain the simultaneous presence of these opposing views of obligation toward animals? The goal of this study was to describe convenience euthanasia of companion animals as experienced by veterinarians in order to understand their thought processes. A qualitative study was undertaken to analyze the results of interviews of 14 veterinarians. The study showed that veterinarians interviewed assessed convenience euthanasia based mainly on their subjective evaluation of the owner-animal bond. As most owner-animal bonds stem from an anthropocentric point of view, decisions on convenience euthanasia were taken mostly by considering the veterinarian's and the client/owner's interests.
Rathwell-Deault, Dominick; Godard, Béatrice; Frank, Diane; Doizé, Béatrice
Companion animal welfare in our society has become increasingly important, yet many healthy animals are euthanized in veterinary facilities. How is it possible to explain the simultaneous presence of these opposing views of obligation toward animals? The goal of this study was to describe convenience euthanasia of companion animals as experienced by veterinarians in order to understand their thought processes. A qualitative study was undertaken to analyze the results of interviews of 14 veterinarians. The study showed that veterinarians interviewed assessed convenience euthanasia based mainly on their subjective evaluation of the owner-animal bond. As most owner-animal bonds stem from an anthropocentric point of view, decisions on convenience euthanasia were taken mostly by considering the veterinarian’s and the client/owner’s interests. PMID:28246412
When medical treatment becomes futile, or the patient's suffering is intractable, doctors face the agonising dilemma of whether to proceed with euthanasia. It is important for a doctor to be familiar with the law surrounding euthanasia, in order to avoid prosecution. This paper explores the law in England and Wales regarding the different categories of euthanasia: voluntary euthanasia, nonvoluntary euthanasia, passive euthanasia, and active euthanasia.
Shekhar, Skand; Goel, Ashish
Euthanasia requests have increased as the number of debilitated patients rises in both developed and developing countries such as India due to medical, psychosocial-emotional, socioenvironmental, and existential issues amid fears of potential misuse. WORLD'S POSITION: Albania, Colombia, the Netherlands, and Switzerland permit euthanasia conditionally. Australia's legalization of euthanasia has been withdrawn. The United States permits withdrawal of life support. Mexico and Norway permit active euthanasia. INDIA'S POSITION: Following the Aruna Shanbaug case the Supreme Court granted legal sanction to passive, but not active, euthanasia that is valid till the Parliament legislates on euthanasia. HANDLING EUTHANASIA REQUESTS: Acknowledging the complexity of the problem; individualizing the palliative approach; and accepting the 'There is no alternative' or 'There is no answer' (TINA) factor.
Full Text Available Abstract Background Mortality risk in Danish dairy cows has more than doubled since 1990 (from 2% in 1990 to 5% in 2005. Until now, registrations about dead cows in the Danish Cattle Database have not included information about whether the cow died unassisted or was euthanized. Methods We interviewed a random sample of 196 Danish dairy farmers that had reported a dead cow to the Danish Cattle Database in 2002 and 196 dairy farmers that had reported a dead cow in 2006. Our objectives were to evaluate the proportion of euthanized cows, changes in the behaviour of farmers regarding euthanasia of cows over the years and possible reasons for these changes. Results It seems that the threshold for euthanasia of cows among farmers has changed. Farmers generally reported a lower threshold for euthanasia compared to 5–10 years ago. Conclusion The threshold for euthanasia of cows has, according to the dairy farmers, become lower. This might have positive impacts on animal welfare as more seriously ill cows are euthanized in the herds and not put through a period of suffering associated with disease and treatment or transported to a slaughterhouse in poor condition.
Belgium legalised voluntary euthanasia in 2002, thus ending the long isolation of the Netherlands as the only country in which doctors could openly give lethal injections to patients who have requested help in dying. Meanwhile in Oregon, in the United States, doctors may prescribe drugs for terminally ill patients, who can use them to end their life--if they are able to swallow and digest them. But despite President Bush's oft-repeated statements that his philosophy is to 'trust individuals to make the right decisions' and his opposition to 'distant bureaucracies', his administration is doing its best to prevent Oregonians acting in accordance with a law that its voters have twice ratified. The situation regarding voluntary euthanasia around the world is therefore very much in flux. This essay reviews ethical arguments regarding voluntary euthanasia and physician-assisted suicide from a utilitarian perspective. I shall begin by asking why it is normally wrong to kill an innocent person, and whether these reasons apply to aiding a person who, when rational and competent, asks to be killed or given the means to commit suicide. Then I shall consider more specific utilitarian arguments for and against permitting voluntary euthanasia.
Emotional status and its brain bases change in a chronic pain patient and this change affects his/her decision making ability. Moreover, it is accepted that a mentally disturbed individual is not competent to make critical decisions. According to these bases, this article demonstrates that such patients are not entitled to request voluntary euthanasia.
Feb 17, 2004 ... South African Psychiatry Review - February 2004. 10. Euthanasia: a problem for psychiatrists done to those people had no connection whatsoever with what was in their interests. Here the term “euthanasia” was simply a euphemism for the massacre of persons regarded as undesirable by others in power.
Klopfer, Fredrick J.; Price, William F.
The study presented was conducted to examine potential relationships between attitudes regarding the dying process, including acceptance of euthanasia, and other attitudinal or demographic attributes. The data of the survey was comprised of responses given by 331 respondents to a door-to-door interview. Results are discussed in terms of preferred…
This article deals with the intentional distinction between murder of first degree and passive euthanasia. In Hungary, active euthanasia is considered to be a murder of first degree, whilst the Netherlands, Belgium, Luxemburg and Switzerland have legalized the active form of mercy killing in Europe. The palliative terminal care, when e.g. giving pain-killer morphine to the patient, might result in decreasing the patient's life-span, and thus causing indirect euthanasia. However, the legal institution of living will exists in several counter-euthanasia countries. The living will allows future patients to express their decision in advance to refuse a life-sustaining treatment, e.g. in case of irreversible coma. The institution of living will exists in Germany and in Hungary too. Nevertheless, the formal criteria of living will make it hardly applicable. The patient ought to express his/her will before a notary public in advance, and he/she should hand it over when being hospitalized. If the patient is not able to present his/her living will to his/her doctor in the hospital, then his/her only hope remains that he/she has given a copy of the living will to the family doctor previously, and the family doctor will notify the hospital.
Mayda, Atilla Senih; Ozkara, Erdem; Corapçioğlu, Funda
There have been intensive debates about euthanasia and attempts to change laws on euthanasia in all countries. What doctors and particularly oncologists think about euthanasia must be taken into consideration, as their voices are crucial in this dialogue. The aim of this study was to find out how Turkish doctors approach euthanasia in the context of cancer. A questionnaire was used to collect data from 85 oncologists out of a total 800 in active oncology practice. Of the oncologists surveyed, 43.8% did not object to euthanasia. Some 33.7% had been asked to perform euthanasia and 41.5% believed that euthanasia was performed secretly although it is against the law in Turkey. Forty-two doctors (50.6%) noted that they had withdrawn treatment in patients. Doctors who encounter terminally ill patients with cancer should update their knowledge about patients' rights and euthanasia. Doctors, who are often asked to perform euthanasia, especially in the cancer setting, can help to illuminate the debates about euthanasia.
Muñoz-Mediavilla, C; Cámara, J A; Salazar, S; Segui, B; Sanguino, D; Mulero, F; de la Cueva, E; Blanco, I
Directive 2010/63/EU on the protection of animals used for scientific purposes requires that the killing of mammal foetuses during the last third of their gestational period should be accomplished through effective and humane methods. The fact that murine foetuses are resistant to hypoxia-mediated euthanasia renders the current euthanasia methods ineffective or humane for the foetuses when these methods are applied to pregnant female mice. We have assessed the time to death of foetuses after performing either indirect (dam euthanasia) or direct (via intraplacental injection--a new approach to euthanasia) euthanasia methods in order to determine a euthanasia method that is appropriate, ethical and efficient for the killing of mouse foetuses. The respective times to death of foetuses after performing the three most commonly used euthanasia methods (namely cervical dislocation, CO2inhalation and intraperitoneal sodium pentobarbital administration) were recorded. Absence of foetal heartbeat was monitored via ultrasound. We consider that the most effective and humane method of foetal euthanasia was the one able to achieve foetal death within the shortest possible period of time. Among the indirect euthanasia methods assessed, the administration of a sodium pentobarbital overdose to pregnant female mice was found to be the fastest for foetuses, with an average post-treatment foetal death of approximately 29.8 min. As for the direct euthanasia method assessed, foetal time to death after intraplacental injection of sodium pentobarbital was approximately 14 min. Significant differences among the different mouse strains employed were found. Based on the results obtained in our study, we consider that the administration of a sodium pentobarbital overdose by intraplacental injection to be an effective euthanasia method for murine foetuses. © The Author(s) 2015.
... veterinarian induce its death quietly and humanely through euthanasia. A decision concerning euthanasia may be one of the most difficult decisions ... sure it has a good quality of life, euthanasia may be the right decision. Quality of life ...
Kumaş, Gülşah; Oztunç, Gürsel; Nazan Alparslan, Z
This study was conducted to gain opinions about euthanasia from nurses who work in intensive care units. The research was planned as a descriptive study and conducted with 186 nurses who worked in intensive care units in a university hospital, a public hospital, and a private not-for-profit hospital in Adana, Turkey, and who agreed to complete a questionnaire. Euthanasia is not legal in Turkey. One third (33.9%) of the nurses supported the legalization of euthanasia, whereas 39.8% did not. In some specific circumstances, 44.1% of the nurses thought that euthanasia was being practiced in our country. The most significant finding was that these Turkish intensive care unit nurses did not overwhelmingly support the legalization of euthanasia. Those who did support it were inclined to agree with passive rather than active euthanasia (P = 0.011).
Poreddi, Vijayalakshmi; Nagarajaiah; Konduru, Reddemma; Math, Suresh Bada
Euthanasia provokes controversies in various domains, such as the moral, ethical, legal, religious, scientific, and economic. India legalised passive euthanasia (withdrawal of life support) for patients with brain death or who are in a permanent vegetative state in 2011, but research on perceptions of euthanasia among people in India is limited. This study aimed to examine nurses' perceptions of the practice of euthanasia as well as factors influencing those perceptions. A non-probability quantitative, cross-sectional design was adopted for a sample of 214 nurses working at a tertiary care centre. Data was collected through self-reported questionnaires at the nurses workplace.The findings revealed mixed opinions on euthanasia among the nurses. However, the majority of the participants did not agree with the practice of euthanasia. Nonetheless, further research is needed on this issue across the country among various health professionals in the context of current legislation.
Chiriţă, V; Chiriţă, Roxana; Duică, Lavinia; Talau, Gh
Euthanasia/Assisted Suicide are viewed differently by moral and religious references. In a religious way, cardinal confessions (Christianity, Judaism, Islamism, Buddhism) condemn euthanasia/assisted suicide and, in the same time have a more relaxed attitude regarding passive euthanasia. Other aspects of euthanasia regard financial/economic and ethical-medical considerations. All these contradictory standpoints are expressed in some legal acts that make specifications on the concept of "euthanasia"--Oregon's Death with Dignity Act (1994) and Netherlands's Euthanasia Law (2001).
Alphen, J.E. van; Donker, G.A.; Marquet, R.L.
The Netherlands was the first country in the world to implement a Euthanasia Act in 2002. It is unknown whether legalising euthanasia under strict conditions influences the number and nature of euthanasia requests. AIM: To investigate changes in the number of, and reasons for, requests for
Abdi Omar Shuriye
This paper is an analysis on euthanasia from ethical and religious perspectives. Historically, the classical Greek thinkers including Aristotle had categorically accepted euthanasia with the main reason of minimizing pain. However, as science develops ethical and religious isuues related to the subject have increasingly created fervent debates on euthanesia. ABSTRAK: Kertas ini mengkaji euthanasia dari perspektif agama dan etika. Sejarah telah melihat para pemikir Greek termasuk Aristotle sec...
There has been renewed interest in the moral arguments surrounding euthanasia. Some patients are now apprehensive of advanced medical technology which they fear may result in a prolonged and undignified death. In the current situation of scarce resources for health care, both patients and doctors could be coerced into considering active euthanasia if it was legally available. In this paper it is argued that doctors now need to make a clear statement rejecting active euthanasia but affirming t...
Full Text Available The topic of euthanasia can be defined and analyzed upon considering several perspectives, such as the legal, religious, historical, philosophical, medical or ethical ones. This article attempts to supply a brief presentation of these perspectives, indicating the existing trends and standpoints at world level in connection to perceptions regarding the phenomenon mentioned, exemplified by opinions described in the doctrine and relevant jurisprudence. At the same time, in this article I will try to indicate the weak spots of the Romanian legislation in the euthanasia area, upon supplying some proposals for legislative intervention. Concomitantly, it should appear the idea that not the right to die per se is to receive motivations and be included in the law, but the duty to live. This should be done first by drafting an adequate law to the terminal states that would guide their medical practice and comply with the world legislative trends.
Yuvraj Dilip Patil
Full Text Available Dying has become imposition upon humans, who seek to avoid it as they encounter the inevitably fatal aging process. After the case of Aruna Shanbag a nurse who spent 42 years in a vegetative state as a result of sexual assault, the issue of euthanasia-mercy killing gained attention. The formulation of regulatory provision for euthanasia was earlier examined in Health Ministry in th 2006 based on the 196 report of the law commission of India however; health ministry at that time had opted not to make law on it. Interestingly the health ministry has enacted bill for terminally ill patient in 2016. In this article author has discussed The Medical Treatment of Terminally Ill Patients (Protection of patients and medical practitioners bill- 2016 with position in other countries.
Low, J A; Pang, W S
There has been a gradual shift in the attitude of the medical community as well as the lay public towards greater acceptance of euthanasia as an option for care of the terminally ill and dying. There have also been calls by certain groups to actually legalize voluntary euthanasia and physician-assisted suicide for patients who meet certain conditions, some of which are as follows: that the patient be of a sound mind, suffering from an incurable or terminal illness, experiencing unbearable suffering and uncontrollable pain. The rationale for legalizing euthanasia is based on the principle of the patient's right of self-determination and the duty of doctors to relieve pain and suffering at all times. A few within the medical community quickly saw certain similarities in terms of goals and aims between euthanasia and palliative care and, thus, proposed that euthanasia be an option or choice for difficult palliative care cases. Some even went as far as to suggest that euthanasia and palliative care be part of the continuum of care for terminally ill patients. When palliative medicine fails to fully control pain and suffering for the patient, euthanasia can be the logical next step in the continuum of care. This article seeks to discuss why the rationale for legalizing euthanasia is flawed, why euthanasia goes against the fundamental principles of Medicine in general and why it is incompatible with the practice of palliative medicine.
Sanders, K; Chaloner, C
Euthanasia is a highly emotive and contentious subject, giving rise to a great deal of debate. However, despite its frequent exposure in public and professional media, there appears to be a lack of clarity about the concepts and definitions used in the euthanasia debate. This suggests that discussions on this subject are inadequately informed and ineffectual. The ethical focus of the euthanasia debate concerns the moral legitimacy of 'voluntary euthanasia'. This article provides an overview and clarification of some of the key ethical issues at the centre of that debate.
In 2002 the Dutch Euthanasia Act came into force. This Act is the result of a lengthy developmental process. It codifies the requirements that have evolved in case law and medical ethics since 1973. Empirical data indicate that the Dutch euthanasia practice is stabilising. Euthanasia and assisted suicide occur in 2.7% of all deaths. Now that the Act has been passed, the focus is on improving the quality of medical decision-making. From an international perspective, the Dutch legislation is exceptional. However, it appears that other countries and international organisations are considering euthanasia legislation as well. It remains to be seen how influential the Dutch model will prove to be.
Kirmes, Tomasz; Wilk, Mateusz; Chowaniec, Czesław
This article is an attempt to complete and holistically discuss problem of euthanasia, especially its ethical and legal aspects, comparing to Polish law. The subject of euthanasia arouse interest of the society because it touches one of the most important aspects of life, which is the death. Even bigger emotions are aroused amongst physicians. They are forced to put on the line the life as biggest value on the one side and autonomy of human being on the other. It also touches the empathy for suffering. The euthanasia was divided into three forms: active euthanasia, passive euthanasia and assisted suicide. Any form of euthanasia is illegal in Poland according to both the Penal Code and Code of Medical Ethics. Range of possible penal consequences perpetrator is very wide from waiver of punishment to life imprisonment and it comes from different penal qualification of the euthanasia. Qualification of the euthanasia is based on terms of intent of perpetrator's act, request of patient, strong empathy for suffering if the patient and decision based on up-to-date medical knowledge. It is valuable to mention "do-not-resuscitate" DNR procedure, which in case of medical futility is legally accepted in Poland, but in other form may be qualified as passive euthanasia.
There has been renewed interest in the moral arguments surrounding euthanasia. Some patients are now apprehensive of advanced medical technology which they fear may result in a prolonged and undignified death. In the current situation of scarce resources for health care, both patients and doctors could be coerced into considering active euthanasia if it was legally available. In this paper it is argued that doctors now need to make a clear statement rejecting active euthanasia but affirming that in certain cases passive euthanasia, or letting die, may be morally justifiable.
Full Text Available The right to life is one of the fundamental rights of people that have to be respected and protected by each state’s legislation. The connection between the right to life and criminal law is a significant one, as the Criminal Code incriminates a few categories of crimes that can prejudice it. Although that as an object of crimes against life, a person’s life is recognized, the right to life remains a value that can suffer from criminal attempts. Often, in literature, the correlation or the relation between certain criminal acts is discussed, such as the genocide, illegal abortion, euthanasia, infanticide and the right to life, the possibility of mutual influence and their coexistence. Furthermore, the problem ofeuthanasia involves also the examination of practical and juridical connotations connected to the free accomplishment of the human fundamental rights and the right to life in particular. Can thecompatibility or the incompatibility of euthanasia with the right to law be decisive? The answer can only be an affirmative one, as through this approach the judicial statute and the scope of euthanasia can be determined.
Harvey, J C; Pellegrino, E D
The outcome of the physician-assisted suicide and euthanasia debate will profoundly influence physicians' role in society, the kind of society we become, and the way physicians and patients relate to one another. Three forces account for the move to physician-assisted suicide and euthanasia: an abuse of scientific advancement, a new political philosophy, and the erosion of religious consensus. The relationship between patients and physicians has often been understood as a convenant with rights on patients' part and duties on physicians' part. Physicians' duties in this covenantal relationship are to act for patients' good (a positive duty) and to do no harm (a negative duty). Euthanasia and assisted suicide are morally wrong because, as the Judeo-Christian ethic teaches, human beings are creatures of God and have only stewardship, not dominion, over life. But in our pluralistic society, which seems to lack consensus on religion, on communal responsibility, and on common values, one cannot argue against mercy killing and assisted suicide on theological grounds. Our society generally agrees, however, that a discussion of values may take place in the language of moral philosophy, a language that expresses right reason.
Travis K. Warren
Full Text Available Multiple products are being developed for use against filoviral infections. Efficacy for these products will likely be demonstrated in nonhuman primate models of filoviral disease to satisfy licensure requirements under the Animal Rule, or to supplement human data. Typically, the endpoint for efficacy assessment will be survival following challenge; however, there exists no standardized approach for assessing the health or euthanasia criteria for filovirus-exposed nonhuman primates. Consideration of objective criteria is important to (a ensure test subjects are euthanized without unnecessary distress; (b enhance the likelihood that animals exhibiting mild or moderate signs of disease are not prematurely euthanized; (c minimize the occurrence of spontaneous deaths and loss of end-stage samples; (d enhance the reproducibility of experiments between different researchers; and (e provide a defensible rationale for euthanasia decisions that withstands regulatory scrutiny. Historic records were compiled for 58 surviving and non-surviving monkeys exposed to Ebola virus at the US Army Medical Research Institute of Infectious Diseases. Clinical pathology parameters were statistically analyzed and those exhibiting predicative value for survival are reported. These findings may be useful for standardization of objective euthanasia assessments in rhesus monkeys exposed to Ebola virus and may serve as a useful approach for other standardization efforts.
Warren, Travis K; Trefry, John C; Marko, Shannon T; Chance, Taylor B; Wells, Jay B; Pratt, William D; Johnson, Joshua C; Mucker, Eric M; Norris, Sarah L; Chappell, Mark; Dye, John M; Honko, Anna N
Multiple products are being developed for use against filoviral infections. Efficacy for these products will likely be demonstrated in nonhuman primate models of filoviral disease to satisfy licensure requirements under the Animal Rule, or to supplement human data. Typically, the endpoint for efficacy assessment will be survival following challenge; however, there exists no standardized approach for assessing the health or euthanasia criteria for filovirus-exposed nonhuman primates. Consideration of objective criteria is important to (a) ensure test subjects are euthanized without unnecessary distress; (b) enhance the likelihood that animals exhibiting mild or moderate signs of disease are not prematurely euthanized; (c) minimize the occurrence of spontaneous deaths and loss of end-stage samples; (d) enhance the reproducibility of experiments between different researchers; and (e) provide a defensible rationale for euthanasia decisions that withstands regulatory scrutiny. Historic records were compiled for 58 surviving and non-surviving monkeys exposed to Ebola virus at the US Army Medical Research Institute of Infectious Diseases. Clinical pathology parameters were statistically analyzed and those exhibiting predicative value for survival are reported. These findings may be useful for standardization of objective euthanasia assessments in rhesus monkeys exposed to Ebola virus and may serve as a useful approach for other standardization efforts.
Bolt, Eva E; Pasman, H Roeline W; Deeg, Dorly J H; Onwuteaka-Philipsen, Bregje D
To determine whether older people with advance directive for euthanasia (ADEs) are stable in their advance desire for euthanasia in the last years of life, how frequently older people with an ADE eventually request euthanasia, and what factors determine this. Mortality follow-back study nested in a cohort study. The Netherlands. Proxies of deceased members of a cohort representative of Dutch older people (n = 168) and a cohort of people with advance directives (n = 154). Data from cohort members (possession of ADE) combined with after-death proxy information on cohort members' last 3 months of life. Multiple logistic regression analysis was performed on determinants of a euthanasia request in individuals with an ADE. Response rate was 65%. One hundred forty-two cohort members had an ADE at baseline. Three months before death, 87% remained stable in their desire for euthanasia; 47% eventually requested euthanasia (vs 6% without an ADE), and 16% died after euthanasia. People with an ADE were more likely to request euthanasia if they worried about loss of dignity. The majority of older adults who complete an ADE will have a stable preference over time, but an advance desire for euthanasia does not necessarily result in a euthanasia request. Writing an ADE may reflect a person's need for reassurance that they can request euthanasia in the future. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.
Proponents and opponents of euthanasia have argued passionately about whether it should be legalized. In Australia in the mid-1990s, following the world's first legal euthanasia deaths, Dr. Philip Nitschke initiated a different approach: a search for do-it-yourself technological means of dying with dignity. The Australian government has opposed…
Each of the Benelux countries (Belgium, Luxembourg, Netherlands) has enacted legislation that partially decriminalises euthanasia, defined as an act that intentionally terminates someone's life at their request. In the Netherlands and Luxembourg, but not in Belgium, the legislation partially decriminalised assisted suicide at the same time. In all three countries, euthanasia can only be performed by a doctor, in response to the patient's voluntary and well-considered request, and for patients who have an incurable disease that causes unbearable suffering, without any prospect of relief. In the Netherlands, minors can request euthanasia as of the age of 12 years. In 2011, reported euthanasia accounted for about 1% of deaths in Belgium and 3% in the Netherlands. In 75% of cases, cancer was the disease leading to a request for euthanasia. In the Netherlands, the number of cases of euthanasia reported by doctors in surveys matches the number that is officially declared. In Belgium, it is thought that there are as many unreported as reported cases of euthanasia. Since the enactment of euthanasia legislation, fewer deaths involve the intentional administration of lethal drugs without an explicit request from the patient.
The article examines current opinions toward euthanasia of persons with mental retardation in light of the history of public and professional attitudes. It also discusses the rejection of euthanasia on moral and religious grounds, and notes the use of lifelong incarceration, based on eugenics principles, to accomplish similar ends. (DB)
The Dutch euthanasia legislation has been lauded as well as criticized by legal scholars and physicians in the Netherlands and abroad. The legal framework so established is renowned for setting a number of valuable due-care criteria for the physician to follow when performing euthanasia on a
In 2002, Belgium became the second country to legalise euthanasia after the Netherlands. Three biannual reports have been published by the Federal Control and Evaluation Commission, the body which monitors the application of the law. This article explores how the Belgian law works and what is known about Belgian euthanasia practice both before and since legalisation.
The Dutch Euthanasia Act states that an advance directive can replace an actual request for euthanasia in cases in which a patient has become unable to make autonomous decisions. In Euthanasia and the Severely Demented, I agree with Keizer that the severely demented can suffer unbearably, but contrary to Keizer I do not believe that it is impossible to state in advance the conditions under which one would not wish to go on living any longer. Consequently, euthanasia can be permissible even in patients with late-stage dementia, provided that the other due-care criteria are met. Permissibility by itself, however, will not settle disputes about borderline cases. Due to the erratic course of the disease, the right moment for euthanasia may very well be impossible to determine.
Most arguments against active euthanasia, as do most arguments in applied ethics generally, take place within the framework of what can broadly be referred to as a modern, as opposed to an ancient, approach to moral theory. In this paper, I argue that this fact works to the disadvantage of opponents of active euthanasia, and that if there is a successful argument against active euthanasia, it will be of the latter sort. In Part I, I attempt to clarify the distinction between modern and ancient approaches with which I am concerned. In Part II, I attempt to show that any argument against active euthanasia that is of the first sort is bound to fail. In Part III, I propose an argument against active euthanasia of the second sort that I believe has a better chance for success. In Part IV, I consider some objections that can be raised against this argument and attempt to show how they can be overcome.
Current opinions on euthanasia of persons with mental retardation were discussed within the framework of the development of social policy towards this population. Historians of mental retardation have emphasized that incarceration and sterilization were the only two policy options available in the late 19th and early 20th centuries, but a third option, euthanasia, was also suggested. The significance of the euthanasia option as the nation struggled to find a solution to the question of how to deal with what was thought to be a sharp rise in the number of people with mental retardation in the United States in the late 19th and early 20th centuries was examined. The responses of service providers to suggestions that euthanasia be implemented were reviewed. The rejection of proposals for euthanasia on moral and religious grounds and on the basis that custodial institutions, based on eugenics principles, were able to achieve the same end through a scientifically justifiable means was explored.
Eliott, Jaklin A; Olver, Ian N
Within developed nations, there is increasing public debate about and apparent endorsement of the appropriateness of euthanasia as an autonomous choice to die in the face of intolerable suffering. Surveys report socio-demographic differences in rates of acceptance of euthanasia, but there is little in-depth analysis of how euthanasia is understood and positioned within the social and moral lives of individuals, particularly those who might be considered suitable candidates-for example, terminally-ill cancer patients. During discussions with 28 such patients in Australia regarding medical decisions at the end of life, euthanasia was raised by 13 patients, with the others specifically asked about it. Twenty-four patients spoke positively of euthanasia, 19 of these voicing some concerns. None identified euthanasia as a currently favoured option. Four were completely against it. Endorsement for euthanasia was in the context of a hypothetical future or for a hypothetical other person, or temporally associated with acute pain. Arguments supporting euthanasia framed the issue as a matter of freedom of choice, as preserving dignity in death, and as curbing intolerable pain and suffering, both of the patient and of those around them. A common analogy featured was that of euthanising a dog. These arguments were typically presented as self-evident justification for euthanasia, construed as an appropriate choice to die, with opposers positioned as morally inferior or ignorant. The difficulties of ensuring 'choice' and the moral connotations of 'choosing to die,' however, worked to problematise the appropriateness of euthanising specific individuals. We recommend further empirical investigation of the moral and social meanings associated with euthanasia.
Gastmans, C; Van Neste, F; Schotsmans, P
On 23 September 2002, the Belgian law on euthanasia came into force. This makes Belgium the second country in the world (after the Netherlands) to have an Act on euthanasia. Even though there is currently legal regulation of euthanasia in Belgium, very little is known about how this legal regulation could be translated into care for patients who request euthanasia.
Gastmans, C; Van Neste, F; Schotsmans, P
On 23 September 2002, the Belgian law on euthanasia came into force. This makes Belgium the second country in the world (after the Netherlands) to have an Act on euthanasia. Even though there is currently legal regulation of euthanasia in Belgium, very little is known about how this legal regulation could be translated into care for patients who request euthanasia. PMID:15082821
Skuterud, L.; Strand, P. [Norwegian Radiation Protection Authority (Norway); Howard, B.J. [Inst. of Terrestrial Ecology (United Kingdom)
The radionuclides of most concern with respect to contamination of animals after a nuclear accident are radioiodine, radiocaesium and radiostrontium (ICRP 30, 1979). Of the other significant anthropogenic radionuclides likely to be released in most accidents, only small proportions of that ingested will be absorbed in an animals gut, and the main animal products, milk and meat, will not normally be contaminated to a significant extent. Animal products will mostly be contaminated as a result of ingestion of contaminated feed and possibly, but to a much lesser extent, from inhalation (for radioiodine only). Direct external contamination of animals is of little or no consequence in human food production. Radioiodine and radiostrontium are important with respect to contamination of milk; radiocaesium contaminates both milk and meat. The physical and chemical form of a radionuclide can influence its absorption in the animal gut. For example, following the Chernobyl accident radiocaesium incorporated into vegetation by root uptake was more readily absorbed than that associated with the original deposit. The transfer of radiocaesium and radiostrontium to animals will be presented both as transfer coefficients and aggregated transfer coefficients. For most animal meat products, only radiocaesium is important as other radionuclides do not significantly contaminate muscle. Farm animal products are the most important foodstuff determining radiocaesium intake by the average consumer in the Nordic countries. The major potential source of radioiodine and radiostrontium to humans is milk and milk products. Of the different species, the smaller animals have the highest transfer of radiocaesium from fodder to meat and milk. (EG). 68 refs.
Kuře, Josef; Vaňharová, Michaela
Both in the general public and in the professional communities, very diverse notions of euthanasia can be found. At the same time determining of the precise semantics of euthanasia is one of the crucial prerequisites for subsequent meaningful ethical discussion of euthanasia. The paper analyzes an empirical study investigating the understanding of euthanasia by medical students. The aim of the conducted research was to identify the semantic definitions of euthanasia used by the first-year medical students.
van Zyl, Liezl
Following the recent revival of virtue ethics, a number of ethicists have discussed the moral problems surrounding euthanasia by drawing on concepts such as compassion, benevolence, death with dignity, mercy, and by inquiring whether euthanasia is compatible with human flourishing. Most of these writers assert, or simply assume, that their arguments concerning the morality of euthanasia also support their views with regard to legislation. I argue, against these writers, that legislation cannot and should not be based on our moral and religious beliefs concerning whether euthanasia allows a person to die a good death. I then outline an Aristotelian approach to the role of law and government in a good society, according to which the task of the legislator is not to ensure that people actually act virtuously, but is instead to make it possible for them to choose to live (and die) well by ensuring that they have access to the goods that are necessary for flourishing. In the second half of the paper I apply this approach to the question of whether voluntary active euthanasia should be legalised by asking (1) whether euthanasia always deprives people of the necessary conditions for flourishing, and (2) whether the option to request euthanasia is ever necessary for flourishing.
Naseh, Ladan; Heidari, Mohammad
One of the most common morally controversial issues in endof-life care is euthanasia. Examining the attitudes of nursing students to this issue is important because they may encounter situations related to euthanasia during their clinical courses. The aim of our study was to examine nursing students' attitudes to euthanasia in Shahrekord city in western Iran. This was done using the Euthanasia Attitude Scale. The scale is divided into four categories, ie ethical considerations, practical considerations, treasuring life and naturalistic beliefs. Of 132 nursing students, 120 participated in the study (response rate 93.1%). According to the study's findings, 52.5%, 2.5% and 45% of the students reported a negative, neutral and positive attitude to euthanasia, respectively. There was a significant correlation between the nursing students' attitudes to euthanasia and some demographic characteristics, including sex, age and religious beliefs. Iranian Muslim nursing students participating in the study had a negative attitude to euthanasia. Further studies are recommended among nursing students from different cultures and of different religious faiths.
Direct active euthanasia is prohibited in most countries while passive and indirect is not. However, many arguments against the legalization of voluntary active euthanasia are flawed. Ethical differences between active and passive or indirect euthanasia are difficult to maintain especially when the passivity of the actor causes death. The crucial point is not activity or passivity but respect for the autonomy of individual human beings. In particular there appears to be little ethical difference between active and indirect euthanasia. Indirect euthanasia has often been justified by the principle of double effect, which traces back to Thomas Aquinas. But resorting to this rule contains a logical fallacy. The principle of double effect does not allow foreseen and unwanted adverse effects of an action to occur when they are avoidable. In terminal sedation, an example for indirect euthanasia, hypoxemia and dehydration can easily be prevented by respirator therapy and fluid administration. Therefore the rule of double effect is not applicable. Indirect and direct active euthanasia cannot be ethically distinguished by resorting to the principle of double effect.
Smets, Tinne; Cohen, Joachim; Bilsen, Johan; Van Wesemael, Yanna; Rurup, Mette L; Deliens, Luc
Since the legalization of euthanasia, physicians in Belgium may, under certain conditions, administer life-ending drugs at the explicit request of a patient. To study the attitudes of Belgian physicians toward the use of life-ending drugs and euthanasia law, factors predicting attitudes, and factors predicting whether a physician has ever performed euthanasia. In 2009, we sent a questionnaire to a representative sample of 3006 Belgian physicians who, because of their specialty, were likely to be involved in the care of the dying. Response rate was 34%. Ninety percent of physicians studied were accepting of euthanasia for terminal patients who had extreme uncontrollable pain/symptoms. Sixty-six percent agreed that the euthanasia law contributes to the carefulness of physicians' end-of-life behavior; 10% agreed that the law impedes the development of palliative care. Religious beliefs and geographic region were strong determinants of attitude. Training in palliative care did not influence attitudes regarding euthanasia, but trained physicians were less likely to agree that the euthanasia law impedes the development of palliative care than were nontrained physicians. One in five physicians had performed euthanasia; they were more likely to be nonreligious, older, specialist, trained in palliative care, and to have had more experience in treating the dying. Most physicians studied support euthanasia for terminal patients with extreme uncontrollable pain/symptoms and agree that euthanasia can be part of good end-of-life care. Although physicians had little involvement in the process of legalizing euthanasia, they now generally endorse the euthanasia law. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
Full Text Available This study aimed to carry out an analysis of the figure of euthanasia and its ethical implications. Addressed to aspects of bioethics and principlism, the theory developed by Beauchamp and Childress. Also presented is the right philosopher Ronald Dworkin position, in favor of euthanasia. Euthanasia is a complex, multidisciplinary subject, your debate is very timely because of the medical possibilities of keeping a person alive indefinitely, regardless of their suffering. The search for alternatives should continue in order to defend the autonomy of patients in their end of life choices and to respect their dignity.
Beca, J P; Leiva, A
The recent enactment of a law that allows infant euthanasia in Belgium raises questions with varied answers. To contribute to a better understanding of the topic, euthanasia and legislation concepts are described. After a bioethical analysis, we propose as conclusion that children euthanasia could only be acceptable in very exceptional situations in which palliative measures have failed. The answer should be that it is not acceptable in our setting, not until we have public policies, protocols and palliative care services for terminally ill children.
Full Text Available Death is a universal phenomenon, it happens touches every person. One of the aspects of wide concern regarding death is euthanasia. It invokes much controversy, with some people being supporters whilst others being opposed against it. In some countries euthanasiahas been legalized. The Catholic Church is decidedly against euthanasia, but at the same time is critical of the use of excessive therapy. Public opinion in Western Europe, the USA, Canada and Australia supports the allowance of the use of euthanasia. In Poland most people reject such a possibility; however the number of supporters of “death by personal choice” in recent years has increased.
Johnson, Karen L; Cicirelli, Jon
Cat impoundments were increasing at the municipal San Jose animal shelter in 2009, despite long-term successful low cost sterilization programs and attempts to lower the euthanasia rate of treatable...
von Engelhardt, Dietrich
Euthanasia signifies in antiquity an easy and happy death and not at all an active termination of life, which was forbidden in the Hippocratic oath, but justified by philosophers. In the Christian middle ages active euthanasia and abortion are explicitly refused. At the beginnings of modern times MORE (1516) and BACON (1623) plead for euthanasia and differentiate for the first time between "euthanasia interior" as a mental preparation and "euthanasia exterior" as a physical and direct termination of life. Around 1900 a change takes place--in medicine as well as in the humanities and arts. The lawyer Karl BINDING and the psychiatrist Alfred HOCHE (1920) support active euthanasia in the case of mental deficiency; similar views are taken by the population. Under the "Third Reich" euthanasia unlawfully is carried out as termination of life without or even against consent. Today oaths, declarations and laws are intended to prevent such a "medicine without humanity" (MITSCHERLICH and MIELKE 1947). Active voluntary euthanasia is under certain conditions allowed by the legislation in some countries (Netherlands, Belgium, Luxembourg). Essential seem the consideration of different types of euthanasia and above all a psychical-mental assistance in the process of dying. The height of culture is measured by dealing with death and dying.
Coenen, A.M.L.; Drinkenburg, W.H.I.M.; Hoenderken, R.; Luijtelaar, E.L.J.M. van
This paper records the effects of carbon dioxide when used for euthanasia, on behaviour, electrical brain activity and heart rate in rats. Four different methods were used. Animals were placed in a box (a) that was completely filled with carbon dioxide; (b) into which carbon dioxide was streamed at
Saad, Toni C
This article describes and evaluates the Belgian euthanasia experience by considering its practice and policy, both before and after the formal decriminalisation of euthanasia in 2002. The pre-legal practice of euthanasia, the evolution of euthanasia legislation, criticism of this legislation, the influence of politics, and later changes to the 2002 Act on Euthanasia are discussed, as well as the subject of euthanasia of minors and the matter of organ procurement. It is argued that the Belgian euthanasia experience is characterised by political expedition, and that the 2002 Act and its later amendments suffer from practical and conceptual flaws. Illegal euthanasia practices remain a live concern in Belgium, something which nations who are seeking to decriminalise euthanasia should consider. Copyright © 2017 by the National Legal Center for the Medically Dependent and Disabled, Inc.
In The Netherlands, euthanasia is defined as the deliberate termination of the life of a person on his request by another person. Although, in this limited sense, euthanasia is only one of the issues raised by medical decision-making at the end of life, it is, in particular, the acceptance of euthanasia in this country that has attracted attention from abroad. Also, in The Netherlands itself, the toleration of the courts of euthanasia (if carried out by a physician under strict conditions) has given rise to much debate. This contribution surveys the developments in the law (including recent legislation), and in medical practice, and explores the relation between the two, with particular attention to the position of the physician.
Cristina Otovescu Frasie; Andreea Bandoiu
.... Subsequently, it examines the issues regarding the euthanasia and it presents different cases of citizens from Great Britain, France, and Romania who claimed for their right to assisted suicide...
