As euthanasia has become a widely debated issue in many Western countries, hospitals and nursing homes especially are increasingly being confronted with this ethically sensitive societal issue. The focus of this paper is how healthcare institutions can deal with euthanasia requests on an organizational level by means of a written institutional ethics policy. The general aim is to make a critical analysis whether these policies can be considered as organizational-ethical instruments that support healthcare institutions to take their institutional responsibility for (...) dealing with euthanasia requests. By means of an interpretative analysis, we conducted a process of reinterpretation of results of former Belgian empirical studies on written institutional ethics policies on euthanasia in dialogue with the existing international literature. The study findings revealed that legal regulations, ethical and care-oriented aspects strongly affected the development, the content, and the impact of written institutional ethics policies on euthanasia. Hence, these three cornerstones—law, care and ethics—constituted the basis for the empirical-based organizational-ethical framework for written institutional ethics policies on euthanasia that is presented in this paper. However, having a euthanasia policy does not automatically lead to more legal transparency, or to a more professional and ethical care practice. The study findings suggest that the development and implementation of an ethics policy on euthanasia as an organizational-ethical instrument should be considered as a dynamic process. Administrators and ethics committees must take responsibility to actively create an ethical climate supporting care providers who have to deal with ethical dilemmas in their practice. (shrink)

Slippery slope arguments appear regularly whenever morally contested social change is proposed. Such arguments assume that all or some consequences which could possibly flow from permitting a particular practice are morally unacceptable.Typically, “slippery slope” arguments claim that endorsing some premise, doing some action or adopting some policy will lead to some definite outcome that is generally judged to be wrong or bad. The “slope” is “slippery” because there are claimed to be no plausible halting points between the initial commitment to (...) a premise, action, or policy and the resultant bad outcome. The desire to avoid such projected future consequences provides adequate reasons for not taking the first step.Thus the legalization of abortion in limited circumstances is asserted to lead down the slippery slope towards abortion on demand and even infanticide; and the legalization of assisted suicide to lead inexorably to the acceptance of voluntary euthanasia and subsequently to the sanctioning of the practice of nonvoluntary euthanasia – even involuntary euthanasia of “undesirable” individuals. (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)

Slippery slope arguments are frequently dismissed as fallacious or weak arguments but are nevertheless commonly used in political and bioethical debates. This paper gives an overview of different variants of the argument commonly found in the literature and addresses their argumentative strength and the interrelations between them. The most common variant, the empirical slippery slope argument, predicts that if we do A, at some point the highly undesirable B will follow. I discuss both the question which factors affect likelihood of (...) slippage and the relation between the strength of the prediction and the justificatory power of the argument. (shrink)

Simon Woods proposes that we ought to re-orientate clinical decisions at the end of life back towards the patient, so as to honour his or her account of their “global” interests. Woods condemns the current medico-legal approach for remaining too closely tethered to the views of doctors. In this response, I trace the story of Mrs Kelly Taylor, who sought to be sedated and have life-sustaining treatment withdrawn, and I do so in order to show not only why Woods is (...) right to detect an asymmetry in the law but also why there is more to the legal landscape than first appears. I argue that patient choice is indeed bounded—most obviously by the views of the doctors (and the judges), but no less significantly by so-called “public interest” concerns. Woods’ proposal implicitly, and rightly, forces reconsideration of these public interest dimensions of medico-legal decision-making. This often invisible boundary is not presently granted the attention it deserves (not least by the judges themselves). However, as soon as we delve into the ethical values at stake, then it becomes apparent that there are many more questions to be asked regarding their meaning and interaction before we can determine the appropriate ethical prism through which to view the health care endeavour in English medical law. (shrink)

This paper considers the way in which English law safeguards fundamental rights to respect for faith and belief in relation to the delivery of health care. It explores the implications of the Human Rights Act 1998 and the Equality Act 2010. It explores some of the challenges in attempting to reconcile fundamental rights to faith and belief and the delivery of health care, both now and in the future and whether this is a realistic aspiration in a state funded health (...) care service. (shrink)

This paper explores the claim that someone can reasonably consider themselves to be under a duty to respect the autonomy of a person who does not have the capacities normally associated with substantial self-governance.

