In the last decades, new technologies have improved the survival of patients affected by chronic illnesses. Among them, left ventricular assist device has represented a viable solution for patients with advanced heart failure. Even though the LVAD prolongs life expectancy, patients’ vulnerability generally increases during follow up and patients’ request for the device withdrawal might occur. Such a request raises some ethical concerns in that it directly hastens the patient’s death. Hence, in order to assess the ethical acceptability of LVAD (...) withdrawal, we analyse and examine an ethical argument, widely adopted in the literature, that we call the “descriptive approach”, which consists in giving a definition of life-sustaining treatment to evaluate the ethical acceptability of treatment withdrawal. Focusing attention on LVAD, we show criticisms of this perspective. Finally, we assess every patient’s request of LVAD withdrawal through a prescriptive approach, which finds its roots in the criterion of proportionality. (shrink)

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. (shrink)

The management of patients suffering from chronic disorders of consciousness inevitably raises important ethical questions about the end of life decisions. Some ethical positions claim respect of human life sacredness and the use of good medical practices require allowing DOC patients to live as long as possible, since no one can arbitrarily end either his/her or others’ life. On the other hand, some currents of thought claim respect of human life dignity, patients’ wishes, and the right of free choice entail (...) allowing the withdrawal of life sustaining therapy. This could happen when patients believe their own life to be not worth living, or if therapy is not very beneficial, excessively burdensome, or even futile. Indeed, the decision to withdraw therapies in a DOC patient should be guided by reliable information about DOC diagnosis and prognosis and on how the patient would wish to be treated in such a condition. Taking into account such issues, it would be possible to make the decision that more adequately fits a DOC patient’s best interest. This review aims to overview the range of ethical issues referring to end-of-life decisions in DOC patients, with regard to the thorny debate on the sacredness and dignity of human life. (shrink)

Contemporary arguments concerning the permissibility of physician-assisted suicide [PAS], or suicide in general, often rehearse classical arguments over whether individual persons have a fundamental right based on autonomy to determine their own death, or whether the community has a legitimate interest in individual members’ welfare that would prohibit suicide. I explicate historical arguments pertaining to PAS aligned with these poles. I contend that an ethical indictment of PAS entails moral duties on the part of one’s community to provide effective means (...) of ameliorating physical and existential suffering. I further elucidate how such duties have been affirmed by the Roman Catholic Church. My aim is to provide reasons why the expanding legalization of PAS should not preclude social investment in effective palliative care and providing a communal presence to the dying as they confront their subjectively experienced suffering. (shrink)

Most quantitative studies that survey nurses’ attitudes toward euthanasia and/or assisted suicide, also attempt to assess the influence of religion on these attitudes. We wanted to evaluate the operationalisation of religion and world view in these surveys. In the Pubmed database we searched for relevant articles published before August 2008 using combinations of search terms. Twenty-eight relevant articles were found. In five surveys nurses were directly asked whether religious beliefs, religious practices and/or ideological convictions influenced their attitudes, or the respondents (...) were requested to mention the decisional basis for their answers on questions concerning end-of-life issues. In other surveys the influence of religion and world view was assessed indirectly through a comparison of the attitudes of different types of believers and/or non-believers toward euthanasia or assisted suicide. In these surveys we find subjective religious or ideological questions (questions inquiring about the perceived importance of religion or world view in life, influence of religion or world view on life in general, or how religious the respondents consider themselves) and objective questions (questions inquiring about religious practice, acceptance of religious dogmas, and religious or ideological affiliation). Religious or ideological affiliation is the most frequently used operationalisation of religion and world view. In 16 surveys only one religious or ideological question was asked. In most articles the operationalisation of religion and world view is very limited and does not reflect the diversity and complexity of religion and world view in contemporary society. Future research should pay more attention to the different dimensions of religion and world view, the religious plurality of Western society and the particularities of religion in non-Western contexts. (shrink)

In theoretical matters, ecclesiastical claims to knowledge have lead to various conflicts with science. Claims in orientational matters, sometimes connected to attempts to establish them as a rule for legislation, have often been in conflict with the justified claims of non-believers. In addition they violate the Principle of Autonomy of the individual, which is at the very heart of European identity so decisively shaped by the Enlightenment. The Principle of Autonomy implies that state legislation should not interfere in the life (...) of individual citizens, as long as his or her actions do not violate the rights of others. This paper—using the example of the theory of evolution—rejects ecclesiastical claims to theoretical knowledge as completely unfounded and preposterous. In the case of orientational knowledge—using the example of euthanasia—ecclesiastical claims to (universalizable) knowledge are shown to be unfounded as well. The Church’s position with respect to euthanasia and a range of other bio-ethical topics, such as pre-marital sex, contraception, abortion, indissolubility of marriage, and homosexuality, rests on a very peculiar ethical position. This ethical position is the natural right theory, which—far from being universalizable—is shared by very few people. Among other things, this position presupposes the belief in God as the creator of nature, and the assumption that ethical norms can be derived from this premise. Thus ecclesiastical knowledge claims, cannot be justified in a way which could be reasonably supposed to be universally acceptable. Kant (see the quote) was the first to require this sort of justification. Claims that fail to implement Kant’s stipulations should be eliminated by what I would like to call “Kant’s razor”. (shrink)