Eduard Verhagen, A A
Decisions about neonatal end-of-life care have been studied intensely over the last 20 years in The Netherlands. Nationwide surveys were done to quantify these decisions, provide details and monitor the effect of guidelines, new regulations and other interventions. One of those interventions was the Groningen Protocol for newborn euthanasia in severely ill newborns, published in 2005. Before publication, an estimated 20 cases of euthanasia per year were performed. After publication, only two cases in five years were reported. Studies suggested that this might be partly caused by the lack of consensus about the dividing line between euthanasia and palliative care. New recommendations about paralytic medication use in dying newborns were issued to increase transparency and to improve reporting of euthanasia. New surveys will be needed to measure the effects of these interventions. This cycle of interventions and measurements seems useful for continuous improvement of end-of-life care in newborns. Copyright © 2014 Elsevier Ltd. All rights reserved.
This article counters arguments made by Bartels and Otlowski in 2010 regarding euthanasia. It suggests that the authors over-emphasised the importance of individual autonomy in its bearing on the euthanasia debate. Drawing on literature concerning elder abuse as well as the "mercy-killing" cases reviewed by Bartels and Otlowski, the article contends that legalising euthanasia may increase the risk that some patients are pressured, inadvertently or deliberately, to request access. Safeguards to detect and deter pressure may be of limited effectiveness against such pressure. Regarding slippery slope arguments, the article discusses the potential for an Australian euthanasia system to eventually be extended in scope to encompass mental suffering. The article encourages consideration of long-term potentialities, including changes in macro-economic conditions.
Banović, Božidar; Turanjanin, Veljko
Background Euthanasia is one of the most intriguing ethical, medical and law issues that marked whole XX century and beginning of the XXI century, sharply dividing scientific and unscientific public...
Perrett, R W
Damien and John Keown claim that there is important common ground between Buddhism and Christianity on the issue of euthanasia and that both traditions oppose it for similar reasons in order to espouse a "sanctity of life" position. I argue that the appearance of consensus is partly created by their failure to specify clearly enough certain key notions in the argument: particularly Buddhism, euthanasia and the sanctity of life. Once this is done, the Keowns' central claims can be seen to be e...
Schmiedebach, H-P; Woellert, K
Many of the judicial and ethical questions raised by euthanasia are still the subject of controversial discussions. In this context the article broaches the issues of the doctor- patient relationship, patient's right to autonomy, and advance directive. It deals with the present judicial possibilities of euthanasia in Germany with reference to the situation in the Netherlands. Finally, there is an outlook on the role of palliative care and of hospices.
Is there a moral difference between euthanasia for terminally ill adults and euthanasia for terminally ill children? Luc Bovens considers five arguments to this effect, and argues that each is unsuccessful. In this paper, I argue that Bovens' dismissal of the sensitivity argument is unconvincing. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Verpoort, Charlotte; Gastmans, Chris; Dierckx de Casterlé, Bernadette
In debates on euthanasia legalization in Belgium, the voices of nurses were scarcely heard. Yet studies have shown that nurses are involved in the caring process surrounding euthanasia. Consequently, they are in a position to offer valuable ideas about this problem. For this reason, the views of these nurses are important because of their palliative expertise and their daily confrontation with dying patients. The aim of this paper is to report a study of the views of palliative care nurses about euthanasia. A grounded theory approach was chosen, and interviews were carried out with a convenience sample of 12 palliative care nurses in Flanders (Belgium). The data were collected between December 2001 and April 2002. The majority of the nurses were not a priori for or against euthanasia, and their views were largely dependent on the situation. What counted was the degree of suffering and available palliative options. Depending on the situation, we noted both resistance and acceptance towards euthanasia. The underlying arguments for resistance included respect for life and belief in the capabilities of palliative care; arguments underlying acceptance included the quality of life and respect for patient autonomy. The nurses commented that working in palliative care had a considerable influence on one's opinion about euthanasia. In light of the worldwide debate on euthanasia, it is essential to know how nurses, who are confronted with terminally ill patients every day, think about it. Knowledge of these views can also contribute to a realistic and qualified view on euthanasia itself. This can be enlightening to the personal views of caregivers working in a diverse range of care settings.
In February 2014 the Belgian parliament voted to extend the existing euthanasia law to cover children under the age of 18. The law sanctions euthanasia for children with terminal or incurable conditions who are near death, suffering 'constant and unbearable pain', and whose parents and health professionals agree with the decision. The child also has to be interviewed by a psychologist or psychiatrist to ascertain and certify their 'capacity of discernment'.
Smets, Tinne; Cohen, Joachim; Bilsen, Johan; Van Wesemael, Yanna; Rurup, Mette L; Deliens, Luc
... and controversial medical acts possible, the law includes a mandatory notification procedure requiring physicians to report each euthanasia case to the Federal Control and Evaluation Committee, which assesses whether the physician has respected all the requirements of the law. 2 Since the enactment of the euthanasia law, the frequency and characteris...
Musgrave, C F
To discuss the critical issues involved in the legalization of active euthanasia and physician-assisted suicide. Nursing, medical, legal, and ethics literature; newspaper articles; book chapters. The major terms employed in the discussion of active euthanasia and physician-assisted suicide are defined. The implications of the recent Supreme Court decision on these practices are outlined. The Dutch euthanasia and the American abortion scenarios are used as models for the interpretation of the effects of future legislation on such practices. Oncology nurses need to be cognizant of the crucial issues involved in the practices of active euthanasia and physician-assisted suicide and determine their philosophical stance regarding the practices. If active euthanasia and physician-assisted suicide practices are legalized, oncology nurses will have to make decisions about their desired degree of involvement in acts that will end their patients' lives.
Kinsella, T D; Verhoef, M J
To ascertain the opinions of a sample of Alberta physicians about the morality and legalization of active euthanasia, the determinants of these opinions and the frequency and sources of requests for assistance in active euthanasia. Cross-sectional survey of a random sample of Alberta physicians, grouped by site and type of practice. Alberta. A total of 2002 (46%) of the licensed physicians in Alberta were mailed a 38-item questionnaire in May through July 1991; usable responses were returned by 1391 (69%). Of the respondents 44% did believe that it is sometimes right to practice active euthanasia; 46% did not. Moral acceptance of active euthanasia correlated with type of practice and religious affiliation and activity. In all, 28% of the physicians stated that they would practice active euthanasia if it were legalized, and 51% indicated that they would not. These opinions were significantly related to sex, religious affiliation and activity, and country of graduation. Just over half (51%) of the respondents stated that the law should be changed to permit patients to request active euthanasia. Requests (usually from patients) were reportedly received by 19% of the physicians, 78% of whom received fewer than five. This survey revealed severely disparate opinions among Alberta physicians about the morality of active euthanasia. In particular, religious affiliation and activity were associated with the polarized opinions. The desire for active euthanasia, as inferred from requests by patients, was not frequent. Overall, there was no strong support expressed by the physicians for the personal practice of legalized active euthanasia. These data will be vital to those involved in health education and public policy formation about active euthanasia in Alberta and the rest of Canada.
van Alphen, Jojanneke E; Donker, Gé A; Marquet, Richard L
The Netherlands was the first country in the world to implement a Euthanasia Act in 2002. It is unknown whether legalizing euthanasia under strict conditions influences the number and nature of euthanasia requests. To investigate changes in the number of, and reasons for, requests for euthanasia in Dutch general practice after implementation of the Euthanasia Act. Retrospective dynamic cohort study comparing 5 years before (1998-2002) and 5 years after (2003-2007) implementation of the Act. Standardised registration forms were used to collect data on requests for euthanasia via the Dutch Sentinel Practice Network. This network of 45 general practices is nationally representative by age, sex, geographic distribution, and population density. The mean annual incidence of requests before implementation amounted to 3.1/10,000 and thereafter to 2.8/10,000 patients. However, trends differed by sex. The number of requests by males decreased significantly from 3.7/10,000 to 2.6/10,000 (P = 0.008); the requests by females increased non-significantly from 2.6/10,000 to 3.1/10,000. Before and after implementation, cancer remained the major underlying disease for requesting euthanasia: 82% versus 77% for men; 73% versus 75% for females. Pain was a major reason for a request, increasing in the period before implementation (mean 27%), but declining in the period thereafter (mean 22%). Loss of dignity became a less important reason after implementation (from 18% to 10%, P = 0.04), predominantly due to a marked decrease in the number of females citing it as a reason (from 17% to 6%, P = 0.02). There was no increase in demand for euthanasia after implementation of the Euthanasia Act. Pain as a reason for requesting euthanasia showed an increasing trend before implementation, but declined thereafter. Loss of dignity as a reason declined, especially in females.
van Alphen, Jojanneke E; Donker, Gé A; Marquet, Richard L
Background The Netherlands was the first country in the world to implement a Euthanasia Act in 2002. It is unknown whether legalising euthanasia under strict conditions influences the number and nature of euthanasia requests. Aim To investigate changes in the number of, and reasons for, requests for euthanasia in Dutch general practice after implementation of the Euthanasia Act. Design of study Retrospective dynamic cohort study comparing 5 years before (1998–2002) and 5 years after (2003–2007) implementation of the Act. Method Standardised registration forms were used to collect data on requests for euthanasia via the Dutch Sentinel Practice Network. This network of 45 general practices is nationally representative by age, sex, geographic distribution, and population density. Results The mean annual incidence of requests before implementation amounted to 3.1/10 000 and thereafter to 2.8/10 000 patients. However, trends differed by sex. The number of requests by males decreased significantly from 3.7/10 000 to 2.6/10 000 (P = 0.008); the requests by females increased non-significantly from 2.6/10 000 to 3.1/10 000. Before and after implementation, cancer remained the major underlying disease for requesting euthanasia: 82% versus 77% for men; 73% versus 75% for females. Pain was a major reason for a request, increasing in the period before implementation (mean 27%), but declining in the period thereafter (mean 22%). Loss of dignity became a less important reason after implementation (from 18% to 10%, P = 0.04), predominantly due to a marked decrease in the number of females citing it as a reason (from 17% to 6%, P = 0.02). Conclusion There was no increase in demand for euthanasia after implementation of the Euthanasia Act. Pain as a reason for requesting euthanasia showed an increasing trend before implementation, but declined thereafter. Loss of dignity as a reason declined, especially in females. PMID:20353671
Kinsella, T D; Verhoef, M J
OBJECTIVE: To ascertain the opinions of a sample of Alberta physicians about the morality and legalization of active euthanasia, the determinants of these opinions and the frequency and sources of requests for assistance in active euthanasia. DESIGN: Cross-sectional survey of a random sample of Alberta physicians, grouped by site and type of practice. SETTING: Alberta. PARTICIPANTS: A total of 2002 (46%) of the licensed physicians in Alberta were mailed a 38-item questionnaire in May through July 1991; usable responses were returned by 1391 (69%). RESULTS: Of the respondents 44% did believe that it is sometimes right to practice active euthanasia; 46% did not. Moral acceptance of active euthanasia correlated with type of practice and religious affiliation and activity. In all, 28% of the physicians stated that they would practice active euthanasia if it were legalized, and 51% indicated that they would not. These opinions were significantly related to sex, religious affiliation and activity, and country of graduation. Just over half (51%) of the respondents stated that the law should be changed to permit patients to request active euthanasia. Requests (usually from patients) were reportedly received by 19% of the physicians, 78% of whom received fewer than five. CONCLUSIONS: This survey revealed severely disparate opinions among Alberta physicians about the morality of active euthanasia. In particular, religious affiliation and activity were associated with the polarized opinions. The desire for active euthanasia, as inferred from requests by patients, was not frequent. Overall, there was no strong support expressed by the physicians for the personal practice of legalized active euthanasia. These data will be vital to those involved in health education and public policy formation about active euthanasia in Alberta and the rest of Canada. PMID:8500029
Ysebaert, D; Van Beeumen, G; De Greef, K; Squifflet, J P; Detry, O; De Roover, A; Delbouille, M-H; Van Donink, W; Roeyen, G; Chapelle, T; Bosmans, J-L; Van Raemdonck, D; Faymonville, M E; Laureys, S; Lamy, M; Cras, P
Euthanasia was legalized in Belgium in 2002 for adults under strict conditions. The patient must be in a medically futile condition and of constant and unbearable physical or mental suffering that cannot be alleviated, resulting from a serious and incurable disorder caused by illness or accident. Between 2005 and 2007, 4 patients (3 in Antwerp and 1 in Liège) expressed their will for organ donation after their request for euthanasia was granted. Patients were aged 43 to 50 years and had a debilitating neurologic disease, either after severe cerebrovascular accident or primary progressive multiple sclerosis. Ethical boards requested complete written scenario with informed consent of donor and relatives, clear separation between euthanasia and organ procurement procedure, and all procedures to be performed by senior staff members and nursing staff on a voluntary basis. The euthanasia procedure was performed by three independent physicians in the operating room. After clinical diagnosis of cardiac death, organ procurement was performed by femoral vessel cannulation or quick laparotomy. In 2 patients, the liver, both kidneys, and pancreatic islets (one case) were procured and transplanted; in the other 2 patients, there was additional lung procurement and transplantation. Transplant centers were informed of the nature of the case and the elements of organ procurement. There was primary function of all organs. The involved physicians and transplant teams had the well-discussed opinion that this strong request for organ donation after euthanasia could not be waived. A clear separation between the euthanasia request, the euthanasia procedure, and the organ procurement procedure is necessary.
Dich, Trine; Hansen, Tina; Algers, Anne
) the blind hens; (2) ANDi the genetically modified monkey; (3) euthanasia of a healthy dog; (4) animal slaughter; and (5) rehabilitation of seals. Special consideration has been given to enhancing the pedagogic value of the program. Students can control their learning by selecting a variety of ways...
Larter, K F; Rees, B B
In many experiments, euthanasia, or humane killing, of animals is necessary. Some methods of euthanasia cause death through cessation of respiratory or cardiovascular systems, causing oxygen levels of blood and tissues to drop. For experiments where the goal is to measure the effects of environmental low oxygen (hypoxia), the choice of euthanasia technique, therefore, may confound the results. This study examined the effects of four euthanasia methods commonly used in fish biology (overdose of MS-222, overdose of clove oil, rapid cooling and blunt trauma to the head) on variables known to be altered during hypoxia (haematocrit, plasma cortisol, blood lactate and blood glucose) or reflecting gill damage (trypan blue exclusion) and energetic status (ATP, ADP and ATP:ADP) in Gulf killifish Fundulus grandis after 24 h exposure to well-aerated conditions (normoxia, 7·93 mg O 2 l -1 , c. 150 mm Hg or c. 20 kPa) or reduced oxygen levels (0·86 mg O 2 l -1 , c. 17 mm Hg or c. 2·2 kPa). Regardless of oxygen treatment, fish euthanized by an overdose of MS-222 had higher haematocrit and lower gill ATP:ADP than fish euthanized by other methods. The effects of 24 h hypoxic exposure on these and other variables, however, were equivalent among methods of euthanasia (i.e. there were no significant interactions between euthanasia method and oxygen treatment). The choice of an appropriate euthanasia method, therefore, will depend upon the magnitude of the treatment effects (e.g. hypoxia) relative to potential artefacts caused by euthanasia on the variables of interest. © 2017 The Fisheries Society of the British Isles.
Smith, J. David
The issue of pediatric euthanasia for handicapped newborns is examined and contrasting viewpoints emphasizing the quality and the sanctity of life are considered. The author asserts that advocacy for handicapped children involves decisions regarding the euthanasia question. (CL)
Carter, Brian S
Recent laws in Europe now allow for pediatric euthanasia. The author reviews some rationale for caution, and addresses why ensuring the availability of pediatric palliative care is an important step before allowing pediatric euthanasia. © The Author(s) 2014.
Mojalefa L.J. Koenane
Debates on euthanasia (or �mercy killing�) have been a concern in moral, philosophical, legal, theological, cultural and sociological discourse for centuries. The topic of euthanasia inspires a variety of strong views of which the �slippery slope� argument is one. The latter warns that the principle(s) underlying any ethical issue (including euthanasia) may be distorted. Scholars� views on euthanasia are influenced mainly by cultural, personal, political and religious convictions. In South Af...
Struggles over euthanasia can be examined in terms of tactics used by players on each side of the issue to reduce outrage from actions potentially perceived as unjust. From one perspective, the key injustice is euthanasia itself, especially when the person or relatives oppose death. From a different perspective, the key injustice is denial of euthanasia, seen as a person's right to die. Five types of methods are commonly used to reduce outrage from something potentially seen as unjust: covering up the action; devaluing the target; reinterpreting the action, including using lying, minimising consequences, blaming others and benign framing; using official channels to give an appearance of justice; and using intimidation. Case studies considered include the Nazi T4 programme, euthanasia in contemporary jurisdictions in which it is legal, and censorship of Exit International by the Australian government. By examining euthanasia struggles for evidence of the five types of tactics, it is possible to judge whether one or both sides use tactics characteristic of perpetrators of injustice. This analysis provides a framework for examining tactics used in controversial health issues.
BANOVIĆ, Božidar; TURANJANIN, Veljko
Abstract Background Euthanasia is one of the most intriguing ethical, medical and law issues that marked whole XX century and beginning of the XXI century, sharply dividing scientific and unscientific public to its supporters and opponents. It also appears as one of the points where all three major religions (Catholic, Orthodox, and Islamic) have the same view. They are strongly against legalizing mercy killing, emphasizing the holiness of life as a primary criterion by which the countries should start in their considerations. Studying criminal justice systems in the world, the authors concluded that the issue of deprivation of life from compassion is solved on three ways. On the first place, we have countries where euthanasia is murder like any other murder from the criminal codes. Second, the most numerous are states where euthanasia is murder committed under privilege circumstances. On the third place, in the Western Europe we have countries where euthanasia is a legal medical procedure, under requirements prescribed by the law. In this paper, authors have made a brief comparison of the solutions that exist in some Islamic countries, where euthanasia is a murder, with Western countries, where it represents completely decriminalized medical procedure. PMID:26056652
Banović, Božidar; Turanjanin, Veljko
Background Euthanasia is one of the most intriguing ethical, medical and law issues that marked whole XX century and beginning of the XXI century, sharply dividing scientific and unscientific public to its supporters and opponents. It also appears as one of the points where all three major religions (Catholic, Orthodox, and Islamic) have the same view. They are strongly against legalizing mercy killing, emphasizing the holiness of life as a primary criterion by which the countries should start in their considerations. Studying criminal justice systems in the world, the authors concluded that the issue of deprivation of life from compassion is solved on three ways. On the first place, we have countries where euthanasia is murder like any other murder from the criminal codes. Second, the most numerous are states where euthanasia is murder committed under privilege circumstances. On the third place, in the Western Europe we have countries where euthanasia is a legal medical procedure, under requirements prescribed by the law. In this paper, authors have made a brief comparison of the solutions that exist in some Islamic countries, where euthanasia is a murder, with Western countries, where it represents completely decriminalized medical procedure.
Amaraskekara, Kumar; Bagaric, Mirko
The recent Dutch law legalising active voluntary euthanasia will reignite the euthanasia debate. An illuminating method for evaluating the moral status of a practice is to follow the implications of the practice to its logical conclusion. The argument for compassion is one of the central arguments in favour of voluntary active euthanasia. This argument applies perhaps even more forcefully in relation to incompetent patients. If active voluntary euthanasia is legalised, arguments based on compassion and equality will be directed towards legalising active non-voluntary euthanasia in order to make accelerated termination of death available also to the incompetent. The removal of discrimination against the incompetent has the potential to become as potent a catch-cry as the right to die. However, the legalisation of non-voluntary euthanasia is undesirable. A review of the relevant authorities reveals that there is no coherent and workable "best interests" test which can be invoked to decide whether an incompetent patient is better off dead. This provides a strong reason for not stepping onto the slippery path of permitting active voluntary euthanasia.
The ethics of physician- assisted suicide and euthanasia. In attempting to seize the moral high ground in the debate on the ethics of physician-assisted suicide and euthanasia,. Professor ... Euthanasia is the ultimate form of therapeutic nihilism in this situation ... The issue of what are termed dehumanising diseases, such as ...
This paper discusses the ethics of euthanasia. Situations are described in which the normal duty to sustain life is overridden by other duties towards the patient; but these situations are contrasted with euthanasia properly so called. Arguments for euthanasia are considered, and a refutation of those arguments is offered.
Klopfer, Frederick J.; Price, William F.
Information on euthanasia attitudes was obtained from fixed-schedule interviews gathered from 331 respondents. It was found that a favorable attitude toward euthanasia coincided with (1) belief in an afterlife; (2) a less favorable attitude toward euthanasia if relatives make the decision; and (3) younger respondents. (Author)
Buiting, Hilde M.; Willems, Dick L.; Pasman, H. Roeline W.; Rurup, Mette L.; Onwuteaka-Philipsen, Bregje D.
There is much debate about euthanasia within the context of palliative care. The six criteria of careful practice for lawful euthanasia in The Netherlands aim to safeguard the euthanasia practice against abuse and a disregard of palliative treatment alternatives. Those criteria need to be evaluated
Van Wesemael, Yanna; Cohen, Joachim; Bilsen, Johan; Smets, Tinne; Onwuteaka-Philipsen, Bregje; Deliens, Luc
Since 2002, the administration of a lethal drug by a physician at the explicit request of the patient has been legal in Belgium. The incidence of euthanasia in Belgium has been studied, but the process and outcomes of euthanasia requests have not been investigated. To describe which euthanasia requests were granted, withdrawn, and rejected since the enactment of the euthanasia law in terms of the characteristics of the patient, treating physician, and aspects of the consultation with a second physician. A representative sample of 3006 Belgian physicians received a questionnaire investigating their most recent euthanasia request. The response rate was 34%. Since 2002, 39% of respondents had received a euthanasia request. Forty-eight percent of requests had been carried out, 5% had been refused, 10% had been withdrawn, and in 23%, the patient had died before euthanasia could be performed. Physicians' characteristics associated with receiving a request were not being religious, caring for a high number of terminally ill patients, and having experience in palliative care. Patient characteristics associated with granting a request were age, having cancer, loss of dignity, having no depression, and suffering without prospect of improvement as a reason for requesting euthanasia. A positive initial position toward the request from the attending physician and positive advice from the second physician also contributed to having a request granted. Under the Belgian Act on Euthanasia, about half of the requests are granted. Factors related to the reason for the request, position of the attending physician toward the request, and advice from the second physician influence whether a request is granted or not. Copyright Â© 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
Gesundheit, Benjamin; Steinberg, Avraham; Glick, Shimon; Or, Reuven; Jotkovitz, Alan
End-of-life care poses fundamental ethical problems to clinicians. Defining euthanasia is a difficult and complex task, which causes confusion in its practical clinical application. Over the course of history, abuse of the term has led to medical atrocities. Familiarity with the relevant bioethical issues and the development of practical guidelines might improve clinical performance. To define philosophical concepts, to present historical events, to discuss the relevant attitudes in modern bioethics and law that may be helpful in elaborating practical guidelines for clinicians regarding euthanasia and end-of-life care. Concepts found in the classic sources of Jewish tradition might shed additional light on the issue and help clinicians in their decision-making process. An historical overview defines the concepts of active versus passive euthanasia, physician-assisted suicide and related terms. Positions found in classical Jewish literature are presented and analyzed with their later interpretations. The relevance and application in modern clinical medicine of both the general and Jewish approaches are discussed. The overview of current bioethical concepts demonstrates the variety of approaches in western culture and legal systems. Philosophically and conceptually, there is a crucial distinction between active and passive euthanasia. The legitimacy of active euthanasia has been the subject of major controversy in recent times in various countries and religious traditions. The historical overview and the literature review demonstrate the need to provide clearer definitions of the concepts relating to euthanasia, for in the past the term has led to major confusion and uncontrolled abuse. Bioethical topics should, therefore, be included in medical training and continuing education. There are major debates and controversies regarding the current clinical and legal approaches. We trust that classical Jewish sources might contribute to the establishment of clinical
It is increasingly asserted that the disagreements of abstract principle between adversaries in the euthanasia debate fail to account for the complex, particular and ambiguous experiences of people at the end of their lives. A greater research effort into experiences, meaning, connection, vulnerability, and motivation is advocated, during which the euthanasia 'question' should remain open. I argue that this is a normative strategy, which is felicitous to the status quo and further medicalises the end of life, but which masquerades as a value-neutral assertion about needing more knowledge.
Perrett, R W
Damien and John Keown claim that there is important common ground between Buddhism and Christianity on the issue of euthanasia and that both traditions oppose it for similar reasons in order to espouse a "sanctity of life" position. I argue that the appearance of consensus is partly created by their failure to specify clearly enough certain key notions in the argument: particularly Buddhism, euthanasia and the sanctity of life. Once this is done, the Keowns' central claims can be seen to be either false or only restrictedly true.
Thomas, J M
In Belgium, the GP can perform euthanasia or be called as a consultant. He must know the laws concerning the end of life and be able to explain his rights to his patients. He will know the best practices and techniques for euthanasia. If necessary, he will call help or refer to a more competent colleague. He negotiates with the patient an advanced care planning following the evolution of its pathologies and will witness its wishes regarding end of life against other institutions and doctors.
Goolam, N M
The constitutional justifiability of euthanasia will depend upon interpretation of the right to life and the right to respect for and protection of one's dignity. Pertinent issues arising hereto are: In our new value-based constitutional interpretation, what are the values underlying our multi-cultural society? Issues of death and dying are inter-linked to a civilization's world view and its approach to human dignity. Western, African and Islamic approaches will be compared. Does euthanasia negate the essential content of the right to life and is its limitation on such right reasonable/justifiable in an open and democratic society based on freedom and equality.
Chong, Alice Ming-Lin; Fok, Shiu-Yeu
This article reports the findings of a randomized general household survey that examined the attitudes of 618 Chinese respondents toward different types of euthanasia. The general public is found to agree with active euthanasia and non-voluntary euthanasia, but is neutral about passive euthanasia. Support for euthanasia is predicted by decreasing importance of religious belief, higher family income, experiences in taking care of terminally ill family members, being non-Protestants, and increasing age. Patients were perceived as the chief decision makers in euthanasian decisions. Finally, suggestions on social work practice and professional training are made.
Matthews-Brzozowska, M; Filipowski, H; Musielak, M; Matthews-Brzozowska, T
Euthanasia and a doctor-assisted suicide are not only practiced worldwide, but also legalized in some countries. In Poland they are broadly discussed. The purpose of this paper was to define dentistry students attitude towards human right to ask for death and euthanasia. In the research 148 students of both sexes were questioned. Generally students were against euthanasia in the world as well as in Poland, although men were in majority for euthanasia. Believers were against it due to ethically-religious reasons, while non-believers were for euthanasia motivating it by rational reasons.
Cartwright, C M; Williams, G M; Parker, M H; Steinberg, M A
This study investigated issues raised in qualitative data from our previous studies of health professionals and community members, which suggested that being opposed to euthanasia legislation did not necessarily equate to being anti-euthanasia per se. A postal survey of 1002 medical practitioners, 1000 nurses and 1200 community members was undertaken. In addition to a direct question on changing the law to allow active voluntary euthanasia (AVE), four statements assessed attitudes to euthanasia with or without a change in legislation. Responses were received from 405 doctors (43%), 429 nurses (45%) and 405 community members (38%). Compared with previous studies there was a slight increase in support for a change in the law from medical practitioners, a slight decrease in support from community members and almost no change among nurses. Different interpretations of the results of the four attitude questions are possible, depending on the perspective of the interpreter.
Gielen, Joris; van den Branden, Stef; van Iersel, Trudie; Broeckaert, Bert
To adequately measure the attitudes of Flemish palliative care nurses toward euthanasia, and assess the relationship between these attitudes and demographic factors and the (perceived) influence of experience in palliative care on death anxiety. An anonymous questionnaire was sent to all nurses (n=589) employed in palliative care in Flanders, Belgium: 70.5% of the nurses (n=415) responded. A majority of the nurses supported the Belgian law regulating euthanasia but also believed that most euthanasia requests disappear as soon as a patient experiences the benefits of good palliative care. Three clusters were discovered: staunch advocates of euthanasia (150 nurses, 41.1%); moderate advocates of euthanasia (135 nurses, 37%); and (moderate) opponents of euthanasia (80 nurses, 21.9%). An absolute opposition between advocates and opponents of euthanasia was not observed. A statistically significant relationship was found between the euthanasia clusters and years of experience in palliative care, and (perceived) influence of experience in palliative care on anxiety when a patient dies. Flemish palliative care nurses' attitudes toward euthanasia are nuanced and contextual. By indicating that most euthanasia requests disappear as soon as a patient experiences the benefits of good palliative care, the nurses applied a 'palliative filter' a standard procedure in the case of a euthanasia request.
Sayers, Gwen M
Non-voluntary passive euthanasia, the commonest form of euthanasia, is seldom mentioned in the UK. This article illustrates how the legal reasoning in Airedale NHS Trust v Bland contributed towards this conceptual deletion. By upholding the impermissibility of euthanasia, whilst at the same time permitting 'euthanasia' under the guise of 'withdrawing futile treatment', it is argued that the court (logically) allowed (withdrawing futile treatment and euthanasia). The Bland reasoning was incorporated into professional guidance, which extended the court's ruling to encompass patients who, unlike Anthony Bland, were sentient. But since the lawfulness of (withdrawing futile treatment and euthanasia) hinges on the futility of treatment, and since the guidance provides advice about withdrawing treatment from patients who differ from those considered in court, the lawfulness of such 'treatment decisions' is unclear. Legislation is proposed in order to redress the ambiguity that arose when moral decisions about 'euthanasia' were translated into medical decisions about 'treatment'.
If we accept euthanasia for adults, should we also accept voluntary euthanasia for children? In 'Child Euthanasia: Should We Just Not Talk about It?', Luc Bovens answers this question affirmatively. Bovens examines five arguments against extending euthanasia to minors, the arguments being weightiness, capability of discernment, pressure, sensitivity and sufficient palliative care. He rejects each of these arguments. In this paper, I provide a rejoinder for each of his responses. I also critique his view that opponents of euthanasia have extra responsibility to promote palliative care. On the contrary, if euthanasia is legalised, advocates of euthanasia have a special obligation to promote improvements in palliative care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Hanson, Stephen S
Since the Netherlands produced the Groningen protocol describing the methods to be used for pediatric euthanasia and Belgium passed laws authorizing euthanasia for children who consent to it, the issue of pediatric euthanasia has become a relevant topic to discuss. Most rejections of pediatric euthanasia fall into 1 or more of 3 categories, each of which has problems. This article shows how several recent arguments against pediatric euthanasia fail to prove that pediatric euthanasia is unacceptable. It does not follow from this that the practice is permissible but rather that if one is to reject such a practice, stronger arguments will need to be made, especially in countries where adult euthanasia or assisted suicide is already permitted. © The Author(s) 2015.
Kinsella, T D; Verhoef, M J
OBJECTIVE: To ascertain the opinions of a sample of Alberta physicians about the morality and legalization of active euthanasia, the determinants of these opinions and the frequency and sources of requests for assistance in active euthanasia. DESIGN: Cross-sectional survey of a random sample of Alberta physicians, grouped by site and type of practice. SETTING: Alberta. PARTICIPANTS: A total of 2002 (46%) of the licensed physicians in Alberta were mailed a 38-item questionnaire in May through ...
Lerner, Henrik; Lindblad, Anna; Algers, Bo; Lynöe, Niels
To examine the hypothesis that knowledge about physician-assisted suicide (PAS) and euthanasia is associated with a more restrictive attitude towards PAS. A questionnaire about attitudes towards PAS, including prioritization of arguments pro and contra, was sent to Swedish veterinary surgeons. The results were compared with those from similar surveys of attitudes among the general public and physicians. All veterinary surgeons who were members of the Swedish Veterinary Association and had provided an email address (n=2421). Similarities or differences in response pattern between veterinary surgeons, physicians and the general public. The response pattern among veterinary surgeons and the general public was almost similar in all relevant aspects. Of the veterinarians 75% (95% CI 72% to 78%) were in favour of PAS, compared with 73% (95% CI 69% to 77%) among the general public. Only 10% (95% CI 5% to 15%) of the veterinary surgeons were against PAS, compared with 12% (95% CI 5% to 19%) among the general public. Finally, 15% (95% CI 10% to 21%) of veterinarians were undecided, compared with 15% (95% CI 8% to 22%) among the general public. Physicians had a more restrictive attitude to PAS than the general public. Since veterinary surgeons have frequent practical experience of euthanasia in animals, they do have knowledge about what euthanasia really is. Veterinary surgeons and the general public had an almost similar response pattern. Accordingly it seems difficult to maintain that knowledge about euthanasia is unambiguously associated with a restrictive attitude towards PAS.
Gilbertson, Cody R; Wyatt, Jeffrey D
The euthanasia of invertebrates used in scientific investigations poses unanswered questions regarding the rapid induction of unconsciousness with minimal distress and pain. Relative to vertebrates, invertebrates' sensory experience of pain, nociception, and physiologic response to aversive stimuli are poorly characterized. The scientific communities in the European Union, Canada, United States, Australia, and New Zealand join in consensus regarding the need to address alleviation of pain and distress in cephalopods (octopus, squid, and so forth), which have the best-characterized nervous system among invertebrates. In the current study, we evaluated various euthanasia techniques in a terrestrial gastropod species, with priority on animal wellbeing, scientific variability, feasibility in both field and laboratory settings, and acceptability by personnel. In addition, we demonstrated that the 2-step method of euthanasia described in the AVMA Guidelines as acceptable for aquatic invertebrates is effective for terrestrial snails and meets all welfare and scientific requirements. This 2-step method first induces anesthesia by immersion in 5% ethanol (laboratory-grade ethanol or beer) followed by immersion in a euthanizing and tissue-preserving solution of 70% to 95% ethanol or 10% neutral buffered formalin. Furthermore, alternative methods of euthanasia for terrestrial snails commonly used in field research, such as live immersion in concentrated ethanol or formalin, were shown to be unacceptable.
Neuhaus, Susan J
Issues relating to voluntary euthanasia that are currently being debated by Australian society are distinctly different from those encountered by battlefield doctors. Doctors in war undertake to treat those affected by conflict; their participation in euthanasia challenges the profession's definition of "duty of care". Euthanasia must be distinguished from "triage" and medical withdrawal of care (which are decided within a medical facility where, although resources may be limited, comfort care can be provided in the face of treatment futility). Battlefield euthanasia is a decision made, often immediately after hostile action, in the face of apparently overwhelming injuries; there is often limited availability of pain relief, support systems or palliation that would be available in a civilian environment. The battlefield situation is further complicated by issues of personal danger, the immediacy of decision making and difficulties with distinguishing civilians from combatants. Regardless of the circumstances on a battlefield, doctors, whether they are civilians or members of a defence force, are subject to the laws of armed conflict, the special provisions of the Geneva Conventions and the ethical codes of the medical profession.
Hilker, Christine; And Others
This collection of materials represents a 20-year span (1958-1978) of references on euthanasia found through select indexes and abstracting services. The contents are organized into two general reference sections, periodicals and books, with citations listed alphabetically by author. The last two sections focus on the locations of these materials…
Ethical decisions are involved in life and death decisions for severely handicapped infants. Although it has become common practice for physicians not to treat severely handicapped infants, the ethical considerations involved in euthanasia are complex. A review of the literature reveals that concerns center around the quality of life of the…
I.D. de Beaufort (Inez); S. van de Vathorst (Suzanne)
textabstractAbstract : The number of dementia patients requesting euthanasia in the Netherlands has increased over the past five years. The issue is highly controversial. In this contribution we discuss some of the main arguments: the nature of suffering, the voluntariness of the request and the
Groenhuijsen, M.S.; van Laanen, F.
Euthanasia probably is one of the most natural issues to study in a comparative way. 14 national reports, submitted for discussion during the XVIIth Congress of the International Academy of Comparative Law, as well as a general report were edited and published in this volume. Thus it provides
Narbekovas, Andrius; Meilius, Kazimieras
Human beings are made in the image and likeness of God and are therefore of intrinsic worth or value, beyond all prices. Almost all Christian pro-life arguments spring from the fountain of personal dignity. Euthanasia would make moral sense only if it were possible to say, morally, that this dignity had vanished. To commit euthanasia is to act with the specific intention that somebody should be nobody. This is the fundamental error of all immorality in human relations. To commit euthanasia is to fail to see the intrinsic worth or dignity of the person. The judgement that what has worth, intrinsically, somehow does not have worth, is both logically and morally wrong. The ethics of euthanasia is based on dualistic anthropology and wrong moral presuppositions underlying the defence of euthanasia, namely, proportionalism and consequentialism. The basic claim of proponents of the ethics of euthanasia is that human persons are consciously experiencing subjects whose dignity consists of their ability to made choices and to determine their own lives. Bodily life, according to them, is a condition for personal life because without bodily life one cannot be a consciously experiencing subject. It means that bodily life is distinct from personal life. Thus, the body and bodily life are instrumental goods, goods for the person, not goods of the person. It thus follows that there can be such a thing as a life not worth living--one can judge that bodily life itself is useless or burdensome, and when it is, the person, i.e., the consciously experiencing subject, is at liberty to free himself of this useless burden. Today a key in fighting euthanasia and assisted suicide is better care for the sick and dying. The dignity of the sick cannot be erased by illness and suffering. Such procedures are not private decisions; they affect the whole society. Death with dignity, in the end, is the realisation that human beings are also spiritual beings. We have to promote the way of caring for
Verhoef, M J; Kinsella, T D
OBJECTIVE: To determine whether the opinions of Alberta physicians about active euthanasia had changed and to assess the determinants of potential changes in opinion. DESIGN: Follow-up survey (mailed questionnaire) of physicians included in the 1991 Alberta Euthanasia Survey. SETTING: Alberta. PARTICIPANTS: Of the 1391 physicians who participated in the 1991 survey 1291 (93%) had indicated that they were willing to take part in a follow-up survey. A follow-up questionnaire was mailed in 1994 to 1146 physicians who could be traced through the 1994 Medical Directory of the provincial college of physicians and surgeons; 25 questionnaires were returned because they could not be delivered. OUTCOME MEASURES: Physicians' opinions about (a) the morality of active euthanasia, (b) changes in the law to permit active euthanasia and (c) the practice of legalized euthanasia. RESULTS: Of the 1121 physicians sent a follow-up questionnaire 866 (77%) returned it completed. The responses of these same 866 physicians in 1991 provided a basis for comparison. Of the 866, 360 (42%) stated in the 1994 survey that it is sometimes right to practise active euthanasia; a similar proportion (384 [44%]) gave this response in 1991. However, other opinions changed significantly. In 1991, 250 of the respondents (29%) indicated that they would practise active euthanasia if it were legalized, as compared with 128 (15%) in 1994 (p euthanasia, as compared with 316 (37%) in 1994 (p euthanasia between 1991 and 1994, in both surveys at least 70% of those who responded to this question indicated that active euthanasia, if it were legalized, should be performed only by physicians and should be taught at medical sites. CONCLUSION: Alberta physicians' support for the practice and legalization of active euthanasia decreased considerably between 1991 and 1994. However, most physicians remain in favour of restricting active euthanasia, if it were legalized, to the medical profession. These results suggest a
euthanasia , whole blood, serum, and the long bones of the hindquarters were extracted to be used for analysis. Skeletal tissue was analyzed on the...arrival to the animal facility, prior to euthanasia and, at a minimum, weekly. Body mass was recorded along with body temperatures as a means of...control at either the arrival to the facility or prior to euthanasia (Figure 2, 3, 4). Additionally, no significant differences exist between any
Conlee, K M; Stephens, M L; Rowan, A N; King, L A
Carbon dioxide (CO2) is the most commonly used agent for euthanasia of laboratory rodents, used on an estimated tens of millions of laboratory rodents per year worldwide, yet there is a growing body of evidence indicating that exposure to CO2 causes more than momentary pain and distress in these and other animals. We reviewed the available literature on the use of CO2 for euthanasia (as well as anaesthesia) and also informally canvassed laboratory animal personnel for their opinions regarding this topic. Our review addresses key issues such as CO2 flow rate and final concentration, presence of oxygen, and prefilled chambers (the animal is added to the chamber once a predetermined concentration and flow rate have been reached) versus gradual induction (the animal is put into an empty chamber and the gas agent(s) is gradually introduced at a fixed rate). Internationally, animal research standards specify that any procedure that would cause pain or distress in humans should be assumed to do so in non-human animals as well (Public Health Service 1986, US Department of Agriculture 1997, Organization for Economic Cooperation and Development 2000). European Union guidelines, however, specify a certain threshold of pain or distress, such as 'skilled insertion of a hypodermic needle', as the starting point at which regulation of the use of animals in experimental or other scientific procedures begins (Biotechnology Regulatory Atlas n.d.). There is clear evidence in the human literature that CO2 exposure is painful and distressful, while the non-human literature is equivocal. However, the fact that a number of studies do conclude that CO2 causes pain and distress in animals indicates a need for careful reconsideration of its use. Finally, this review offers recommendations for alternatives to the use of CO2 as a euthanasia agent.
