Euthanasia

According to Aristotle, the medical art aims at health, which is a virtue of the body, and does so in an unlimited way. Consequently, medicine does not determine the extent to which health should be pursued, and “mental health” falls under medicine only via pros hen predication. Because medicine is inherently oriented to its end, it produces health in accordance with its nature and disease contrary to its nature—even when disease is good for the patient. Aristotle’s politician understands that this (...) inherent orientation can be systematically distorted, and so would see the need for something like the Hippocratic Oath. (shrink)

Most people who defend physician-assisted death (PAD) endorse the Joint View, which holds that two conditions—autonomy and welfare—must be satisfied for PAD to be justified. In this paper, we defend an Autonomy Only view. We argue that the welfare condition is either otiose on the most plausible account of the autonomy condition, or else is implausibly restrictive, particularly once we account for the broad range of reasons patients cite for desiring PAD, such as “tired of life” cases. Moreover, many of (...) the common objections to an Autonomy Only view fail once we understand the extent of the autonomy condition’s requirements—in particular, the importance of one’s values for autonomous choices. If our view is correct, then the scope of permissible PAD is broader than is currently accepted in both the philosophical literature and the law, and therefore poses an important challenge to this widely accepted view on justified PAD. (shrink)

In this paper, I defend the view that the requested euthanasia of adults is morally permissible and should be legalised; I use an argument from analogy which compares physician-assisted euthanasia with morally less ambiguous and, in my opinion, an acceptable instance of mercy killing. I also respond to several objections that either try to prove that the instance of mercy killing is not acceptable, or that there is a fundamental difference between these two cases of killing. Furthermore, in the remainder (...) of the paper I defend the moral permissibility and legalisation of euthanasia against several objections that appeared in local disputes on this issue, based on the concepts of the limits of freedom, the slippery slope, and the needlessness of euthanasia. (shrink)

Advocates of physician-assisted suicide often argue that, although the provision of PAS is morally permissible for persons with terminal, somatic illnesses, it is impermissible for patients suffering from psychiatric conditions. This claim is justified on the basis that psychiatric illnesses have certain morally relevant characteristics and/or implications that distinguish them from their somatic counterparts. In this paper, I address three arguments of this sort. First, that psychiatric conditions compromise a person’s decision-making capacity. Second, that we cannot have sufficient certainty that (...) a person’s psychiatric condition is untreatable. Third, that the institutionalisation of PAS for mental illnesses presents morally unacceptable risks. I argue that, if we accept that PAS is permissible for patients with somatic conditions, then none of these three arguments are strong enough to demonstrate that the exclusion of psychiatric patients from access to PAS is justifiable. (shrink)

The book attempts to conceptualize the “ancient” issues of human death and human mortality in connection to the timely and vital subject of euthanasia. This subject forces the meditation to actually consider those ideological, ethical, deontological, legal, and metaphysical frameworks which guide from the very beginning any kind of approach to this question. This conception – in dialogue with Heideggerian fundamental ontology and existential analytics – reveals that, on the one hand, the concepts and ethics of death are originally determined (...) by the ontology of death, and, on the other hand, that, on this account, the question of euthanasia can only be authentically discussed in the horizon of this ontology. It is only this that may reveal to whom dying – our dying – pertains, while it also reveals our relationship to euthanasia as a determined human potentiality or final possibility. Thus euthanasia is outlined in the analysis as the possibility of becoming a mortal on the one hand, while on the other hand it appears in relation to the particularities of its existential structure, which essentially differ from the existential and ontological structure of any other possibility of dying. This is why it should not be mixed up with, or mistaken for, any of these. (shrink)

The article examines the so-called slippery slope argument (SSA) against the legalization of active voluntary euthanasia (AVE). According to the SSA, by legalizing AVE, the least morally controversial type of euthanasia, we will take the first step onto a slippery slope and inevitably end up in the moral abyss of widespread abuse and violations of the rights of the weakest and most vulnerable patients. In the first part of the paper, empirical evidence to the contrary is presented and analyzed: None (...) of the forecasted regrettable trends can be elicited from the body of existing statistical data. Accordingly, we have no good reason to believe either that we already are, or are sooner or later going to be, sliding into a moral abyss. A related question is then considered: Would it not be wiser and safer to stick to the status quo and preserve the existing legal ban on AVE even if the risk of its abuse is uncertain and may well turn out to be relatively low? It is argued that such an appeal to precautionary reasoning fails to justify an outright legal ban on AVE for at least two reasons: (i) it grossly underestimates the hidden moral costs of current legal arrangements (competent terminal patients suffer both disrespect for their autonomous will and deprivation of the good of a timely death) and (ii) the ban is both too inefficient and disproportionate to qualify as a reasonable measure of precaution. (shrink)