This article examines the evidence for the empirical argument that there is a slippery slope between the legalization of voluntary and non-voluntary euthanasia. The main source of evidence in relation to this argument comes from the Netherlands. The argument is only effective against legalization if it is legalization which causes the slippery slope. Moreover, it is only effective if it is used comparatively-to show that the slope is more slippery in jurisdictions which have legalized voluntary euthanasia than it is in (...) jurisdictions which have not done so. Both of these elements are examined comparatively. (shrink)

I have a hairstylist whose lover was very sick. I’d been seeing this stylist for ten years and we’re good friends. [His lover was] becoming an invalid, not able to get out of bed. He said “I hate to ask you this but would you mind writing a prescription to help us out?” [So] I wrote a prescription to a patient who I had never seen, and I sent it to him in the mail and I heard the next time (...) I went in to get my hair cut that it was the most beautiful experience that my stylist had ever had. It was Valentine’s Day and they had a lovely meal with champagne. And they held each other and then, you know, his partner took his pills and was released. (shrink)

Objective: To explore the experiences of people with a “terminal illness”, focusing on the patients’ perspective of euthanasia and assisted suicide.Method: A qualitative study using narrative interviews was conducted throughout the UK. The views of the 18 people who discussed euthanasia and assisted suicide were explored. These were drawn from a maximum variation sample, who said that they had a “terminal” illness, malignant or non-malignant.Results: That UK law should be changed to allow assisted suicide or voluntary euthanasia was felt strongly (...) by most people. Those who had seen others die were particularly convinced that this should be a right. Some had multiple reasons, including pain and anticipated pain, fear of indignity, loss of control and cognitive impairment. Those who did not want to be a burden also had other reasons for wanting euthanasia. Suicide was contemplated by a few, who would have preferred a change in the law to allow them to end their lives with medical help and in the company of family or friends. The few who opposed a change in UK law, or who felt ambivalent, focused on involuntary euthanasia, cited religious reasons or worried that new legislation might be open to abuse.Conclusion: Qualitative research conducted on people who know they are nearing death is an important addition to the international debate on euthanasia and assisted suicide. Those who had seen others die were particularly convinced that the law should be changed to allow assisted death. (shrink)

In April 2004 the Parliamentary Assembly of the Council of Europe debated a report from its Social, Health and Family Affairs Committee , which questioned the Council of Europe’s opposition to legalising euthanasia. This article exposes the Report’s flaws, not least its superficiality and selectivity.

In medical ethics, business ethics, and some branches of political philosophy (multi-culturalism, issues of just allocation, and equitable distribution) the literature increasingly combines insights from ethics and the social sciences. Some authors in medical ethics even speak of a new phase in the history of ethics, hailing "empirical ethics" as a logical next step in the development of practical ethics after the turn to "applied ethics." The name empirical ethics is ill-chosen because of its associations with "descriptive ethics." Unlike descriptive (...) ethics, however, empirical ethics aims to be both descriptive and normative. The first question on which I focus is what kind of empirical research is used by empirical ethics and for which purposes. I argue that the ultimate aim of all empirical ethics is to improve the context-sensitivity of ethics. The second question is whether empirical ethics is essentially connected with specific positions in meta-ethics. I show that in some kinds of meta-ethical theories, which I categorize as broad contextualist theories, there is an intrinsic need for connecting normative ethics with empirical social research. But context-sensitivity is a goal that can be aimed for from any meta-ethical position. (shrink)

This paper introduces the controversy surrounding active voluntary euthanasia and describes the legal position on euthanasia and assisted suicide in the UK. Findings from studies of the nurses' attitudes to euthanasia from the national and international literature are reviewed. There are acknowledged difficulties in carrying out research into attitudes to euthanasia and hence the review of findings from the published studies is followed by a methodological review. This methodological review examines the research design and data collection methods used in the (...) published studies, problems with understanding definitions of euthanasia and the measurement of attitudes. The paper concludes with a discussion of how research in this area may influence nursing practice. (shrink)

People often justify their moral opinions by referring to larger moral concerns. Is there a general agreement about what concerns apply to different moral opinions? We used surveys in the United States and the United Kingdom to measure the perceived applicability of eight concerns to a wide range of moral opinions. Within countries, argument applicability scores were largely similar whether they were calculated among women or men, among young or old, among liberals or conservatives, or among people with or without (...) higher education. Thus, the applicability of a given moral concern to a specific opinion can be viewed as an objective quality of the opinion, largely independent of the population in which it is measured. Finally, we used similar surveys in Israel and Brazil to establish that this independence of populations also extended to populations in different countries. However, the extent to which this holds across cultures beyond those included in the current study is still an open question. (shrink)