Verpoort, Charlotte; Gastmans, Chris; De Bal, Nele; Dierckx de Casterlé, Bernadette
This article provides an overview of the scarce international literature concerning nurses' attitudes to euthanasia. Studies show large differences with respect to the percentage of nurses who are (not) in favour of euthanasia. Characteristics such as age, religion and nursing specialty have a significant influence on a nurse's opinion. The arguments for euthanasia have to do with quality of life, respect for autonomy and dissatisfaction with the current situation. Arguments against euthanasia are the right to a good death, belief in the possibilities offered by palliative care, religious objections and the fear of abuse. Nurses mention the need for more palliative care training, their difficulties in taking a specific position, and their desire to express their ideas about euthanasia. There is a need to include nurses' voices in the end-of-life discourse because they offer a contextual understanding of euthanasia and requests to die, which is borne out of real experience with people facing death.
de Boer, Marike E; Dröes, Rose-Marie; Jonker, Cees; Eefsting, Jan A; Hertogh, Cees M P M
To obtain insight into current practices regarding compliance with advance directives for euthanasia (ADEs) in cases of incompetent patients with dementia in Dutch nursing homes, in light of the legal possibility offered by the new euthanasia law to perform euthanasia in these cases. A written questionnaire was completed by 434 elderly care physicians (ECPs). Over the years 2005-2006, many ECPs took care of patients with dementia and an ADE, actual life termination of these patients took place very rarely and never in incompetent patients. ECPs reported practical difficulties in determining the 'unbearableness' of the suffering and choosing the right moment of carrying out the ADE. Although the enactment of the Dutch euthanasia law in theory provided a window of opportunity for euthanasia in incompetent patients with dementia and an ADE, it has not led to obvious changes in compliance with ADEs of this patient group in practice. Crucial in the reticent attitudes of ECPs appears to be the impossibility of patient-physician communication. This raises questions on the feasibility of the law on this point. In our opinion, the role of ADEs in end-of-life care of patients with advanced dementia in the Netherlands deserves serious reconsideration. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
This bsachelor thesis is devided into two parts, theoretical and practical. The work focuses on opinions of workers in palliative care on euthanasia. The theoretical part deals with the definition of palliative care, its goals and principles. Futhermore, it also introduced quality of palliative care in Czech Republic. Second chapter explains the term euthanasia and its forms. It also contains opinions of citizens of the Czech Republic on euthanasia. Third chapter is dedicated to terms such as...
Jochemsen, H; Keown, J
Nineteen ninety-six saw the publication of a major Dutch survey into euthanasia in the Netherlands. This paper outlines the main statistical findings of this survey and considers whether it shows that voluntary euthanasia is under effective control in the Netherlands. The paper concludes that although there has been some improvement in compliance with procedural requirements, the practice of voluntary euthanasia remains beyond effective control. PMID:10070633
Bier, J C; Salmon, E; Ivanoiu, A
Among legislative criteria granting the right to practice euthanasia or assisted suicide, there are systematically four major elements. Precisely, any request must be voluntary, persistent, to be well thought and well informed. Such euthanasia raises numerous difficult questions in case of dementia. It also justifies thinking about possibilities that can offer specific arrangements of anticipated demands in such peculiar cases. Empirical experiences show us that it applies with difficulties in practice. Finally, to avoid that a big majority of these demands would find themselves not applied in practice, it would certainly be necessary to add to it structural valuation of advance care planning, and assure its recognition and development. These should not be limited to a single pathological target but would address all of us to increase advance care planning initiation, which remains the most limiting factor of such any early but continuous procedure.
Anne Mullens used a recent fellowship provided by the Atkinson Foundation to take an in-depth look at euthanasia in the Netherlands. During her time in Holland, she discussed the issue with doctors who support and oppose euthanasia. She accompanied a doctor as he visited a patient who was dying of cancer and was beginning to consider the possibility of euthanasia. She talked to a nonphysician who is adamantly opposed to euthanasia and carries a card stating that. She visited a hospital in Amsterdam that has received requests from foreigners seeking euthansia. Mullens offers a comprehensive look at an issue that continues to provoke strong feelings among Canadian physicians and patients.
Abdo, W F Farid
Recently, organ donation after euthanasia has been a topic of discussion in the Dutch media and scientific literature. Unfortunately, both the articles in question and the media interviews contained several unsubstantiated statements. This article describes the background of organ donation after euthanasia and refutes some of the recent statements. It discusses why it is expected that organ donation after euthanasia will result in a far fewer additional organ donors that originally stated. In conclusion, euthanasia is a topic that should be handled with great care.
Euthanasia motivated by mental disorders is legal in only a few countries and has a short history. In a recent report of all psychiatric euthanasia cases in Belgium between 2002 and 2013, Dierickx and colleagues suggest that the number of these cases is increasing, and provide a profile of the applicants. To date, knowledge of the practice of psychiatric euthanasia is limited, but rising public awareness might increase the number of requests. The authors reveal several shortcomings in cases of psychiatric euthanasia and open avenues for future research.Please see related article: https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-017-1369-0.
Thomsen, Peter; Sørensen, Jan Tind
a random sample of 196 Danish dairy farmers that had reported a dead cow to the Danish Cattle Database in 2002 and 196 dairy farmers that had reported a dead cow in 2006. Our objectives were to evaluate the proportion of euthanized cows, changes in the behaviour of farmers regarding euthanasia of cows over...... the years and possible reasons for these changes. Results It seems that the threshold for euthanasia of cows among farmers has changed. Farmers generally reported a lower threshold for euthanasia compared to 5-10 years ago. Conclusions The threshold for euthanasia of cows has, according to the dairy farmers...
Georges, Jean-Jacques; Onwuteaka-Philipsen, Bregje D; van der Heide, Agnes; van der Wal, Gerrit; van der Maas, Paul J
In recent decades significant developments in end-of-life care have taken place in The Netherlands. There has been more attention for palliative care and alongside the practice of euthanasia has been regulated. The aim of this paper is to describe the opinions of physicians with regard to the relationship between palliative care and euthanasia, and determinants of these opinions. Cross-sectional. Representative samples of physicians (n = 410), relatives of patients who died after euthanasia and physician-assisted suicide (EAS; n = 87), and members of the Euthanasia Review Committees (ERCs; n = 35). Structured interviews with physicians and relatives of patients, and a written questionnaire for the members of the ERCs. Approximately half of the physicians disagreed and one third agreed with statements describing the quality of palliative care in The Netherlands as suboptimal and describing the expertise of physicians with regard to palliative care as insufficient. Almost two thirds of the physicians disagreed with the suggestion that adequate treatment of pain and terminal care make euthanasia redundant. Having a religious belief, being a nursing home physician or a clinical specialist, never having performed euthanasia, and not wanting to perform euthanasia were related to the belief that adequate treatment of pain and terminal care could make euthanasia redundant. The study results indicate that most physicians in The Netherlands are not convinced that palliative care can always alleviate all suffering at the end of life and believe that euthanasia could be appropriate in some cases.
Božidar Banović; Veljko Turanjanin
Abstract Background Euthanasia is one of the most intriguing ethical, medical and law issues that marked whole XX century and beginning of the XXI century, sharply dividing scientific and unscientific public to its supporters and opponents. It also appears as one of the points where all three major religions (Catholic, Orthodox, and Islamic) have the same view. They are strongly against legalizing mercy killing, emphasizing the holiness of life as a primary criterion by which the countries sh...
Despite tremendous advances in medical care for critically ill newborn infants, caregivers in neonatal intensive care units still struggle with how to approach those patients whose prognoses appear to be the most grim, and whose treatments appear to be the most futile. Although the practice of passive neonatal euthanasia, from a moral perspective, has been widely (albeit quietly) condoned, those clinicians and families involved in such cases may still be found legally guilty of child abuse or...
Ogunbanjo, GA; Knapp van Bogaert, D
This article discusses various ethical and legal concepts regarding euthanasia and includes notions such as physician-assisted suicide, assisted suicide, voluntary active euthanasia, killing versus...
Swarte, N B; Heintz, A P
In the Netherlands there are about 9700 explicit requests for euthanasia or physician-assisted suicide (EAS) each year, of which approximately 3600 are granted. Other countries have criticized the Dutch policy concerning EAS. It has been suggested that palliative care in the Netherlands is not adequate and that euthanasia is often requested by patients with depression. In addition, this criticism is partly based on the firm stance that 'human life has an absolute value and a human being has under no circumstances the right of self-determination over his or her own life'. Many aspects of EAS are currently the focus of attention in the literature. In this review the following aspects of EAS are discussed: ethics, judicial questions, the relationship between depression and euthanasia, and the impact of EAS on members of the family. Also, the current situation concerning EAS in the Netherlands is summarized and described. Despite the fact that EAS have been widely discussed in the literature, the association between depression and the number of requests for EAS remains to be discovered. It is also not yet known what the effects of EAS are on members of the family, and whether unnatural death causes a higher incidence of complicated grief.
Buiting, Hilde M; Willems, Dick L; Pasman, H Roeline W; Rurup, Mette L; Onwuteaka-Philipsen, Bregje D
There is much debate about euthanasia within the context of palliative care. The six criteria of careful practice for lawful euthanasia in The Netherlands aim to safeguard the euthanasia practice against abuse and a disregard of palliative treatment alternatives. Those criteria need to be evaluated by the treating physician as well as an independent euthanasia consultant. To investigate 1) whether and how palliative treatment alternatives come up during or preceding euthanasia consultations and 2) how the availability of possible palliative treatment alternatives are assessed by the independent consultant. We interviewed 14 euthanasia consultants and 12 physicians who had requested a euthanasia consultation. We transcribed and analyzed the interviews and held consensus meetings about the interpretation. Treating physicians generally discuss the whole range of treatment options with the patient before the euthanasia consultation. Consultants actively start thinking about and proposing palliative treatment alternatives after consultations, when they have concluded that the criteria for careful practice have not been met. During the consultation, they take into account various aspects while assessing the criterion concerning the availability of reasonable alternatives, and they clearly distinguish between euthanasia and continuous deep sedation. Most consultants said that it was necessary to verify which forms of palliative care had previously been discussed. Advice concerning palliative care seemed to be related to the timing of the consultation ("early" or "late"). Euthanasia consultants were sometimes unsure whether or not to advise about palliative care, considering it not their task or inappropriate in view of the previous discussions. Two different roles of a euthanasia consultant were identified: a limited one, restricted to the evaluation of the criteria for careful practice, and a broad one, extended to actively providing advice about palliative care. Further
Terkamo-Moisio, Anja; Gastmans, Chris; Ryynänen, Olli-Pekka; Pietilä, Anna-Maija
Nurses' voices remain unheard in most debates about euthanasia, although their crucial role in the euthanasia process is widely acknowledged. Moreover, in Canadian euthanasia law, nurses have a more active role, which further highlights the need for knowledge about nurses' attitudes towards their role in the euthanasia process. What are Finnish nurses' attitudes towards their potential role in the euthanasia process? Which characteristics are associated with those attitudes? Cross-sectional web-based survey. Participants and research context: 1003 nurses, recruited via social media and the members' bulletin of the Finnish Nurses Association. Ethical considerations: Ethical approval was obtained from the Committee on Research Ethics of the university to which the first author was affiliated. The great majority (85.2%) of nurses felt that their perspective should be considered in decision-making related to euthanasia. Furthermore, most of the participants (74.7%) reported willingness to participate in the euthanasia process if it were legal, and 88.6% agreed that a nurse should be present when euthanasia is performed if the patient wishes so. Furthermore, over half agreed that some of the preparatory tasks were part of their job description. However, a minority (32.9%) agreed with a possible obligation to participate based on their profession. Nurses' age, religiosity and educational level influenced their attitudes in the current results. Despite the strong agreement on decision-making concerning euthanasia and participation in the euthanasia process, obligation to participate based on the profession was rejected by most participants. Nurses regarded themselves as consultants in the decision-making process, which may indicate their unwillingness to share the responsibility for the decision itself. Specific safety mechanisms should be considered to protect nurses who refuse to be involved in the euthanasia process due to harm that involuntary participation might
Smets, Tinne; Cohen, Joachim; Bilsen, Johan; Van Wesemael, Yanna; Rurup, Mette L; Deliens, Luc
Belgium legalized euthanasia in 2002. Physicians must report each euthanasia case to the Federal Control and Evaluation Committee. This study examines which end-of-life decisions (ELDs) Belgian physicians label 'euthanasia', which ELDs they think should be reported and the physician characteristics associated with correct labelling of euthanasia cases, the awareness that they should be reported and the reporting of them. Five hypothetical cases of ELDs: intensified pain alleviation, palliative/terminal sedation, euthanasia with neuromuscular relaxants, euthanasia with morphine and life-ending without patient request were presented in a cross-sectional survey of 914 physicians in Belgium in 2009. About 19% of physicians did not label a euthanasia case with neuromuscular relaxants 'euthanasia', 27% did not know that it should be reported. Most physicians labelled a euthanasia case with morphine 'intensification of pain and symptom treatment' (39%) or 'palliative/terminal sedation' (37%); 21% of physicians labelled this case 'euthanasia'. Cases describing other ELDs were sometimes also labelled 'euthanasia'. Factors associated with a higher likelihood of labelling a euthanasia case correctly were: living in Flanders, being informed about the euthanasia law and having a positive attitude towards societal control over euthanasia. Whether a physician correctly labelled the euthanasia cases strongly determined their reporting knowledge and intentions. There is no consensus among physicians about the labelling of euthanasia and other ELDs, and about which cases must be reported. Mislabelling of ELDs could impede societal control over euthanasia. The provision of better information to physicians appears to be necessary.
Overmyer, Katherine A.; Thonusin, Chanisa; Qi, Nathan R.; Burant, Charles F.; Evans, Charles R.
A critical application of metabolomics is the evaluation of tissues, which are often the primary sites of metabolic dysregulation in disease. Laboratory rodents have been widely used for metabolomics studies involving tissues due to their facile handing, genetic manipulability and similarity to most aspects of human metabolism. However, the necessary step of administration of anesthesia in preparation for tissue sampling is not often given careful consideration, in spite of its potential for causing alterations in the metabolome. We examined, for the first time using untargeted and targeted metabolomics, the effect of several commonly used methods of anesthesia and euthanasia for collection of skeletal muscle, liver, heart, adipose and serum of C57BL/6J mice. The data revealed dramatic, tissue-specific impacts of tissue collection strategy. Among many differences observed, post-euthanasia samples showed elevated levels of glucose 6-phosphate and other glycolytic intermediates in skeletal muscle. In heart and liver, multiple nucleotide and purine degradation metabolites accumulated in tissues of euthanized compared to anesthetized animals. Adipose tissue was comparatively less affected by collection strategy, although accumulation of lactate and succinate in euthanized animals was observed in all tissues. Among methods of tissue collection performed pre-euthanasia, ketamine showed more variability compared to isoflurane and pentobarbital. Isoflurane induced elevated liver aspartate but allowed more rapid initiation of tissue collection. Based on these findings, we present a more optimal collection strategy mammalian tissues and recommend that rodent tissues intended for metabolomics studies be collected under anesthesia rather than post-euthanasia. PMID:25658945
Although it is widely accepted that murder is crime under the Nigerian law, a clearly defined stand has not been taken on euthanasia. The Nigerian populace views euthanasia as an unnecessary paradox, murder in disguise, a situation where the supposed healer becomes a killer. This, therefore, forms the nitty-gritty of ...
Home care providers should be concerned about the mounting pressure to control health care expenditures and the reportedly growing public acceptance of assisted suicide and euthanasia. As the aging and disability communities organize politically for the expansion of flexible, consumer-driven, in-home support services, the euthanasia movement has begun to rally its forces behind accelerating death.
Concentrates on the joint issues of suicide and euthanasia in the context of the doctor-patient relationship. A new evaluation of suicide prevention and euthanasia, especially as they relate to the training of medical students and doctors, is advocated. (Author/BL)
Albright, Dianne E.; Hazler, Richard J.
Euthanasia is considered an important social issue of the 1990s. Mental health professionals should understand the differences between voluntary, involuntary, passive, and active euthanasia; mercy killing, and assisted suicide. Encourages counselors to ethically formulate client-supportive positions to help clients face life-and-death decisions.…
In this paper, we critically reflect on the concept of Euthanasia as understood in the West and in Africa, and especially in sub-Saharan Africa. From the Western block, we rely on the contributions of Ronald Otremba and James Rachels. In our view, Otremba represents the Traditional Western view of euthanasia, which holds ...
This article introduces and compares the contrasting views of two well-known theologians, Gilbert Meilaender and Harry Kuitert, on euthanasia and medically assisted suicide. Meilaender rejects euthanasia and medically assisted suicide, but accepts refusal of treatment, as long as it is not done with the intention to cause ...
The issue of voluntary active euthanasia was thrust into the public policy arena by the Stransham-Ford lawsuit. The High Court legalised voluntary active euthanasia – however, ostensibly only in the specific case of Mr Stransham-Ford. The Supreme Court of Appeal overturned the High Court judgment on technical grounds, ...
The article examines two common rationalizations for euthanasia of persons with severe handicaps and presents arguments to refute them. The article calls for parents, professionals, and friends of persons with severe handicaps to be vocal in refuting euthanasia and its rationales. (Author/CL)
Rietjens, Judith A C; van Delden, Johannes J M; van der Heide, Agnes; Vrakking, Astrid M; Onwuteaka-Philipsen, Bregje D; van der Maas, Paul J; van der Wal, Gerrit
An important issue in the debate about terminal sedation is the extent to which it differs from euthanasia. We studied clinical differences and similarities between both practices in the Netherlands. Personal interviews were held with a nationwide stratified sample of 410 physicians (response rate, 85%) about the most recent cases in which they used terminal sedation, defined as administering drugs to keep the patient continuously in deep sedation or coma until death without giving artificial nutrition or hydration (n = 211), or performed euthanasia, defined as administering a lethal drug at the request of a patient with the explicit intention to hasten death (n = 123). We compared characteristics of the patients, the decision-making process, and medical care of both practices. Terminal sedation and euthanasia both mostly concerned patients with cancer. Patients receiving terminal sedation were more often anxious (37%) and confused (24%) than patients receiving euthanasia (15% and 2%, respectively). Euthanasia requests were typically related to loss of dignity and a sense of suffering without improving, whereas requesting terminal sedation was more often related to severe pain. Physicians applying terminal sedation estimated that the patient's life had been shortened by more than 1 week in 27% of cases, compared with 73% in euthanasia cases. Terminal sedation and euthanasia both are often applied to address severe suffering in terminally ill patients. However, terminal sedation is typically used to address severe physical and psychological suffering in dying patients, whereas perceived loss of dignity during the last phase of life is a major problem for patients requesting euthanasia.
Calls for a change in the law to allow strictly controlled forms of voluntary euthanasia and assisted dying in the United Kingdom continue following two recent cases. In this article Richard Griffith reviews the current stance of the law on euthanasia and assisted dying and discusses attempts at reform made by Lord Joffe in the Assisted Dying for the Terminally Ill Bill 2005 (HL).
“When a country legalizes active euthanasia, it puts itself on a slippery slope from where it may well go further downward.” If true, this is a forceful argument in the battle of those who try to prevent euthanasia from becoming legal. The force of any slippery-slope argument, however, is by
Zatroch, Katie K; Knight, Cameron G; Reimer, Julie N; Pang, Daniel S J
The Canadian Council on Animal Care and American Veterinary Medical Association classify intraperitoneal (IP) pentobarbital as an acceptable euthanasia method in rats. However, national guidelines do not exist for a recommended dose or volume and IP euthanasia has been described as unreliable, with misinjections leading to variable success in ensuring a timely death. The aims of this study were to assess and improve efficacy and consistency of IP euthanasia. In a randomized, blinded study, 51 adult female Sprague-Dawley rats (170-495 g) received one of four treatments: low-dose low-volume (LL) IP pentobarbital (n = 13, 200 mg/kg pentobarbital), low-dose high-volume (LH) IP pentobarbital (n = 14, 200 mg/kg diluted 1:3 with phosphate buffered saline), high-dose high-volume (HH, n = 14, 800 mg/kg pentobarbital), or saline. Times to loss of righting reflex (LORR) and cessation of heartbeat (CHB) were recorded. To identify misinjections, necropsy examinations were performed on all rats. Video recordings of LL and HH groups were analyzed for pain-associated behaviors. Between-group comparisons were performed with 1-way ANOVA and Games-Howell post hoc tests. Variability in CHB was assessed by calculating the coefficient of variation (CV). The fastest euthanasia method (CHB) was HH (283.7 ± 38.0 s), compared with LL (485.8 ± 140.7 s, p = 0.002) and LH (347.7 ± 72.0 s, p = 0.039). Values for CV were: HH, 13.4%; LH, 20.7%; LL, 29.0%. LORR time was longest in LL (139.5 ± 29.6 s), compared with HH (111.6 ± 19.7 s, p = 0.046) and LH (104.2 ± 19.3 s, p = 0.01). Misinjections occurred in 17.0% (7/41) of euthanasia attempts. Pain-associated behavior incidence ranged from 36% (4/11, LL) to 46% (5/11, HH). These data illustrate refinement of the IP pentobarbital euthanasia technique. Both dose and volume contribute to speed of death, with a dose of 800 mg/kg (HH) being the most effective method. An increase in volume alone does not significantly reduce variability. The
Lavery, J V; Dickens, B M; Boyle, J M; Singer, P A
Euthanasia and assisted suicide involve taking deliberate action to end or assist in ending the life of another person on compassionate grounds. There is considerable disagreement about the acceptability of these acts and about whether they are ethically distinct from decisions to forgo life-sustaining treatment. Euthanasia and assisted suicide are punishable offences under Canadian criminal law, despite increasing public pressure for a more permissive policy. Some Canadian physicians would be willing to practise euthanasia and assisted suicide if these acts were legal. In practice, physicians must differentiate between respecting competent decisions to forgo treatment, providing appropriate palliative care, and acceeding to a request for euthanasia or assisted suicide. Physicians who believe that euthanasia and assisted suicide should be legally accepted in Canada should pursue their convictions only through legal and democratic means.
de Vries, Ubaldus
Dutch author Ubaldus de Vries reviews the current state of the euthanasia law in the Netherlands. The legislation, enacted in 2001, creates a medical exception that allows for euthanasia in cases where patients experience "hopeless and unbearable suffering." A brief history of the Dutch approach to euthanasia is set forth, case law is reviewed, and the unique role of the doctor is examined in seeking to understand the extent of one's right to euthanasia in the Netherlands. Because the courts must determine what constitutes "hopeless and unbearable suffering," Professor de Vries analyzes the judicial interpretation of "suffering" and concludes that judicial interpretation has reached its limits, and thus by implication, the limits of lawful euthanasia have been reached.
Altruism is arguably the quintessential moral trait, involving willingness to benefit others and unwillingness to harm them. In this study, I explored how altruism and other personality variables relate to acceptance of euthanasia. In addition, I investigated the role of culture in attitudes to subcategorical distinctions of euthanasia. 190 Iranian students completed the Attitude Towards Euthanasia scale, the HEXACO Personality Inventory-Revised, and an interest in religion measure. Higher scores on altruism, Honesty-Humility, Agreeableness, Conscientiousness and religiousness were associated with viewing euthanasia as unacceptable. As expected, altruism explained unique variance in euthanasia attitude beyond gender, religiosity and broad personality factors. Cultural and individual differences should be taken into consideration in moral psychology research and end-of-life decision-making.
Lavery, J V; Dickens, B M; Boyle, J M; Singer, P A
Euthanasia and assisted suicide involve taking deliberate action to end or assist in ending the life of another person on compassionate grounds. There is considerable disagreement about the acceptability of these acts and about whether they are ethically distinct from decisions to forgo life-sustaining treatment. Euthanasia and assisted suicide are punishable offences under Canadian criminal law, despite increasing public pressure for a more permissive policy. Some Canadian physicians would be willing to practise euthanasia and assisted suicide if these acts were legal. In practice, physicians must differentiate between respecting competent decisions to forgo treatment, providing appropriate palliative care, and acceeding to a request for euthanasia or assisted suicide. Physicians who believe that euthanasia and assisted suicide should be legally accepted in Canada should pursue their convictions only through legal and democratic means. PMID:9164399
Shaikh, M A; Kamal, A
Opinions of university students about euthanasia were studied in 4 cities in Pakistan using convenience sampling. A total of 836 students (316 males and 520 females) completed a questionnaire in which euthanasia was defined as deliberate administration of an overdose of a drug by a doctor to relieve pain and suffering of a dying patient at his/her explicit request to end his/her life. Only 25.6% of students agreed that euthanasia should be legalized in Pakistan. The most common reason cited for legalization of euthanasia was to relieve patient's suffering but only when a committee of physicians agreed to recommend it. Students who opposed legalization (74.4%) cited impediments to future medical research as the most common reason, followed by the risk of misuse by physicians or family members. Only 8.9% of students cited religious beliefs as a reason against legalization. There is a need in Pakistan for more debate about euthanasia.
Salib, E; Tadros, G
A sample of carers was asked to complete a self-administered questionnaire designed to collect information about carers' characteristics and obtain their views on passive euthanasia. Each carer was given an information sheet about the study, which included a detailed and clear account for the different types of euthanasia. The study showed a strong support for passive euthanasia from the non-professional carers of dementia patients. The strongest support was for the idea of a 'Living Will'. Having previous experience in looking after other people with dementia would appear to influence carers' perception of passive euthanasia. The subject of passive euthanasia and its ramifications for sufferers, carers and professionals warrants further exploration.
Donker, G.A.; Alphen, J.E. van; Marquet, R.L.
Objective: To investigate changes in the number of and reasons for requests of Euthanasia and physician assisted suicide (E/PAS) in Dutch General Practice after implementing the Euthanasia Act in 2002. Design: Retrospective dynamic cohort study during the period 1977–2007. Participants Standardized
Donker, G.; Alphen, J. van; Marquet, R.
Aim: To investigate changes in the number of and reasons for requests of Euthanasia and physician assisted suicide (E/PAS) in Dutch General Practice after implementing the Euthanasia Act in 2002. Design: Retrospective dynamic cohort study during the period 1977–2007. Participants: Standardized
Inghelbrecht, E.; Bilsen, J.J.; Mortier, F.; Deliens, L.H.J.
BACKGROUND: Nurses have an important role in caring for terminally ill patients. They are also often involved in euthanasia. However, little is known about their attitudes towards it. OBJECTIVES: To investigate on a nationwide level nurses' attitudes towards euthanasia and towards their role in
This paper considers the problems that arise when death, which is a philosophically difficult concept, is incorporated into healthcare metrics, such as the quality-adjusted life year (QALY). These problems relate closely to the debate over euthanasia and assisted suicide because negative QALY scores can be taken to mean that patients would be 'better off dead'. There is confusion in the literature about the meaning of 0 QALY, which is supposed to act as an 'anchor' for the surveyed preferences on which QALYs are based. In the context of the debate over euthanasia, the QALY assumes an ability to make meaningful comparisons between life-states and death. Not only is this assumption questionable, but the ethical debate is much more broad than the question of whether death is preferable to a state of living. QALYs are derived from preferences about health states, so do not necessarily reflect preferences about events (eg, dying) or actions (eg, killing). This paper presents a new kind of problem for the QALY. As it stands, the QALY provides confused and unreliable information when it reports zero or negative values, and faces further problems when it appears to recommend death. This should preclude its use in the debate over euthanasia and assisted suicide. These problems only apply where the QALY involves or seems to involve a comparison between life-states and death, and are not relevant to the more general discussion of the use of QALYs as a tool for comparing the benefits derived from treatment options. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
ten Have, Henk; Welie, Jos V M
The aim of this article was to review the ethical debate concerning palliative sedation. Although recent guidelines articulate the differences between palliative sedation and euthanasia, the ethical controversies remain. The dominant view is that euthanasia and palliative sedation are morally distinct practices. However, ambiguous moral experiences and considerable practice variation call this view into question. When heterogeneous sedative practices are all labeled as palliative sedation, there is the risk that palliative sedation is expanded to include practices that are actually intended to bring about the patients' death. This troublesome expansion is fostered by an expansive use of the concept of intention such that this decisive ethical concept is no longer restricted to signify the aim in guiding the action. In this article, it is argued that intention should be used in a restricted way. The significance of intention is related to other ethical parameters to demarcate the practice of palliative sedation: terminality, refractory symptoms, proportionality, and separation from other end-of-life decisions. These additional parameters, although not without ethical and practical problems, together formulate a framework to ethically distinguish a more narrowly defined practice of palliative sedation from practices that are tantamount to euthanasia. Finally, the article raises the question as to what impact palliative sedation might have on the practice of palliative care itself. The increasing interest in palliative sedation may reemphasize characteristics of health care that initially encouraged the emergence of palliative care in the first place: the focus on therapy rather than care, the physical dimension rather than the whole person, the individual rather than the community, and the primacy of intervention rather than receptiveness and presence. Copyright © 2014 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
Ypma, Tjipke D; Hoekstra, Herman L
To determine how uniformly Support and Consultation on Euthanasia in the Netherlands (SCEN) doctors assess a euthanasia request in patients not in the final stages of a terminal illness. Qualitative research. Internal survey among SCEN doctors in the 'SCEN-Drenthe' peer group, who were asked to provide an opinion on the requirements of due care, items a to d, of the Termination of life on request and assisted suicide act (WTL) in three fictitious patients. Sixty assessments were received from 20 SCEN physicians. Half of the reviews were assessed as 'due care requirements not met". 45% of these were for a patient whose request was based on the grounds of a "completed life", 50% for a patient with Alzheimer's, and 55% for a patient with a reduced level of consciousness. Uncertainty about the place of Article 2.2 of the WTL, personal assessment of the unbearable nature of hopeless suffering and the rejection of alternative solutions were responsible for the heterogeneous assessments. Uniformity of assessment is important to avoid legal disparity in this patient group. We found no medical or ethical benchmarks for determining the unbearable nature of suffering. A verifying assessment by the SCEN physician can only provide an opinion regarding the presence of hopeless pain that is classified as "unbearable". A negative SCEN assessment undermines a person's sense of justice at a difficult time, while the hopeless suffering may well be accepted as unbearable in comparable cases. Adapting the KNMG "Guidelines on euthanasia for patients in a state of reduced consciousness" so that they are in line with the WTL could also contribute to greater uniformity.
There is a marked disparity between medical intuitions and philosophical argument about euthanasia. In this paper I argue that the following objections can be raised. First, medical intuitions are against it and this is an area in which judgement and sensitivity are required in that death is a unique and complex process and the patient has many needs including the need to know that others have not discounted his or her worth. Also, part of the moral constitution of a good doctor is a devotion...
de Beaufort, Inez D; van de Vathorst, Suzanne
The number of dementia patients requesting euthanasia in the Netherlands has increased over the past five years. The issue is highly controversial. In this contribution we discuss some of the main arguments: the nature of suffering, the voluntariness of the request and the role of the physician. We argue that society has a duty to care for patients who suffer from dementia and to make their lives as good and comfortable as possible. We also argue that it can be morally acceptable for those who do not want to continue their life with dementia to choose to die. The choice can be based on good reasons.
There are no specific articles on the end of life in French law. Thus an act of euthanasia can be qualified as murder, murder with premeditation or non-assistance to a person in danger. Recent events and debates have raised the question of enacting new legislation to deal with this problem. Two contrary positions could be considered: either create a special offence or explicitly authorize acts of euthanasia. There are major objections to both these propositions. The first one would require taking account of various situations, --unbearable suffering, loss of dignity, and precise requests,--that would be impossible to specify in legislative terms. The second proposition would be open to the same objection; it would also derogate from the major principle of respect for the life of persons and thus risk setting a precedent that could be used in other circumstances to evade this principle. Finally, if a law were enacted to this effect, it would constitute a threat for the development of palliative care.
Garcia, J L A
This essay rebuts Gary Seay's efforts to show that committing euthanasia need not conflict with a physician's professional duties. First, I try to show how his misunderstanding of the correlativity of rights and duties and his discussion of the foundation of moral rights undermine his case. Second, I show aspects of physicians' professional duties that clash with euthanasia, and that attempts to avoid this clash lead to absurdities. For professional duties are best understood as deriving from professional virtues and the commitments and purposes with which the professional as such ought to act, and there is no plausible way in which her death can be seen as advancing the patient's medical welfare. Third, I argue against Prof. Seay's assumption that apparent conflicts among professional duties must be resolved through "balancing" and argue that, while the physician's duty to extend life is continuous with her duty to protect health, any duty to relieve pain is subordinate to these. Finally, I show that what is morally determinative here, as throughout the moral life, is the agent's intention and that Prof. Seay's implicitly preferred consequentialism threatens not only to distort moral thinking but would altogether undermine the medical (and any other) profession and its internal ethics.
Alberthsen, C; Rand, J S; Bennett, P C; Paterson, M; Lawrie, M; Morton, J M
A lack of information limits understanding of the excess cat problem and development of effective management strategies. This study describes cats entering Royal Society for the Prevention of Cruelty to Animals (RSPCA) Queensland shelters and identifies risk factors for euthanasia. Data for cats entering relevant shelters (July 2006-June 2008) were obtained from the RSPCA's electronic database. Univariable and multivariable logistic regression analyses were conducted to identify risk factors for euthanasia. Of 33,736 cats admitted, 46% were adult cats (≥3 months) and 54% were kittens (<3 months). The most common reason for admission was stray (54%), followed by owner surrender (44%). Euthanasia was the most common outcome (65%), followed by adoption (30%). The odds of euthanasia were lower for kittens and for cats that were desexed prior to admission. Of the strays, 8% had been desexed. For cats of similar age, sex, desexed and feral status, stray cats were more likely to be adopted than owner-surrenders. Strategies are needed to reduce numbers of cats admitted and euthanased. Given the high proportion of admissions that were kittens, reducing the incidence of delayed sterilisation of owned cats may be an important strategy for reducing the number of unwanted kittens. Many cats admitted as strays were rehomable, but given the high proportion of admissions that are strays, further research on stray populations is needed. Future studies of cats entering shelters would be enhanced if data collection definitions, categories and methods were standardised. © 2013 The Authors. Australian Veterinary Journal © 2013 Australian Veterinary Association.
Mullins, Caitlyn R; Pairis-Garcia, Monique D; Campler, Magnus R; Anthony, Raymond; Johnson, Anna K; Coleman, Grahame J; Rault, Jean-Loup
With extensive knowledge and training in the prevention, management, and treatment of disease conditions in animals, veterinarians play a critical role in ensuring good welfare on swine farms by training caretakers on the importance of timely euthanasia. To assist veterinarians and other industry professionals in training new and seasoned caretakers, an interactive computer-based training program was created. It consists of three modules, each containing five case studies, which cover three distinct production stages (breeding stock, piglets, and wean to grower-finisher pigs). Case study development was derived from five specific euthanasia criteria defined in the 2015 Common Swine Industry Audit, a nationally recognized auditing program used in the US. Case studies provide information regarding treatment history, clinical signs, and condition severity of the pig and prompt learners to make management decisions regarding pig treatment and care. Once a decision is made, feedback is provided so learners understand the appropriateness of their decision compared to current industry guidelines. In addition to training farm personnel, this program may also be a valuable resource if incorporated into veterinary, graduate, and continuing education curricula. This innovative tool represents the first interactive euthanasia-specific training program in the US swine industry and offers the potential to improve timely and humane on-farm pig euthanasia.
Lam, R C S; Chien, Wai-Tong
The global euthanasia debate by health care professionals has raised important ethical issues concerning the professional duties and responsibilities of nurses caring for terminal patients. The purpose of this study was to examine the attitudes of acutely ill patients towards the practice of euthanasia in Hong Kong. A modified form of the 23-item Questionnaire for General Household Survey scale was used. This cross-sectional survey study was conducted with a stratified sample of in-patients recruited from a wide variety of departments in a regional, acute general hospital. Seventy-seven out of 129 patients responded (59.7%) and a high proportion of patients agreed with the use of euthanasia in the following circumstances: 'where they were a third party', if 'someone they loved' was affected, or if 'they themselves were the patient'. Of the 77 patients, 54 agreed with active euthanasia (70.1%) and 65 with passive (84.4%). The results also indicated that a few socio-demographic characteristics (such as age, gender and household income) statistically significantly correlated with patients' attitudes towards euthanasia. These findings highlight that Chinese patients with acute illness generally accept the use of euthanasia. Further research on the attitudes and perceptions of patients towards the use of euthanasia is recommended, particularly in diverse groups of Chinese and Asian patients with acute or terminal illness.
Full Text Available Numerous questionnaire studies on attitudes towards euthanasia produced conflicting results, precluding any general conclusion. This might be due to the fact that human behavior can be influenced by automatically triggered attitudes, which represent ingrained associations in memory and cannot be assessed by standard questionnaires, but require indirect measures such as reaction times (RT or electroencephalographic recording (EEG. Event related potentials (ERPs of the EEG and RT during an affective priming task were assessed to investigate the impact of automatically triggered attitudes and were compared to results of an explicit questionnaire. Explicit attitudes were ambivalent. Reaction time data showed neither positive nor negative associations towards euthanasia. ERP analyses revealed an N400 priming effect with lower mean amplitudes when euthanasia was associated with negative words. The euthanasia-related modulation of the N400 component shows an integration of the euthanasia object in negatively valenced associative neural networks. The integration of all measures suggests a bottom-up process of attitude activation, where automatically triggered negative euthanasia-relevant associations can become more ambiguous with increasing time in order to regulate the bias arising from automatic processes. These data suggest that implicit measures may make an important contribution to the understanding of euthanasia-related attitudes.