The article examines the so-called slippery slope argument (SSA) against the legalization of active voluntary euthanasia (AVE). According to the SSA, by legalizing AVE, the least morally controversial type of euthanasia, we will take the first step onto a slippery slope and inevitably end up in the moral abyss of widespread abuse and violations of the rights of the weakest and most vulnerable patients. In the first part of the paper, empirical evidence to the contrary is presented and analyzed: None (...) of the forecast regrettable trends can be elicited from the body of existing statistical data. Accordingly, we have no good reason to believe either that we already are, or are sooner or later going to be, sliding into a moral abyss. A related question is then considered: Would it not be wiser and safer to stick to the status quo and preserve the existing legal ban on AVE even if the risk of its abuse is uncertain and may well turn out to be relatively low? It is argued that such an appeal to precautionary reasoning fails to justify an outright legal ban on AVE for at least two reasons: (i) it grossly underestimates the hidden moral costs of current legal arrangements (competent terminal patients suffer both disrespect for their autonomous will and deprivation of the good of a timely death) and (ii) the ban is both too inefficient and disproportionate to qualify as a reasonable measure of precaution. (shrink)

Sadly, there are people in very bad medical conditions who want to die. They are in pain, they are suffering, and they no longer find their quality of life to be at an acceptable level anymore. -/- When people like this are kept alive by machines or other medical treatments, can it be morally permissible to let them die? -/- Advocates of “passive euthanasia” argue that it can be. Their reasons, however, suggest that it can sometimes be not wrong to (...) actively kill some patients, i.e., that “active euthanasia” can be permissible also. This essay reviews these arguments. (shrink)

In their insightful article, Brent Kious and Margaret Battin (2019) correctly identify an inconsistency between an involuntary psychiatric commitment for suicide prevention and physician aid in dying (PAD). They declare that it may be possible to resolve the problem by articulating “objective standards for evaluating the severity of others’ suffering,” but ultimately they admit that this task is beyond the scope of their article since the solution depends on “a deep and difficult” question about comparing the worseness of two possible (...) scenarios: letting someone die (who could have been helped) with not letting someone die (whose suffering could only be alleviated by death). In our commentary, we argue that creating such standards is more difficult than the authors assume because of the many types of deep uncertainties we have to deal with: (1) diagnostic, (2) motivational, and (3) existential. (shrink)

Patient preference predictors aim to solve the moral problem of making treatment decisions on behalf of incapacitated patients. This commentary on a case of an unrepresented patient at the end of life considers 3 related problems of such predictors: the problem of restricting the scope of inputs to the models (the “scope” problem), the problem of weighing inputs against one another (the “weight” problem), and the problem of multiple reasonable solutions to the scope and weight problems (the “multiple reasonable models” (...) problem). Each of these problems poses challenges to reliably implementing patient preference predictors in important, high-stakes health care decision making. This commentary also suggests a way forward. (shrink)

According to the Standard View, a doctor who withdraws life-sustaining treatment does not kill the patient but rather allows the patient to die—an important distinction, according to some. I argue that killing can be understood in either of two ways, and given the relevant understanding, the Standard View is insulated from typical criticisms. I conclude by noting several problems for the Standard View that remain to be fully addressed.

Opponents of medically assisted dying have long appealed to ‘slippery slope’ arguments. One such slippery slope concerns palliative care: That the introduction of medically assisted dying will lead to a diminution in the quality or availability or palliative care for patients near the end of their lives. Empirical evidence from jurisdictions where assisted dying has been practiced for decades, such as Oregon and the Netherlands, indicate that such worries are largely unfounded. The failure of the palliation slope argument is nevertheless (...) instructive with respect to how slippery slope arguments can be appraised without having to await post-facto evidence regarding the effects of a proposed change in public policy. Close attention in particular to the norms operative in a given institution and how changes to policy will interact with those norms enable slippery slopes to be credibly appraised. (shrink)

Why do we consider killing and letting someone die to be two different things? Why do we believe that a doctor who refuses to treat a terminally ill patient is doing anything less than administering a lethal substance? After all, the consequences are the same, and perhaps the moral status of these acts should be judged accordingly. -/- Reviewed: Jonathan Glover, Questions de vie ou de mort (Causing Death and Saving Lives), translated into French and introduced by Benoît Basse, Genève, (...) Labor et Fides, 2017, 386 pp. (shrink)