In 2002 with the passing of the Euthanasia Law, Belgium became one of the few countries worldwide to legalize euthanasia. In the 18 years since the passing of the law, much has changed. We argue that in Belgium a widening of the use of euthanasia is occurring and that this can be ethically and legally problematic. This is in part related to the fact that several legal requirements intended to operate as safeguards and procedural guarantees in reality often fail to (...) operate as such. We focus on three kinds of safeguards or procedural guarantees: the legally defined due care criteria for eligibility for euthanasia; the consultation of a second physician; and the reporting of euthanasia cases to the Federal Control and Evaluation Commission for Euthanasia. We will show how each of these three safeguards can exhibit shortcomings in theory and practice. (shrink)

BackgroundRespect for autonomy is a paramount principle in end-of-life ethics. Nevertheless, empirical studies show that decision-making, exclusively focused on the individual exercise of autonomy fails to align well with patients’ preferences at the end of life. The need for a more contextualized approach that meets real-life complexities experienced in end-of-life practices has been repeatedly advocated. In this regard, the notion of ‘relational autonomy’ may be a suitable alternative approach. Relational autonomy has even been advanced as a foundational notion of palliative (...) care, shared decision-making, and advance-care planning. However, relational autonomy in end-of-life care is far from being clearly conceptualized or practically operationalized.Main bodyHere, we develop a relational account of autonomy in end-of-life care, one based on a dialogue between lived reality and conceptual thinking. We first show that the complexities of autonomy as experienced by patients and caregivers in end-of-life practices are inadequately acknowledged. Second, we critically reflect on how engaging a notion of relational autonomy can be an adequate answer to addressing these complexities. Our proposal brings into dialogue different ethical perspectives and incorporates multidimensional, socially embedded, scalar, and temporal aspects of relational theories of autonomy. We start our reflection with a case in end-of-life care, which we use as an illustration throughout our analysis.ConclusionThis article develops a relational account of autonomy, which responds to major shortcomings uncovered in the mainstream interpretation of this principle and which can be applied to end-of-life care practices. (shrink)

The term “value of life” can refer to life’s intrinsic dignity: something nonincremental and time-unaffected in contrast to the fluctuating, incremental “value” of our lives, as they are longer or shorter and more or less flourishing. Human beings are equal in their basic moral importance: the moral indignities we condemn in the treatment of e.g. those with dementia reflect the ongoing human dignity that is being violated. Indignities licensed by the person in advance remain indignities, as when people might volunteer (...) their living, unconscious bodies for surrogacy or training in amputation techniques. Respect for someone’s dignity is significantly impacted by a failure to value that person’s very existence, whatever genuine respect and good will is shown by wanting the person’s life to go well. Valuing and respecting life is not, however, vitalism: there can be good and compelling reasons for eschewing some means of prolonging life. (shrink)

Ethical arguments about assisted dying often focus on whether or not respect for an individual’s autonomy gives a reason to offer them an assisted death if they want it. In this paper, I present an argument for legalising assisted dying which appeals to the autonomy of people who don’t want to die. Adding that option can transform the nature of someone’s choice set, enabling them to pursue other options voluntarily where that would otherwise be harder or impossible. This does not (...) contradict the more familiar arguments for legalising assisted dying based on the autonomy of those who seek to die. But it does suggest that a wider constituency of support for that legislative change might be created by emphasising that one need not be in that position to be benefited by the change. (shrink)

Volume 19, Issue 10, October 2019, Page 50-51.

Volume 19, Issue 10, October 2019, Page 3-7.

Ramsey sees life as a gift and a trust given to people by God. This theological understanding of human life frames his judgment of the immorality of euthanasia in its many forms. Assuming Ramsey’s theological insights and framing of this issue, I highlight a particular way of thinking about euthanasia that both seems to capture the essence of the debate and does not necessarily build the moral evaluation into its description. I aim to identify and unpack the description most consistent (...) with the claims made by Ramsey of how other end-of-life (EOL) care options are seen as life choices in order to die well enough. If this project is right-headed, it can be used as a backdrop for assessing how many of the currently accepted and perhaps developing options in EOL and palliative care may or may not be morally distinct from euthanasia. Therefore, those who oppose euthanasia while wanting also to maintain the appropriateness of many of other EOL care options in certain situations are not acting inconsistently. This primarily conceptual work is done in service to those who take Ramsey’s theological framework seriously. (shrink)

I have a hairstylist whose lover was very sick. I’d been seeing this stylist for ten years and we’re good friends. [His lover was] becoming an invalid, not able to get out of bed. He said “I hate to ask you this but would you mind writing a prescription to help us out?” [So] I wrote a prescription to a patient who I had never seen, and I sent it to him in the mail and I heard the next time (...) I went in to get my hair cut that it was the most beautiful experience that my stylist had ever had. It was Valentine’s Day and they had a lovely meal with champagne. And they held each other and then, you know, his partner took his pills and was released. (shrink)