Adchalingam, K; Kong, W H; Zakiah, M A; Zaini, M; Wong, Y L; Lang, C C
A cross-sectional survey of 400 medical students of multicultural backgrounds at the University of Malaya was conducted to understand their attitudes towards euthanasia and factors related to medical decisions and ethical reasoning concerning the prolongation of life, the right to die and euthanasia. The student respondents completed self-administered questionnaires that comprised of twelve questions with multiple stems addressing personal perceptions, knowledge, attitudes, and decisions about euthanasia and the relief of suffering. The majority of respondents (52%) were for the withdrawal of active therapy in a patient suffering from a terminal painful disease while 48% of them were against it. Seventy-one percent of the students involved in the study were against the idea of active euthanasia i.e. the administration of a lethal injection. However, 27% of the respondents felt that there was a moral justification to assist patients to die. Thirty-two percent of the respondents favoured the legalization of euthanasia in Malaysia while 67% of them were strongly against it. The majority (61%) of respondents would not practice euthanasia as a doctor nor would they have performed on themselves if or when it became legal. The main issue surrounding euthanasia that concerned the respondents was the misuse of it by unethical practitioners and they felt that further debate on the matter was essential, both within the local and international communities.
Enke, Martin; Meyer, Patric; Flor, Herta
Numerous questionnaire studies on attitudes towards euthanasia produced conflicting results, precluding any general conclusion. This might be due to the fact that human behavior can be influenced by automatically triggered attitudes, which represent ingrained associations in memory and cannot be assessed by standard questionnaires, but require indirect measures such as reaction times (RT) or electroencephalographic recording (EEG). Event related potentials (ERPs) of the EEG and RT during an affective priming task were assessed to investigate the impact of automatically triggered attitudes and were compared to results of an explicit questionnaire. Explicit attitudes were ambivalent. Reaction time data showed neither positive nor negative associations towards euthanasia. ERP analyses revealed an N400 priming effect with lower mean amplitudes when euthanasia was associated with negative words. The euthanasia-related modulation of the N400 component shows an integration of the euthanasia object in negatively valenced associative neural networks. The integration of all measures suggests a bottom-up process of attitude activation, where automatically triggered negative euthanasia-relevant associations can become more ambiguous with increasing time in order to regulate the bias arising from automatic processes. These data suggest that implicit measures may make an important contribution to the understanding of euthanasia-related attitudes.
Terkamo-Moisio, Anja; Kvist, Tarja; Kangasniemi, Mari; Laitila, Teuvo; Ryynänen, Olli-Pekka; Pietilä, Anna-Maija
Despite the significant role of nurses in end-of-life care, their attitudes towards euthanasia are under-represented both in the current literature and the controversial debate that is ongoing in several countries. What are the attitudes towards euthanasia among Finnish nurses? Which characteristics are associated with those attitudes? Cross-sectional web-based survey. Participants and research context: A total of 1003 nurses recruited via the members' bulletin of the Finnish Nurses Association and social media. Ethical considerations: Ethical approval was obtained from the Committee on Research Ethics of the university to which the authors were affiliated. The majority (74.3%) of the participants would accept euthanasia as part of Finnish healthcare, and 61.8% considered that Finland would benefit from a law permitting euthanasia. Most of the nurses (89.9%) thought that a person must have the right to decide on his or her own death; 77.4% of them considered it likely that they would themselves make a request for euthanasia in certain situations. The value of self-determination and the ability to choose the moment and manner of one's death are emphasized in the nurses' attitudes towards euthanasia. A continuous dialogue about euthanasia and nurses' shared values is crucial due to the conflict between nurses' attitudes and current ethical guidelines on nursing.
The institution of active euthanasia has been legal in Colombia since 2015. In California, the regulation on physician-assisted suicide will come into effect on January 1, 2016. The legal institution of active euthanasia is not accepted under the law of the United States of America, however, physician-assisted suicide is accepted in an increasing number of member states. The related regulation in Oregon is imitated in other member states. In South America, Colombia is not the first country to legalize active euthanasia: active euthanasia has been legal in Uruguay since 1932. The North American legal tradition markedly differs from the South American one and both are incompatible with the Central European rule of law. In Hungary and in most European Union countries, solely the passive form of euthanasia is legal. In the Benelux countries, the active form of euthanasia is legal because the supranational law of the European Union does not prohibit it. Notwithstanding, European Union law does not prescribe legalization of either the active form of euthanasia, or the physician-assisted suicide.
Enke, Martin; Meyer, Patric; Flor, Herta
Numerous questionnaire studies on attitudes towards euthanasia produced conflicting results, precluding any general conclusion. This might be due to the fact that human behavior can be influenced by automatically triggered attitudes, which represent ingrained associations in memory and cannot be assessed by standard questionnaires, but require indirect measures such as reaction times (RT) or electroencephalographic recording (EEG). Event related potentials (ERPs) of the EEG and RT during an affective priming task were assessed to investigate the impact of automatically triggered attitudes and were compared to results of an explicit questionnaire. Explicit attitudes were ambivalent. Reaction time data showed neither positive nor negative associations towards euthanasia. ERP analyses revealed an N400 priming effect with lower mean amplitudes when euthanasia was associated with negative words. The euthanasia-related modulation of the N400 component shows an integration of the euthanasia object in negatively valenced associative neural networks. The integration of all measures suggests a bottom-up process of attitude activation, where automatically triggered negative euthanasia-relevant associations can become more ambiguous with increasing time in order to regulate the bias arising from automatic processes. These data suggest that implicit measures may make an important contribution to the understanding of euthanasia-related attitudes. PMID:27088244
Hosseinzadeh, Kazem; Rafiei, Hossein
Euthanasia is among the most common and controversial end-of-life care issues. Examining the attitudes of nursing students to this issue is important because they may well encounter these issues during the course of their clinical placements. Research aims: This study aims to examine the attitudes of a sample of Iranian nursing students towards euthanasia. This is a descriptive cross-sectional study. Participants and research context: Using convenience sampling, 382 Muslim nursing students were enrolled in this study. Data were collected using a demographic variables checklist and a self-administered questionnaire that included a definition of euthanasia and 11 closed questions that sought to record participants' level of agreement with euthanasia based on a Likert scale. Ethical consideration: Consent for participation was implicit, indicated by the participants having returned the completed questionnaires. Participants were assured that their data would remain anonymous, be kept confidential and be stored safely. Of the 382 participants, 61.5% were female, and the remainder were male. The mean age was 62.6 ± 14.1 years (range: 32-91 years). In total, 34.2%, 41.6% and 24% of students reported a negative, neutral and positive attitude to euthanasia, respectively. Most students with clinical experience, and 38.5% of students with no clinical experience, indicated their agreement with active euthanasia. There are a number of misconceptions among Iranian Muslim nursing students regarding the definition of euthanasia. Nonetheless, most students exhibit positive attitudes to euthanasia consistent with their clinical experiences. It is recommended to explore the factors that induced nursing students' tendency to euthanasia.
I question whether, in those cases where physician-assisted suicide is invoked to alleviate unbearable pain and suffering, there can be such a thing as voluntary euthanasia. The problem is that when a patient asks to die under such conditions there is good reason to think that the decision to die is compelled by the pain, and hence not freely chosen. Since the choice to die was not made freely it is inadvisable for physicians to act in accordance with it, for this may be contrary to the patient's genuine wishes. Thus, what were thought to be cases of voluntary euthanasia might actually be instances of involuntary euthanasia. PMID:10390679
“When a country legalizes active euthanasia, it puts itself on a slippery slope from where it may well go further downward.” If true, this is a forceful argument in the battle of those who try to prevent euthanasia from becoming legal. The force of any slippery-slope argument, however, is by definition limited by its reference to future developments which cannot empirically be sustained. Experience in the Netherlands—where a law regulating active euthanasia was accepted in April 2001—may shed...
In order to discuss the normative aspects of euthanasia one has to clarify what is meant by active and passive euthanasia. Many philosophers deny the possibility of distinguishing the two by purely descriptive means, e.g. on the basis of theories of action or the differences between acting and omitting to act. Against this, such a purely descriptive distinction will be defended in this paper by discussing and refining the theory developed by Dieter Birnbacher in his "Tun und Unterlassen". On this basis I will suggest a new definition of active and passive euthanasia.
Voultsos, Polichronis; Njau, Samuel N; Vlachou, Maria
Modern Greek society appears to be split regarding the legalization of euthanasia. The Greek Orthodox Church maintains a negative attitude. Research shows that some forms of euthanasia are carried out "behind closed doors". There is no specific legal provision. The government avoids bearing the political cost of regulating this marginal issue. According to the dominant view of Criminal Law jurists, some forms of euthanasia are considered permissible de lege lata, under certain conditions. The safety of the concurrence of these conditions, safeguarding of the acceptability of forms that are considered permissible and - mostly - the need to regulate the prohibited forms in exceptional cases, all force the legislators to promptly fill any legal vacuums.
Full Text Available This paper aims to be a scientific approach to the issue of euthanasia, bringing into the debate current and future controversies raised by euthanasia, as a result of the introduction into the Romanian penal law of the criminal offence of homicide by request of the victim. The study represents an approach to moral, religious, constitutional, civil, criminal procedure debates and last but not least to criminal debates regarding the legalization of the euthanasia, as the most difficult task lies with the criminal law.
Köhler, Norbert; Brähler, Elmar; Götze, Heide
It is a matter of debate whether euthanasia should be part of medical practice. The current study investigates the attitudes of bereaved family members of cancer patients towards euthanasia. We conducted a survey with 211 people who had recently lost a close relative to cancer. Participants were asked whether euthanasia should be part of medical practice.Two logistic regression models were calculated in order to determine the factors influencing the attitude towards active euthanasia and assisted suicide. About 70% and 75% of the respondents approved active euthanasia and assisted suicide, respectively. Religious denomination and psychological distress had a significant impact on the attitude towards active euthanasia. About 10%of the deceased patients had asked for active euthanasia. There was no difference between bereaved family members and the general population regarding the acceptance of euthanasia. Attitudes towards active euthanasia are associated with psychological distress and shaped by cultural values rather than by the experience of end-of-life care.
Randall, Fiona; Downie, Robin
It is widely assumed by the general public that if assisted suicide (AS) or euthanasia (VE) were legalised doctors must be essentially involved in the whole process including prescribing the medication...
Research has documented associations among religious affiliation, religious practice, and attitudes toward voluntary euthanasia, yet very few studies have investigated how particular religious beliefs influence these attitudes. I use data from the General Social Survey (GSS; N = 19,967) to evaluate the association between the belief in life after death and attitudes toward voluntary euthanasia. I find that those who believe in life after death are significantly less likely than those who do not believe in life after death or those who doubt the existence of life after death to have positive attitudes toward voluntary euthanasia. These associations hold even after controlling for religious affiliation, religious attendance, views of the Bible, and sociodemographic factors. The findings indicate that to understand individuals' views about voluntary euthanasia, one must pay attention to individuals' particular religious beliefs.
Haugen, O A
While there has been a growing acceptance among the general public in Norway that euthanasia and physician assisted suicide should be made legal, the Norwegian Medical Association still strongly opposes such acts. A recent survey at the University Hospital in Trondheim confirms that Norwegian physicians in general have a very restrictive attitude towards euthanasia. Among 483 physicians (response rate 72.8%), only 17.6% were in favour of physicians actively contributing to shortening the life of a patient. However, 36% of the surgeons and gynecologists had a more liberal view, although only 16.5% would personally assist in such acts. None of 69 oncologists, pediatricians, neurologists or neurosurgeons were willing to perform euthanasia. Should euthanasia be established as a legal right, a considerable number of physicians would probably insist on having the right to abstain.
Johnson, David; And Others
Analysis indicates that religious intensity, sex, age, and education are important associational variables regarding attitudes toward suicide and euthanasia. Males are more accepting than females. Females are influenced by family life conditions. Males are influenced by health status. (JMF)
It appears that the attitudes of health professionals differ towards suicide and voluntary active euthanasia. An acceptance of, if not an agreement with, voluntary active euthanasia exists, while there is a general consensus that suicide should be prevented. This paper searches for a working definition of suicide, to discover ethical reasons for the negative value that suicide assumes, and also to provide a term of reference when comparing suicide with euthanasia. On arriving at a working definition of suicide, it is compared with voluntary active euthanasia. An analysis of utilitarian and deontological considerations is provided and proves to be inconclusive with respect to the ethical principles informing the attitudes of professionals. Therefore, a search for other influences is attempted; this indicates that psychological influences inform attitudes to a greater degree than ethical principles.
.... The topic is still contentious; arguments for and against it seem to stretch infinitely, but at the same time there are many who form opinions on the topic without having a clear image of the concept and forms of euthanasia...
Tepehan, Selma; Ozkara, Erdem; Yavuz, M Fatih
The aim of this study was to reveal doctors' and nurses' attitudes to euthanasia in intensive care units and surgical, internal medicine and paediatric units in Turkey. A total of 205 doctors and 206 nurses working in several hospitals in Istanbul participated. Data were collected by questionnaire and analysed using SPSS v. 12.0. Significantly higher percentages of doctors (35.3%) and nurses (26.6%) working in intensive care units encountered euthanasia requests than those working in other units. Doctors and nurses caring for terminally ill patients in intensive care units differed considerably in their attitudes to euthanasia and patient rights from other health care staff. Euthanasia should be investigated and put on the agenda for discussion in Turkey.
Adchalingam, K; Kong, W H; Zakiah, M A; Zaini, M; Wong, Y L; Lang, C C
A cross-sectional survey of 400 medical students of multicultural backgrounds at the University of Malaya was conducted to understand their attitudes towards euthanasia and factors related to medical...
Objective: The research was conducted to investigate the opinions of nurses and physicians pertaining to euthanasia who are working at Internal Medicine, Surgery and Intensive Care Unit departments at Baskent...
Anne Mullens used a recent fellowship provided by the Atkinson Foundation to take an in-depth look at euthanasia in the Netherlands. During her time in Holland, she discussed the issue with doctors who support and oppose euthanasia. She accompanied a doctor as he visited a patient who was dying of cancer and was beginning to consider the possibility of euthanasia. She talked to a nonphysician who is adamantly opposed to euthanasia and carries a card stating that. She visited a hospital in Amsterdam that has received requests from foreigners seeking euthansia. Mullens offers a comprehensive look at an issue that continues to provoke strong feelings among Canadian physicians and patients. Images p1846-a p1849-a p1850-a p1852-a PMID:7773901
This paper reports the findings of an unobtrusive research inquiry investigating the possible use and misuse of Alzheimer's disease in public policy debate on the legalization of euthanasia. The component of the study being reported identified the problematic use of five key metaphors: the Alzheimer metaphor, which in turn was reinforced by three additional metaphors--the epidemic metaphor, the military metaphor, and the predatory thief metaphor; and the euthanasia metaphor. All metaphors were found to be morally loaded and used influentially to stigmatize Alzheimer's disease and mediate public opinion supporting the legalization of euthanasia as an end-of-life 'solution' for people with the disease. It is contended that, in the interests of promoting intellectual honesty and giving proper recognition to the extraordinary complexity of the issue, the problematic use and influence of metaphoric thinking in the public debate about Alzheimer's disease and euthanasia needs to be made transparent, questioned and challenged.
The Belgian law legalizing euthanasia under strict conditions came into effect September 22, 2002. Any physician performing euthanasia has to complete a registration document and to send it within four days to a federal commission whose mission is to verify that the legal conditions were fulfilled. From September 22, 2002 to December 31, 2013, 8.767 documents have been registered and analyzed by this commission. They are described in six reports referred to Parliament. The present paper analyzes the work of this commission and answers the criticisms concerning its quality and its efficiency. The allegations that clandestine euthanasia's escaping any control are performed are also discussed. In conclusion, it appears that the legal obligations concerning the practice of euthanasia in Belgium are fully effective.
This article provides a critical analysis of Dutch euthanasia policy and practice. The research benefited from twenty-eight interviews conducted in the Netherlands during the summer of 1999 with some of the leading figures who dictate the decision-making process and take an active part in the debates. The discussion begins with a review of the two major Dutch reports on euthanasia and the conflicting views and interpretations offered by the literature. Next, I provide some data about the interviews, and then analysis indicating that the Dutch Guidelines on the policy and practice of euthanasia do not provide ample mechanisms against abuse. I argue that the Dutch Guidelines are insufficient, do not provide adequate control over the practice of euthanasia, and that the entire policy should be revised and made more coherent and more comprehensive.
Anne Pamela Frances Wand; Carmelle Peisah; Brian Draper; Carolyn Jones; Henry Brodaty
Suicide amongst the very old is an important public health issue. Little is known about why older people may express a wish to die or request euthanasia and how such thoughts may intersect with suicide attempts...
Helly Prajitno Soetjipto
konteks sosial dan konstruksi sosial kematian. Euthanasia didiskusikan di dalam suatu kerangka pikir yang mencoba memberi perhatian kepada hal-hal yang kontekstual dan interpretatif fenomena sosial suatu proses kematian dan kejadian kematian
Full Text Available The aim of this work is twofold. On the one hand, the intention is to provide analysis of the issue of euthanasia. On the other hand, this approach necessarily leads to a discussion toward the provision of an adequate definition of euthanasia. Therefore the article, first of all, refers to the multilayered aspect of the term euthanasia. To avoid ambiguity and other uncertainties while providing the definition of euthanasia, the authors carefully perform a conceptual analysis. This leads to the establishment of a clear distinction between actions which, due to their motives or their method of execution, cast a shadow on the meaning of this medical procedure. [Projekat Ministarstva nauke Republike Srbije, br. 179041: Dinamički sistemi u prirodi i društvu: filozofski i empirijski aspekti
Keywords: infanticide, child euthanasia, Roman Christian era,. Abuja,. Introduction .... human flesh visit the spot and feast unhindered on the infants, a fine ... law accorded all the rights of property of exposed infants to those who had the charity ...
In Japan, there are no acts and, specific provisions or official guidelines on euthanasia, but recently, as I will mention below, an official guideline on "death with dignity" has been made. Nevertheless in fact, this guideline provides only a few rules of process on terminal care. Therefore the problems of euthanasia and "death with dignity" are mainly left to the legal interpretation by literatures and judicial precedents of homicide (Article 199 of the Criminal Code; where there is no distinction between murder and manslaughter) and of homicide with consent (Article 202 of the Criminal Code). Furthermore, there are several cases on euthanasia or "death with dignity" as well as borderline cases in Japan. In this paper I will present the situation of the latest discussions on euthanasia and "death with dignity" in Japan from the viewpoint of medical law. Especially, "death with dignity" is seriously discussed in Japan, therefore I focus on it.
Stronegger, Willibald J; Schmölzer, Christin; Rásky, Eva; Freidl, Wolfgang
In most European countries the attitudes regarding the acceptability of active euthanasia have clearly changed in the population since World War II. Therefore, it is interesting to know which trends in attitudes prevail among the physicians of the future. The present study analyses trends in the attitudes towards active euthanasia in medical students at the Medical University of Graz, Austria. The survey was conducted over a period of 9 years, enabling us to investigate trends regarding both attitudes and underlying motives. Acceptance of active euthanasia increased from 16.3% to 29.1% to 49.5% in the periods from 2001 to 2003/04 to 2008/09. The survey period from 2001 to 2009 reveals a massive change in medical students' attitudes towards active euthanasia under medical supervision. Ethical convictions of medical doctors seem to fall back behind a higher valuation of the autonomy of the patient.
Although many studies of euthanasia and physician-assisted death (PAD) have been performed in the United States, none have specifically addressed attitudes among physicians practicing in Tennessee. In January 2001, we mailed a 30-item survey instrument to a stratified random sample of 1,117 physicians drawn from the Tennessee Licensing Bureau. Tennessee physicians are highly polarized over the issues of euthanasia and assisted death. A slight majority (47%) did not favor euthanasia or PAD and would oppose the legalization of such procedures. Of the physicians supporting euthanasia or PAD (43%), only 25% would administer a lethal overdose and less than a third would counsel/prescribe medication for an overdose. Attitudes were influenced by three primary factors: ethics, religion, and the role of the physician to relieve pain and suffering. Regardless of their overall position, the majority of physicians agreed on basic restrictions and safeguards to prevent abuses and to protect vulnerable patients.
.... While the focus is largely on euthanasia and associated legislative and health-care issues in Canada and the United States, the question of what we owe the hopelessly ill and suffering is universal...
Orthodox Christian ethics is grounded in the sacredness of life principle. Yet, it can accept a quality of life approach where "quality" refers not to capacities or states, but to the relationship between the patient's condition and the quest for transcendent life goals (Walter and Shannon, 1990). The true quality of human life derives from the vocation to stewardship, which enjoins an attitude of humble acceptance toward beneficial or "redemptive" suffering. The proper response to suffering in terminal cases is not active euthanasia or physician-assisted suicide but appropriate pain management and personal care. In cases of PVS or deep coma, only the determination of higher brain death can warrant the withholding or withdrawing of food and hydration. Yet, artificial maintenance of biological existence is also immoral. Death is to be accepted and embraced as a transition to eternal life.
Siqueira-Batista, Rodrigo; Schramm, Fermin Roland
The principle of respect for autonomy has proved very useful for bioethical arguments in favor of euthanasia. However unquestionable its theoretical efficacy, countless aporiae can be raised when conducting a detailed analysis of this concept, probably checkmating it. Based on such considerations, this paper investigates the principle of autonomy, starting with its origins in Greek and Christian traditions, and then charting some of its developments in Western cultures through to its modern formulation, a legacy of Immanuel Kant. The main paradoxes of this concept are then presented in the fields of philosophy, biology, psychoanalysis and politics, expounding several of the theoretical difficulties to be faced in order to make its applicability possible within the scope of decisions relating to the termination of life.
Mojalefa L.J. Koenane
Full Text Available Debates on euthanasia (or �mercy killing� have been a concern in moral, philosophical, legal, theological, cultural and sociological discourse for centuries. The topic of euthanasia inspires a variety of strong views of which the �slippery slope� argument is one. The latter warns that the principle(s underlying any ethical issue (including euthanasia may be distorted. Scholars� views on euthanasia are influenced mainly by cultural, personal, political and religious convictions. In South Africa, the issue of euthanasia has arisen from time to time, but the question of whether it should be legalised was not seriously considered until it recently attracted attention because of a particular case, that of Cape Town advocate Robin StranshamFord. Although euthanasia is still illegal (this is because the Stransham-Ford ruling is confined to this particular case only, as stated in the ratio decidendi by Judge Hans Fabricius of the High Court in Pretoria, the Court granted leave to appeal its April 2015 judgement regarding euthanasia in the application lodged by Stransham-Ford. In considering the contentious nature of the issue of euthanasia, this article adopts a multidisciplinary approach which includes historical, legal, theological, philosophical, theoretical and analytic frameworks, discussing euthanasia from philosophical and theological perspectives, in particular. We conclude by recommending that the subject of applied ethics, which helps to educate citizens about contemporary moral problems such as euthanasia, be introduced at school level. Exposing young people to the debates around thorny issues such as this would familiarise them with the discourse, encourage them to engage with it and empower them as mature citizens to make informed, reasonable decisions, obviating confusion and conflict which might otherwise arise. The problems surrounding the issue of euthanasia are multidimensional and have the capacity to polarise the nation and
Verhoef, M J; Kinsella, T D
OBJECTIVE: To determine whether the opinions of Alberta physicians about active euthanasia had changed and to assess the determinants of potential changes in opinion. DESIGN: Follow-up survey (mailed questionnaire) of physicians included in the 1991 Alberta Euthanasia Survey. SETTING: Alberta. PARTICIPANTS: Of the 1391 physicians who participated in the 1991 survey 1291 (93%) had indicated that they were willing to take part in a follow-up survey. A follow-up questionnaire was mailed in 1994 ...
Full Text Available Objective: This study includes evaluation of views of the nurses working in two different university hospitals on euthanasia. Methods: This research was planned in form of a cross-sectional definitive questionnaire to analyze views of the nurses on euthanasia according to their departments. A face to face interview was performed with the nurses working in Medical Faculties of Dicle and Gaziantep Universities in 2013. One hundred and fifty two volunteers were examined according to the gender, age, marital status, number of children, family type that they live in, the department that they work, their frequency to meet death, professional experience, presence of any relative confined to bed, their ideas on whether the euthanasia law should be enacted, whether they would request euthanasia for themselves and their relatives. Result: Participants included 125 (82.2% women and 27 (17.8% men; average age was 26.68 ± 12.76 (20-56 years and 21 (13.8% cases did not report their ages. Eighty-nine (58.6% participants were married, 50 (32.9% participants were single and 105 (69.1% participants lived in an elementary family environment. Fifty eight (38.2% participants expressed an opinion on requirement of a legal regulation to make euthanasia possible and 40 (26.3% reported that they were uncertain about this subject. No statistically significant difference was detected between willingness and unwillingness of euthanasia according to their departments (p>0.05. Conclusion: As a result of this study, we find that some of the nurses consider application of the passive euthanasia occurs in our country although euthanasia is forbidden.
Full Text Available Objective: The research was conducted to investigate the opinions of nurses and physicians pertaining to euthanasia who are working at Internal Medicine, Surgery and Intensive Care Unit departments at Baskent University Ankara hospital.Methods: The research is a descriptive one. The sample consisted of 154 nurses and physicians who are working at Internal Medicine, Surgery and Intensive Care Unit departments at Baskent University Ankara hospital and accepted to participate and could be reached. A questionnaire with 30 items was used to collect data to obtain the socio-demographic characteristics and the opinions pertaining to euthanasia of nurses and physicians. Frequencies, mean values and chi-square tests were used in statistical analysis.Results: The participants didn’t approve euthanasia with a high ratio however it was determined that almost half of them asserted it as patient’s rights of a patient who want his/her death to be fastened and who has no chance to be cured and who are spending the last days of their life with unbearable pain. Except the age groups and marital status there was no significant difference found statistically between the opinions of physicians and nurses regarding euthanasia (p>0.05.Conclusion: It was stated that nurses and physicians consider not active euthanasia but passive euthanasia as acceptable.
Chvetzoff, G; Perret, M; Thevenet, G; Arbiol, E; Gobet, S; Saltel, P
Euthanasia is a controversial issue in today's society. In countries where euthanasia is legal, it is mainly associated with people with cancer. We retrospectively studied the frequency and basis of patients' requests for active euthanasia in the oncology setting.MethodsRecurrent requests for euthanasia made by the patients of Leon-Berard cancer center (Lyon, France) between 2001 and 2003 were recorded by questioning the physicians and nurse supervisors in charge or by collecting information from the minutes of multidisciplinary palliative care meetings. We also collected information on the general health status of the patients, their motives and their evolution over time, as well as responses from caregivers.ResultsWe identified 16 requests for euthanasia. These involved 8 men, 7 women and 1 child (median age, 56 years), corresponding to 1% of the total deaths recorded during the period. In 2 cases, the request had come from the family only. The most frequent motives were psychological distress (38%), desire for self-autonomy (31%) and pain (31%). Half of the patients, particularly those striving for autonomy, persisted with their request until death, whereas 2 of 3 requests motivated by physical or psychological distress were not maintained. Sedation was administered to 3 patients in response to recurrent requests.ConclusionRequests for euthanasia in cancer patients are rare but may occur. Sometimes suffering is not relieved by palliative care and the request is maintained. Dealing with these patients puts caregivers in a difficult situation.
Lemiengre, Joke; Dierckx de Casterlé, Bernadette; Denier, Yvonne; Schotsmans, Paul; Gastmans, Chris
To describe the form and content of ethics policies on euthanasia in Flemish hospitals and the possible influence of religious affiliation on policy content. Content analysis of policy documents. Forty-two documents were analyzed. All policies contained procedures; 57% included the position paper on which the hospital's stance on euthanasia was based. All policies described their hospital's stance on euthanasia in competent terminally ill patients (n=42); 10 and 4 policies, respectively, did not describe their stance in incompetent terminally and non-terminally ill patients. Catholic hospitals restrictively applied the euthanasia law with palliative procedures and interdisciplinary deliberations. The policies described several phases of the euthanasia care process--confrontation with euthanasia request (93%), decision-making process (95%), care process in cases of no-euthanasia decision (38%), preparation and performance of euthanasia (79%), and aftercare (81%)--as well as involvement of caregivers, patients, and relatives; ethical issues; support for caregivers; reporting; and practical examples of professional attitudes and communication skills. Euthanasia policies go beyond summarizing the euthanasia law by addressing the importance of the euthanasia care process, in which palliative care and interdisciplinary cooperation are important factors. Euthanasia policies provide tangible guidance for physicians and nurses on handling euthanasia requests.
Rietjens, Judith A C; Raijmakers, Natasja J H; Kouwenhoven, Pauline S C; Seale, Clive; van Thiel, Ghislaine J M W; Trappenburg, Margo; van Delden, Johannes J M; van der Heide, Agnes
The Netherlands is one of the few countries where euthanasia is legal under strict conditions. This study investigates whether Dutch newspaper articles use the term 'euthanasia' according to the legal definition and determines what arguments for and against euthanasia they contain. We did an electronic search of seven Dutch national newspapers between January 2009 and May 2010 and conducted a content analysis. Of the 284 articles containing the term 'euthanasia', 24% referred to practices outside the scope of the law, mostly relating to the forgoing of life-prolonging treatments and assistance in suicide by others than physicians. Of the articles with euthanasia as the main topic, 36% described euthanasia in the context of a terminally ill patient, 24% for older persons, 16% for persons with dementia, and 9% for persons with a psychiatric disorder. The most frequent arguments for euthanasia included the importance of self-determination and the fact that euthanasia contributes to a good death. The most frequent arguments opposing euthanasia were that suffering should instead be alleviated by better care, that providing euthanasia can be disturbing, and that society should protect the vulnerable. Of the newspaper articles, 24% uses the term 'euthanasia' for practices that are outside the scope of the euthanasia law. Typically, the more unusual cases are discussed. This might lead to misunderstandings between citizens and physicians. Despite the Dutch legalisation of euthanasia, the debate about its acceptability and boundaries is ongoing and both sides of the debate are clearly represented.
Full Text Available Introduction: Deliberation over euthanasia has been enduring for an extended period of time. On one end, there are populaces talking for the sacrosanctity of life and on the other end, there are those, who promote individual independence. All over the world professionals from different areas have already spent mammoth period over the subject. A large number of cases around the world have explored the boundaries of current legal distinctions, drawn between legitimate and nonlegitimate instances of ending the life. The term euthanasia was derived from the Greek words "eu" and "thanatos" which means "good death" or "easy death." It is also known as mercy killing. Euthanasia literally means putting a person to painless death especially in case of incurable suffering or when life becomes purposeless as a result of mental or physical handicap. Objective: To study the attitude of doctors toward euthanasia in Delhi. Methodology: It was a questionnaire based descriptive cross-sectional study carried out between July 2014 and December 2014. The study population included Doctors from 28 hospitals in Delhi both public and private. Equal numbers of doctors from four specialties were included in this study (50 oncologists, 50 hematologists, 50 psychiatrists, and 50 intensivists. Demographic questionnaire, as well as the Euthanasia Attitude Scale (EAS, a 30 items Likert-scale questionnaire developed by (Holloway, Hayslip and Murdock, 1995 was used to measure attitude toward Euthanasia. The scale uses both positively (16 items and negatively (14 items worded statements to control the effect of acquiescence. The scale also has four response categories, namely "definitely agree," "agree," "disagree," and "definitely disagree." The total score for the EAS was generated by adding all the sub-scales (question′s responses. The demographic questionnaire and EAS, a 30 items Likert-scale questionnaire developed by (Holloway, Hayslip and Murdock, 1995 was distributed
Cuervo Pinna, M Á; Rubio, M; Altisent Trota, R; Rocafort Gil, J; Gómez Sancho, M
The decriminalisation of euthanasia and assisted medical suicide has generated a continuous debate. The terminological confusion is one of the main difficulties in obtaining medical practice consensus. The objective of this study was to determine whether the terms of Euthanasia and physician assisted suicide are used with the same meaning by doctors in Extremadura (Spain). A qualitative study was conducted using two focus groups in which doctors from different specialties who attended a large number of terminal patients participated. No other focus group was required due to saturation. The sessions were tape recorded and transcribed by two experts in qualitative methodology. Atlas.ti software was used for the analysis. We were advised by the "Health Care at the end of life" Group of the Organizacion Médica Colegial of Spain. Terminological confusion was verified in: 1) The mixture of etymological, functional and social concepts, 2) the term Passive Euthanasia, 3) the association between euthanasia and physician assisted suicide, 4) the confusion with the equivalent "wish to hasten death", and 5) the difficulty of differentiating sedation with Euthanasia. There was consensus on some aspects: a) Full voluntariness, b) the condition of terminal illness, and c) the condition of unbearable symptoms. Conceptual variability persists in relation to the concept of Euthanasia, and is particularly noticeable in the persistence of the concept of passive euthanasia. It would be desirable to achieve a common language to assign a precise meaning to these words to help doctors in their professional practice. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.
Oehmichen, Manfred; Meissner, Christoph
The debate on legalization of active euthanasia in the Netherlands and Belgium and the refused legal right to choose the circumstances of Diana Pretty's own death are the last actual reasons for reconsidering the situation in Germany. Around the world heated debates have broken out on the topic of active euthanasia. Specialists in the field of 'forensic medicine' have taken full part in these discussions. The present survey from the point of view of forensic medicine begins with a look at current terminology and at the laws pertaining to euthanasia in Germany. These laws are then contrasted with actual practice, including a description of the increasing acceptance of active euthanasia by the German population. The main argument against legalization of active euthanasia is that its formal acceptance in law would cause the dam of restraint to burst, culminating in widespread misuse, as already seen in recent serial killings by nurses in hospitals and homes for the elderly around the world. Contrasted with this are the arguments for taking active steps at the end of life, including emotional considerations such as the revulsion against mechanized medicine and the fear of pain and rational arguments such as the necessity to end a 'life unworthy of life', to save medical costs, and obtaining prior consent in 'living wills'. Such considerations have put in jeopardy the moral integrity of the medical profession - and thus the layperson's trust in physicians--around the world. In Germany especially the history of mass killing during the Nazi era constitutes a fundamental argument against active euthanasia. As a consequence, in Germany active euthanasia will not receive legal sanction, although recommendations on rendering dying more bearable are permitted.
.... Adopting this argument usually leads to less positive attitudes towards euthanasia. Tying in with this, it is assumed here that greater trust diminishes such slippery slope fears, and thereby increases euthanasia acceptance...
Lemiengre, Joke; Dierckx de Casterlé, Bernadette; Denier, Yvonne; Schotsmans, Paul; Gastmans, Chris
To describe the form and content of ethics policies on euthanasia in Flemish nursing homes and to determine the possible influence of religious affiliation on policy content. Content analysis of euthanasia policy documents. Of the 737 nursing homes we contacted, 612 (83%) completed and returned the questionnaire. Of 92 (15%) nursing homes that reported to have a euthanasia policy, 85 (92%) provided a copy of their policy. Nursing homes applied the euthanasia law with additional palliative procedures and interdisciplinary deliberations. More Catholic nursing homes compared to non-Catholic nursing homes did not permit euthanasia. Policies described several phases of the euthanasia care process as well as involvement of caregivers, patients, and relatives; ethical issues; support for caregivers; reporting; and procedures for handling advance directives. Our study revealed that euthanasia requests from patients are seriously considered in euthanasia policies of nursing homes, with great attention for palliative care and interdisciplinary cooperation.
Lusthaus, Evelyn W.
The author examines current attempts to define mentally retarded persons as less than human and suggests that these ideologies are being used to justify euthanasia practices and to formulate euthanasia policies. (CL)
J.H. Groenewoud (Hanny); A. van der Heide (Agnes); B.D. Onwuteaka-Philipsen (Bregje); D.L. Willems (Dick); P.J. van der Maas (Paul); G. van der Wal (Gerrit)
textabstractBACKGROUND AND METHODS: The characteristics and frequency of clinical problems with the performance of euthanasia and physician-assisted suicide are uncertain. We analyzed data from two studies of euthanasia and physician-assisted suicide in The Netherlands
The death of Freud raises the ethical dilemma about euthanasia. It can be characterized as indirect active euthanasia according to the rule of double effect, or terminal sedation, or palliated death...
J.H. Groenewoud (Hanny); A. van der Heide (Agnes); B.D. Onwuteaka-Philipsen (Bregje); D.L. Willems (Dick); P.J. van der Maas (Paul); G. van der Wal (Gerrit)
textabstractBACKGROUND AND METHODS: The characteristics and frequency of clinical problems with the performance of euthanasia and physician-assisted suicide are uncertain. We analyzed data from two studies of euthanasia and physician-assisted suicide in The
Euthanasia in the Netherlands, which has been legal since 1984, is often talked about; yet, only rarely does it culminate in a euthanasia death. In 2001, for example, only 1 in 10 of those who initiated a request for euthanasia with their physician died a euthanasia death. Using data gathered during a 15-month ethnographic study with general practitioners, families, and patients, this article explores the practice of euthanasia, a practice based mainly in talk. Applying a Foucauldian concept of discourse, I will examine euthanasia as a script for how people think, feel, and act at the end of Dutch life, attempting to answer the question: What are Dutch people talking about when they talk about euthanasia? This article is intended to provide ethnographic data not currently available on the modern-day practice of euthanasia and to add to a growing body of literature on death, dying, and the role of the state.
Katherine A Overmyer
Full Text Available A critical application of metabolomics is the evaluation of tissues, which are often the primary sites of metabolic dysregulation in disease. Laboratory rodents have been widely used for metabolomics studies involving tissues due to their facile handing, genetic manipulability and similarity to most aspects of human metabolism. However, the necessary step of administration of anesthesia in preparation for tissue sampling is not often given careful consideration, in spite of its potential for causing alterations in the metabolome. We examined, for the first time using untargeted and targeted metabolomics, the effect of several commonly used methods of anesthesia and euthanasia for collection of skeletal muscle, liver, heart, adipose and serum of C57BL/6J mice. The data revealed dramatic, tissue-specific impacts of tissue collection strategy. Among many differences observed, post-euthanasia samples showed elevated levels of glucose 6-phosphate and other glycolytic intermediates in skeletal muscle. In heart and liver, multiple nucleotide and purine degradation metabolites accumulated in tissues of euthanized compared to anesthetized animals. Adipose tissue was comparatively less affected by collection strategy, although accumulation of lactate and succinate in euthanized animals was observed in all tissues. Among methods of tissue collection performed pre-euthanasia, ketamine showed more variability compared to isoflurane and pentobarbital. Isoflurane induced elevated liver aspartate but allowed more rapid initiation of tissue collection. Based on these findings, we present a more optimal collection strategy mammalian tissues and recommend that rodent tissues intended for metabolomics studies be collected under anesthesia rather than post-euthanasia.
Conti, Adelaide; Baratta, Adriana
This article deals with the problem of euthanasia, a topic of recent interest, namely the rights of minors to make their own decision regarding to euthanasia. In fact the problem of decisions on euthanasia has always been considered an adult interest while leaving the will of minors in the hands of their parents or tutors. The purpose of this article is to underline the rights of self-determination of minors on the problem of euthanasia in Italy.
This month the Senate Committee on Euthanasia and Assisted Suicide will issue its long-awaited report. Within a year, MPs are likely to decide in a free vote whether euthanasia should be legalized in Canada. Indications are that while there is public sentiment supporting euthanasia, there is also vehement opposition, even from some who once supported the right of choice. The Senate committee is wrestling with the issue of whether public opinion and the surreptitious practice of euthanasia are...