Many philosophers, psychologists, and medical practitioners believe that killing is no worse than letting die on the basis of James Rachels's Bare-Difference Argument. I show that his argument is unsound. In particular, a premise of the argument is that his examples are as similar as is consistent with one being a case of killing and the other being a case of letting die. However, the subject who lets die has both the ability to kill and the ability to let die (...) while the subject who kills lacks the ability to let die. Modifying the latter example so that the killer has both abilities yields a pair of cases with morally different acts. The hypothesis that killing is worse than letting die is the best explanation of this difference. (shrink)

This article explores theoretical conditions necessary for “quantum immortality” (QI) as well as its possible practical implications. It is demonstrated that the QI is a particular case of “multiverse immortality” (MI) which is based on two main assumptions: the very large size of the Universe (not necessary because of quantum effects), and the copy-friendly theory of personal identity. It is shown that a popular objection about the lowering of the world-share (measure) of an observer in the case of QI doesn’t (...) work, as the world-share decline could be compensated by the merging timelines for the simpler minds, and also some types of personal preferences are not dependent on such changes. Despite large uncertainty about MI’s validity, it still has appreciable practical consequences in some important outcomes like suicide and aging. The article demonstrates that MI could be used to significantly increase the expected subjective probability of success of risky life extension technologies, like cryonics, but makes euthanasia impractical, because of the risks of eternal suffering. Euthanasia should be replaced with cryothanasia, i.e. cryopreservation after voluntary death. Another possible application of MI is as a last chance to survive a global catastrophe. MI could be considered a plan D of reaching immortality, where plan A consists of the survival until the creation of the beneficial AI via fighting aging, plan B is cryonics, and plan C is digital immortality. (shrink)

Central elements of Roman Catholic treatment ethics include: 1) that rejection of treatment with the intent of hastening death (even for a good end) is ethically equivalent to active euthanasia with the same intent; 2) a distinction between morally obligatory “ordinary” treatment and morally optional “extraordinary treatment”; 3) that the quality of the patient’s life is not be a legitimate basis for rejecting treatment; and 4) that extraordinary treatment is not forbidden, but optional, and that it is the patient or (...) the patient’s legal surrogate–not the doctor– who has the right to choose or reject it. Despite these principles, even in a cultural climate fully sympathetic to Catholic treatment ethics, it is appropriate as a legal matter to maintain the doctrine of informed consent under which it is possible for patients or their surrogates to reject life-preserving treatment, including for unethical reasons. It is normally impossible to enforce in practice in the external forum a differentiation between rejection of treatment for ethically acceptable and ethically unacceptable reasons. By contrast, in cases of direct killing, such as assisting suicide, the intent to cause death is unmistakable (as opposed to accepting an increased risk of death as a foreseeable but unintended consequence of pursuing a good end). In a pluralistic society Catholic ethics cannot be legislatively enforced on the ground that they are compelled by Catholic teaching. However, the basic principles of Catholic treatment ethics may be justified based on logic and widely accepted norms of human equality independently of revelation or ecclesiastical authority. Particularly in protecting the right of individuals to choose and obtain life-saving medical treatment regardless of their “quality of life,” and in suicide prevention, secular law can and should be congruent with key aspects of Catholic health care ethics. (shrink)

It is widely believed to be permissible for a physician to discontinue any treatment upon the request of a competent patient. Many also believe it is never permissible for a physician to intentionally kill a patient. I argue that the prospect of deactivating a patient’s artificial heart presents us with a dilemma: either the first belief just mentioned is false or the second one is. Whichever horn of the dilemma we choose has significant implications for contemporary medical ethics.

Given the wide the range of legally available options for end-of-life care in recent decades: from aggressive, even experimental, treatment to active euthanasia, our ethical analysis struggles to keep pace with technology and law. In this essay I show that the principle of double effect (PDE) remains, and will continue to be, a useful tool for ethical analysis of end-of-life care. According to PDE, an agent may ethically perform an act that s/he foresees will have a significant bad effect (e.g., (...) death) in addition to a good effect (e.g., pain relief) only if s/he does not intend the bad effect, the act is not bad for reasons other than its causing the bad effect, and there is a proportionately serious reason to act. Following a brief explanation of PDE and preliminary considerations in favor of counting death as a bad effect, I analyze several end-of-life options in terms of the principle. I begin with those that enjoy significant consensus among proponents of PDE: active euthanasia, “passive euthanasia,” and palliative care. Then I consider the less-straightforward cases of drug provision, refusing food and water, and terminal sedation, arguing that participation in such actions is justifiable via PDE only under very limited conditions. (shrink)