Medicalized Death and the Right to Die Movement Prior to the 20th Century, most Americans died at home, surrounded by family, friends, and neighbors. Religion, not medicine, governed the death bed for there was little physicians could do for the dying. Eventually, however, advances in medicine and technology would lead to dramatic changes in the timing and location of death: patients not only began living longer, they were also dying longer, and unlike their predecessors, were more likely to die alone, (...) in institutions, and among strangers. Modern medicine, in its zeal to conquer death, had become obsessed with its curative function and ability to extend the lives of the dying. To many in the medical community, death represented failure and was something to be avoided at all costs, and like many other social problems in the United States, had become medicalized. (shrink)

In this chapter, I consider the idea that physician-assisted death might come into question in the cases of psychiatric patients who are incapable of making autonomous choices about ending their lives. I maintain that the main arguments for physician-assisted death found in recent medical ethical literature support physician-assisted death in some of those cases. After assessing several possible criticisms of what I have argued, I conclude that the idea that physicianassisted death can be acceptable in some cases of psychiatric patients (...) who lack autonomy ought to be taken into account in assessing the moral and legal acceptability of physician-assisted death. (shrink)

Ethical issues in healthcare and biomedical research are often a matter of public debate. This entry will explore several prominent views on how such debate should be conducted within pluralistic democratic societies. It begins by considering John Rawls’s account of public reason. It then examines how this account applies to the controversial issues of abortion and physician-assisted suicide, where one can see why some have objected to this view, especially with regard to the way it requires citizens to bracket their (...) comprehensive moral, religious, and philosophical doctrines. Next, this entry will consider some alternative approaches that endorse more expansive forms of public reason that allow greater room for appeals to comprehensive doctrines. While one might expect that many of the controversial issues in bioethics will continue to be a matter of public debate going forward, it will be seen that a necessary step towards making progress in these debates is to get clear on how such debate should be conducted. (shrink)

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 “doctrine of double effect” has a pleasing ring to it. It is regarded by some as the cornerstone of any sound approach to end-of-life issues and by others as religious mumbo jumbo. Discussions about “the doctrine” often generate more heat than light. They are often conducted at cross-purposes and laced with footnotes from Leviticus.

It has been argued that voluntary euthanasia (VE) and physician-assisted suicide (PAS) are morally wrong. Yet, a gravely suffering patient might insist that he has a moral right to the procedures even if they were morally wrong. There are also philosophers who maintain that an agent can have a moral right to do something that is morally wrong. In this article, I assess the view that a suffering patient can have a moral right to VE and PAS despite the moral (...) wrongness of the procedures in light of the main argument for a moral right to do wrong found in recent philosophical literature. I maintain that the argument does not provide adequate support for such a right to VE and PAS. (shrink)

The recent ruling from England on the case of M is one of very few worldwide to consider whether life-sustaining treatment, in the form of clinically assisted nutrition and hydration, should continue to be provided to a patient in a minimally conscious state. Formally concerned with the English law pertaining to precedent autonomy (specifically advance decision-making) and the best interests of the incapacitated patient, the judgment issued in M's case implicitly engages with three different accounts of the value of human (...) life, which respectively emphasise its self-determined, intrinsic and instrumental value. The judge appeared to be most persuaded by the intrinsic value of life and he concluded that treatment ought to continue. Assessing whether his approach or conclusion were ethically appropriate involves significant substantive and evidential questions regarding where the burden of proof should lie and what standard of proof should be required when decisions are to be made about the fates of patients inhabiting ‘twilight worlds’. (shrink)

This paper discusses physician-assisted suicide and voluntary active euthanasia, supplies a short history and argues in favour of permitting both once rigid criteria have been set and the cases retro-reviewed. I suggest that among these criteria should be that VAE should only be permitted with one more necessary criterion: that VAE should only be allowed when physician assisted suicide is not a possible option. If the patient is able to ingest and absorb the medication there is no reason why VAE (...) should be permitted. A brief history of VAE and PAS is given and some of the arguments which have been given are analyzed. The Principle of the Double Effect is briefly discussed and why, in my opinion, it is not a valid principle is briefly discussed. (shrink)