Clouser, K D
There is a significant pattern emerging in the discourse about euthanasia and assisted suicide as exemplified in the other articles in this special issue of the Journal of Pain and Symptom Management. That pattern is a dynamic tension that should be nurtured in the best interests of our options at the end of life. On the one hand, there is general acceptance of the right to self-determination and (within debatable limits) of the rationality and mortality of suicide. And on the other hand, there has been emphasis on comfort care through appropriately chosen medications and through a wholesome doctor-patient relationship that fosters a view of life worth living. Thus the creative tension is between the freedom to be dispatched with a minimum of suffering and the efforts to make it more desirable to stay and fight. It is a variation of the "fight or flight" response. The tension must be maintained for the good of us all. Too much emphasis on either one would skew the balance, and a dangerous extreme could result.
Nielsen, T O
Arguments for liberty, mercy, and dignity support the legalization of euthanasia, but there remains a possibility of undesirable social consequences should this occur. Accordingly, proposals must prevent involuntary euthanasia, prevent unconscious coercion of the terminally ill to request euthanasia, protect and enshrine the availability of first-class palliative care, ensure documentation for purposes of enforcement and study, and spell out enforceable consequences for violations. Guidelines set by the Royal Dutch Medical Association have largely failed to meet these requirements. In North America, proposals for legalization, such as Oregon's Measure 16 and the minority opinion in Canada's Rodriguez case, also have flaws in meeting these criteria. Legislation in the Northern Territory of Australia came closest to meeting the requirements outlined, but was overruled after a brief period in effect. In Canada, a comprehensive survey of current euthanasia practices and improved availability of palliative care must precede attempts at legalization. A specific proposal is made for ethics committees operating at a regional health board level to approve legal euthanasia fitting within careful guidelines. Composition, procedures and mandate are described. If a set of guidelines, balancing any right there is "to die with dignity" with a responsibility to protect the weakest in society, is proposed first by the medical community, Parliament may have the courage to enact legislation.
van Marwijk, Harm; Haverkate, Ilinka; van Royen, Paul; The, Anne-Mei
There is only limited knowledge about the emotional impact that performing euthanasia has on primary care physicians (PCPs) in the Netherlands. To obtain more insight into the emotional impact on PCPs of performing euthanasia or assisted suicide, and to tailor the educational needs of vocational PCP trainees accordingly. Qualitative research, consisting of four focus group studies. The setting was primary care in the Netherlands; 22 PCPs participated, in four groups (older males, older females, younger males and a group with interest with regard to euthanasia). Various phases with different emotions were distinguished: before (tension), during (loss) and after (relief) the event. Although it is a very rare occurrence, euthanasia has a major impact on PCPs. Their relationship with the patient, their loneliness, the role of the family, and pressure from society are the main issues that emerged. Making sufficient emotional space and time available to take leave adequately from a patient is important for PCPs. Many PCPs stressed that young physicians should form their own opinions about euthanasia and other end-of-life decisions early on in their career. We recommend that these issues are officially included in the vocational training programme for general practice.
Belgium has recently extended its euthanasia legislation to minors, making it the first legislation in the world that does not specify any age limit. I consider two strands in the opposition to this legislation. First, I identify five arguments in the public debate to the effect that euthanasia for minors is somehow worse than euthanasia for adults--viz, arguments from weightiness, capability of discernment, pressure, sensitivity and sufficient palliative care--and show that these arguments are wanting. Second, there is another position in the public debate that wishes to keep the current age restriction on the books and have ethics boards exercise discretion in euthanasia decisions for minors. I interpret this position on the background of Velleman's 'Against the Right to Die' and show that, although costs remain substantial, it actually can provide some qualified support against extending euthanasia legislation to minors. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Lee, Carol Hj; Duck, Isabelle M; Sibley, Chris G
To explore the distribution of New Zealanders' support towards the legalisation of euthanasia and examine demographic and psychological factors associated with these attitudes. 15,822 participants responded to the 2014/15 New Zealand Attitudes and Values Study (NZAVS) survey. This survey included an item on people's attitudes towards euthanasia, and information on their demographic and psychological characteristics. The majority of New Zealanders expressed support for euthanasia, which was assessed by asking "Suppose a person has a painful incurable disease. Do you think that doctors should be allowed by law to end the patient's life if the patient requests it?" Non-religious, liberal, younger, employed, non-parents and those living in rural areas were more supportive. Those of Pacific or Asian ethnicity, with lower income and higher deprivation, education and socio-economic status were less supportive. Furthermore, those high on extraversion, conscientiousness and neuroticism showed more support, while those high on agreeableness and honesty-humility exhibited less support. There is strong public support for euthanasia when people are asked whether doctors should be allowed by law to end the life of a patient with a painful incurable disease upon their request. There are reliable demographic and personality differences in support for euthanasia.
Bloodworth, Melissa; Bloodworth, Nathaniel; Ely, E Wesley
We submit this manuscript as part of the ongoing conversation in society at large about physician-assisted death (PAD) and euthanasia. This outlines an approach used by lay healthcare professionals in arguing against PAD/euthanasia during a 1-hour debate conducted on a secular medical school campus. We have included the elements chosen for the "con" side of the argument (i.e., against PAD) by the medical students and attending physician. The goal of this manuscript is to provide a focused and pithy template upon which to build an approach that honors the dignity of life in all circumstances. Lay summary: The discussion over physician assisted death and euthanasia remains ongoing in secular academic medical institutions across the United States and much of the western world. These debates have incentivized efforts to develop a framework for arguments against Euthanasia that will find traction in an environment generally hostile to religion and religious thought. In this essay, we present arguments given by the "con" side in a student-led debate over physician assisted death and euthanasia at Vanderbilt University with the hope that they will provide a foundation for future discussions promoting truth and life without alienating our secular colleagues.
Ward, P R
Explicit rationing decisions are being made to encompass a wide range of health care issues. Voluntary euthanasia has largely been excluded from this debate due to, in my view, the emotive nature of the issue. Euthanasia is an issue in which economists have been largely excluded and in which ethicists and philosophers dominate. It is the purpose of this paper to review the economic and ethical literature on euthanasia and to discuss their compatibility within the debate on euthanasia. The potential cost savings by the use of advance directives, do-not-resuscitate orders, and futile care withdrawal are then reviewed, as are the potential cost savings created by hospice care. As a conclusion, the ethical and economic arguments are then balanced to assess their compatibility. It is the contention of this paper that reducing medical care costs near the end of life should not be a taboo subject, and that rationing decisions could focus on an exploration of this area and the approaches to it, which are ethically justifiable and economically worthwhile. The introduction of a policy of voluntary euthanasia could have a large impact on the rationing of health care resources whilst also promoting patient choice and an arena for a more dignified death.
Novaković, Milan; Babić, Dragan; Dedić, Gordana; Leposavić, Ljubica; Milovanović, Aleksanadar; Novaković, Mitar
This study deals with frequency and form of euthanasia in dialysis patients with chronic renal failure (CRF) in Bosnia and Herzegovina (B&H) within the period from 2000 to 2006. Of total number of 2700 patients on dialysis we examined n = 753 of them. Examinees with the Balkan Endemic Nephropathy (BEN) (n = 348) were in the first group, and the Control group was formed of patients with other diseases (n = 405). In this study the following methods were used: adapted Questionnaire from the Renal Registry of B&H, Beck's Anxiety Inventory (BAI), Hamilton's Depression Rating Scale (HDRS) and Mini-Mental Scale of Estimation (MMSE). Age of the BEN group of patients ranged: 64.77 +/- 8.86 and the control one 53.85 +/- 3.60. Multivariate analysis for the BEN group with passive euthanasia was: 0.760 (95%, CI = 0.590-0.710) (p = 0.001) and for the active one was 0.450 (95%, CI = 0.125-0.510 (p = 0.001). Euthanasia is associated with the rural life and renal heredity, and psychological BAI scale-total, HDRS-total and MMSE-total. For the BEN group passive euthanasia is 3.75% as well as active 0.86%. The findings stressed that euthanasia of dialysis patients requires better nephrological-psychiatric control and social care in B&H as well as complete program for the CRF samples protection too.
Kon, Alexander A
The growing support for voluntary active euthanasia (VAE) is evident in the recently approved Dutch Law on Termination of Life on Request. Indeed, the debate over legalized VAE has increased in European countries, the United States, and many other nations over the last several years. The proponents of VAE argue that when a patient judges that the burdens of living outweigh the benefits, euthanasia can be justified. If some adults suffer to such an extent that VAE is justified, then one may conclude that some children suffer to this extent as well. In an attempt to alleviate the suffering of extremely ill neonates, the University Medical Center Groningen developed a protocol for neonatal euthanasia. In this article, I first present the ethical justifications for VAE and discuss how these arguments relate to euthanizing ill neonates. I then argue that, even if one accepts the justification for VAE in adults, neonatal euthanasia cannot be supported, primarily because physicians and parents can never accurately assess the suffering of children. I argue that without the testament of the patient herself as to the nature and magnitude of her suffering, physicians can never accurately weigh the benefits and burdens of a child's life, and therefore any such system would condemn to death some children whose suffering is not unbearable. I conclude that because the primary duty of physicians is to never harm their patients, neonatal euthanasia cannot be supported.
Chong, Alice Ming-lin; Fok, Shiu-yeu
This article reports the findings of a cross-sectional study that compared the attitudes of 618 respondents of a general household survey and a random sample of 1,197 physicians toward different types of euthanasia in Hong Kong. The general public was found to agree with active euthanasia and non-voluntary euthanasia and was neutral about passive…
Smets, T.; Cohen, J.; Bilsen, J.; van Wesemael, Y.; Rurup, M.L.; Deliens, L.
Background: Belgium legalized euthanasia in 2002. Physicians must report each euthanasia case to the Federal Control and Evaluation Committee. This study examines which end-of-life decisions (ELDs) Belgian physicians label 'euthanasia', which ELDs they think should be reported and the physician
Abstract. This article discusses various ethical and legal concepts regarding euthanasia and includes concepts like physician assisted suicide, assisted suicide, voluntary active euthanasia, killing vs. letting die, indirect euthanasia and terminal sedation. Is there a difference if death is only foreseen but not intended?
J.A.C. Rietjens (Judith); N.J.H. Raijmakers (Natasja); P.S.C. Kouwenhoven (Pauline); C. Seale (Clive); G.J.M.W. van Thiel (Ghislaine); M.J. Trappenburg (Margo); J.J.M. van Delden (Johannes); A. van der Heide (Agnes)
textabstractBackground: The Netherlands is one of the few countries where euthanasia is legal under strict conditions. This study investigates whether Dutch newspaper articles use the term euthanasia according to the legal definition and determines what arguments for and against euthanasia they
Jorgenson, David E.; Neubecker, Ron C.
A study on the attitudes of adults related to the voluntary termination of life showed that those persons with favorable attitudes toward suicide were also favorable toward euthanasia. Religiosity was negatively associated with pro-euthanasia attitudes. Whites and males were more favorable toward euthanasia than Blacks and females. (Author)
Slezak, Michael E.
Studied the relationship of attitudes toward euthanasia to death fears and demographic variables in a sample of 100 adults. Found the strongest predictors of euthanasia attitude were age and amount of education. Suggests individuals who are more experienced with life and death have a more positive attitude toward euthanasia. (Author)
Borgsteede, Sander D.; Deliens, Luc; Graafland-Riedstra, Corrie; Francke, Anneke L.; van der Wal, Gerrit; Willems, Dick L.
OBJECTIVE: Public opinion and professional organisations dominate the euthanasia debate, and there is a need to understand the opinions of people confronted with euthanasia. The aim of this study was to investigate whether patients and their GPs talk about euthanasia, and if so, how they communicate
Borgsteede, S.D.; Deliens, L.; Graafland-Riedstra, C.; Francke, A.L.; Wal, G. van der; Willems, D.L.
Public opinion and professional organisations dominate the euthanasia debate, and there is a need to understand the opinions of people confronted with euthanasia. The aim of this study was to investigate whether patients and their GPs talk about euthanasia, and if so, how they communicate about
Rurup, Mette L; Buiting, Hilde M; Pasman, H Roeline W; van der Maas, Paul J; van der Heide, Agnes; Onwuteaka-Philipsen, Bregje D
To study trends in reporting rates of euthanasia from 1990 to 2005 in relation to whether recommended or nonrecommended drugs were used, and the most important differences between reported and unreported cases in 2005. Questionnaires were sent to a sample of 6860 physicians who had reported a death in 2005 (response 78%). Previously, 3 similar studies were done at 5-year intervals. The total number of euthanasia and physician-assisted suicide cases was estimated using a "gold standard" definition: death was-according to the physician-the result of the use of drugs at the explicit request of the patient with the explicit goal of hastening death (denominator). The Euthanasia Review Committees provided the number of reported cases (numerator). The reporting rate of euthanasia and physician-assisted suicide increased from 18% in 1990, 41% in 1995, and 54% in 2001 to 80% in 2005. The reporting rate in the subgroup of euthanasia with recommended drugs (barbiturates and muscle relaxants) was 73% in 1995, 71% in 2001, and 99% in 2005. The reporting rate of euthanasia with nonrecommended drugs (eg, opioids) was below 3% in 1995, 2001, and 2005. Unreported euthanasia differed also from reported euthanasia in the fact that physicians less often labeled their act as euthanasia. Euthanasia with nonrecommended drugs is almost never reported. The total reporting rate increased because of an increase in the use of recommended drugs for euthanasia between 1995 and 2001, and an increase in the reporting rate for euthanasia with recommended drugs between 2001 and 2005.
Full Text Available Physician assisted suicide (PAS and Euthanasia as it is now known, is essentially the doctrine that when, owing to disease, senility or the like, a person’s life has permanently ceased to be either agreeable or useful , the sufferer should be painlessly killed either by himself or by another. The intentional termination of patient’s life in such a situation by an act or omission of medical care is called euthanasia or mercy killing. This is the most active area of research in contemporary bio ethics. The present article is aimed to have a global overview regarding legalization of euthanasia and the current Indian scenari o, legally and ethically regarding this issue
Materstvedt, Lars Johan
Palliative sedation at the end of life has become an important last-resort treatment strategy for managing refractory symptoms as well as a topic of controversy within palliative care. Furthermore, palliative sedation is prominent in the public debate about the possible legalisation of voluntary assisted dying (physician-assisted suicide and euthanasia). This article attempts to demonstrate that palliative sedation is fundamentally different from euthanasia when it comes to intention, procedure, outcome and the status of the person. Nonetheless, palliative sedation in its most radical form of terminal deep sedation parallels euthanasia in one respect: both end the experience of suffering. However, only the latter intentionally ends life and also has this as its goal. There is the danger that deep sedation could bring death forward in time due to particular side effects of the treatment. Still that would, if it happens, not be intended, and accordingly is defensible in view of the doctrine of double effect.
White, Ben; Willmott, Lindy
This article invites consideration of how Australia should regulate voluntary euthanasia and assisted suicide. It attempts to pose this question as neutrally as possible, acknowledging that both prohibition and legalisation of such conduct involve decisions about regulation. It begins by charting the wider field of law at the end of life, before considering the repeated, but ultimately unsuccessful, attempts at law reform in Australia. The situation in Australia is contrasted with permissive jurisdictions overseas where voluntary euthanasia and/or assisted suicide are lawful. The authors consider the arguments for and against legalisation of such conduct along with the available empirical evidence as to what happens in practice both in Australia and overseas. The article concludes by outlining a framework for deliberating on how Australia should regulate voluntary euthanasia and assisted suicide. It asks a threshold question of whether such conduct should be criminal acts (as they presently are), the answer to which then leads to a range of possible regulatory options.
Iltis, Ana S
Roman Catholic healthcare institutions in the United States face a number of threats to the integrity of their missions, including the increasing religious and moral pluralism of society and the financial crisis many organizations face. These organizations in the United States often have fought fervently to avoid being obligated to provide interventions they deem intrinsically immoral, such as abortion. Such institutions no doubt have made numerous accommodations and changes in how they operate in response to the growing pluralism of our society, but they have resisted crossing certain lines and providing particular interventions deemed objectively wrong. Catholic hospitals in Belgium have responded differently to pluralism. In response to a growing diversity of moral views and to the Belgian Act of Euthanasia of 2002, Catholic hospitals in Belgium now engage in euthanasia. This essay examines a defense that has been offered of this practice of euthanasia in Catholic hospitals and argues that it is misguided.
In the Netherlands the government's proposal for the legal regulation of euthanasia, assisted suicide and the termination of a patient's life without request has been approved by Parliament. The defence of this proposal is to a large extent based on a specific interpretation of data about the practice of euthanasia in that country, published in 1991 (the Remmelink Report). This paper discusses both the interpretation of the data and the new law. On the basis of that and other data, the author concludes that many cases of euthanasia, assisted suicide and termination of a patient's life without request remain unnotified and therefore unreviewed by the legal authorities. It is argued that the new law will not guarantee an improvement to this situation. In short, the new law will not protect effectively the lives of patients, and must, therefore, be open to ethical and legal objection. PMID:7861425
Gielen, Joris; van den Branden, Stef; Broeckaert, Bert
In this review of empirical studies we aimed to assess the influence of religion and world view on nurses' attitudes towards euthanasia and physician assisted suicide. We searched PubMed for articles published before August 2008 using combinations of search terms. Most identified studies showed a clear relationship between religion or world view and nurses' attitudes towards euthanasia or physician assisted suicide. Differences in attitude were found to be influenced by religious or ideological affiliation, observance of religious practices, religious doctrines, and personal importance attributed to religion or world view. Nevertheless, a coherent comparative interpretation of the results of the identified studies was difficult. We concluded that no study has so far exhaustively investigated the relationship between religion or world view and nurses' attitudes towards euthanasia or physician assisted suicide and that further research is required.
This paper discusses and analyses three articles appearing in a 1942 issue of the American Journal of Psychiatry. In the first, neurologist Foster Kennedy argued that 'feebleminded' people should be killed (an act which he referred to as 'euthanasia'). The rebuttal was written by psychiatrist Leo Kanner, who argued against 'euthanasia'. An unsigned editorial discussing these positions clearly sided with Kennedy: that 'euthanasia' would be appropriate in some cases, and that parents' opposition to this procedure should be the subject of psychiatric concern. The arguments are analysed and discussed within the context of eugenics and the murder of mental patients in Germany. Finally, the author points out that currently ascendant genetic theories in psychiatry could be a precursor for future proposals similar to Kennedy's.
Active euthanasia, a question of individual existence, fundamentally concerns the concept of human society. Although legalizing voluntary euthanasia seems to be consequent in liberal democracy, delegation of the act of homicide leads to a paradox in liberalism: Generalization in the assessment of individual life--as it is necessary in such a context--undermines the fundamental right of the individual for social existence irrespective of any assessment whatsoever. This is reflected by the humanistic principle of human dignity as it has been described by Kant. Conventional jurisdiction, which permits passive and indirect euthanasia but prosecutes active homicide, avoids this fundamental problem. Nevertheless it facilitates a humane demise within the framework of adequate hospice care.
Conroy, CJ; Papenfuss, T; Parker, J; Hahn, NE
Tricaine methanesulfonate (MS222) injected into the intracoelomic cavity of reptiles was evaluated as a chemical euthanasia method. Three western fence lizards, 2 desert iguanas, 4 garter snakes, and 6 geckos were euthanized by intracoelomic injection of 250 to 500 mg/kg of 0.7% to 1% sodium-bicarbonate–buffered MS222 solution followed by intracoelomic injection of 0.1 to 1.0 ml unbuffered 50% (v/v) MS222 solution. A simple 2-stage protocol for euthanasia of reptiles by using MS222 is outlined. In addition, the conditions for safe use of MS222 are discussed. MS222 offers an alternative to sodium pentobarbital for euthanasia of reptiles. PMID:19245747
Smets, Tinne; Bilsen, Johan; Van den Block, Lieve; Cohen, Joachim; Van Casteren, Viviane; Deliens, Luc
Background Euthanasia became legal in Belgium in 2002. Physicians must adhere to legal due care requirements when performing euthanasia; for example, consulting a second physician and reporting each euthanasia case to the Federal Review Committee. Aim To study the adherence and non-adherence of GPs to legal due care requirements for euthanasia among patients dying at home in Belgium and to explore possible reasons for non-adherence. Design of study Large scale, retrospective study. Setting General practice in Belgium. Method A retrospective mortality study was performed in 2005–2006 using the nationwide Belgian Sentinel Network of General Practitioners. Each week GPs reported medical end-of-life decisions taken in all non-sudden deaths of patients in their practice. GP interviews were conducted for each euthanasia case occurring at home. Results Interviews were conducted for nine of the 11 identified euthanasia cases. Requirements concerning the patient's medical condition were met in all cases. Procedural requirements such as consultation of a second physician were sometimes ignored. Euthanasia cases were least often reported (n = 4) when the physician did not regard the decision as euthanasia, when only opioids were used to perform euthanasia, or when no second physician was consulted. Factors that may contribute to explaining non-adherence to the euthanasia law included: being unaware of which practices are considered to be euthanasia; insufficient knowledge of the euthanasia law; and the fact that certain procedures are deemed burdensome. Conclusion Substantive legal due care requirements for euthanasia concerning the patient's request for euthanasia and medical situation were almost always met by GPs in euthanasia cases. Procedural consultation and reporting requirements were not always met. PMID:20353662
Smets, Tinne; Bilsen, Johan; Van den Block, Lieve; Cohen, Joachim; Van Casteren, Viviane; Deliens, Luc
Euthanasia became legal in Belgium in 2002. Physicians must adhere to legal due care requirements when performing euthanasia; for example, consulting a second physician and reporting each euthanasia case to the Federal Review Committee. To study the adherence and non-adherence of GPs to legal due care requirements for euthanasia among patients dying at home in Belgium and to explore possible reasons for non-adherence. Large scale, retrospective study. General practice in Belgium. A retrospective mortality study was performed in 2005-2006 using the nationwide Belgian Sentinel Network of General Practitioners. Each week GPs reported medical end-of-life decisions taken in all non-sudden deaths of patients in their practice. GP interviews were conducted for each euthanasia case occurring at home. Interviews were conducted for nine of the 11 identified euthanasia cases. Requirements concerning the patient's medical condition were met in all cases. Procedural requirements such as consultation of a second physician were sometimes ignored. Euthanasia cases were least often reported (n = 4) when the physician did not regard the decision as euthanasia, when only opioids were used to perform euthanasia, or when no second physician was consulted. Factors that may contribute to explaining non-adherence to the euthanasia law included: being unaware of which practices are considered to be euthanasia; insufficient knowledge of the euthanasia law; and the fact that certain procedures are deemed burdensome. Substantive legal due care requirements for euthanasia concerning the patient's request for euthanasia and medical situation were almost always met by GPs in euthanasia cases. Procedural consultation and reporting requirements were not always met.
Benedict, Susan; Chelouche, Tessa
In 1939, Hitler authorized a programme of 'euthanasia' of children and adults with physical and psychiatric disorders. Initially, gas chambers were established at six psychiatric institutions in Germany and Austria. This programme was discontinued in August 1941 but the killings continued on an individual basis. Physicians selected patients who were unable to work or who required extensive care, and ordered the nurses to administer lethal doses of sedatives. Meseritz-Obrawalde was a site for 10,000 of these killings. Using documents from the trial of one of Obrawalde's physicians, Hilde Wernicke, the era of 'wild euthanasia' is described and her rationale for participating in the killings is explored.
Hurst, Samia A; Mauron, Alex
The ethical underpinnings of palliative care and those of voluntary euthanasia and assisted suicide (VE/AS) are often viewed as opposites. In this article, we review the values held in common by the euthanasia legalization movement and palliative care providers. Outlining this common ground serves to define, with greater clarity, the issues on which differences do exist, and ways in which some open questions, which are as yet unresolved, could be approached. Open discussion between VE/AS legalization advocates and palliative care providers is important to address these open questions seriously, and to enrich the care of terminally ill patients by giving members of both groups access to each other's experience.
Chinweze, Madu Benedict
Sometimes relatives have taken me on one side and told me they cannot bear it any more:"Isn't there something you can do to end it all?"More often requests for euthanasia have come from those who are ill. I remember visiting a man with lung cancer. He asked his wife to leave the room. As she closed the door he leaned over and grabbed my arm. "I want to die", he said. "Please can you give me something." He felt a burden on his wife and wanted euthanasia for himself . Often in their duty, physi...
388 Japanese religious groups--143 Shinto, 157 Buddhist, 58 Christian and 30 others--were asked to answer questions regarding several forms of euthanasia and extraordinary treatment during the dying process. Passive euthanasia and indirect euthanasia were accepted by around 70% of the respondents. Active euthanasia was favored by less than 20% of them. Christians were less supportive of euthanasia than practitioners of other religions. Shinto and Buddhist corporations advocated "being natural," when medical treatment became futile at the terminal stage. Religionists' views may deepen the discussion of end-of-life issues.
Martens, Willem H J
In this article the arguments against euthanasia are examined. One of the weightiest arguments of mental health professionals against the practice of euthanasia is that a doctor's active commitment to euthanasia can be interpreted as causing harm. It is investigated whether this statement can be ethically justified on the basis of the text of the medical oath or medical declaration. Furthermore, it will be discussed whether it is ethically acceptable when doctors refuse a) to help candidates of euthanasia who (would likely) meet the legal standards of euthanasia, or b) to refer them to a colleague.
Dierickx, Sigrid; Deliens, Luc; Cohen, Joachim; Chambaere, Kenneth
In the international debate about assisted dying, it is commonly stated that euthanasia is incompatible with palliative care. In Belgium, where euthanasia was legalized in 2002, the Federation for Palliative Care Flanders has endorsed the viewpoint that euthanasia can be embedded in palliative care. To examine the involvement of palliative care services in euthanasia practice in a context of legalized euthanasia. Population-based mortality follow-back survey. Physicians attending a random sample of 6871 deaths in Flanders, Belgium, in 2013. People requesting euthanasia were more likely to have received palliative care (70.9%) than other people dying non-suddenly (45.2%) (odds ratio = 2.1 (95% confidence interval, 1.5-2.9)). The most frequently indicated reasons for non-referral to a palliative care service in those requesting euthanasia were that existing care already sufficiently addressed the patient's palliative and supportive care needs (56.5%) and that the patient did not want to be referred (26.1%). The likelihood of a request being granted did not differ between cases with or without palliative care involvement. Palliative care professionals were involved in the decision-making process and/or performance of euthanasia in 59.8% of all euthanasia deaths; this involvement was higher in hospitals (76.0%) than at home (47.0%) or in nursing homes (49.5%). In Flanders, in a context of legalized euthanasia, euthanasia and palliative care do not seem to be contradictory practices. A substantial proportion of people who make a euthanasia request are seen by palliative care services, and for a majority of these, the request is granted.
Dierickx, Sigrid; Deliens, Luc; Cohen, Joachim; Chambaere, Kenneth
Background: In the international debate about assisted dying, it is commonly stated that euthanasia is incompatible with palliative care. In Belgium, where euthanasia was legalized in 2002, the Federation for Palliative Care Flanders has endorsed the viewpoint that euthanasia can be embedded in palliative care. Aim: To examine the involvement of palliative care services in euthanasia practice in a context of legalized euthanasia. Design: Population-based mortality follow-back survey. Setting/participants: Physicians attending a random sample of 6871 deaths in Flanders, Belgium, in 2013. Results: People requesting euthanasia were more likely to have received palliative care (70.9%) than other people dying non-suddenly (45.2%) (odds ratio = 2.1 (95% confidence interval, 1.5–2.9)). The most frequently indicated reasons for non-referral to a palliative care service in those requesting euthanasia were that existing care already sufficiently addressed the patient’s palliative and supportive care needs (56.5%) and that the patient did not want to be referred (26.1%). The likelihood of a request being granted did not differ between cases with or without palliative care involvement. Palliative care professionals were involved in the decision-making process and/or performance of euthanasia in 59.8% of all euthanasia deaths; this involvement was higher in hospitals (76.0%) than at home (47.0%) or in nursing homes (49.5%). Conclusion: In Flanders, in a context of legalized euthanasia, euthanasia and palliative care do not seem to be contradictory practices. A substantial proportion of people who make a euthanasia request are seen by palliative care services, and for a majority of these, the request is granted. PMID:28849727
Bendiane, M K; Bouhnik, A-D; Galinier, A; Favre, R; Obadia, Y; Peretti-Watel, P
Hospital nurses are frequently the first care givers to receive a patient's request for euthanasia or physician-assisted suicide (PAS). In France, there is no consensus over which medical practices should be considered euthanasia, and this lack of consensus blurred the debate about euthanasia and PAS legalisation. This study aimed to investigate French hospital nurses' opinions towards both legalisations, including personal conceptions of euthanasia and working conditions and organisation. A phone survey conducted among a random national sample of 1502 French hospital nurses. We studied factors associated with opinions towards euthanasia and PAS, including contextual factors related to hospital units with random-effects logistic models. Overall, 48% of nurses supported legalisation of euthanasia and 29%, of PAS. Religiosity, training in pallative care/pain management and feeling competent in end-of-life care were negatively correlated with support for legalisation of both euthanasia and PAS, while nurses working at night were more prone to support legalisation of both. The support for legalisation of euthanasia and PAS was also weaker in pain treatment/palliative care and intensive care units, and it was stronger in units not benefiting from interventions of charity/religious workers and in units with more nurses. Many French hospital nurses uphold the legalisation of euthanasia and PAS, but these nurses may be the least likely to perform what proponents of legalisation call "good" euthanasia. Improving professional knowledge of palliative care could improve the management of end-of-life situations and help to clarify the debate over euthanasia.
Berghs, M; d Dierckx; Gastmans, C
In this literature review, a picture is given of the complexity of nursing attitudes toward euthanasia. The myriad of data found in empirical literature is mostly framed within a polarised debate and inconclusive about the complex reality behind attitudes toward euthanasia. Yet, a further examination of the content as well as the context of attitudes is more revealing. The arguments for euthanasia have to do with quality of life and respect for autonomy. Arguments against euthanasia have to do with non-maleficence, sanctity of life, and the notion of the slippery slope. When the context of attitudes is examined a number of positive correlates for euthanasia such as age, nursing specialty, and religion appear. In a further analysis of nurses' comments on euthanasia, it is revealed that part of the complexity of nursing attitudes toward euthanasia arises because of the needs of nurses at the levels of clinical practice, communication, emotions, decision making, and ethics. PMID:16076966
Berghs, M; Dierckx de Casterlé, B; Gastmans, C
In this literature review, a picture is given of the complexity of nursing attitudes toward euthanasia. The myriad of data found in empirical literature is mostly framed within a polarised debate and inconclusive about the complex reality behind attitudes toward euthanasia. Yet, a further examination of the content as well as the context of attitudes is more revealing. The arguments for euthanasia have to do with quality of life and respect for autonomy. Arguments against euthanasia have to do with non-maleficence, sanctity of life, and the notion of the slippery slope. When the context of attitudes is examined a number of positive correlates for euthanasia such as age, nursing specialty, and religion appear. In a further analysis of nurses' comments on euthanasia, it is revealed that part of the complexity of nursing attitudes toward euthanasia arises because of the needs of nurses at the levels of clinical practice, communication, emotions, decision making, and ethics.
Allen-Worthington, Krystal H; Brice, Angela K; Marx, James O; Hankenson, F Claire
Compassion, professional ethics, and public sensitivity require that animals are euthanized humanely and appropriately under both planned and emergent situations. According to the 2013 AVMA Guidelines for the Euthanasia of Animals, intraperitoneal injection of ethanol is "acceptable with conditions" for use in mice. Because only limited information regarding this technique is available, we sought to evaluate ethanol by using ECG and high-definition video recording. Mice (n = 85) and rats (n = 16) were treated with intraperitoneal ethanol (70% or 100%), a positive-control agent (pentobarbital-phenytoin combination [Pe/Ph]), or a negative-control agent (saline solution). After injection, animals were assessed for behavioral and physiologic responses. Pain-assessment techniques in mice demonstrated that intraperitoneal injection of ethanol was not more painful than was intraperitoneal Pe/Ph. Median time to loss of consciousness for all mice that received ethanol or Pe/Ph was 45 s. Median time to respiratory arrest was 2.75, 2.25, and 2.63 min, and time (mean ± SE) to cardiac arrest was 6.04 ± 1.3, 2.96 ± 0.6, and 4.03 ± 0.5 min for 70% ethanol, 100% ethanol, and Pe/Ph, respectively. No mouse that received ethanol or Pe/Ph regained consciousness. Although successful in mice, intraperitoneal ethanol at the doses tested (9.2 to 20.1 g/kg) was unsuitable for euthanasia of rats (age, 7 to 8 wk) because of the volume needed and prolonged time to respiratory effects. For mice, intraperitoneal injection of 70% or 100% ethanol induced rapid and irreversible loss of consciousness, followed by death, and should be considered as "acceptable with conditions."
Busch, Jacob; Rodogno, Raffaele
It has recently been suggested by Shaw (2007) that the distinction between voluntary active euthanasia, such as giving a patient a lethal overdose with the intention of ending that patient's life, and voluntary passive euthanasia, such as removing a patient from a ventilator, is much less obvious than is commonly acknowledged in the literature. This is argued by suggesting a new perspective that more accurately reflects the moral features of end-of-life situations. The argument is simply that if we consider the body of a mentally competent patient who wants to die, a kind of 'unwarranted' life support, then the distinction collapses. We argue that all Shaw has provided is a perspective that makes the conclusion that there is little distinction between voluntary active euthanasia and voluntary passive euthanasia only seemingly more palatable. In doing so he has yet to convince us that this perspective is superior to other perspectives and thus more accurately reflects the moral features of the situations pertaining to this issue.
D. Etienne de Villiers
Full Text Available The article deals with the question: ‘Is it morally acceptable for terminally ill Christians to voluntarily request medically assisted suicide or euthanasia?’ After a brief discussion of relevant changes in the moral landscape over the last century, two influential, but opposite views on the normative basis for the Christian ethical assessment of medically assisted suicide and voluntary euthanasia are critically discussed. The inadequacy of both the view that the biblical message entails an absolute prohibition against these two practices, and the view that Christians have to decide on them on the basis of their own autonomy, is argued. An effort is made to demonstrate that although the biblical message does not entail an absolute prohibition it does have normative ethical implications for deciding on medically assisted suicide and voluntary euthanasia. Certain Christian beliefs encourage terminally ill Christians to live a morally responsible life until their death and cultivate a moral prejudice against taking the life of any human being. This moral prejudice can, however, in exceptional cases be outweighed by moral considerations in favour of medically assisted suicide or voluntary euthanasia.
den Hartogh, G.; Youngner, S.J.; Kimsma, G.K.
Euthanasia and physician-assisted suicide have been legal in the Netherlands since 1984, first by judicial legislation and since 2002 by statute, if enacted by a doctor who meets a number of requirements of due care and makes it possible to assess whether he or she met them. How successful is this
Patelarou, Evridiki; Vardavas, Constantine I; Fioraki, Ioanna; Alegakis, Thanasis; Dafermou, Maria; Ntzilepi, Penelope
Euthanasia has become a prominent social and ethical issue in which nurses play an important role. This study evaluated, for the first time in Greece, the acceptance and enactment of passive euthanasia among Greek nursing staff, measured in relation to the type of patients cared for. Passive euthanasia, illegal in Greece, is defined as either withdrawing or withholding life-sustaining treatment. Fifty-one per cent responded that they would not be willing to withhold life-sustaining treatment if legalized, while almost 30% responded that they had withheld life-sustaining treatment from a patient at least once in the past; specifically 47.7% of intensive care unit nurses (OR 8.2; 95% CI: 1.6-41.3), 20% of cancer ward nurses (OR 2.7; 95% CI: 0.5-15.6) and 8.3% of other nurses from other wards (P = 0.001). Age, gender and self-reported levels of religiosity among Greek nurses were not found to affect statistically any variable regarding euthanasia and its enactment.
Recently, organ donation after euthanasia has been a topic of discussion in the Dutch media and scientific literature. Unfortunately, both the articles in question and the media interviews contained several unsubstantiated statements. This article describes the background of organ donation after
Felix, Zirleide Carlos; da Costa, Solange Fátima Geraldo; Alves, Adriana Marques Pereira de Melo; de Andrade, Cristiani Garrido; Duarte, Marcella Costa Souto; de Brito, Fabiana Medeiros
There is currently widespread concern among researchers in debating questions that generate ethical conflicts within the scope of health care geared to the human being in the terminal phase, especially euthanasia, dysthanasia and orthothanasia. This study sought to characterize the scientific production at the national level on euthanasia, dysthanasia and orthothanasia. It involves an integrative review of the literature. The study universe consisted of 41 publications related to the theme in question by means of a survey conducted online in the Virtual Health Library in the Capes Portal and in the Bioethical Magazine. Of these, 25 articles comprised the sample taking into consideration the established inclusion and exclusion criteria. Data collection occurred in March 2013, by means of an instrument containing information pertinent to the proposed objective. The key words used were euthanasia, dysthanasia and orthothanasia. With respect to the focus of the publications, three themes emerged: Theme I - Euthanasia; Theme II - Dysthanasia and Theme III - Orthothanasia. The studies analyzed reflected the current concern in terms of ethical dilemmas concerning care of the human being in the end of life phase. Thus, it is hoped that this research can contribute to bolster the critical reading with respect to the theme.
Although the withdrawal of treatment and active euthanasia are viewed as two different processes with two different objectives, the conditions under which these actions are justified by physicians have much in common, as the following articles on two new surveys show.
Elks, Martin A.
Historical discussions of the euthanasia or "lethal chamber" option in relation to people with mental retardation are presented. The paper concludes that eugenic beliefs in the primacy of heredity over environment and the positive role of natural selection may have condoned the poor conditions characteristic of large, segregated institutions and…
Nagi, Mostafa H.; And Others
Even though Catholic and Protestant clergymen, in about the same proportions, tend to see the terminal patient as competent to make decisions concerning euthanasia, the two groups, strongly agree that neither the individual patient nor the state should be allowed sole responsibility for the decision. (Author)
Chong, Alice Ming-Lin; Fok, Shiu-Yeu
This article reports the validation of the Chinese version of an expanded 31-item Euthanasia Attitude Scale. A 4-stage validation process included a pilot survey of 119 college students and a randomized household survey with 618 adults in Hong Kong. Confirmatory factor analysis confirmed a 4-factor structure of the scale, which can therefore be…
on the ethics of physician-assisted suicide and euthanasia,. Professor Landman' suggests that personal autonomy or individual self-determination is the overriding ethical principle and implies that death is a therapeutic option in cases of uncontrollable and dehumanising suffering. This would represent a major ethical shift ...
During 2015, Mr Stransham-Ford, who was terminally ill at the time, approached the Pretoria High Court on an urgent basis. The relief that he sought was nothing short of a medicolegal earthquake: Mr. Stransham-Ford requested the Court to develop the common law to legalise voluntary active euthanasia – at least in his ...
Whether persons wishing to have doctor-assisted suicide or voluntary active euthanasia may make a court application based on their rights in the Constitution has not been answered by the Appeal Court. Therefore, if Parliament does not intervene beforehand, such applications can be made – provided the applicants have ...