Lawful euthanasia involves State endorsed termination of human life. Apart from a period of less than 9 months, in the Northern Territory, euthanasia has been illegal in Australia. Many of Australia’s parliaments have regularly considered introducing the practice and they continue to do so. In this context, this paper considers another type of State endorsed termination of human life: capital punishment. These took place in Australia from 1788 to 1967. The practice was abolished nationwide by 1985 and the Commonwealth passed (...) laws, in 2010, to prevent its reintroduction. This paper does not consider all of the arguments for or against euthanasia or capital punishment and nor does it argue that the two practices are identical. Instead, it argues that introducing euthanasia without careful consideration of the arguments and experiences of capital punishment would risk repetition of past mistakes. The paper considers whether introducing euthanasia would be inconsistent with arguments accepted as grounds for the abolition of capital punishment. It focuses, on the irrevocable argument. This is the argument that death is irrevocable and that the risk of an innocent person being executed should never be taken. The paper argues that, any criteria which might be adopted by the State as sufficient to justify euthanasia, would run the risk of people outside that criteria being euthanised. The paper argues that capital punishment and euthanasia each pose disproportionate risks to minority and vulnerable groups. The paper also argues that, the evidence of pain and suffering endured by the condemned in their execution require careful consideration in relation to arguments for euthanasia as a means to a quick and pain free “good death.” It considers the evidence that demonstrates that, like execution, euthanasia in practice can be slow and painful. The paper then argues that requiring health professional to administer lethal injections in acts of euthanasia would be inconsistent with the approach taken in Australia and the United States to the identification of those willing to administer the death penalty. The paper concludes that many of the key arguments which resulted in the abolition of the death penalty in Australia support the continued prohibition of euthanasia in Australia and ought to be addressed by proponents of change but its primary aim is to encourage further examination of the extent to which learnings relevant to the current euthanasia debate can be gained by examining the arguments and experience of capital punishment. (shrink)

Philosophers who defend a person’s right, under certain circumstances, to end his own life or to have a physician end it for him typically appeal both to respect for patient autonomy and to considerations of beneficence. Neither autonomy alone nor beneficence alone can ground a persuasive case for euthanasia. I argue, however, that the standard argument for euthanasia is unsound. It is not possible to combine the principles of autonomy and beneficence in such a way as to justify euthanasia for (...) those who request it and are either incurably ill, in irremediable pain, or fearful of future incapacity, while excluding both involuntary euthanasia and assisted death for those who request it despite being neither incurably ill, in irremediable pain nor fearful of future incapacity. (shrink)

In this paper I argue that no state should legalise euthanasia, either voluntary or non-voluntary. I begin by outlining three political arguments against such legalisation, by Russell Hittinger, Elizabeth Anscombe and David Novak. Each concludes, on different grounds, that legalised euthanasia fatally erodes the role and authority of the state. Although correct in their conclusion, the arguments they provide are deficient. To fill this gap, I elaborate what I call a ‘fourfold dialectic’ between autonomy and compassion, the two central motivations (...) for legalising euthanasia. I show that these motivations systematically and progressively undermine each other, yielding a situation where individual autonomy and doctors’ duty of care are effectively eviscerated. It follows that state authority, which depends on upholding both of these, is itself eviscerated. In this way, the conclusion of the political arguments above finally finds demonstrative support. (shrink)

In most jurisdictions where euthanasia is legal, patients seeking euthanasia need to seek out the approval of their request from two clinicians (one of who is a psychiatrist). These doctors are required to assess whether euthanasia is ‘appropriate’ for the patient in question. In this paper I claim that doctors qua doctors are not qualified (or, at least, not typically) to evaluate suffering of an existential kind, and consequently they are not qualified to 'evaluate' the requests of patients seeking euthanasia. (...) Importantly, this argument is only focused on patients who are seeking euthanasia on account of acute suffering. To defend my central thesis, I discuss the limits of the professional expertise of clinicians, in addition to considering the nature of suffering experienced by patients requesting euthanasia (which is, typically, a combination of physiological, psychological and existential suffering). (shrink)

I will argue that physicians have an ethical obligation to justify their conscientious objection and the most reliable interpretation of the Polish legal framework claims that conscientious objection is permissible only when the justification shows the genuineness of the judgment of conscience that is not based on false beliefs and arises from a moral norm that has a high rank. I will demonstrate that the dogma accepted in the Polish doctrine that the reasons that lie behind conscientious objection in medicine (...) cannot be evaluated or controlled by anyone is based either on a mistaken interpretation of the Constitution or on the unreliable concept of conscience. I will refer to the legal regulations concerning military refusals that require from objectors to reveal and justify their views. Finally, I will demonstrate why conscientious objection under uncertainty does not deserve acceptance, because it is based on a specific version of the precautionary principle. (shrink)

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. (shrink)

Many participants in debates about the morality of assisted dying maintain that individuals may only turn to assisted dying as a ‘last resort’, i.e., that a patient ought to be eligible for assisted dying only after she has exhausted certain treatment or care options. Here I argue that this last resort condition is unjustified, that it is in fact wrong to require patients to exhaust a prescribed slate of treatment or care options before being eligible for assisted dying. The last (...) resort condition effectively pits one right of patients, their right to refuse medical treatment or interventions, against another patient right acknowledged by advocates of assisted dying, the right to die. Drawing on an analogy with the legal notion of an unconstitutional condition, I argue that the last resort condition unjustly demands that an arguably more fundamental right—the right to refuse medical treatment or intervention—be foregone in order to acquire a less fundamental right—the right to die. I then address three rationales for the last resort condition and find that they subject individuals to arbitrarily stringent standards for exercising the right to die, standards to which those who seek to end their lives by voluntarily ending life-sustaining treatments are not subject. Subjecting those who seek assisted dying to the last resort condition therefore wrongfully infringes on their right to refuse medical treatment or interventions. (shrink)

On Don Marquis’s future of value account of the wrongness of killing, ‘what makes it wrong to kill those individuals we all believe it is wrong to kill, is that killing them deprives them of their future of value’. Marquis has recently argued for a narrow interpretation of his future of value account of the wrongness of killing and against the broad interpretation that I had put forward in response to Carson Strong. In this article I argue that the narrow (...) view is problematic because it violates some basic principles of equality and because it allows for some of the very killing that Marquis sets out to condemn; further, I argue that the chief reason why Marquis chooses the narrow view over the broad view – namely that the broad view would take the killing of some nonhuman animals to be also wrong – should rather be considered a welcome upshot of the broad view. (shrink)

[From Euthanasia to Infanticide] The paper revisits the recent controversy over Dr. Mitlőhner’s defense of infanticide, published in this journal. In section 1, I point out the weaknesses of Mitlőhner’s paper. In sections 2 and 3 I turn to the most sophisticated defense of infanticide on offer today, that of Peter Singer’s. Section 2 sums up Singer’s description of the medical practice as already having abandoned the traditional ethic of equal value of all human lives, which motivates ethical revisionism. However, (...) an explicit justification of a revision is necessary. This is the job of Singer’s Replacement Argument, examined in section 3. I argue that this justification of infanticide in completely impersonal terms fails. In section 4, I reject it in favor of Ronald Dworkin’s distinction between experiential interests, possessed by infants, and critical interests that develop later. Hence, neonatal euthanasia can sometimes be justified in terms of a newborn‘s own interests (presumably, to relieve its suffering), not in impersonal terms. The only exception is those infants that lack any capacity for cognitive activity whatsoever, and who thus lack even experiential interests. It is an open question whether their “life” differs from death, and whether by killing them we perform infanticide. (shrink)

Helen Frowe (2006/2010) contends that there is a substantial moral difference between killing and letting die, arguing that in Michael Tooley's infamous machine case it is morally wrong to flip a coin to determine who lives or dies. Here I argue that Frowe fails to show that killing and letting die are morally inequivalent. However, I believe that she has succeeded in showing that it is wrong to press the button in Tooley's case, where pressing the button will change who (...) lives and dies. I argue that because killing and letting die are morally equivalent we have no reason to press the button in the machine case. Pressing the button in this case is morally wrong because there is no reason to do it; to press the button is to treat matters of life and death irreverently. (shrink)

Ong, Caroline In February 2014, the Belgian parliament passed an amendment to the Belgian Act on Euthanasia of May 28th, 2002 removing the age limit of those requesting euthanasia provided that they have discerning capabilities and their parents approve. After mentioning briefly the arguments against legalising euthanasia, this article questions the ethical validity of removing the age limit, as well as the presumption that ending lives prematurely allows people to die with dignity. Caring for people who are vulnerable in their (...) suffering is the proper goal of the healing professions, not terminating lives. (shrink)

Ong, Caroline In the debate about euthanasia, it is important that we consider all views, including those which might not at first seem attractive to us. Whether we believe in God or not, the views of the Catholic Church make a significant contribution to this debate. The Church does not support the deliberate killing either of oneself or another person. It also emphasises our moral obligation to respect life and to uphold the dignity of each person.