The identification and validation of a humane method to euthanize piglets is critical to address concern that current methods are not acceptable. This research sought to: 1) identify a method of scientifically determining if pigs find a specific euthanasia method aversive, and 2) develop an innovati...
Coulter, David L.
The paper examines ethical issues in the transplantation of organs from infants with anencephaly into infants with severe heart and kidney disease. It argues that active euthanasia of infants with anencephaly should be prohibited to safeguard the rights of all persons with severe neurological disabilities. (Author/DB)
Monica Omoye Aneni* http://dx.doi.org/10.4314/ujah.v14i2.2. Abstract. The purpose of this paper is an attempt to examine infanticide practices in the Roman Christian era and interrogate infanticide and child euthanasia in the same era. It also attempts to point out infanticide practices in Abuja and makes a distinction ...
van Wijngaarden, A K S; van Westerloo, D J; Ringers, J
In 2014, there was still a shortage of available organs for transplantation, and 1044 patients were waiting for an organ in the Netherlands. Maximizing the pool of organ donors is part of the solution. In 2001, the Dutch Termination of Life on Request and Assisted Suicide Act was adopted, legalizing euthanasia under strict conditions. In 2010, 3136 reports were made of euthanasia and assisted suicide; in 2014, 5306 reports were made. Among them were patients with a desire to donate their organs after their deaths. Although a potential source of donor organs, only a few cases of organ donation after active euthanasia have been described. Since 2012, 16 combinations of these procedures have been performed in the Netherlands. The literature mentions 16 Belgian cases between 2005 and 2013. This limited number can be the result of lack of knowledge about this subject among healthcare professionals or because of practical, ethical, and/or legal considerations. Performing this combination has possible advantages, both in number as well as in transplantation outcomes. By describing a recent case in our center, we will try to outline the state of the art in the Netherlands and disseminate knowledge about the possibilities and limitations of organ donation after active euthanasia. Copyright Â© 2016. Published by Elsevier Inc.
Banović, Božidar; Turanjanin, Veljko; Miloradović, Anđela
In the majority of countries, active direct euthanasia is a forbidden way of the deprivation of the patients' life, while its passive form is commonly accepted. This distinction between active and passive euthanasia has no justification, viewed through the prism of morality and ethics. Therefore, we focused on attention on the moral and ethical implications of the aforementioned medical procedures. Data were obtained from the Clinical Hospital Center in Kragujevac, collected during the first half of the 2015. The research included 88 physicians: 57 male physicians (representing 77% of the sample) and 31 female physicians (23% of the sample). Due to the nature, subject and hypothesis of the research, the authors used descriptive method and the method of the theoretical content analysis. A slight majority of the physicians (56, 8%) believe that active euthanasia is ethically unacceptable, while 43, 2% is for another solution (35, 2% took a viewpoint that it is completely ethically acceptable, while the remaining 8% considered it ethically acceptable in certain cases). From the other side, 56, 8% of respondents answered negatively on the ethical acceptability of the physician-assisted suicide, while 33% of them opted for a completely ethic viewpoint of this procedure. Out of the remaining 10, 2% opted for the ethical acceptability in certain cases. Physicians in Serbia are divided on this issue, but a group that considers active euthanasia and physician-assisted suicide as ethically unacceptable is a bit more numerous.
In western societies where the principle of autonomy is jealously guarded, perhaps active euthanasia is more often the focus of public concern and debates rather than any other forms of euthanasia. However due to the advance in technology and its corresponding ability in prolonging life, in Malaysia passive euthanasia presents more of a dilemma. For those concerned and involved with end of life decision-making, it is generally agreed that this is an area fraught with not only medical but legal and ethical issues. In Malaysia where the society is not homogenous but is multi-cultural and multi-religious, in addition to medical, legal and ethical issues, religious principles and cultural norms further impact and play significant roles in end of life decision-making. This paper seeks to identify the issues surrounding the practice of passive euthanasia in Malaysia. It will be shown that despite applicable legal provisions, current practice of the medical profession combined with religious and cultural values together affect decision-making which involves the withholding and/or withdrawing of life-saving treatment.
J.A.C. Rietjens (Judith); J.J.M. van Delden (Johannes); A. van der Heide (Agnes); A.M. Vrakking (Astrid); B.D. Onwuteaka-Philipsen (Bregje); P.J. van der Maas (Paul); G. van der Wal (Gerrit)
textabstractBackground: An important issue in the debate about terminal sedation is the extent to which it differs from euthanasia. We studied clinical differences and similarities between both practices in the Netherlands. Methods: Personal interviews were held with a nationwide stratified sample
Gevers, J. K. M.
In the last five to ten years there has been increasing debate on terminal sedation, a medical practice that is difficult to place between other decisions at the end of life, like alleviating pain, withholding treatment, and (in jurisdictions where this is allowed) euthanasia or physician-assisted
van Delden, J J M
In April 2002 a new law regarding euthanasia came into effect in The Netherlands. This law holds that euthanasia remains a criminal offence unless it is (1) performed by a physician who (2) acts according to six specified rules of due care and (3) reports the case to a review committee. The six rules of due care are similar to those of the previous regulation and are largely based on jurisprudence. Completely new, however, is the article concerning a competent patient who has written an advance directive requesting euthanasia under certain circumstances. The law stipulates that a physician may act according to that written request, as long as he or she fulfils all other rules of due care. The author defends the view that these requests are neither feasible nor ethically justifiable, and presents both moral and practical arguments for this, claiming that for consistency reasons one cannot act on the basis of a written statement and fulfil the other rules of due care at the same time. The author also examines a difficult case of a demented, severely depressed woman who had written a living will requesting euthanasia before she became demented.
Alzheimer's disease, clinical depression or any other disease does not meet the requirements of informed consent, PAS and euthanasia would not be ethically permissible. (An advance directive which makes provision for conditions brought on by, for example, amyotrophic lateral sclerosis or. Alzheimer's disease may meet ...
Subba, Sonu Hangma; Khullar, Varun; Latafat, Yusra; Chawla, Khushboo; Nirmal, Apoorva; Chaudhary, Tanvi
Euthanasia is a controversial issue that puts doctors into a dilemma and can have the capacity to end the patients' sufferings. However, it is never an easy decision; hence, this study was planned to find the attitude of practicing doctors of medical colleges in a South Indian city of Mangalore towards euthanasia. A cross sectional study was conducted in March-April 2010 among the doctors practicing in the four medical colleges of Mangalore city. A pretested semi-structured questionnaire was used to collect data from 220 doctors after their informed consent. Data was analyzed using SPSS version 11.5. Mean age of the doctors was 37.9 years (SD=9. 4), most of them were males and belonging to the Hindu religion. Euthanasia was justified according to 46.8% of the doctors in order to curtail the sufferings of the patients or to ameliorate the emotional and financial burden. Another 41% said it should be legalized and 39% said that they would use it if it was legalized. Nevertheless 84.5% of them were concerned that it may be misused if legalized. More than half of them felt it was not justified in the face of moral obligations and legal complications. Religion and department were independently associated with the doctors feeling that euthanasia was justified with 69.4% of Muslim doctors saying it was justified as compared to 59.2% of Hindu doctors (OR=2.82; p=.001) and 59.3% of doctors from medical specialities said it was justified as opposed to 39.8% of doctors from surgical specialities (OR=2.3; p=.008). Despite the illegality of it, 25% of the doctors had received requests from patients and 22.3% from relatives for euthanasia. Though euthanasia is illegal in the country, there are doctors who feel it is justified in some situations, yet not without reservations. The fact that they had been requested for euthanasia by the patients and relatives show that even the public are being aware and accepting the practice. Yet, the law in our country has not changed and it
Woods, M; Bickley Asher, J
Through an examination of the present situation relating to legalizing euthanasia and/or physician-assisted death in New Zealand, this paper is intended to encourage nurses worldwide to ponder about their own position on the ever present topic of assisted dying and euthanasia. In New Zealand, euthanasia remains illegal, but in 2012, the 'End of Life Choice Bill' was put in the ballot for potential selection for consideration by Parliament, later to be withdrawn. However, it is increasingly likely that New Zealand will follow international trends to offer people a choice about how their lives should end, and that such a Bill will be resubmitted in the near future. Undoubtedly, the passage of such legislation would have an impact on the day-to-day practices of nurses who work with dying people. This article has been prepared following a comprehensive review of appropriate literature both in New Zealand and overseas. This article aims to highlight the importance of nursing input into any national debates concerning proposed euthanasia or assisted dying laws. The discussion therefore covers New Zealand's experience of such proposed legislation, that is, the draft Bill itself and the implications for nurses, the history of the assisted dying debate in New Zealand, public and professional opinion, and national and international nursing responses to euthanasia. New Zealand nurses will eventually have an opportunity to make their views on proposed euthanasia legislation known, and what such legislation might mean for their practice. Nurses everywhere should seriously consider their own knowledge and viewpoint on this vitally important topic, and be prepared to respond as both individuals and as part of their professional bodies when the time inevitably arrives. The result will be a better informed set of policies, regulations and legislation leading to a more meaningful and dignified experience for dying people and their families. Nurses need to be fully informed about
Gevers, J K M
In the last five to ten years there has been increasing debate on terminal sedation, a medical practice that is difficult to place between other decisions at the end of life, like alleviating pain, withholding treatment, and (in jurisdictions where this is allowed) euthanasia or physician-assisted suicide. Terminal sedation is the administration of sedative drugs with the aim to reduce the consciousness of a terminal patient in order to relieve distress. It is frequently accompanied by the withdrawal (or withholding) of life-sustaining interventions, such as hydration and nutrition. It is typically a measure of the last resort, to be considered in situations where all other measures to reduce pain and suffering have failed. While similar to palliative measures as far as the sedation itself is concerned, withholding of hydration and nutrition brings terminal sedation into the realm of non treatment decisions. At the same time, to the extent that the combination of these two measures may shorten the patient's life, the practice may be easily associated with euthanasia. It is no surprise therefore, that terminal sedation has been called (and has been disqualified as) 'slow euthanasia' or 'backdoor euthanasia'. This paper addresses the question how terminal sedation may be looked upon from a legal point of view. Is it indeed a disguised form of euthanasia, or should it be considered as a practice in its own right? In the latter case, what does it imply in legal terms, and under which conditions and safeguards could it be legally justified? To answer these questions, I will look first at the different clinical realities that may be brought under the heading 'terminal sedation'. Then I will deal with its two components--sedation on the one hand, and withholding artificial feeding on the other--in a legal perspective. The paper ends with conclusions on terminal sedation as a whole.
Following considerable debate, the practice of euthanasia was legalized in Belgium in 2002, thereby making Belgium one of the few places in the world where this practice is legal. In 2014 the law was amended for the first time. The 2014 amendment makes euthanasia legally possible for all minors who repeatedly and voluntarily request euthanasia and who are judged to possess "capacity of discernment" (regardless of their biological age), as well as fulfil a number of other criteria of due care. This extension of the 2002 euthanasia law generated a lot of national and international debate and has been applauded by many and heavily criticized by others. This evolution is clearly of interest to end-of-life debates in the entire world. This paper will therefore describe how this amendment came to get passed using official documents from Belgium's Senate and Chamber of Representatives where this amendment was discussed and subsequently passed. Next, some of the most commonly given arguments in favour of the law are identified, as well as the arguments most often voiced against the amendment. All these arguments will be expanded upon and it will be examined whether they hold up to ethical scrutiny. Analysing the official documents and identifying the most commonly voiced arguments gives valuable insight into how Belgium came to amend its euthanasia law and why it did so in 2014. It also becomes clear that although the current amendment is often seen as far-reaching, more radical ideas were proposed during the drafting of the law. Also, in analysing those arguments in favour of the amendment and those against, it is clear that the validity of some of these is questionable.
Methods: Data was collected using questionnaires, administered at 39 highly ranked academic and research institutions aiming to identify those that used animals, their sources of animals, and application of the three Rs. Perceived challenges to the use of non-animal alternatives and common methods of euthanasia were ...
Laux, Johannes; Röbel, Andreas; Parzeller, Markus
In Germany, physician-assisted euthanasia involves numerous risks for the attending physician under criminal and professional law. In the absence of clear legal provisions, four different categories of euthanasia have been developed in legal practice and the relevant literature: help in the dying process, direct active euthanasia, indirect active euthanasia and passive euthanasia. The so-called "help during the dying process" by administering medically indicated analgesic drugs without a life-shortening effect is exempt from punishment if it corresponds to the will of the patient. If the physician omits to give such analgesic drugs although the patient demands them, this is deemed a punishable act of bodily injury. The same applies if the physician administers analgesics against the will of the patient. Medically indicated pain treatment which has a potential or certain life-shortening effect (indirect active euthanasia) is permitted under certain conditions: if there are no alternative and equally suitable treatment options without the risk of shortening the patient's life, if the patient has given his consent to the treatment and if the physician does not act with the intention to kill. The deliberate killing of a dying or terminally ill patient for the purpose of ending his suffering (direct active euthanasia) is prohibited. This includes both deliberately killing a patient against or without his will (by so-called "angels of death") and the killing of a patient who expressly and earnestly demands such an act from his physician (killing on request/on demand). Physician-assisted suicide is generally not liable to punishment in Germany. Nevertheless, the action may be subject to punishment if the physician omits to rescue the life of an unconscious suicide victim. "Palliative sedation" is regarded as a special case. It may become necessary if certain symptoms in the terminal stage of a fatal disease unbearable for the patient cannot be controlled by any other
Musgrave, C F; Soudry, I
Over the past three decades, active euthanasia and abortion have received increasing international attention. Since both these practices are relevant to the role of the nurse-midwife, it is important to know what influences their attitudes towards them. Therefore, the purpose of this study was: 1, to survey the attitudes of nurse-midwives' to active euthanasia and its legalization; 2, to determine the relationship between nurse-midwives' attitudes toward active euthanasia and its legalization, and attitudes toward abortion, self-reported religiosity and religious affiliation. The study setting was an international midwifery conference and the sample consisted of 139 nurse-midwives attending the conference. The majority of nurse-midwives displayed a positive attitude toward active euthanasia and its legalization. In addition, there was a positive relationship between their attitude to abortion and active euthanasia. Self-reported religiosity and religious affiliation were significantly related to attitudes toward active euthanasia and its legalization. An interesting positive relationship between country of practice and attitudes to euthanasia was also found. Nurse-midwives practicing in countries with more liberal euthanasia and assisted suicide legislation were more supportive of active euthanasia. With the increasing acceptance of active euthanasia's legalization, the results of this study pose some ethical questions that nurse-midwives internationally will have to consider.
Walsh, Jessica; Percival, Aaron; Tapscott, Brian; Turner, Patricia V
Appropriate and timely on-farm euthanasia is the responsibility of the producer, working together with their herd veterinarian. Unfortunately, validated methods for euthanasia of commercial meat rabbits are lacking and there are few educational materials available for producer training. Because euthanasia must be performed in a timely fashion to minimise suffering, it is critical to ensure that methods used are aesthetic, humane and effective. We surveyed Canadian meat rabbit producers for current on-farm euthanasia practices as well as attitudes towards the methods they employed and thoughts on novel euthanasia techniques. Surveys were distributed with a response rate of 26 per cent (n=26). Blunt force trauma was the most common euthanasia method used (54 per cent), followed by assisted manual cervical dislocation (31 per cent). Half of producers admitted to not having a euthanasia method in place for all age groups of rabbits, instead electing to let sick and injured rabbits die on their own. While some producers reported feeling highly skilled and satisfied with their current euthanasia method, 58 per cent reported concerns with their current method and 42 per cent desired alternative methods to be developed. Responses to additional questions on training and awareness of euthanasia resources indicated that veterinarians are not part of on-farm euthanasia planning for meat rabbits. © British Veterinary Association (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Nilstun, T; Melltorp, G; Hermerén, G
To present surveys on active euthanasia and to discuss what normative conclusions can be drawn. Two summary articles and 30 recent surveys on attitudes to active euthanasia are discussed. According to the first summary article, acceptance of active euthanasia among the public has stabilized around 65%; according to the second, almost 60% of physicians are in favour of legalizing active euthanasia. As for the 30 recent surveys, physicians are most often respondents. while the general public is surveyed in only three. The differences in attitudes are striking: 21-78% answered that active euthanasia should be legalized, and 14-51% rejected this idea. The core of the general problem of drawing normative conclusions from empirical data is first addressed; then we discuss the principles of autonomy and beneficence, which are often referred to in arguments for and against euthanasia.
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.
Sercu, M; Pype, P; Christiaens, T; Grypdonck, M; Derese, A; Deveugele, M
In 2002, Belgium set a legal framework for euthanasia, whereby granting and performing euthanasia is entrusted entirely to physicians, and-as advised by Belgian Medical Deontology--in the context of a trusted patient--physician relationship. Euthanasia is, however, rarely practiced, so the average physician will not attain routine in this matter. To explore how general practitioners in Flanders (Belgium) deal with euthanasia. This was performed via qualitative analysis of semistructured interviews with 52 general practitioners (GPs). Although GPs can understand a patient's request for euthanasia, their own willingness to perform it is limited, based on their assumption that legal euthanasia equates to an injection that ends life abruptly. Their willingness to perform euthanasia is affected by the demanding nature of a patient's request, by their views on what circumstances render euthanasia legitimate and by their own ability to inject a lethal dose. Several GPs prefer increasing opioid dosages and palliative sedation to a lethal injection, which they consider to fall outside the scope of euthanasia legislation. Four attitudes can be identified: (1) willing to perform euthanasia; (2) only willing to perform as a last resort; (3) feeling incapable of performing; (4) refusing on principle. The situation where GPs have to consider the request and-if they grant it-to perform the act may result in arbitrary access to euthanasia for the patient. The possibility of installing transparent referral and support strategies for the GPs should be further examined. Further discussion is needed in the medical profession about the exact content of the euthanasia law.
Randall, Fiona; Downie, Robin
It is widely assumed by the general public that if assisted suicide (AS) or euthanasia (VE) were legalised doctors must be essentially involved in the whole process including prescribing the medication and (in euthanasia) administering it. This paper explores some reasons for this assumption and argues that it flatly contradicts what it means to be a doctor. The paper is thus not mainly concerned with the ethics of AS/VE but rather with the concept of a doctor that has evolved since the time of Hippocrates to current professional guidance reflected in healthcare law. The paper argues that the most common recent argument for AS/VE--that patients have a right to control when and how they die--in fact points to the involvement not of doctors but of legal agencies as decision makers plus technicians as agents.
J. L. A. Garcia holds that my defense of voluntary euthanasia in an earlier paper amounts to an "assault on traditional common sense" about what medical ethics permits physicians to do, particularly insofar as I hold that a physician's duty to abstain from intentionally killing is only a defeasible duty, not an unconditional one. But I argue here that it is Garcia's views that are more at odds with common sense, and that voluntary euthanasia is in fact a humane alternative that respects patient autonomy and is consistent with the most fundamental moral duties of physicians. Among these is a duty to relieve suffering, which can sometimes outweigh the fundamental duty to conserve life.
Komesaroff, Paul A; Charles, Stephen
Intense debate has continued for many years about whether voluntary euthanasia or assisted suicide should be permitted by law. The community is bitterly divided and there has been vigorous opposition from medical practitioners and the Australian Medical Association. Despite differences of religious and philosophical convictions and ethical values, there is widespread community agreement that people with terminal illnesses are entitled to adequate treatment, and should also be allowed to make basic choices about when and how they die. A problem with the current law is that doctors who follow current best practice cannot be confident that they will be protected from criminal prosecution. We propose simple changes to Commonwealth and state legislation that recognise community concerns and protect doctors acting in accordance with best current practice. This minimalist solution should be widely acceptable to the community, including both the medical profession and those who object to euthanasia for religious reasons. Important areas of disagreement will persist that can be addressed in future debates.
Vanden Eijnden, Serge; Martinovici, Dana
Active ending of the life of a newborn baby is a crime. Yet its clandestine practise is a reality in several European countries. In this paper, we defend the necessity to institute a proper legal frame for what we define as active neonatal euthanasia. The only legal attempt so far, the Dutch Groningen protocol, is not satisfactory. We critically analyse this protocol, as well as several other clinical practises and philosophical stances. Furthermore, we have tried to integrate our opinions as clinicians into a law project, with the purpose of pinpointing several issues, specific of perinatality that should be addressed by such a law. In conclusion, we argue that the legalisation of neonatal euthanasia under exceptional circumstances is the only way to avoid all the "well-intentioned" malpractices associated with ending life at the very dawn of it.
Kelleher, M; Clark, D; Goldney, B; Kerkhof, A; Wasserman, J; Wedler, H
The first meeting of the IASP Task Force on Euthanasia and Assisted Suicide took place in Venice on June 7, 1995. Several interested observers were present. It was decided that at the public IASP meeting the following day each speaker should address, briefly, the current legal situation and the pressure for change, as well as give a personal statement. David Clark spoke for North America, Bob Goldney for Australia, Michael Kelleher for Britain and Ireland, Jerzy Wasserman for Scandinavia, and Hans Wedler for the German-speaking world. Their views are published in this article. Ad Kerkhof requested that the Dutch television film "Death on Request" be discussed. The committee was of the opinion that clear definitions were essential. In their view, these should take into account the differences between active and passive euthanasia, as well as between professionally assisted and lay-assisted suicide.
Benedict, S; Kuhla, J
During the Nazi era, so-called euthanasia programs were established for handicapped and mentally ill children and adults. Organized killings of an estimated 70,000 German citizens took place at killing centers and in psychiatric institutions. Nurses were active participants; they intentionally killed more than 10,000 people in these involuntary euthanasia programs. After the war was over, most of the nurses were never punished for these crimes against humanity--although some nurses were tried along with the physicians they assisted. One such trial was of 14 nurses and was held in Munich in 1965. Although some of these nurses reported that they struggled with a guilty conscience, others did not see anything wrong with their actions, and they believed that they were releasing these patients from their suffering.
Di Mola, G
The word 'euthanasia' has been used with a variety of meanings, all of which refer to one precise action: the killing of a suffering person. A moral evaluation of such an act can lead us either to condemn it a priori, shutting the door upon any argument, or to allow further discussion. But the issue must be discussed, starting with an analysis of the meaning of the word and then examining both whether it is justifiable or not in palliative care, and whether it is acceptable within a general medical context. This paper supports the assumption that a correct and clear-cut analysis of the word euthanasia and of the act to which the word refers can be carried out only through a debate which separates the various levels of reasoning (medical, ethical, religious, political, legal) and keeps distinct from one another.
Active ending of the life of a newborn baby is a crime. Yet its clandestine practise is a reality in several European countries. In this paper, we defend the necessity to institute a proper legal frame for what we define as active neonatal euthanasia. The only legal attempt so far, the Dutch Groningen protocol, is not satisfactory. We critically analyse this protocol, as well as several other clinical practises and philosophical stances. Furthermore, we have tried to integrate our opinions as clinicians into a law project, with the purpose of pinpointing several issues, specific of perinatality that should be addressed by such a law. In conclusion, we argue that the legalisation of neonatal euthanasia under exceptional circumstances is the only way to avoid all the “well-intentioned” malpractices associated with ending life at the very dawn of it. PMID:24068880
Bartels, Lorana; Otlowski, Margaret
This article examines the legal regulation of active voluntary euthanasia and assisted suicide in Australia. The Dying with Dignity Bill 2009 (Tas), which was recently defeated by the Tasmanian Parliament, is discussed, as well as other jurisdictions' past and present legislative developments in this context. The recent case law is also considered to ascertain how "mercy killing" or assisted suicide cases are dealt with by the criminal justice system, with particular reference to the case of R v Justins  NSWSC 1194. This is followed by a critical evaluation of the key arguments for and against euthanasia. The article concludes by examining the significance of the Tasmanian Bill and the implications of such legislation.
Anne Pamela Frances Wand
Full Text Available Suicide amongst the very old is an important public health issue. Little is known about why older people may express a wish to die or request euthanasia and how such thoughts may intersect with suicide attempts. Palliative care models promote best care as holistic and relieving suffering without hastening death in severely ill patients; but what of those old people who are tired of living and may have chronic symptoms, disability, and reduced quality of life? Two cases of older people who attempted suicide but expressed a preference for euthanasia were it legal are presented in order to illustrate the complexity underlying such requests. The absence of a mood or anxiety disorder underpinning their wishes to die further emphasises the importance of understanding the individual’s narrative and the role of a formulation in guiding broad biopsychosocial approaches to management.
Wilkes, L; White, K; Tolley, N
This paper reports on a study which investigated whether nurses from Eastern and Western cultures hold differing definitions of euthanasia and different perspectives of the effect of their attitudes to euthanasia on professional relationships with patients and colleagues. The focus of the study was the lived experience of Chinese and Australian nurses working in palliative care. The results indicate that there were differences between these two groups in their definitions of euthanasia. Lived experience obtained from both groups revealed conflict with patients and colleagues, and a lack of opportunity to discuss the ethical issue of euthanasia in the workplace.
This month the Senate Committee on Euthanasia and Assisted Suicide will issue its long-awaited report. Within a year, MPs are likely to decide in a free vote whether euthanasia should be legalized in Canada. Indications are that while there is public sentiment supporting euthanasia, there is also vehement opposition, even from some who once supported the right of choice. The Senate committee is wrestling with the issue of whether public opinion and the surreptitious practice of euthanasia are enough to justify changes to the Criminal Code. PMID:11653152
Karlsson, Marit; Milberg, Anna; Strang, Peter
Although intolerable suffering is a core concept used to justify euthanasia, little is known about dying cancer patients' own interpretations and conclusions of suffering in relation to euthanasia. Sixty-six patients with cancer in a palliative phase were selected through maximum-variation sampling, and in-depth interviews were conducted on suffering and euthanasia. The interviews were analyzed using qualitative content analysis with no predetermined categories. The analysis demonstrated patients' different perspectives on suffering in connection to their attitude to euthanasia. Those advocating euthanasia, though not for themselves at the time of the study, did so due to (1) perceptions of suffering as meaningless, (2) anticipatory fears of losses and multi-dimensional suffering, or (3) doubts over the possibility of receiving help to alleviate suffering. Those opposing euthanasia did so due to (1) perceptions of life, despite suffering, as being meaningful, (2) trust in bodily or psychological adaptation to reduce suffering, a phenomenon personally experienced by informants, and (3) by placing trust in the provision of help and support by healthcare services to reduce future suffering. Dying cancer patients draw varying conclusions from suffering: suffering can, but does not necessarily, lead to advocations of euthanasia. Patients experiencing meaning and trust, and who find strategies to handle suffering, oppose euthanasia. In contrast, patients with anticipatory fears of multi-dimensional meaningless suffering and with lack of belief in the continuing availability of help, advocate euthanasia. This indicates a need for healthcare staff to address issues of trust, meaning, and anticipatory fears.
Futile medical care and euthanasia are hard to assess unequivocally and are becoming a frequent topic of social discussion. The problem requires both ethical and moral consideration as well as legal regulations. As a medical issue it has got both its supporters and opponents. The aim of the study was to evaluate of nurses' attitudes and knowledge concerning euthanasia and persistend therapy. The survey group included 183 nurses aged 30-58. The diagnostic method poll was applied, the technique used was a questionnaire. Among the nurses participating in the survey, 83% is against providing futile medical care when it is known that it will not bring any effect, while increasing the suffering and prolonging dying. 45% of the respondents consider euthanasia unacceptable, 41% think that euthanasia could be performed in cases in which patient's suffering cannot be relieved. 49% of the surveyed think that euthanasia should remain strictly prohibited by the Polish law, while 31% think that Polish legal system should legalize euthanasia. The nurses are aware that futile medical care for terminally ill and dying patients does not lead to successful treatment but instead it prolongs dying and suffering, at the same time resulting in extremely high financial costs. In most cases they are advocates of its discontinuing. The surveyed nurses differ in their approach towards euthanasia, some of them supporting the idea, the other--opposing it. Most of them express the opinion that euthanasia should be forbidden in the Polish law and their personal approach towards euthanasia is negative.
Leppert, Wojciech; Gottwald, Leszek; Majkowicz, Mikolaj; Kazmierczak-Lukaszewicz, Sylwia; Forycka, Maria; Cialkowska-Rysz, Aleksandra; Kotlinska-Lemieszek, Aleksandra
The aim of the study conducted upon completion of obligatory palliative medicine courses among 588 medical students at two universities was to compare their attitudes toward euthanasia. Four hundred ninety-two (84.97 %) students were Catholics; 69 (11.73 %) declared they would practice euthanasia, 303 (51.53 %) would not, and 216 students (36.73 %) were not sure. The idea of euthanasia legalisation was supported by 174 (29.59 %) respondents, opposed by 277 (47.11 %), and 137 (23.30 %) were undecided. Five hundred fifty-six (94.56 %) students did not change their attitudes toward euthanasia after palliative medicine courses. Students from the two universities were found to have different opinions on practicing euthanasia, euthanasia law and possible abuse which might follow euthanasia legalisation, but they shared similar views on the choice of euthanasia if they themselves were incurably ill and the legalisation of euthanasia. Gender and religion influenced students' answers. Differences observed between medical students at the two universities might be related to gender and cultural differences.
Vilela, Luciana Pricoli; Caramelli, Paulo
Euthanasia is an increasingly debated subject among specialized professionals and also among lay people, even in countries such as Brazil where it is not authorized. It is questionable, however, if the concept of euthanasia is well known by these persons. The goal of this study was to investigate knowledge about the definition of euthanasia by family caregivers of patients with dementia and by specialized physicians and also to investigate their personal opinion on this topic. We prospectively interviewed 30 physicians from three different medical specialties and 40 family caregivers of patients with Alzheimer's disease using a structured questionnaire. Two clinical vignettes were also presented to the physicians in order to ascertain their personal opinion about euthanasia. Among the caregivers, 10 (25.0%) knew the correct definition of euthanasia. Regarding their personal view, nine (22.5%) were in favor, while 20 (50.0%) were against. The remaining 11 (27.5%) caregivers were unable to define their position. Among the physicians, 19 (63.3%) gave a coherent answer regarding the definition of euthanasia. When they were presented with the clinical vignettes, less than 50% of them were in favor of euthanasia. The definition of euthanasia was unknown by most of the lay individuals and also by one third of the physicians. Although it is not officially approved in Brazil, a small proportion of family caregivers and also of specialized physicians would be in favor of the practice of euthanasia.
Onwuteaka-Philipsen, Bregje D; Rurup, Mette L; Pasman, H Roeline W; van der Heide, Agnes
When suffering becomes unbearable for patients they might request for euthanasia. To study which patients request for euthanasia and which requests actually resulted in euthanasia in relation with diagnosis, care setting at the end of life, and patient demographics. A cross-sectional study covering all Dutch health care settings. In 2005, of death certificates of deceased persons, a stratified sample was derived from the Netherlands central death registry. The attending physician received a written questionnaire (n = 6860; response 78%). If deaths were reported to have been nonsudden, the attending physician filled in a 4-page questionnaire on end-of-life decision-making. Data regarding the deceased person's age, sex, marital status, and cause of death were derived from the death certificate. Of patients whose death was nonsudden, 7% explicitly requested for euthanasia. In about two thirds, the request did not lead to euthanasia or physician-assisted suicide being performed, in 39% because the patient died before the request could be granted and in 38% because the physician thought the criteria for due care were not met. Factors positively associated with a patient requesting for euthanasia are (young) age, diagnosis (cancer, nervous system), place of death (home), and involvement of palliative teams and psychiatrist in care. Diagnosis and place of death are also associated with requests resulting in euthanasia. Only a minority of patients request euthanasia at the end of life and of these requests a majority is not granted. Careful decision-making is necessary in all requests for euthanasia.
Pierson, C A
Euthanasia is an emerging public problem. The recent "medicalization" of the dying process in industrialized nations has engendered a fear of a painful and undignified death and the loss of control over one's final days. For people who live in societies with advanced medical resources and technology, euthanasia seems the only sure way to have "a good death." This article examines the public and private faces of euthanasia and provides another moral lens through which to view the issue. The article includes an interview with the son of a 78-year-old man who had active euthanasia performed by a family physician in the Netherlands.
Sheetal Singh; Sharma, D. K.; Vijay Aggarwal; Preeti Gandhi; Sajjan Rajpurohit
Introduction: Deliberation over euthanasia has been enduring for an extended period of time. On one end, there are populaces talking for the sacrosanctity of life and on the other end, there are those, who promote individual independence. All over the world professionals from different areas have already spent mammoth period over the subject. A large number of cases around the world have explored the boundaries of current legal distinctions, drawn between legitimate and nonlegitimate instance...
Keown, D.; Keown, J
In 1993 The Parliament of the World's Religions produced a declaration known as A Global Ethic which set out fundamental points of agreement on moral tissues between the religions of the world. However, the declaration did not deal explicitly with medical ethics. This article examines Buddhist and Christian perspectives on euthanasia and finds that in spite of their cultural and theological differences both oppose it for broadly similar reasons. Both traditions reject consequentialist pattern...
Eijnden, Serge Vanden; Martinovici, Dana
Active ending of the life of a newborn baby is a crime. Yet its clandestine practise is a reality in several European countries. In this paper, we defend the necessity to institute a proper legal frame for what we define as active neonatal euthanasia. The only legal attempt so far, the Dutch Groningen protocol, is not satisfactory. We critically analyse this protocol, as well as several other clinical practises and philosophical stances. Furthermore, we have tried to integrate our opinions as...
Nihal İşler; Handan Eren; Mahmure Can; Gamze Aydoğmuş; Gül Pınar; Alper Beder1,; Sevinç Yılmaz; Müberra Birli
Objective: The research was conducted to investigate the opinions of nurses and physicians pertaining to euthanasia who are working at Internal Medicine, Surgery and Intensive Care Unit departments at Baskent University Ankara hospital.Methods: The research is a descriptive one. The sample consisted of 154 nurses and physicians who are working at Internal Medicine, Surgery and Intensive Care Unit departments at Baskent University Ankara hospital and accepted to participate and could be reache...
Americans think about right-to-die questions in two very distinct ways--as a public policy issue generally in support of euthanasia, and as an issue of personal choice for themselves, which they would prefer to avoid. The following articles summarize the factors affecting public choice, the public's attitude toward Kevorkian, Washington's new natural death act, political fallout from the failure of Initiative 119, and Derek Humphry's plea for physicians to join in the suicide rights battle.
Inbadas, Hamilton; Zaman, Shahaduz; Whitelaw, Alexander; Clark, David
Background: The production of 'declarations' (formal, public statements to influence policy, raise awareness and call others to action) is increasing in the end of life care field. Several declarations have been issued on ‘assisted dying/euthanasia’ but have not yet been analysed systematically.\\ud Aim: To map the emergence of assisted dying/euthanasia declarations in the international context and to establish the representation of palliative care in these declarations.\\ud Methods: A two stag...
Juth, Niklas; Lindblad, Anna; Lynöe, Niels; Sjöstrand, Manne; Helgesson, Gert
In palliative care there is much debate about which end of life treatment strategies are legitimate and which are not. Some writers argue that there is an important moral dividing-line between palliative sedation and euthanasia, making the first acceptable and the latter not. We have questioned this. In a recent article, Lars Johan Materstvedt has argued that we are wrong on two accounts: first, that we fail to account properly for the moral difference between continuous deep palliative sedation at the end of life and euthanasia, and, second, that we fail to account properly for the difference between permanent loss of consciousness and death. Regarding the first objection, we argue that Materstvedt misses the point: we agree that there is a difference in terms of intentions between continuous deep palliative sedation and euthanasia, but we question whether this conceptual difference makes up for a moral difference. Materstvedt fails to show that it does. Regarding the second objection, we argue that if nothing else is at stake than the value of the patient's life, permanent unconsciousness and death are morally indifferent.
Fernandes, Ashley K
The lack of consensus in American society regarding the permissibility of assisted suicide and euthanasia is due in large part to a failure to address the nature of the human person involved in the ethical act itself. For Karol Wojtyla, philosopher and Pope, ethical action finds meaning only in an authentic understanding of the person; but it is through acting (actus humanus) alone that the human person reveals himself. Knowing what the person ought to be cannot be divorced from what he ought to do; for Wojtyla, the structure of the ethical "do"--the act itself--comes first. The current paper will focus on four arguments used to justify assisted suicide and euthanasia: (1) the argument from autonomy, (2) the argument from compassion, (3) the argument from the evil of suffering, and (4) the argument from the loss of dignity. It will seek to answer each claim from the perspective of Karol Wojtyla's philosophical anthropology. Much of this will come from his defining work in pure philosophy, The Acting Person (1969). The final part of the paper will suggest some positive solutions to the stalemate over the euthanasia debate, again drawn from Wojtyla's idea of human fufillment through participation with the other, and with the community itself.
van Bruchem-van de Scheur, Ada; van der Arend, Arie; van Wijmen, Frans; Abu-Saad, Huda Huijer; ter Meulen, Ruud
This article presents the attitudes of nurses towards three issues concerning their role in euthanasia and physician-assisted suicide. A questionnaire survey was conducted with 1509 nurses who were employed in hospitals, home care organizations and nursing homes. The study was conducted in the Netherlands between January 2001 and August 2004. The results show that less than half (45%) of nurses would be willing to serve on committees reviewing cases of euthanasia and physician-assisted suicide. More than half of the nurses (58.2%) found it too far-reaching to oblige physicians to consult a nurse in the decision-making process. The majority of the nurses stated that preparing euthanatics (62.9%) and inserting an infusion needle to administer the euthanatics (54.1%) should not be accepted as nursing tasks. The findings are discussed in the context of common practices and policies in the Netherlands, and a recommendation is made not to include these three issues in new regulations on the role of nurses in euthanasia and physician-assisted suicide.
Bollen, J; de Jongh, W; Hagenaars, J; van Dijk, G; Ten Hoopen, R; Ysebaert, D; Ijzermans, J; van Heurn, E; van Mook, W
Many physicians and patients do not realize that it is legally and medically possible to donate organs after euthanasia. The combination of euthanasia and organ donation is not a common practice, often limited by the patient's underlying pathology, but nevertheless has been performed >40 times in Belgium and the Netherlands since 2005. In anticipation of patients' requests for organ donation after euthanasia and contributing to awareness of the possibility of this combination among general practitioners and medical specialists, the Maastricht University Medical Center and the Erasmus University Medical Center Rotterdam have developed a multidisciplinary practical manual in which the organizational steps regarding this combined procedure are described and explained. This practical manual lists the various criteria to fulfill and the rules and regulations the different stakeholders involved need to comply with to meet all due diligence requirements. Although an ethicist was involved in writing this paper, this report is not specifically meant to comprehensively address the ethical issues surrounding the topic. This paper is focused on the operational aspects of the protocol. © Copyright 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.