Suppose that we think it important that people have the chance to enjoy autonomous lives. An obvious corollary of this thought is that people should, if they want it, have control over the time and manner of their deaths, either ending their own lives, or by securing the help of others in doing so. So, generally, and even if we overall think that the practice should not be legalized on other grounds, it looks like common sense to think that considerations (...) of autonomy tell at least somewhat in favour of legalizing at least some acts of suicide and voluntary euthanasia. In this paper, I argue that, in fact, when we scrutinize the reasons for most end of life decisions, it turns out that they are seriously problematic from the point of view of autonomy. Full autonomy requires that we are responsible for the consequences of our decisions, and responsibility is precluded by non-voluntariness, which is to say decisions made because there are no acceptable alternatives. Since most end of life decisions are made for precisely this reason, it looks as though most such decisions are non-voluntary, and therefore undermine our autonomy: a discomforting and paradoxical claim. I argue that we should respond by taking the paradox to illuminate the context required by an autonomy-respecting framework for legalizing assisted suicide and euthanasia. People should have a legal right to a reasonable choice about when and how to die. However, this must go hand in hand with institutions that ensure, as far as possible, that such choices are made against a background which ensures, as far as possible, that people choose death clear-sightedly and not because nothing else is acceptable. (shrink)

The current impasse in the old debate about the morality of euthanasia is mainly due to the fact that the actual source of conflict has not been properly identified—or so I shall argue. I will first analyse the two different issues involved in the debate, which are sometimes confusingly mixed up, namely: (a) what is euthanasia?, and (b) why is euthanasia morally problematic? Considering documents by physicians, philosophers and the Roman Catholic Church, I will show that (a) ‘euthanasia’ is defined (...) by the intention to bring about a patient’s death, and (b) the distinction between what is intentional and what is not does not represent the morally problematic reason against euthanasia. Therefore, although the debate on euthanasia so far has mainly focussed on the distinctions ‘active /passive’ and ‘intentional /unintentional,’ I argue that neither constitutes the genuine source of the controversies. I will clarify what the source of controversies is, and outline the minimal requirement for an argument against euthanasia. (shrink)

Some form of assisted dying (voluntary euthanasia and/or assisted suicide) is lawful in the Netherlands, Belgium, Oregon, and Switzerland. In order to be lawful in these jurisdictions, a valid request must precede the provision of assistance to die. Non-adherence to the criteria for valid requests for assisted dying may be a trigger for civil and/or criminal liability, as well as disciplinary sanctions where the assistor is a medical professional. In this article, we review the criteria and evidence in respect of (...) requests for assisted dying in the Netherlands, Belgium, Oregon, and Switzerland, with the aim of establishing whether individuals who receive assisted dying do so on the basis of valid requests. We conclude that the evidence suggests that individuals who receive assisted dying in the four jurisdictions examined do so on the basis of valid requests and third parties who assist death do not act unlawfully. However, further research on the elements that may undermine the validity of requests for assisted dying is warranted. More research on the reasons why requests for assisted dying are refused is also desirable. (shrink)

This article examines the reporting requirements in four jurisdictions in which assisted dying (euthanasia and/or assisted suicide) is legally regulated: the Netherlands, Belgium, Oregon and Switzerland. These jurisdictions were chosen because each had a substantial amount of empirical evidence available. We assess the available empirical evidence on reporting and what it tells us about the effectiveness of such requirements in encouraging reporting. We also look at the nature of requirements on regulatory bodies to refer cases not meeting the legal criteria (...) to either prosecutorial or disciplinary authorities. We assess the evidence available on the outcomes of reported cases, including the rate of referral and the ultimate disposition of referred cases. (shrink)

[Utilitarism, Nazism, and Euthanasia] The article is an answer to Prof. Munzarová who criticised my defence of physician-assisted suicide. The article points to shortcomings in the reply of prof. Munzarová which flow from the author’s underestimation of normative theory. Among these shortcomings are the ignoring of the arguments of her opponent; her calling into question the moral credit of the proponents of the competing theory (utilitarianism) rather than a critical analysis; unclear theoretical principles (a switching between paternalism and autonomy, the (...) presentation of the “principle of double-effect” as the standpoint of common sense); an unconvincing version of the “argument of the slippery slope” (ignoring the diametrical differences between the contemporary demand of some patients for assisted death and the Nazi programme of involuntary euthanasia). (shrink)

Evidence from jurisdictions that allow assisted dying is frequently used in the debate about assisted dying in the UK, since it provides important information about how assisted suicide and voluntary euthanasia work in practice. However, in order to interpret these data meaningfully, it is essential that they are understood in the context of the different legal and regulatory frameworks in operation in these countries. -/- The Commission on Assisted Dying has commissioned this expert briefing paper in order to help unpick (...) these complexities, and identify evidence for the effectiveness of the various legal safeguards that have been employed in jurisdictions that allow assisted dying. In the briefing paper the authors identify and explain the features of the legal regimes that regulate assisted dying in four target jurisdictions: the Netherlands, Belgium, Oregon and Switzerland. -/- They explore the evidence for the effectiveness of individual safeguards in each of these regimes in turn. Then they evaluate the evidence for the effectiveness of each safeguard, drawing on a detailed examination of the evidence, and, where possible, make recommendations on how these regimes could implement and regulate assisted dying more effectively. (shrink)