Frileux, S; Lelievre, C; Munoz, S; Mullet, E; Sorum, P
Objectives: To discover what factors affect lay people's judgments of the acceptability of physician assisted suicide and euthanasia and how these factors interact. Design: Participants rated the acceptability of either physician assisted suicide or euthanasia for 72 patient vignettes with a five factor design—that is, all combinations of patient's age (three levels); curability of illness (two levels); degree of suffering (two levels); patient's mental status (two levels), and extent of patient's requests for the procedure (three levels). Participants: Convenience sample of 66 young adults, 62 middle aged adults, and 66 older adults living in western France. Main measurements: In accordance with the functional theory of cognition of N H Anderson, main effects, and interactions among patient factors and participants' characteristics were investigated by means of both graphs and ANOVA. Results: Patient requests were the most potent determinant of acceptability. Euthanasia was generally less acceptable than physician assisted suicide, but this difference disappeared when requests were repetitive. As their own age increased, participants placed more weight on patient age as a criterion of acceptability. Conclusions: People's judgments concur with legislation to require a repetition of patients' requests for a life ending act. Younger people, who frequently are decision makers for elderly relatives, place less emphasis on patient's age itself than do older people. PMID:14662811
Goldstein, Nathan E; Cohen, Lewis M; Arnold, Robert M; Goy, Elizabeth; Arons, Stephen; Ganzini, Linda
Little is known about how often physicians are formally accused of hastening patient deaths while practicing palliative care. We conducted an Internet-based survey on a random 50% sample of physician-members of a national hospice and palliative medicine society. The final sample consisted of 663 physicians (response rate 53%). Over half of the respondents had had at least one experience in the last 5 years in which a patient's family, another physician, or another health care professional had characterized palliative treatments as being euthanasia, murder, or killing. One in four stated that at least one friend or family member, or a patient had similarly characterized their treatments. Respondents rated palliative sedation and stopping artificial hydration/nutrition as treatments most likely to be misconstrued as euthanasia. Overall, 25 physicians (4%) had been formally investigated for hastening a patient's death when that had not been their intention-13 while using opiates for symptom relief and six for using medications while discontinuing mechanical ventilation. In eight (32%) cases, another member of the health care team had initiated the charges. At the time of the survey, none had been found guilty, but they reported experiencing substantial anger and worry. Commonly used palliative care practices continue to be misconstrued as euthanasia or murder, despite this not being the intention of the treating physician. Further efforts are needed to explain to the health care community and the public that treatments often used to relieve patient suffering at the end of life are ethical and legal.
Draper, Brian; Peisah, Carmelle; Snowdon, John; Brodaty, Henry
Diagnosis of dementia is occurring earlier, and much research concerns the identification of predementia states and the hunt for biomarkers of Alzheimer's disease. Reports of suicidal behavior and requests for euthanasia in persons with dementia may be increasing. We performed a selective literature review of suicide risk in persons with dementia and the ethical issues associated with euthanasia in this population. In the absence of any effective treatments for Alzheimer's disease or other types of dementia, there is already evidence that persons with mild cognitive change and early dementia are at risk of suicidal behavior, often in the context of comorbid depression. The ensuing clinical, ethical, and legal dilemmas associated with physician-assisted suicide and euthanasia in the context of dementia are a subject of intense debate. By analogy, the preclinical and early diagnoses of Huntington's disease are associated with an increased risk of suicidal behavior. Thus there is the potential for a preclinical and early diagnosis of Alzheimer's disease (through biomarkers, neuroimaging, and clinical assessment) to result in increased suicide risk and requests for physician-assisted suicide. Although dementia specialists have long recognized the importance of a sensitive approach to conveying bad news to patients and families and the possibility of depressive reactions, suicidal behavior has not been regarded as a likely outcome. Such preconceptions will need to change, and protocols to monitor and manage suicide risk will need to be developed for this population. 2010 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.
Karen L. Johnson
Full Text Available Cat impoundments were increasing at the municipal San Jose animal shelter in 2009, despite long-term successful low cost sterilization programs and attempts to lower the euthanasia rate of treatable-rehabilitatable impounds beginning in 2008. San Jose Animal Care and Services implemented a new strategy designed to control overall feral cat reproduction by altering and returning feral cats entering the shelter system, rather than euthanizing the cats. The purpose of this case study was to determine how the program affected the shelter cat intakes over time. In just over four years, 10,080 individual healthy adult feral cats, out of 11,423 impounded at the shelter during this time frame, were altered and returned to their site of capture. Included in the 11,423 cats were 862 cats impounded from one to four additional times for a total of 958 (9.5% recaptures of the previously altered 10,080 cats. The remaining 385 healthy feral cats were euthanized at the shelter from March 2010 to June 2014. Four years into the program, researchers observed cat and kitten impounds decreased 29.1%; euthanasia decreased from over 70% of intakes in 2009, to 23% in 2014. Euthanasia in the shelter for Upper Respiratory Disease decreased 99%; dead cat pick up off the streets declined 20%. Dog impounds did not similarly decline over the four years. No other laws or program changes were implemented since the beginning of the program.
Verhoef, M J; Kinsella, T D
To ascertain the opinions of Alberta physicians about the acceptance of active euthanasia as a medical act (the "medicalization" of active euthanasia) and the reporting of colleagues practising active euthanasia, as well as the sociodemographic correlates. Cross-sectional survey of a random sample of Alberta physicians, grouped by site and type of practice. Alberta. A total of 2002 (46%) of the licensed physicians in Alberta were mailed a 38-item questionnaire in May through July 1991; usable responses were returned by 1391 (69%). Although only 44% of the respondents considered active euthanasia morally "right" at least 70% opted to medicalize the practice if it were legal by restricting it to be performed by physicians and to be taught at medical sites. Even though active euthanasia is criminal homicide in Canada, 33% of the physicians stated that they would not report a colleague participating in the act of anyone, and 40% and 60% stated that they would not report a colleague to medical or legal authorities respectively. Acceptance or rejection of active euthanasia as a medical act was strongly related to religious affiliation and activity (p euthanasia revealed profound incongruities in the opinions of the sample of Alberta physicians concerning their ethical and social duties in the practice of medicine. These data highlight the need for relevant modifications of health education policies concerning biomedical ethics and physicians' obligations to society.
Verhoef, M J; Kinsella, T D
OBJECTIVE: To ascertain the opinions of Alberta physicians about the acceptance of active euthanasia as a medical act (the "medicalization" of active euthanasia) and the reporting of colleagues practising active euthanasia, as well as the sociodemographic correlates. DESIGN: Cross-sectional survey of a random sample of Alberta physicians, grouped by site and type of practice. SETTING: Alberta. PARTICIPANTS: A total of 2002 (46%) of the licensed physicians in Alberta were mailed a 38-item questionnaire in May through July 1991; usable responses were returned by 1391 (69%). RESULTS: Although only 44% of the respondents considered active euthanasia morally "right" at least 70% opted to medicalize the practice if it were legal by restricting it to be performed by physicians and to be taught at medical sites. Even though active euthanasia is criminal homicide in Canada, 33% of the physicians stated that they would not report a colleague participating in the act of anyone, and 40% and 60% stated that they would not report a colleague to medical or legal authorities respectively. Acceptance or rejection of active euthanasia as a medical act was strongly related to religious affiliation and activity (p active euthanasia revealed profound incongruities in the opinions of the sample of Alberta physicians concerning their ethical and social duties in the practice of medicine. These data highlight the need for relevant modifications of health education policies concerning biomedical ethics and physicians' obligations to society. PMID:8500030
Three characteristic developments in modern western societies usually are considered to be independent variables in the ethical discussion:1. An explosion-like increase in medical and social expenditures following a rapid multiplication of old and multiply disabled people in this century. 2. the increasing economic importance of the "health industry", and 3. the "new" debate of euthanasia. All these developments are discussed controversially. The volume of geriatric support is mostly considered to be insufficient, but usually it is restricted by both, scarcity of resources as well as increasing demands to focus on "evidence-based medicine" (which might exclude a lot of medical procedures in old age). The mutation of health systems from - originally - social activities to business branches more and more gives priority to economical based decisions in medicine, but otherwise has advanced an increasing number of new health professions. The origin of the actual debate on euthanasia is the development and judicial certification of individual's self-determination in modern societies. However, euthanasia is still refused world-wide because it is considered to be linked with a process of weakening basic ethical principles. The 3 seemingly independent developments certainly are facts in modern societies. They hardly can be influenced by the medical profession, being forced to conform to them. However, there are significant connections between them.A geriatric health system, primarily denying individual demands and basic convictions of old people, contributes to an attitude of non-acceptance towards daily practice medicine. The same effect may result from the economic transformation of medicine when creating a system of self-perpetuating demand (being characteristic for an "ideal" business branch) by "unlimited" prolongation of life of the very old and highly disabled patients. The result from this development undoubtedly will be an increasing demand for self
Conclusions: A majority of the doctors in this study supported euthanasia for the relief of unbearable pain and suffering. Religion and speciality appear to be significant in determining attitudes toward euthanasia.
Rathor, Mohammad Yousuf; Abdul Rani, Mohammad Fauzi; Shahar, Mohammad Arif; Jamalludin, A Rehman; Che Abdullah, Shahrin Tarmizi Bin; Omar, Ahmad Marzuki Bin; Mohamad Shah, Azarisman Shah Bin
.... As euthanasia has gained world-wide prominence, the objectives of our study therefore were to explore the attitude of physicians and chronically ill patients toward euthanasia and related issues...
McGlade, K J; Slaney, L; Bunting, B P; Gallagher, A G
BACKGROUND: There has been much recent interest in the press and among the profession on the subject of euthanasia and physician-assisted suicide. The BMA recently conducted a 'consensus conference' over the internet to collect views on physician-assisted suicide. Any surveys to date have addressed a variety of specialties; however, no recent surveys have looked at general practitioner (GP) attitudes and experiences. AIM: To explore the attitudes of GPs in Northern Ireland towards the issue of patient requests for euthanasia, their nature, and doctors' experiences of such requests. METHOD: An anonymous, confidential postal survey of all (1053) GP principals in Northern Ireland. RESULTS: Seventy per cent of responders believe that passive euthanasia is both morally and ethically acceptable. Fewer (49%) would be prepared to take part in passive euthanasia. However, over 70% of physicians responding consider physician-assisted suicide and voluntary active euthanasia to be wrong. Thirty per cent of responders have received requests from patients for euthanasia in the past five years. One hundred and seven doctors gave information about these requests. Thirty-nine out of 54 patient requests for passive euthanasia had been complied with, as had one of 19 requests for physician-assisted suicide and four out of 38 patient requests for active euthanasia. Doctors perceived the main reasons why patients sought euthanasia was because of fear of loss of dignity and fear of being a burden to others. CONCLUSIONS: While the majority of GPs support passive euthanasia, they, in common with those who approve of assisted suicide and active euthanasia, often express a reluctance to take part in such actions. This may reflect the moral, legal, and emotional dilemmas doctors encounter when facing end-of-life decisions. PMID:11127168
Vézina-Im, Lydi-Anne; Lavoie, Mireille; Krol, Pawel; Olivier-D'Avignon, Marianne
While a number of reviews have explored the attitude of health professionals toward euthanasia, none of them documented their motivations to practice euthanasia. The objective of the present systematic review was to identify physicians' and nurses' motives for having the intention or for performing an act of voluntary euthanasia and compare findings from countries where the practice is legalized to those where it is not. The following databases were investigated: MEDLINE/PubMed (1950+), PsycINFO (1806+), CINAHL (1982+), EMBASE (1974+) and FRANCIS (1984+). Proquest Dissertations and Theses (1861+) was also investigated for gray literature. Additional studies were included by checking the references of the articles included in the systematic review as well as by looking at our personal collection of articles on euthanasia. This paper reviews a total of 27 empirical quantitative studies out of the 1 703 articles identified at the beginning. Five studies were in countries where euthanasia is legal and 22 in countries where it is not. Seventeen studies were targeting physicians, 9 targeted nurses and 1 both health professionals. Six studies identified the motivations underlying the intention to practice euthanasia, 16 the behavior itself and 5 both intention and behavior. The category of variables most consistently associated with euthanasia is psychological variables. All categories collapsed, the four variables most frequently associated with euthanasia are past behavior, medical specialty, whether the patient is depressed and the patient's life expectancy. The present review suggests that physicians and nurses are motivated to practice voluntary euthanasia especially when they are familiar with the act of euthanasia, when the patient does not have depressive symptoms and has a short life expectancy and their motivation varies according to their medical specialty. Additional studies among nurses and in countries where euthanasia is legal are needed.
This study tests how various kinds of trust impact attitudes toward euthanasia among the general public. The indication that trust might have an impact on euthanasia attitudes is based on the slippery slope argument, which asserts that allowing euthanasia might lead to abuses and involuntary deaths. Adopting this argument usually leads to less positive attitudes towards euthanasia. Tying in with this, it is assumed here that greater trust diminishes such slippery slope fears, and thereby increases euthanasia acceptance. The effects of various trust indicators on euthanasia acceptance were tested using multilevel analysis, and data from the European Values Study 2008 (N = 49,114, 44 countries). More precisely, the influence of people's general levels of trust in other people, and their confidence in the health care system, were measured--both at the individual and at the country level. Confidence in the state and the press were accounted for as well, since both institutions might monitor and safeguard euthanasia practices. It was shown that the level of trust in a country was strongly positively linked to euthanasia attitudes, both for general trust and for confidence in health care. In addition, within countries, people who perceived their fellow citizens as trustworthy, and who had confidence in the press, were more supportive of euthanasia than their less trusting counterparts. The pattern was, however, not true for confidence in the state and for confidence in the health care system at the individual level. Notably, all confirmative effects held, even when other variables such as religiosity, education, and values regarding autonomy were controlled for. Trust seems to be a noteworthy construct to explain differences in attitudes towards euthanasia, especially when drawing cross-country comparisons. Therefore, it should be added to the existing literature on correlates of euthanasia attitudes.
Background While a number of reviews have explored the attitude of health professionals toward euthanasia, none of them documented their motivations to practice euthanasia. The objective of the present systematic review was to identify physicians’ and nurses’ motives for having the intention or for performing an act of voluntary euthanasia and compare findings from countries where the practice is legalized to those where it is not. Methods The following databases were investigated: MEDLINE/PubMed (1950+), PsycINFO (1806+), CINAHL (1982+), EMBASE (1974+) and FRANCIS (1984+). Proquest Dissertations and Theses (1861+) was also investigated for gray literature. Additional studies were included by checking the references of the articles included in the systematic review as well as by looking at our personal collection of articles on euthanasia. Results This paper reviews a total of 27 empirical quantitative studies out of the 1 703 articles identified at the beginning. Five studies were in countries where euthanasia is legal and 22 in countries where it is not. Seventeen studies were targeting physicians, 9 targeted nurses and 1 both health professionals. Six studies identified the motivations underlying the intention to practice euthanasia, 16 the behavior itself and 5 both intention and behavior. The category of variables most consistently associated with euthanasia is psychological variables. All categories collapsed, the four variables most frequently associated with euthanasia are past behavior, medical specialty, whether the patient is depressed and the patient’s life expectancy. Conclusions The present review suggests that physicians and nurses are motivated to practice voluntary euthanasia especially when they are familiar with the act of euthanasia, when the patient does not have depressive symptoms and has a short life expectancy and their motivation varies according to their medical specialty. Additional studies among nurses and in countries where
Dierickx, Sigrid; Deliens, Luc; Cohen, Joachim; Chambaere, Kenneth
Background: In 2002, the Belgian Act on Euthanasia came into effect, regulating the intentional ending of life by a physician at the patient’s explicit request. We undertook this study to describe trends in officially reported euthanasia cases in Belgium with regard to patients’ sociodemographic and clinical profiles, as well as decision-making and performance characteristics. Methods: We used the database of all euthanasia cases reported to the Federal Control and Evaluation Committee on Euthanasia in Belgium between Jan. 1, 2003, and Dec. 31, 2013 (n = 8752). The committee collected these data with a standardized registration form. We analyzed trends in patient, decision-making and performance characteristics using a χ2 technique. We also compared and analyzed trends for cases reported in Dutch and in French. Results: The number of reported euthanasia cases increased every year, from 235 (0.2% of all deaths) in 2003 to 1807 (1.7% of all deaths) in 2013. The rate of euthanasia increased significantly among those aged 80 years or older, those who died in a nursing home, those with a disease other than cancer and those not expected to die in the near future (p euthanasia requests, beyond the legal requirements to do so (p euthanasia request (from 34.0% in 2003 to 42.6% in 2013). These trends were not significant for cases reported in French. Interpretation: Since legalization of euthanasia in Belgium, the number of reported cases has increased each year. Most of those receiving euthanasia were younger than 80 years and were dying of cancer. Given the increases observed among non–terminally ill and older patients, this analysis shows the importance of detailed monitoring of developments in euthanasia practice. PMID:27620630
Pritchett, K.; Corrow, D.; Stockwell, J.; Smith, A.
Exposure to carbon dioxide (CO2) is the most prevalent method used to euthanize rodents in biomedical research. The purpose of this study was to determine the time of CO2 exposure required to euthanize neonatal mice (0 to 10 days old). Multiple groups of mice were exposed to 100% CO 2 for time periods between 5 and 60 min. Mice were placed in room air for 10 or 20 min after CO2 exposure, to allow for the chance of recovery. If mice recovered at one time point, a longer exposure was examined. Inbred and outbred mice were compared. Results of the study indicated that time to death varied with the age of the animals and could be as long as 50 min on the day of birth and differed between inbred and outbred mice. Institutions euthanizing neonatal mice with CO2 may wish to adjust their CO 2 exposure time periods according the age of the mice and their genetic background. Copyright 2005 by the American Association for Laboratory Animal Science.
Paul-Murphy, Joanne R; Engilis, Andrew; Pascoe, Peter J; Williams, D Colette; Gustavsen, Kate A; Drazenovich, Tracy L; Keel, M Kevin; Polley, Tamsen M; Engilis, Irene E
OBJECTIVE To compare intraosseous pentobarbital treatment (IPT) and thoracic compression (TC) on time to circulatory arrest and an isoelectric electroencephalogram (EEG) in anesthetized passerine birds. ANIMALS 30 wild-caught adult birds (17 house sparrows [Passer domesticus] and 13 European starlings [Sturnus vulgaris]). PROCEDURES Birds were assigned to receive IPT or TC (n = 6/species/group). Birds were anesthetized, and carotid arterial pulses were monitored by Doppler methodology. Five subdermal braided-wire electrodes were used for EEG. Anesthetic depth was adjusted until a continuous EEG pattern was maintained, then euthanasia was performed. Times from initiation of euthanasia to cessation of carotid pulse and irreversible isoelectric EEG (indicators of death) were measured. Data (medians and first to third quartiles) were summarized and compared between groups within species. Necropsies were performed for all birds included in experiments and for another 6 birds euthanized under anesthesia by TC (4 sparrows and 1 starling) or IPT (1 sparrow). RESULTS Median time to isoelectric EEG did not differ significantly between treatment groups for sparrows (19.0 and 6.0 seconds for TC and IPT, respectively) or starlings (88.5 and 77.5 seconds for TC and IPT, respectively). Median times to cessation of pulse were significantly shorter for TC than for IPT in sparrows (0.0 vs 18.5 seconds) and starlings (9.5 vs 151.0 seconds). On necropsy, most (14/17) birds that underwent TC had grossly visible coelomic, pericardial, or perihepatic hemorrhage. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that TC might be an efficient euthanasia method for small birds. Digital pressure directly over the heart during TC obstructed venous return, causing rapid circulatory arrest, with rupture of the atria or vena cava in several birds. The authors propose that cardiac compression is a more accurate description than TC for this procedure.
Anniballi, Fabrizio; Fiore, Alfonsina; Löfström, Charlotta
and supportive therapies are used to treat sick animals. Once the diagnosis has been made, euthanasia is frequently advisable. Vaccine administration is subject to health authorities' permission, and it is restricted to a small number of animal species. Several measures can be adopted to prevent or minimize...
Otten, Nina Dam; Nielsen, Liza Rosenbaum; Thomsen, P. T.
AWL) defined as occurrence of at least one of the two most frequently violated measures found at recent inspections in Denmark, namely (a) presence of injured animals not separated from the rest of the group and/or (b) animals in a condition warranting euthanasia still being present in the herd. A total of 25...
Boivin, Gregory P; Bottomley, Michael A; Schiml, Patricia A; Goss, Lori; Grobe, Nadja
Rodent euthanasia using exposure to increasing concentrations of CO2 has come under scrutiny due to concerns of potential pain during the euthanasia process. Alternatives to CO2, such as isoflurane and barbiturates, have been proposed as more humane methods of euthanasia. In this study, we examined 3 commonly used euthanasia methods in mice: intraperitoneal injection of pentobarbital–phenytoin solution, CO2 inhalation, and isoflurane anesthesia followed by CO2 inhalation. We hypothesized that pentobarbital–phenytoin euthanasia would cause fewer alterations in cardiovascular response, result in less behavioral evidence of pain or stress, and produce lower elevations in ACTH than would the isoflurane and CO2 methods, which we hypothesized would not differ in regard to these parameters. ACTH data suggested that pentobarbital–phenytoin euthanasia may be less stressful to mice than are isoflurane and CO2 euthanasia. Cardiovascular, behavioral, and activity data did not consistently or significantly support isoflurane or pentobarbital–phenytoin euthanasia as less stressful methods than CO2. Euthanasia with CO2 was the fastest method of the 3 techniques. Therefore, we conclude that using CO2 with or without isoflurane is an acceptable euthanasia method. Pathologic alterations in the lungs were most severe with CO2 euthanasia, and alternative euthanasia techniques likely are better suited for studies that rely on analysis of the lungs. PMID:28905718
del Río, Asunción Álvarez; Marván, Ma Luisa
Euthanasia has become the subject of ethical and political debate in many countries including Mexico. Since many physicians are deeply concerned about euthanasia, due to their crucial participation in its decision and implementation, it is important to know the psychological meaning that the term 'euthanasia' has for them, as well as their attitudes toward this practice. This study explores psychological meaning and attitudes toward euthanasia in 546 Mexican subjects, either medical students or physicians, who were divided into three groups: a) beginning students, b) advanced students, and c) physicians. We used the semantic networks technique, which analyzed the words the participants associated with the term 'euthanasia'. Positive psychological meaning, as well as positive attitudes, prevailed among advanced students and physicians when defining euthanasia, whereas both positive and negative psychological meaning together with more ambivalent attitudes toward euthanasia predominated in beginning students. The findings are discussed in the context of a current debate on a bill proposing active euthanasia in Mexico City. © 2011 Blackwell Publishing Ltd.
Kouwenhoven, P.S.C.; Thiel, G.J.M.W. van; Raijmakers, N.J.H.; Rietjens, J.A.C.; Heide, A. van der; Delden, J.J.M. van
Background: Legalizing euthanasia or physician-assisted suicide (PAS) is a current topic of debate in many countries. The Netherlands is the only country where legislation covers both. Objectives: To study physicians’ experiences and attitudes concerning the choice between euthanasia and PAS.
Cohen, Joachim; Marcoux, Isabelle; Bilsen, Johan; Deboosere, Patrick; van der Wal, Gerrit; Deliens, Luc
We wanted to examine how the acceptance of euthanasia among the general public in Western Europe has changed in the last decades, and we wanted to look for possible explanations. We analysed data from the European Values Surveys, held in 1981, 1990, and 1999-2000 in 12 West European countries. In each country, representative samples of the general public were interviewed using the same structured questionnaire in all countries. Euthanasia was explained in the questionnaires as 'terminating the life of the incurably sick'. A total of 46 199 respondents participated in the surveys. A significant increase in acceptance of euthanasia could be observed in all countries except (West) Germany. While the average increase in euthanasia acceptance was 22%, the increase was particularly obvious in Belgium, Italy, Spain, and Sweden. Although changes in several characteristics of respondents, such as decrease in religious beliefs, rising belief in the right to self-determination, and (to a lesser extent) rise in levels of education, were associated with growing acceptance of euthanasia, they could only partly explain the increase of euthanasia acceptance over the years. An increase of euthanasia acceptance among the general public took place over the last two decades in almost all West European countries, possibly indicating a growing support for personal autonomy regarding medical end-of-life decisions. If this trend continues, it is likely to increase the public and political debate about the (legal) regulation of euthanasia under certain conditions of careful medical practice in several West European countries.
Buiting, Hilde; van Delden, Johannes; Onwuteaka-Philpsen, Bregje; Rietjens, Judith; Rurup, Mette; van Tol, Donald; Gevers, Joseph; van der Maas, Paul; van der Heide, Agnes
Background: An important principle underlying the Dutch Euthanasia Act is physicians' responsibility to alleviate patients' suffering. The Dutch Act states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These
H.M. Buiting (Hilde); J.J.M. van Delden (Johannes); B.D. Onwuteaka-Philipsen (Bregje); J.A.C. Rietjens (Judith); M.L. Rurup (Mette); D. van Tol (Donald); J.K.M. Gevers (Joseph); P.J. van der Maas (Paul); A. van der Heide (Agnes)
textabstractBackground: An important principle underlying the Dutch Euthanasia Act is physicians' responsibility to alleviate patients' suffering. The Dutch Act states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due
Euthanasia is, and probably will remain a controversial, issue. Although many doctors will agree that under certain circumstances a demand for euthanasia should be granted (and in fact often is granted when the occasion arises), the subject generally gives rise to very emotional debates. Attempts to
Buiting, H.; van Delden, J.; Onwuteaka-Philpsen, B.; Rietjens, J.; Rurup, M.; Tol, D.; Gevers, J.; Maas, P.; van der Heide, A.
Background: An important principle underlying the Dutch Euthanasia Act is physicians' responsibility to alleviate patients' suffering. The Dutch Act states that euthanasia and physician-assisted suicide are not punishable if the attending physician acts in accordance with criteria of due care. These
Rietjens, J.A.C.; Raijmakers, N.J.H.; Kouwenhoven, P.S.C.; Seale, C.; Thiel, G.J.M.W. van; Trappenburg, M.; Delden, J.J.M. van; Heide, A. van der
Background: The Netherlands is one of the few countries where euthanasia is legal under strict conditions. This study investigates whether Dutch newspaper articles use the term ‘euthanasia’ according to the legal definition and determines what arguments for and against euthanasia they contain.
Rietjens, J.A.C.; Raijmakers, N.J.; Kouwenhoven, P.S.C.; Seale, C.; van Thiel, G.J.M.W.; Trappenburg, M.J.|info:eu-repo/dai/nl/111650836; van Delden, J.J.M.; van der Heide, A.
Background The Netherlands is one of the few countries where euthanasia is legal under strict conditions. This study investigates whether Dutch newspaper articles use the term ‘euthanasia’ according to the legal definition and determines what arguments for and against euthanasia they contain.
Kranidiotis, Georgios; Ropa, Julia; Mprianas, John; Kyprianou, Theodoros; Nanas, Serafim
To investigate the attitudes of Greek intensive care unit (ICU) medical and nursing staff towards euthanasia. ICU physicians and nurses deal with end-of-life dilemmas on a daily basis. Therefore, the exploration of their stances on euthanasia is worthwhile. This was a descriptive quantitative study conducted in three ICUs in Athens. The convenience sample included 39 physicians and 107 nurses. Of respondents, 52% defined euthanasia inaccurately, as withholding or withdrawal of treatment, while 15% ranked limitation of life-support among the several forms of euthanasia, together with active shortening of the dying process and physician - assisted suicide. Only one third of participants defined euthanasia correctly. While 59% of doctors and 64% of nurses support the legalization of active euthanasia, just 28% and 26% of them, respectively, agree with it ethically. Confusion prevails among Greek ICU physicians and nurses regarding the definition of euthanasia. The majority of staff disagrees with active euthanasia, but upholds its legalization. Copyright © 2015 Elsevier Inc. All rights reserved.
Rietjens, J.A.C.; Raijmakers, N.J.H.; Kouwenhoven, P.S.C.; Seale, C.; van Thiel, G.J.M.W.; Trappenburg, M.; van Delden, J.J.M.; van der Heide, A.
Background: The Netherlands is one of the few countries where euthanasia is legal under strict conditions. This study investigates whether Dutch newspaper articles use the term ‘euthanasia’ according to the legal definition and determines what arguments for and against euthanasia they contain.
Boivin, Gregory P; Hickman, Debra L; Creamer-Hente, Michelle A; Pritchett-Corning, Kathleen R; Bratcher, Natalie A
Selecting an appropriate, effective euthanasia agent is controversial. Several recent publications provide clarity on the use of CO2 in laboratory rats and mice. This review examines previous studies on CO2 euthanasia and presents the current body of knowledge on the subject. Potential areas for further investigation and recommendations are provided. PMID:28903819
Powell, T. Hennessy; And Others
Recent reports have indicated that parents and/or physicians occasionally decide not to provide life-sustaining treatment (referred to as involuntary euthanasia), thus ensuring that the severely handicapped newborn will die. The issues involved relative to treatment or involuntary euthanasia are reviewed from two opposing perspectives…
Levy, Tal Bergman; Azar, Shlomi; Huberfeld, Ronen; Siegel, Andrew M; Strous, Rael D
Euthanasia and physician assisted-suicide are terms used to describe the process in which a doctor of a sick or disabled individual engages in an activity which directly or indirectly leads to their death. This behavior is engaged by the healthcare provider based on their humanistic desire to end suffering and pain. The psychiatrist's involvement may be requested in several distinct situations including evaluation of patient capacity when an appeal for euthanasia is requested on grounds of terminal somatic illness or when the patient is requesting euthanasia due to mental suffering. We compare attitudes of 49 psychiatrists towards euthanasia and assisted suicide with a group of 54 other physicians by means of a questionnaire describing different patients, who either requested physician-assisted suicide or in whom euthanasia as a treatment option was considered, followed by a set of questions relating to euthanasia implementation. When controlled for religious practice, psychiatrists expressed more conservative views regarding euthanasia than did physicians from other medical specialties. Similarly female physicians and orthodox physicians indicated more conservative views. Differences may be due to factors inherent in subspecialty education. We suggest that in light of the unique complexity and context of patient euthanasia requests, based on their training and professional expertise psychiatrists are well suited to take a prominent role in evaluating such requests to die and making a decision as to the relative importance of competing variables. © 2012 John Wiley & Sons Ltd.
Naseh, Ladan; Rafiei, Hossein; Heidari, Mohammad
Nurses have an important role in caring for terminally ill patients. They are often confronted with euthanasia but little is known about their attitudes towards it. The present study aimed to examine Iranian Muslim nurses' attitudes towards euthanasia. In this exploratory cross-sectional study, all qualified registered nurses working in two teaching hospitals (Kashani and Hajar hospitals) in Iran were invited to participate. The Euthanasia Attitude Scale (EAS) was used to assess the nurses' attitude towards euthanasia. Of 266 nurses who fit the criteria, 190 participated in the study (response rate 72.9%); 91.1% (n=173) were female and 8.9% (n=17) were male. In total, 57.4%, 3.2% and 39.5% of nurses reported a negative, neutral and positive attitude to euthanasia respectively. Nurses reported their most negative attitude to the domain 'practical consideration' with mean of 2.36±0.9 and most positive attitude to the domain 'treasuring life' with a mean EAS score of 2.85±0.4. The majority of Muslim nurses were found to have negative attitudes to euthanasia. We recommend that future studies should be conducted to examine Muslim nurses' attitudes to euthanasia in different cultures to determine the role of culture and religious beliefs in attitude to euthanasia.
Pardon, Koen; Deschepper, Reginald; Vander Stichele, Robert; Bernheim, Jan L; Mortier, Freddy; Schallier, Denis; Germonpré, Paul; Galdermans, Daniella; Van Kerckhoven, Willem; Deliens, Luc
This study explores expressed wishes and requests for euthanasia (i.e. administration of lethal drugs at the explicit request of the patient), and incidence of end-of-life decisions with possible life-shortening effects (ELDs) in advanced lung cancer patients in Flanders, Belgium. We performed a prospective, longitudinal, observational study of a consecutive sample of advanced lung cancer patients and selected those who died within 18 months of diagnosis. Immediately after death, the pulmonologist/oncologist and general practitioner (GP) of the patient filled in a questionnaire. Information was available for 105 out of 115 deaths. According to the specialist or GP, one in five patients had expressed a wish for euthanasia; and three in four of these had made an explicit and repeated request. One in two of these received euthanasia. Of the patients who had expressed a wish for euthanasia but had not made an explicit and repeated request, none received euthanasia. Patients with a palliative treatment goal at inclusion were more likely to receive euthanasia. Death was preceded by an ELD in 62.9% of patients. To conclude, advanced lung cancer patients who expressed a euthanasia wish were often determined. Euthanasia was performed significantly more among patients whose treatment goal after diagnosis was exclusively palliative.
Ogden, Russel D.
In response to the general prohibition of euthanasia and assisted suicide, some right-to-die activists have developed non-medical methods to covertly hasten death. One such method is a "debreather," a closed system breathing device that laypersons can use to induce hypoxia for persons seeking euthanasia or assisted suicide. This article presents…
Shah, Amber; Mushtaq, Ammara
“It is choice alone that is being honored, without regards for what is chosen.” The debate on euthanasia in medical community stays unresolved. In this manuscript, we present arguments for and against euthanasia, review arguments from both the sides and conclude it with our opinion.
The deaths last September of a British Columbia physician and his wife have raised troubling questions about euthanasia and Alzheimer's disease. Police described the deaths of Dr. Tom Powell and his wife Dr. Lorraine Miles, a retired dentist, as a murder-suicide. Friends of the couple wonder if more lenient laws concerning euthanasia and assisted suicide might have saved Miles' life.
Noor Tri Hastuti
Full Text Available Euthanasia is an actual issue, that has been a long debate either law or medical world Does a medical doctor permitted to end a patients life, upon the request of a desperate patient because of the long, incurable disease? It is dilemma, indeed but anyhow euthanasia is strongly prohibited in KUHR medical ethics, and against the human rights.
Noor Tri Hastuti; Ratna Winahyu Lestari Dewi
Euthanasia is an actual issue, that has been a long debate either law or medical world Does a medical doctor permitted to end a patients life, upon the request of a desperate patient because of the long, incurable disease? It is dilemma, indeed but anyhow euthanasia is strongly prohibited in KUHR medical ethics, and against the human rights.
Shah, Amber; Mushtaq, Ammara
"It is choice alone that is being honored, without regards for what is chosen." The debate on euthanasia in medical community stays unresolved. In this manuscript, we present arguments for and against euthanasia, review arguments from both the sides and conclude it with our opinion.
Rietjens, J. A. C.; van Tol, D. G.; Schermer, M.; van der Heide, A.
Introduction: In The Netherlands, physicians have to be convinced that the patient suffers unbearably and hopelessly before granting a request for euthanasia. The extent to which general practitioners (GPs), consulted physicians and members of the euthanasia review committees judge this criterion
Borgsteede, S.D.; Riedstra, C.; Deliens, L.; Francke, A.L.; Stalman, W.A.B.; Willems, D.L.; Eijk, T.T.M. van; Wal, G. van der
Object of the study: Euthanasia continues to be an issue of moral debate in end of life care. As the general practitioner has a central role in performing and co-ordinating en-of-life home care in the Netherlands, he is regulartly confronted with patients requesting (information on) euthanasia. The
van Dijk, Gert; Giezeman, Ariane; Ultee, Fred; Hamers, Raoul
In countries where active euthanasia by a physician is allowed under law - Belgium and the Netherlands - physicians are sometimes confronted with patients who want to donate organs after active euthanasia has been performed. This combination of procedures has been reported in Belgium, and this article is the first description of such a case in the Netherlands. It concerns a patient with a neurodegenerative disease who donated organs after euthanasia. The combination of two complex and controversial procedures - active euthanasia and organ donation - raises important ethical, legal and practical issues. It is suggested that with a thorough preparation and a strict separation of both procedures, organ donation after active euthanasia can strengthen patient autonomy and increase the number of donated organs.
Grodin, Michael A; Miller, Erin L; Kelly, Johnathan I
This article, in commemoration of the 70th anniversary of the Doctors' Trial at Nuremberg, reflects on the Nazi eugenics and "euthanasia" programs and their relevance for today. The Nazi doctors used eugenic ideals to justify sterilizations, child and adult "euthanasia," and, ultimately, genocide. Contemporary euthanasia has experienced a progression from voluntary to nonvoluntary and from passive to active killing. Modern eugenics has included both positive and negative selective activities. The 70th anniversary of the Doctors' Trial at Nuremberg provides an important opportunity to reflect on the implications of the Nazi eugenics and "euthanasia" programs for contemporary health law, bioethics, and human rights. In this article, we will examine the role that health practitioners played in the promotion and implementation of State-sponsored eugenics and "euthanasia" in Nazi Germany, followed by an exploration of contemporary parallels and debates in modern bioethics. 1 .
Van den Akker, B; Janssens, R M; Ten Have, H A
In this paper we examine in what respects international human rights law can provide a basis for the establishment of an international debate on euthanasia. Such a debate seems imperative, as in many countries euthanasia is considered taboo in the context of medical practice, yet at the same time, supposedly, decisions are taken to intentionally shorten patients' lives. In the Netherlands, the act of euthanasia will not lead to the prosecution of the physician involved if the physician has complied with certain procedures. The Dutch debate centres on procedures marginalizing important moral aspects of euthanasia. An international debate, addressing the fundamental morality of euthanasia and of other medical decisions involving the end of life, will eventually enhance medical practice in the Netherlands as well as in other countries.
Levene, Ilana; Parker, Michael
There is an established link between depression and interest in hastened death in patients who are seriously ill. Concern exists over the extent of depression in patients who actively request euthanasia/physician-assisted suicide (PAS) and those who have their requests granted. To estimate the prevalence of depression in refused and granted requests for euthanasia/PAS and discuss these findings. Methods A systematic review was performed in MEDLINE and PsycINFO in July 2010, identifying studies reporting rates of depression in requests for and cases of euthanasia/PAS. One author critically appraised the strength of the data using published criteria. 21 studies were included covering four countries. There was considerable heterogeneity in methods of assessing depression and selecting patients. In the highest quality studies, in the Netherlands and Oregon, 8-47% of patients requesting euthanasia/PAS had depressive symptoms and 2-17% of completed euthanasia/PAS cases had depressive symptoms. In the Netherlands, depression was significantly higher in refused than granted requests, and there was no significant difference in the rate of depression between euthanasia cases and similar patients who had not made a request for euthanasia. It is unclear whether depression increases the probability of making a request for euthanasia/PAS, but in the Netherlands most requests in depressed patients are rejected, leaving a depression rate in cases that is similar to the surrounding population. Less evidence is available elsewhere, but some level of depression has been identified in patients undergoing euthanasia/PAS in all the countries studied. Whether the presence of depression is ever compatible with an ethical decision on euthanasia/PAS is discussed.
de Nooijer, K; van de Wetering, V E; Geijteman, E C T; Postma, L; Rietjens, J A C; van der Heide, A
To present the knowledge, experiences and attitudes of the general population, patients, relatives and health care professionals concerning written advance euthanasia directives in patients who have become mentally incompetent. Systematic review of the literature. We systematically searched Medline, Cochrane Library and Embase for articles published in the period 2002-2016. The search yielded 775 articles, of which 11 met the inclusion criteria. Six studies had a quantitative design, four studies had a qualitative design and one a combination of both. Nine articles included patients with advanced dementia, two included patients with Huntington's disease. Patients, their relatives and the general population appear to have limited knowledge about written advance euthanasia directives. However, most of them were open to the practice of euthanasia based on a written advance directive. Few persons and patients had written a euthanasia directive and if they had, it was not always discussed with health care professionals. The majority of health care professionals thought - incorrectly - that euthanasia based on a written advance euthanasia directive is not permitted. Some of them had a positive attitude towards written advance euthanasia directives, and a very small number would be prepared to carry out euthanasia on the basis of a written directive. In practice, there are very few who have actually done so. There is fairly wide support from the general population and empathy from health care professionals for the idea that euthanasia based on a written advance euthanasia directive of a mentally incompetent patient should be possible. Even so, there is a discrepancy between the expectations of the general population and what health care professionals think they can actually do in this situation.