[On the Ethics of Euthanasia Again: A Reply to Critics] The article is a reply to three critics of a previous piece on the ethics of euthanasia in which I defended physician-assisted suicide. According to Ingrid Strobachová it is necessary to give a greater attention to the significance of pain, which, she claims, may benefit from a phenomenological description. According to Marta Vlasáková my argument is not valid because two principles on which it is founded – i.e. the conception of (...) life as of fundamental value and the autonomy of the patient – are not in mutual harmony. Jakub Jirsa criticises the very concept of assisted suicide and the moral legitimacy and need for the legalisation of assisted suicide. To Dr Strobachová I reply that phenomenological description is as acceptable a method as any other – as long, that is, as it is not only a verbal game, but constitutes a real source of knowledge. To Dr. Vlasáková I argue that a more charitable reading of my argument is possible. The arguments of Dr. Jirsa against assisted suicide are beset with various inconsistencies, including the fact that he himself allows that doctors should tolerate suicide by the refusal of food and drink. Such an act does not, however, differ in any relevant way from doctor-assisted suicide. (shrink)

As medical technology advances and severely injured or ill people can be kept alive and functioning long beyond what was previously medically possible, the debate surrounding the ethics of end-of-life care and quality-of-life issues has grown more urgent. In this lucid and vigorous book, Craig Paterson discusses assisted suicide and euthanasia from a fully fledged but non-dogmatic secular natural law perspective. He rehabilitates and revitalises the natural law approach to moral reasoning by developing a pluralistic account of just why we (...) are required by practical rationality to respect and not violate key demands generated by the primary goods of persons, especially human life. Important issues that shape the moral quality of an action are explained and analysed: intention/foresight; action/omission; action/consequences; killing/letting die; innocence/non-innocence; person/non-person. Paterson defends the central normative proposition that ‘it is always a serious moral wrong to intentionally kill an innocent human person, whether self or another, notwithstanding any further appeal to consequences or motive’. (shrink)

When people suffer they always suffer as a whole human being. The emotional, cognitive and spiritual suffering of human beings cannot be completely separated from all other kinds of suffering, such as from harmful natural, ecological, political, economic and social conditions. In reality they interact with each other and influence each other. Human beings do not only suffer from somatic illnesses, physical pain, and the lack of decent opportunities to satisfy their basic vital, social and emotional needs. They also suffer (...) when they are not able to experience and grasp any meaning of life even if such suffering is not quite as obvious as most forms of physical, social and emotional suffering. Suffering from the lack for the sense of the meaning of life is a special form of emotional, cognitive, and spiritual suffering. Although all human beings share the same basic human need for some meaning of life, the fulfilment of this need is highly individual and personal. Although all forms of human suffering can be a challenge to the meaning of life, the personal conditions of suffering usually are a stronger challenge for the meaning of life. Among the personal conditions of human suffering, the Grenzsituationen cannot be cancelled or raised at all, but only accepted and coped with as existential aspects of the conditio humana. According to Karl Jaspers these are: death, suffering, struggling, guilt, and failing. The challenge for human beings to cope with these Grenzsituationen is a way to move from the mere Being-there to true human Existence. (shrink)

In the future, human destiny may depend on our ethics. In particular, biotechnology and expansion in space can transform life, raising profound questions. Guidance may be found in Life-centered ethics, as biotic ethics that value the basic patterns of organic gene/protein life, and as panbiotic ethics that always seek to expand life. These life-centered principles can be based on scientific insights into the unique place of life in nature, and the biological unity of all life. Belonging to life then implies (...) a human purpose: to safeguard and propagate life. Expansion in space will advance this purpose but will also raise basic questions. Should we expand all life or only intelligent life? Should we aim to create populations of trillions? Should we seed other solar systems? How far can we change but still preserve the human species, and life itself? The future of all life may be in our hands, and it can depend on our guiding ethics whether life will fulfil its full potentials. Given such profound powers, life-centered ethics can best secure future generations. Our descendants may then understand nature more deeply, and seek to extend life indefinitely. In that future, our human existence can find a cosmic purpose. (shrink)

In debates over life and death it is often said that one should err on the side of caution—that is, on the side of life. In light of the recent case of Terri Schiavo, it is explained how the “err-on-the-side-of-life” argument proceeds, and an objection to it is offered.

Arguments concerning central issues of contemporary Medical Ethics often not only bear similarities, but also derive their sheer essence from notions which belong to the celebrated history of Ethics. Thus, argumentation pro euthanasia and assisted suicide which focus on the detainment of dignity and the ensuring of posthumous reputation on behalf of the moral agent is shown to echo stoic views on arête and the subordination of life to the primary human goal, namely the achievement of virtue. The progress made (...) in palliative care when seen alongside the — steadily increasing — requests for suicide, is indicative of the fact that, though pain now days can be effectively controlled, moral agents often consider the preservation of their life detrimental to the detainment of virtue or posthumous reputation. The stoic view is considered to justify elective death as a personal choice, but is deemed inadequate as well as inconsistent in the broader context of a coherent value theory. (shrink)

Extended review of Assisted Suicide and Euthanasia: A Natural Law Ethics Approach by Craig Paterson. Ashgate, 2008.

There has been much debate regarding the 'double-effect' of sedatives and analgesics administered at the end-of-life, and the possibility that health professionals using these drugs are performing 'slow euthanasia.' On the one hand analgesics and sedatives can do much to relieve suffering in the terminally ill. On the other hand, they can hasten death. According to a standard view, the administration of analgesics and sedatives amounts to euthanasia when the drugs are given with an intention to hasten death. In this (...) paper we report a small qualitative study based on interviews with 8 Australian general physicians regarding their understanding of intention in the context of questions about voluntary euthanasia, assisted suicide and particularly the use of analgesic and sedative infusions (including the possibility of voluntary or non-voluntary 'slow euthanasia'). We found a striking ambiguity and uncertainty regarding intentions amongst doctors interviewed. Some were explicit in describing a 'grey' area between palliation and euthanasia, or a continuum between the two. Not one of the respondents was consistent in distinguishing between a foreseen death and an intended death. A major theme was that 'slow euthanasia' may be more psychologically acceptable to doctors than active voluntary euthanasia by bolus injection, partly because the former would usually only result in a small loss of 'time' for patients already very close to death, but also because of the desirable ambiguities surrounding causation and intention when an infusion of analgesics and sedatives is used. The empirical and philosophical implications of these findings are discussed. (shrink)

Euthanasia or mercy killing is, now a day, a major problem widely discussed in medical field. Medical professionals are facing dilemma to take decision regarding their incompetent patient while tend to do euthanasia. The dilemma is by nature moral i.e. whether it is morally permissible or not. In some countries of Europe and in some provinces of USA euthanasia is legally permitted fulfilling some conditions. It is claimed by Rachels that in our practical medical practice we do euthanasia by forbidding (...) patients from taking drugs. He concludes that if that type of euthanasia can be practiced in our society without any hesitation then why assisting euthanasia will not be permitted1. There are so many arguments both pro and con of euthanasia. But it is not the function of the current paper to discuss all the arguments. Philippa Foot in her article „Euthanasia‟ and J Velleman in his article titled as „A Right to Self-termination‟ discussed about the permissibility of euthanasia. The objective of the paper is to justify their arguments and then come to a conclusion regarding the permissibility of euthanasia. The focus will be given mainly on non- voluntary active and non-voluntary passive euthanasia. The method of discussion will be that an example will be given from Bangladesh and then the arguments provided by Foot and Velleman in their above mentioned papers will be discussed to justify the act of euthanasia on concerned patient. In the last section of the paper the situation of Bangladesh will also be considered for the permissibility of euthanasia i.e. whether the act of euthanasia can be permitted in our country considering the existing socio-cultural-religious practice. (shrink)

The euthanasia literature typically discusses the difference between “active” and “passive” means of ending a patient’s life. Physician-assisted suicide differs from both active and passive forms of euthanasia insofar as the physician does not administer the means of suicide to the patient. Instead, she merely prescribes and dispenses them to the patient and lets the patient “do the rest” – if and when the patient chooses. One supposed advantage of this process is that it maximizes the patient’s autonomy with respect (...) to both her decision to die and the dying process itself. Still, despite this supposed advantage, Oregon is the only state to have legalized physician-assisted suicide. After summarizing the most important Supreme Court opinions on euthanasia (namely, Cruzan v. Director, Missouri Dep’t of Health; Vacco v. Quill; Washington v. Glucksberg; and Gonzales v. Oregon), this paper argues that while there are no strong ethical reasons against legalizing physician-assisted suicide, there are some very strong policy reasons for keeping it criminal in the other forty-nine states. (shrink)