Broekman, M L D; Verlooy, J S A
Euthanasia and physician assisted suicide (PAS) are two controversial topics in neurosurgical practice. Personal attitudes and opinions on these important issues may vary between professionals, and may also depend on their location since current legislation differs between European countries. As these issues may have significant impact on clinical practice, the goal of the present study was to survey the opinions of neurosurgical residents and young neurosurgeons across Europe with respect to euthanasia and physician assisted suicide. We performed a survey among the participants of the European Association of Neurosurgical Societies (EANS) training courses (2011-2012), asking residents and young neurosurgeons nine questions on euthanasia and PAS. For the analysis of this survey, we divided all 295 participants into four European regions (North, South, East, West). We found that even though most residents are aware of regulations about euthanasia or PAS in their country or hospital, a substantial number were not aware of the regulations. We observed no significant differences in terms of their opinions on euthanasia and PAS among the four European regions. While most are actually in favor of euthanasia or PAS, if legally allowed, under appropriate circumstances, very few neurosurgeons would be willing to actively participate in these end-of-life practices. The results of this first survey on neurosurgical residents' attitudes towards euthanasia and PAS show that a significant number of residents is not familiar with national and/or local regulations regarding euthanasia and PAS. If legally allowed, most residents would be in favor of euthanasia and PAS, but only a minority would be willing to actively participate in these practices. We did not observe a difference in stances on euthanasia and PAS among residents from different regions in Europe.
Background The Netherlands is one of the few countries where euthanasia is legal under strict conditions. This study investigates whether Dutch newspaper articles use the term ‘euthanasia’ according to the legal definition and determines what arguments for and against euthanasia they contain. Methods We did an electronic search of seven Dutch national newspapers between January 2009 and May 2010 and conducted a content analysis. Results Of the 284 articles containing the term ‘euthanasia’, 24% referred to practices outside the scope of the law, mostly relating to the forgoing of life-prolonging treatments and assistance in suicide by others than physicians. Of the articles with euthanasia as the main topic, 36% described euthanasia in the context of a terminally ill patient, 24% for older persons, 16% for persons with dementia, and 9% for persons with a psychiatric disorder. The most frequent arguments for euthanasia included the importance of self-determination and the fact that euthanasia contributes to a good death. The most frequent arguments opposing euthanasia were that suffering should instead be alleviated by better care, that providing euthanasia can be disturbing, and that society should protect the vulnerable. Conclusions Of the newspaper articles, 24% uses the term ‘euthanasia’ for practices that are outside the scope of the euthanasia law. Typically, the more unusual cases are discussed. This might lead to misunderstandings between citizens and physicians. Despite the Dutch legalisation of euthanasia, the debate about its acceptability and boundaries is ongoing and both sides of the debate are clearly represented. PMID:23497284
Cuman, Giulia; Gastmans, Chris
Euthanasia was first legalised in the Netherlands in 2002, followed by similar legislation in Belgium the same year. Since the beginning, however, only the Netherlands included the possibility for minors older than 12 years to request euthanasia. In 2014, the Belgian Act legalising euthanasia was amended to include requests by minors who possess the capacity of discernment. This amendment sparked great debate, and raised difficult ethical questions about when and how a minor can be deemed competent. We conducted a systematic review of argument-based literature on euthanasia in minors. The search process followed PRISMA guidelines. Thirteen publications were included. The four-principle approach of medical ethics was used to organise the ethical arguments underlying this debate. The justification for allowing euthanasia in minors is buttressed mostly by the principles of beneficence and respect for autonomy. Somewhat paradoxically, both principles are also used in the literature to argue against the extension of legislation to minors. Opponents of euthanasia generally rely on the principle of non-maleficence. The present analysis reveals that the debate surrounding euthanasia in minors is at an early stage. In order to allow a more in-depth ethical discussion, we suggest enriching the four-principle approach by including a care-ethics approach. What is Known: • The Netherlands and Belgium are the only two countries in the world with euthanasia legislation making it possible for minors to receive euthanasia. • This legislation provoked great debate globally, with ethical arguments for and against this legislation. What is New: • A systematic description of the ethical concepts and arguments grounding the debate on euthanasia in minors, as reported in the argument-based ethics literature. • A need has been identified to enrich the debate with a care-ethics approach to avoid oversimplifying the ethical decision-making process.
Cohen, Joachim; Van Wesemael, Yanna; Smets, Tinne; Bilsen, Johan; Deliens, Luc
Since 2002, Belgium has had a national law legalising euthanasia. The law prescribes several substantive due care requirements and two procedural due care requirements, i.e. consultation with an independent physician and reporting of euthanasia to a Federal Control Committee. A large discrepancy in reporting rates between the Dutch-speaking (Flanders) and the French-speaking (Wallonia) parts of Belgium has led to speculation about cultural differences affecting the practice of euthanasia in both regions. Using Belgian data from the European Values Study conducted in 2008 among a representative sample of the general public and data from a large-scale mail questionnaire survey on euthanasia of 480 physicians from Flanders and 305 from Wallonia (conducted in 2009), this study presents empirical evidence of differences between both regions in attitudes towards and practice of euthanasia. Acceptance of euthanasia by the general population was found to be slightly higher in Flanders than in Wallonia. Compared with their Flemish counterparts, Walloon physicians held more negative attitudes towards performing euthanasia and towards the reporting obligation, less often labelled hypothetical cases correctly as euthanasia, and less often defined a case of euthanasia having to be reported. A higher proportion of Flemish physicians had received a euthanasia request since the introduction of the law. In cases of a euthanasia request, Walloon physicians consulted less often with an independent physician. Requests were more often granted in Flanders than in Wallonia (51% vs 38%), and performed euthanasia cases were more often reported (73% vs 58%). The study points out some significant differences between Flanders and Wallonia in practice, knowledge and attitudes regarding euthanasia and its legal requirements which are likely to explain the discrepancy between Wallonia and Flanders in the number of euthanasia cases reported. Cultural factors seem to play an important role in the
Results of logistic regression analysis of data from the General Social Survey (N = 1,799) find that those who have a strong belief in miracles are more likely to say that a person with an incurable illness should not be allowed to accept medical treatments that painlessly hasten death than those who have a less strong belief in miracles or do not believe in miracles, net of respondents' religious affiliations, frequency of religious attendance, views of the Bible, and other sociodemographic controls. Results highlight the need to consider specific religious beliefs when predicting individuals' attitudes towards voluntary euthanasia.
den Hartogh, G.; Youngner, S.J.; Kimsma, G.K.
Euthanasia and physician-assisted suicide have been legal in the Netherlands since 1984, first by judicial legislation and since 2002 by statute, if enacted by a doctor who meets a number of requirements of due care and makes it possible to assess whether he or she met them. How successful is this Dutch model? The answer to that question of course depends on what we understand "success" to mean. In this chapter, I will try to assess the extent to which the Dutch model is successful on its own...
Keown, D; Keown, J
In 1993 The Parliament of the World's Religions produced a declaration known as A Global Ethic which set out fundamental points of agreement on moral tissues between the religions of the world. However, the declaration did not deal explicitly with medical ethics. This article examines Buddhist and Christian perspectives on euthanasia and finds that in spite of their cultural and theological differences both oppose it for broadly similar reasons. Both traditions reject consequentialist patterns of justification and espouse a 'sanctity of life' position which precludes the intentional destruction of human life by act or omission.
With this special issue the Report once again joins the debate on what patients, physicians, and society can -- and cannot -- live with at the end of life. The articles gathered here address in various ways, from various perspectives, the questions that inform the debate on euthanasia and assisted suicide. Do the canons of self-determination and respect for persons compel us to honor the choices of those who request active assistance in dying? Can we coherently argue that physicians' professional obligations to alleviate suffering extend so far as to taking life on request? To what extent ought our policy decisions rest on consideration of possible consequences?
Smokowski, P R; Wodarski, J S
Considering the recent actions of Dr. Jack Kevorkian, Dr. Timothy Quill and the Hemlock Society's initiatives for legalizing physician assisted suicide for special cases in the state of Washington, Oregon, and California, arguments for and against euthanasia and physician assisted suicide have grown into a substantial and impassioned debate. This paper outlines and analyzes salient issues within the controversy of legalizing physician assisted suicide for terminally ill patients. It highlights significant issues for state and federal policy formation and further suggests unique roles which medical social workers might play in developing and implementing a compassionate and reliable system for caring for the terminally ill.
Christiansen, Stine B.; Kristensen, Annemarie Thuri; Lassen, Jesper
such as ‘paternalism’, ‘respect for autonomy’ and ‘shared decision-making’. This study takes as a starting point a situation where the animal is chronically ill, or aged, with potentially reduced animal welfare and client quality of life, and thus where clients need to consider treatment options or euthanasia...... of veterinarians in these situations. Qualitative interviews were conducted with 12 dog owners considering treatment or euthanasia of their chronically ill or aged dogs. Results: Challenges relating to the dog and to the client were identified. Some situations left the interviewees hesitant, e.g. if lacking...
People ascribe "euthanasia" different values and view it differently. This study hypothesized that a different framing of objectively the same euthanasia situations would affect people's attitudes toward it. Indeed, "positive" framing of euthanasia as not prolonging life resulted in more support for both passive and active euthanasia relative to "negative" framing of the objectively same situations as ending life. Two experiments replicated this pattern using either continuous measures of attitude or dichotomous measures of choice. The article offers two theoretical explanations for the effect of message framing on attitudes toward euthanasia, discusses implications of this effect, and suggests future research.
Laux, Johannes; Röbel, Andreas; Parzeller, Markus
The generic term "passive euthanasia" includes different issues dealing with the omission, discontinuation or termination of life-sustaining or life-prolonging medical treatments. The debate around passive euthanasia focuses on the constitutional right of self-determination of every human being on the one hand and the constitutional mandate of the State to protect human life on the other. Issues of passive euthanasia always require a differentiated approach. Essentially, it comes down to the following: In Germany, the human right of self-determination includes the right to prohibit the performance of life-sustaining treatments, even if this leads to the death of the patient. A physician who does not take life-sustaining treatment measures because this is the free will expressed by the patient is not subject to prosecution. On the other hand, if the physician treats the patient against his will, this can be deemed a punishable act of bodily injury. The patient's will is decisive even if his concrete state of health does no longer allow him to freely express his will. In the Patient's Living Will Act of 2009, the German legislator clarified the juridical assessment of such constellations being of particular relevance in practice. A written living will of a person in which he requests to take or not to take certain medical treatment measures in case that he is no longer able to make the decision himself shall be binding for the people involved in the process of medical treatment. If there is no living will, the supposed will of the patient shall be relevant. In its judgment in the "Putz case", the German Federal Court of Justice ruled in 2010 that actions terminating a life-sustaining treatment that does not correspond to the patient's will must be limited to letting an already ongoing disease process run its course. In this context it is not important, however, whether treatment is discontinued by an active act or by omission. Under certain circumstances, the
The professional career of Paul Nitsche reflects the contradictory path taken by a German institutional psychiatrist who was a leader in the field at the time. During the Weimar Republic he advocated improving the institutional system based on principles of psychiatric reform, but was already receptive to concepts of racial hygiene. Shortly after the National Socialists seized power, Nitsche was already an influential proponent and participant in eugenic measures in Saxony and actively involved in implementing the "Law for the Prevention of Genetically Diseased Offspring." He increasingly appraised the value of a patient according to the person's economic performance. It was also Nitsche's opinion that the consequence of this extreme rationalization of human life was to exterminate "life unworthy of life." As a T4 appointed head assessor he decided in the last instance whether thousands of people would live or die. As the Medical Director of the T4 program, he was later directly responsible for continuing the massacre as "decentralized euthanasia." At the euthanasia trial in Dresden he was condemned to death and executed in 1948.
Since 2002, Belgian law has authorized the practice of euthanasia under certain clear conditions. All cases have to be reported to the Assessment and Control Commission (ACC). To date, more than 9000 cases have been reported. To make a statement about the Belgian experience requires consideration of several different essential points: detailed data and information from the ACC reports, their analysis, consequences on medical practice, problems experienced, legal and medical perspectives, criticism and attacks. The concept of individual and institutional conscience is also considered. Euthanasia for minors has been permitted since March 2014 but, to date, no case has been reported. In the light of what has happened in Belgium, we propose to analyse the legal situation in France. The Belgian experience is much more than an example and shows that, in difficult and painful situations, it is possible to meet the expectations of patients experiencing intolerable suffering with great respect and without imposing dogmatically something they do not wish. Copyright © 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.
Coons, Christian; Levin, Noah
We argue that the dead donor rule, which states that multiple vital organs should only be taken from dead patients, is justified neither in principle nor in practice. We use a thought experiment and a guiding assumption in the literature about the justification of moral principles to undermine the theoretical justification for the rule. We then offer two real world analogues to this thought experiment, voluntary active euthanasia and capital punishment, and argue that the moral permissibility of terminating any patient through the removal of vital organs cannot turn on whether or not the practice violates the dead donor rule. Next, we consider practical justifications for the dead donor rule. Specifically, we consider whether there are compelling reasons to promulgate the rule even though its corresponding moral principle is not theoretically justified. We argue that there are no such reasons. In fact, we argue that promulgating the rule may actually decrease public trust in organ procurement procedures and medical institutions generally - even in states that do not permit capital punishment or voluntary active euthanasia. Finally, we examine our case against the dead donor rule in the light of common arguments for it. We find that these arguments are often misplaced - they do not support the dead donor rule. Instead, they support the quite different rule that patients should not be killed for their vital organs.
Denier, Yvonne; Dierckx de Casterlé, Bernadette; De Bal, Nele; Gastmans, Chris
The Belgian Act on Euthanasia came into force on 23 September 2002, making Belgium the second country--after the Netherlands--to decriminalize euthanasia under certain due-care conditions. Since then, Belgian nurses have been increasingly involved in euthanasia care. In this paper, we report a qualitative study based on in-depth interviews with 18 nurses from Flanders (the Dutch-speaking part of Belgium) who have had experience in caring for patients requesting euthanasia since May 2002 (the approval of the Act). We found that the care process for patients requesting euthanasia is a complex and dynamic process, consisting of several stages, starting from the period preceding the euthanasia request and ending with the aftercare stage. When asked after the way in which they experience their involvement in the euthanasia care process, all nurses described it as a grave and difficult process, not only on an organizational and practical level, but also on an emotional level. "Intense" is the dominant feeling experienced by nurses. This is compounded by the presence of other feelings such as great concern and responsibility on the one hand, being content in truly helping the patient to die serenely, and doing everything in one's power to contribute to this; but also feeling unreal and ambivalent on the other hand, because death is arranged. Nurses feel a discrepancy, because although it is a nice death, which happens in dignity and with respect, it is also an unnatural death. The clinical ethical implications of these findings are discussed.
Wright, David Kenneth; Fishman, Jennifer R; Karsoho, Hadi; Sandham, Sarah; Macdonald, Mary Ellen
Recent events in Canada have mobilized public debate concerning the controversial issue of euthanasia. Physicians represent an essential stakeholder group with respect to the ethics and practice of euthanasia. Further, their opinions can hold sway with the public, and their public views about this issue may further reflect back upon the medical profession itself. We conducted a discourse analysis of print media on physicians' perspectives about end-of-life care. Print media, in English and French, that appeared in Canadian newspapers from 2008 to 2012 were retrieved through a systematic database search. We analyzed the content of 285 articles either authored by a physician or directly referencing a physician's perspective. We identified 3 predominant discourses about physicians' public views toward euthanasia: 1) contentions about integrating euthanasia within the basic mission of medicine, 2) assertions about whether euthanasia can be distinguished from other end-of-life medical practices and 3) palliative care advocacy. Our data showed that although some medical professional bodies appear to be supportive in the media of a movement toward the legalization of euthanasia, individual physicians are represented as mostly opposed. Professional physician organizations and the few physicians who have engaged with the media are de facto representing physicians in public contemporary debates on medical aid in dying, in general, and euthanasia, in particular. It is vital for physicians to be aware of this public debate, how they are being portrayed within it and its potential effects on impending changes to provincial and national policies.
Jylhänkangas, Leila; Smets, Tinne; Cohen, Joachim; Utriainen, Terhi; Deliens, Luc
In many western societies health professionals play a powerful role in people's experiences of dying. Religious professionals, such as pastors, are also confronted with the issues surrounding death and dying in their work. It is therefore reasonable to assume that the ways in which death-related topics, such as euthanasia, are constructed in a given culture are affected by the views of these professionals. This qualitative study addresses the ways in which Finnish physicians and religious professionals perceive and describe euthanasia and conceptualises these descriptions and views as social representations. Almost all the physicians interviewed saw that euthanasia does not fit the role of a physician and anchored it to different kinds of risks such as the slippery slope. Most of the religious and world-view professionals also rejected euthanasia. In this group, euthanasia was rejected on the basis of a religious moral code that forbids killing. Only one of the religious professionals - the freethinker with an atheist world-view - accepted euthanasia and described it as a personal choice, as did the one physician interviewed who accepted it. The article shows how the social representations of euthanasia are used to protect professional identities and to justify their expert knowledge of death and dying. © 2013 The Authors. Sociology of Health & Illness © 2013 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.
Khan, Farooq; Tadros, George
Physician-assisted suicide (PAS) is a controversial subject which has recently captured the interest of media, public, politicians, and medical profession. Although active euthanasia and PAS are illegal in most parts of the world, with the exception of Switzerland and the Netherlands, there is pressure from some politicians and patient support groups to legalize this practice in and around Europe that could possibly affect many parts of the world. The legal status of PAS and euthanasia in India lies in the Indian Penal Code, which deals with the issues of euthanasia, both active and passive, and also PAS. According to Penal Code 1860, active euthanasia is an offence under Section 302 (punishment for murder) or at least under Section 304 (punishment for culpable homicide not amounting to murder). The difference between euthanasia and physician assisted death lies in who administers the lethal dose; in euthanasia, this is done by a doctor or by a third person, whereas in physician-assisted death, this is done by the patient himself. Various religions and their aspects on suicide, PAS, and euthanasia are discussed. People argue that hospitals do not pay attention to patients' wishes, especially when they are suffering from terminally ill, crippling, and non-responding medical conditions. This is bound to change with the new laws, which might be implemented if PAS is legalized. This issue is becoming relevant to psychiatrists as they need to deal with mental capacity issues all the time.
Borgsteede, Sander D; Deliens, Luc; Graafland-Riedstra, Corrie; Francke, Anneke L; van der Wal, Gerrit; Willems, Dick L
Public opinion and professional organisations dominate the euthanasia debate, and there is a need to understand the opinions of people confronted with euthanasia. The aim of this study was to investigate whether patients and their GPs talk about euthanasia, and if so, how they communicate about this. Qualitative, semi-structured interviews were held with 20 GPs and 30 of their patients in primary care in the Netherlands, where euthanasia is legalised. The patients had a life expectancy of less than 6 months, and cancer, heart failure or chronic obstructive pulmonary disease as underlying disease. Many patients did not communicate about euthanasia with their GP. Neither the patient nor the GP were clear in formulating their expectations concerning future decision making. The initial patient-GP communication consisted of an exchange of opinions about situations in which euthanasia would be desirable. GPs had different opinions about who should initiate communication, and found it difficult to judge the right moment to talk. It is essential to pay attention to education in communication about dying and euthanasia and to train the GPs to gain insight in the patient's end-of-life preferences, and to direct care at the best possible quality of life.
Carter, G L; Clover, K A; Parkinson, L; Rainbird, K; Kerridge, I; Ravenscroft, P; Cavenagh, J; McPhee, J
A majority of patients with cancer have been reported to endorse euthanasia and physician assisted suicide (PAS) in general and a substantial proportion endorse these for themselves. However, the potential influence of mental health and other clinical variables on these decisions is not well understood. This study of 228 outpatients attending an oncology clinic in Newcastle, Australia used a cross-sectional design and logistic regression modelling to examine the relationship of demographic, disease status, mental health and quality of life variables to attitudes toward euthanasia and PAS. The majority reported support for euthanasia (79%, n=179), for PAS (69%, n=158) and personal support for euthanasia/PAS (68%, n=156). However, few reported having asked their doctor for euthanasia (2%, n=5) or PAS (2%, n=5). Three outcomes were modelled: support for euthanasia was associated with active religious belief (adjusted odds ratio (AOR) 0.21, 95% CI: 0.10-0.46); support for PAS was associated with active religious belief (AOR 0.35, 95% CI: 18-0.70) and recent pain (AOR 0.87, 95% CI: 0.0.76-0.99); and personal support for euthanasia/PAS was associated with active religious belief (AOR 0.26, 95% CI: 0.14-0.48). Depression, anxiety, recent suicidal ideation, and lifetime suicide attempt were not independently associated with any of the three outcomes modelled. Copyright (c) 2007 John Wiley & Sons, Ltd.
Meeussen, Koen; Van den Block, Lieve; Bossuyt, Nathalie; Echteld, Michael; Bilsen, Johan; Deliens, Luc
In many countries, physicians are confronted with requests for euthanasia. Notwithstanding that euthanasia is legally permitted in Belgium, it remains the subject of intense debate. To gather in-depth empirical data on how general practitioners (GPs) deal with these requests in Belgium. Mortality follow-back study in 2005-2006 via the nationwide Sentinel Network of General Practitioners. Standardized face-to-face interviews were conducted with GPs for all the reported patients who did not die suddenly or totally unexpectedly at home, as judged by the GP. We conducted 205 interviews. Of these, 27 patients had at some point expressed a wish to receive a drug administered by a physician with the explicit intention to end life, that is, euthanasia. Thirteen of these formulated their requests explicitly and repeatedly, according to their GP. Compared with patients who expressed a wish but not an explicit/repeated request for euthanasia, those patients' requests were more often documented (8 of 13 vs. 2 of 14; P=0.01), and reiterated until their final days of life (6 of 13 vs. 0 of 14; P=0.02). Five patients received euthanasia. For the other 22 patients, GPs gave different reasons for not acceding to the request, often related to criteria stipulated in the Belgian law on euthanasia, and sometimes related to personal reasons. It is not uncommon for patients to ask their GP for euthanasia, although explicit requests remain relatively rare. Requests tend to vary widely in form and content, and far more are expressed than complied with. For many GPs, the Belgian law on euthanasia serves as a guiding principle in this decision-making process, although in a minority of the cases, a GP's personal opinion toward euthanasia seems to be decisive. Copyright © 2011 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
Denier, Yvonne; Gastmans, Chris; De Bal, Nele; Dierckx de Casterlé, Bernadette
To describe the communication during the euthanasia care process for mentally competent, terminally ill patients in general hospitals in Flanders, as seen from the perspective of the nurse. International literature shows that nurses are involved in the care process surrounding euthanasia, regardless of the legal status of euthanasia in the country being studied. In particular, research shows that communication is an important part of good euthanasia care. However, the actual way nurses' communication contributes to the quality of the euthanasia care process remains unclear. A Grounded Theory Design was used. Analysis of 18 in-depth, semi-structured interviews with nurses from nine different hospitals in Flanders (Belgium). The interviews took place during a 20-month period in 2005-2006. The euthanasia care process for mentally competent, terminally ill patients in general hospitals in Flanders is a complex and dynamic process, the connecting thread of which is nurses' communication. During this process, nurses perceive that they communicate often and a lot, with various people, in different contexts, in different ways and with various purposes. This communicative process is intensified by the moral and psychological weight of the theme, and its impact on everyone involved, as well as by the relatively short period of time, during which it all takes place. This article adds to the growing body of literature on nursing care for patients requesting euthanasia. The findings suggest that for nurses, communication is a key instrument for realising good-quality euthanasia care. Being the essence of nursing care for patients requesting euthanasia, nurses' communication requires support and guidance on the level of nursing education, professional guidelines and hospital context. © 2010 Blackwell Publishing Ltd.
Dany, Lionel; Baumstarck, Karine; Dudoit, Eric; Duffaud, Florence; Auquier, Pascal; Salas, Sébastien
The question whether euthanasia should be legalised has led to substantial public debate in France. The objective of this study in a sample of French physicians was to establish the potential determinants of a favourable opinion about euthanasia in general and when faced with a specific situation as embodied in the Humbert affair. The study was a cross-sectional survey investigating two different samples of medical doctors: (1) those specialised in palliative care and affiliated to the French Society for Patient Accompaniment and Palliative Care; (2) medical interns (medical doctors in training course) in a French medical university (Marseille). A questionnaire was sent (email) to each voluntary participant including sociodemographics, professional status, mention of believing in God, and opinion about euthanasia (the question was designed to assess the general opinion about euthanasia and the opinion about a specific case, the Vincent Humbert' case (a man who was rendered quadriplegic, blind, and mute after an accident and has requested euthanasia). A total of 413 physicians participated in the research (participation rate: 48.5%). Less than half of the population were favourable to euthanasia in general and almost two-thirds of the population were favourable to Vincent Humbert's request for euthanasia. Based on the multivariate analysis, individuals believing in God and being a medical intern were significant independent factors linked to having a favourable opinion about euthanasia in general and about the Vincent Humbert's request. There is still no study in France on the development of opinion about euthanasia and its impact. The issue goes beyond the strictly professional sphere and involves broader socio-political stakes. These stakes do not necessarily take into account medical practices and experiences or the desires of end-of-life patients. The professional upheaval that the future French legal framework will doubtlessly trigger will require further
There is unanimity among states to protect the continuation of life of the individual as a safeguard against their collective extinction. The right to life is accordingly guaranteed but its antithesis, the right to die is the subject of an unending debate. The controversy over the right to die is deepened by rapid advances in medicine, creating the capability for prolongation of life beyond the span which one's natural strength can endure. Ghana's supreme law explicitly guarantees the right to life but remains ambiguous on right to die, particularly euthanasia and assisted dying. Thus, some of the other rights, such as the right to dignity and not to be tortured, can creatively be exploited to justify some instances of euthanasia. Ghana's criminal code largely proscribes euthanasia. Notwithstanding, proscription of euthanasia and assisted dying by the law, in Ghana's empirical work undertaken in some of the communities in Ghana, suggests that euthanasia is quietly practisedin health facilities and private homes, especially in the rural areas. Contrary to the popular reasons assigned in the literature of the Western world, with respect to the practice or quest for legalization of euthanasia as being a necessity for providing relief from pain or hopeless quality of life, empirical data from social and anthropological studies conducted in Ghana reveal that poverty is the motivation for informal euthanasia practice in Ghana rather than genuine desire on part of patients to die or their relatives to see to their accelerated death. Apart from poverty, traditional cultural values of African societies consider non-natural death as a taboo and ignominy to the victim and his family. Thus, any move by the government to legalize euthanasia will need to be informed by widely held consultations and a possible referendum; otherwise the law may be just a mere transplant of Western models of legislation on euthanasia without reflecting the ethos of the African people.
Laux, Johannes; Röbel, Andreas; Parzeller, Markus
Under German criminal law, euthanasia assisted by the attending physician involves the risk of criminal prosecution. However, in the absence of clear legal provisions, the law concerning euthanasia has been primarily developed by court rulings and jurisprudential literature in the last 30 years. According to a traditional classification there are four categories of euthanasia: help in the dying process, direct active euthanasia, indirect active euthanasia and passive euthanasia. However, there is still no generally accepted definition for the general term "euthanasia". The development of the law on the permissibility of euthanasia was strongly influenced by the conflict between the right of self-determination of every human being guaranteed by the Constitution and the constitutional mandate of the state to protect and maintain human life. The decisions of the German Federal Court of Justice on euthanasia in the criminal trials "Wittig" (1984), "Kempten" (1994) and "Putz" (2010) as well as the ruling of the 12th Division for Civil Matters of the Federal Court of Justice (2003) are of special importance. Some of these decisions were significantly influenced by the discussions in the jurisprudential literature. However, the German Bundestag became active for the first time as late as in 2009 when it adopted the 3rd Guardianship Amendment Act, which also contains provisions on the legal validity of a living will independent of the nature and stage of an illness. In spite of the new law, an analysis of the "Putz" case makes it especially clear that the criminal aspects of legal issues at the end of a person's life still remain controversial. It is to be expected that this issue will remain the subject of intensive discussion also in the next few years.
Cohen, Joachim; Marcoux, Isabelle; Bilsen, Johan; Deboosere, Patrick; van der Wal, Gerrit; Deliens, Luc
In many European countries, the last decade has been marked by an increasing debate about the acceptability and regulation of euthanasia and other end-of-life decisions in medical practice. Growing public sensibility to a 'right to die' for terminally ill patients has been one of the main constituents of these debates. Within this context, we sought to describe and compare acceptance of euthanasia among the general public in 33 European countries. We used the European Values Study data of 1999-2000 with a total of 41125 respondents (63% response rate) in 33 European countries. The main outcome measure concerned the acceptance of euthanasia (defined as 'terminating the life of the incurably sick', rated on a scale from 1 to 10). Results showed that the acceptance of euthanasia tended to be high in some countries (e.g. the Netherlands, Denmark, France, Sweden), while a markedly low acceptance was found in others (e.g. Romania, Malta and Turkey). A multivariate ordinal regression showed that weaker religious belief was the most important factor associated with a higher acceptance; however, there were also socio-demographic differences: younger cohorts, people from non-manual social classes, and people with a higher educational level tended to have a higher acceptance of euthanasia. While religious belief, socio-demographic factors, and also moral values (i.e. the belief in the right to self-determination) could largely explain the differences between countries, our findings suggest that perceptions regarding euthanasia are probably also influenced by national traditions and history (e.g. Germany). Thus, we demonstrated clear cross-national differences with regard to the acceptance of euthanasia, which can serve as an important basis for further debate and research in the specific countries.
Tang, Wai-Kiu; Mak, Kwok-Kei; Kam, Philip Ming-Ho; Ho, Joanna Wing-Kiu; Chan, Denise Che-Ying; Suen, To-Lam; Lau, Michael Chak-Kwan; Cheng, Adrian Ka-Chun; Wan, Yuen-Ting; Wan, Ho-Yan; Hussain, Assad
This study aimed to examine the reliability and validity of the Euthanasia Attitude Scale (EAS) in Hong Kong medical doctors. A total of 107 medical doctors (61.7% men) participated in a survey at clinical settings in 2008. The 21-item EAS was used to assess their attitudes toward euthanasia. The mean (standard deviation) and median of the EAS were 63.60 (60.31) and 63.00. Total EAS scores correlated well with ''Ethical Considerations,'' ''Practical Considerations,'' and ''Treasuring Life'' (Spearman rho =.37-.96, P Attitude Scale may be a reliable and valid measure for assessing the attitudes toward euthanasia in medical professionals.
Clark, D; Dickinson, G; Lancaster, C J; Noble, T W; Ahmedai, S H; Philp, I
To describe the views of British geriatricians on active voluntary euthanasia and physician-assisted death. Postal questionnaire to 742 consultant members of the British Geriatrics Society. 81% considered active voluntary euthanasia never to be justified ethically, although 23% supported legalization in some situations and 13% would be willing to administer active voluntary euthanasia in some situations. With regard to physician-assisted death, 68% opposed it on ethical grounds and 24% supported its legalization in some instances, with 12% stating they would be willing to provide such assistance in some situations. Free text comments frequently cited good palliative care as an important response to such issues in clinical practice.
Khrustalev, Iu M; Ekkert, N V
The attitude of the society to the problem of euthanasia remains ambiguous from both moral and legal viewpoints. The authors review the attitudes of well-known philosophers, historians, and writers to the man's right for peaceful dying, and analyze various points of view on the problems of euthanasia. The article analyses ethical problems of palliative care as active care for a dying patient and his/her family. The philosophy of modern palliative medicine must favor the realization of the right for a peaceful death. The authors of the article consider palliative care for the dying to be an alternative to euthanasia.
Werren, Julia; Yuksel, Necef; Smith, Saxon
The legalisation of voluntary physician-based euthanasia is currently the subject of much political, social and ethical debate and there is evidence in Australia of growing support for its implementation. In addressing many of the issues that surround legalisation, the article looks at some overseas jurisdictions that have legalised euthanasia to determine whether the social, political and ethical concerns prominent in the Australian debate have proved problematic in other jurisdictions. In addition, the article examines the report on the Dying with Dignity Bill 2009 (Tas) which commented extensively on the issues relating to voluntary physician-based euthanasia.
Kanchan, Tanuj; Atreya, Alok; Krishan, Kewal
Aruna Ramachandra Shanbaug breathed her last after 42 years of being in a persistent vegetative state. Euthanasia in any form is not permitted in India and it was only in the year 2011 that a petition was filed in the court that urged the cessation of her force feeding with a nasogastric tube and the request for her peaceful death. What followed was a string of arguments and counter arguments relating to Euthanasia. The sad demise of Aruna Shanbaug is not the end of an individual, but may be the end of the road for clear cut guidelines and legislation on Euthanasia in India.
Verhagen, A A Eduard
In The Netherlands, neonatal euthanasia has become a legal option and the Groningen Protocol contains an approach to identify situations in which neonatal euthanasia might be appropriate. In the 5 years following the publication of the protocol, neither the prediction that this would be the first step on a slippery slope, nor the prediction of complete transparency and legal control became true. Instead, we experienced a transformation of the healthcare system after antenatal screening policy became a part of antenatal care. This resulted in increased terminations of pregnancy and less euthanasia.
Berger, Jeffrey T
A number of influential reports on influenza pandemic preparedness include recommendations for extra-autonomous decisions to withdraw mechanical ventilation from some patients, who might still benefit from this technology, when demand for ventilators exceeds supply. An unintended implication of recommendations for nonvoluntary and involuntary termination of life support is that it make pandemic preparedness plans vulnerable to patients' claims for assisted suicide and active euthanasia. Supporters of nonvoluntary passive euthanasia need to articulate why it is both morally different and morally superior to voluntary active euthanasia if they do not wish to invite expansion of end-of-life options during health system catastrophe.
Francke, Anneke L; Albers, Gwenda; Bilsen, Johan; de Veer, Anke J E; Onwuteaka-Philipsen, Bregje D
To give insight into Dutch nursing staff's attitudes and involvement regarding euthanasia. The sample was recruited from a nation-wide existent research panel of registered nurses and certified nursing assistants. Descriptive analyses and multivariate logistic regression analyses were performed. 587 respondents (response of 65%) completed the questionnaire. The majority (83%) state that physicians have to discuss the decision about euthanasia with the nurses involved. Besides, 69% state that a physician should discuss a euthanasia request with nurses who have regular contact with a patient. Nursing staff who have religious or other beliefs that they consider important for their attitude towards end-of-life decisions, and staff working in a hospital or home care, are most likely to have this opinion. Being present during the euthanasia is quite unusual: only a small group (7%) report that this has ever been the case in their entire working life. Seven% (incorrectly) think they are allowed to administer the lethal drugs. The majority want to be involved in decision-making processes about euthanasia. Not all are aware that they are not legally allowed to administer the lethal drugs. Nursing staff should be informed of relevant existing legislation and professional guidelines. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
Kamath, Sneha; Bhate, Priya; Mathew, Ginu; Sashidharan, Srijith; Daniel, Anjali B
Advances in expertise and equipment have enabled the medical profession to exercise more control over the processes of life and death, creating a number of moral and ethical dilemmas. People may live for extended periods with chronic painful or debilitating conditions that may be incurable. This study attempts to study the attitudes of doctors toward euthanasia and the possible factors responsible for these attitudes. A cross-sectional survey of 213 doctors working at a tertiary care hospital was conducted to determine their attitudes toward euthanasia. A self-administered questionnaire was used to assess attitudes and personal perceptions about euthanasia. The Chi square test was used to assess factors influencing attitudes toward euthanasia. A majority of the respondents (69.3%) supported the concept of euthanasia. Relief from unbearable pain and suffering was the most commonly (80.3%) cited reason for being willing to consider the option of euthanasia. Majority of those who were against euthanasia (66.2%) felt that the freedom to perform euthanasia could easily be misused. Disapproval of euthanasia was associated with religious affiliation (Peuthanasia for the relief of unbearable pain and suffering. Religion and speciality appear to be significant in determining attitudes toward euthanasia.
Stijn J.M. Niessen
Full Text Available Current pet diabetes mellitus (DM treatment necessitates the active daily involvement of owners and can be costly. The current study aimed to investigate the owner population which opts for euthanasia instead of DM treatment. A survey was designed using multiple feedback steps and made available online to veterinarians world-wide. A total of 1192 veterinarians completed the survey and suggested a median one in 10 diabetic pets are euthanased at diagnosis; a further median one in 10 within one year because of lack of success or compliance. Perceived most important motivating factors included “presence concurrent disease” (45% respondents; “costs” (44%; “animal age” (37%; “problems obtaining adequate control” (35%; “pet welfare” (35%; and “impact owner’s lifestyle” (32%. Cats in Canadian (odds ratio (OR 2.7, Australian (OR 2.3, rural (OR 1.6 and mixed (OR 1.7 practices were more likely to be euthanased because of DM diagnosis, while cats presented to referral/university were less likely to be euthanased (OR 0.6. Dogs were more likely to be euthanased because of DM in Canadian (OR 1.8, rural (OR 1.8 and mixed (OR 1.6 practices. The survey results suggest that benefit exists in improved DM education with emphasis on offering a choice of treatment styles ranging from intense and expensive to hands-off and cheap.
Allman, R L
Argues against the growing acceptance of euthanasia in modern society. Offers both medical and theological reasons for affirming the dignity of the person, and claims that the church ought to take a firm stand against the "culture of death."
García-Romero, H; González-González, A; Galicia, J
A survey was conducted with 3021 employees of the Federal Government using self-administered questionnaires in order to collect data on the socioeconomic background of those surveyed (sex, age, civil status, number of children, religious, affiliation, educational level and monthly income), as well as their opinions about euthanasia. For the purposes of this study, three types of euthanasia were considered: 1) passive (the suspension of life support systems); 2) active (the application of immediate death causing means for people who suffer from incurable illnesses); and 3) active in the medium term (the application of substances which keep a patient sedated and comfortable while all food is withheld). Passive and medium-term active euthanasia were accepted by 40 percent of the population surveyed, while active euthanasia was accepted by 20 percent. These percentages were higher among young people, among those who were not heavily influenced by or did not practice religion, among professionals and among post-graduates.
On 1 April 2002 the Dutch Bill 'Termination of Life on Request and Assisted Suicide (Review Procedures) Act' (Wet toetsing levensbeeindiging op verzoek en hulp bij zelfdoding) came into force. This article starts with an outline of the former legal position in The Netherlands regarding euthanasia and medically assisted suicide, followed by an explanation of the new Act. The main focus of this contribution lays on the requirements of due care, the obligation to notify euthanasia to the coroner and the revised legal position of the so-called Regional Review Commissions. Furthermore, the article considers the termination of life in the case of minors and the function and requirements of written statements of euthanasia by patients no longer capable of communication. Finally, the article gives an overview of the problems [that] may come in the future concerning the approach to euthanasia in The Netherlands.