This paper questions the relevance of distinguishing acts and omissions in moral argument. It responds to an article by McLachlan, published in this issue of the Journal of Medical Ethics .1 I argue that McLachlan fails to establish that there is a moral difference between active and passive euthanasia and that he instead merely asserts that the difference exists. I suggest that McLachlan’s paper relies on a false commitment to general rules that do not apply in every case. Furthermore, I (...) question the lack of a moral framework provided in his argument. Finally, I briefly argue why some omissions may well be considered equivalent to some actions. I conclude that until McLachlan demonstrates that it would be wrong, we should focus on agency and responsibility, rather than seek to derive normative conclusions from contrasts between active and passive causes.In bioethical debates relating to euthanasia and associated end-of-life issues, commentators dispute the relevance of distinctions between so-called active and passive euthanasia. As a general means of assisting analysts in their studies of different practices, a taxonomy that distinguishes active and passive euthanasia can be useful, principally as we can not usefully argue about these matters unless we are clear about what our arguments touch upon.2 Although it seems to have become received wisdom from ethicists of quite conflicting views that moral propriety can not hang merely on whether a situation obtains because of an agent’s action or inaction, there continue to be defences of the act/omission distinction.3 4 In his paper,1 McLachlan has attempted to add support to those who argue that the distinction between active and passive euthanasia is a moral one. Here I respond to McLachlan’s paper, arguing that in it he fails to do more …. (shrink)

Background Care-dependency constitutes an important issue with regard to the approval of end-of-life decisions, yet attitudes towards assisted suicide and euthanasia are understudied among care-dependent older adults. We assessed attitudes towards assisted suicide and euthanasia and tested empirical correlates, including socio-demographics, religiosity, physical illness, psychological distress and social isolation. Methods A nationwide cross-sectional survey among older care allowance recipients in private households in Austria was conducted in 2016. In computer-assisted personal interviews, 493 respondents were asked whether or not they approved (...) of the availability of assisted suicide and euthanasia in case of long-term care dependency and whether or not they would consider using assisted suicide or euthanasia for themselves. Multiple logistic regression analysis was used to assess the impact of potential determinants of attitudes towards assisted suicide and euthanasia. Results About a quarter of the sampled care-dependent older adults approved of the availability of assisted suicide and euthanasia respectively indicated the will to make use of assisted suicide or euthanasia. Attitudes towards assisted suicide were most favourable among care-dependent older adults living in urban areas, those who did not trust physicians, those who reported active suicide ideation, and individuals with a strong fear of dying. With regard to euthanasia, living alone, religiosity and fear of dying were the central determinants of acceptance. Conclusions Positive attitudes towards and will to use assisted suicide and euthanasia were expressed by a substantial minority of care-dependent older adults in Austria and are driven by current psychological suffering and fear of the process of dying in the future. Community-based psychosocial care should be expanded to address psychological distress and fears about end-of-life issues among care-dependent older adults. (shrink)

When two Christian prelates as internationally prominent as Desmond Tutu and George Carey call for the legalization of euthanasia and physician-assisted suicide, their arguments merit close consideration. This article sets out and evaluates their arguments. It concludes that the prelates rehearse the superficial case regularly advanced by euthanasia campaigners and fail adequately to engage with the arguments, both principled and practical, against legalization.

Opponents of voluntary euthanasia and physician-assisted suicide often maintain that the procedures ought not to be accepted because ending an innocent human life would both be morally wrong in itself and have unfortunate consequences. A gravely suffering patient can grant that ending his life would involve such harm but still insist that he would have reason to continue living only if there were something to him in his abstaining from ending his life. Though relatively rarely, the notion of meaning of (...) life has figured in recent medical ethical debate on voluntary euthanasia and physician-assisted suicide. And in current philosophical discussion on meaning of life outside the medical ethical debate on voluntary euthanasia and physician-assisted suicide several authors have argued that being moral and having a meaningful existence are connected to each other. In this article, I assess whether his intentionally refraining from causing the harm related to voluntary euthanasia and physician-assisted suicide would involve something to such a patient in the sense that it would promote the meaningfulness of his life. (shrink)

Death, like many social problems, has become medicalized. In response to this medicalization, physician-assisted suicide has emerged as one alternative among many at the end of life. And although the practice is currently legal in the states of Oregon and Washington, opponents still argue that PAS is unethical, is inconsistent with a physician's role, and cannot be effectively regulated. In comparison, Switzerland, like Oregon, permits PAS, but unlike Oregon, non-physicians and private organizations play a significant role in assisted death. Could (...) the Swiss model be the answer? The following essay explores the Swiss model of assisted suicide for its potential to enhance the regulation of PAS, reduce physician involvement, and perhaps demedicalize the way we die. (shrink)

During the past four decades, the Netherlands played a leading role in the debate about euthanasia and assisted suicide. Despite the claim that other countries would soon follow the Dutch legalization of euthanasia, only Belgium and the American state of Oregon did. In many countries, intense discussions took place. This article discusses some major contributions to the discussion about euthanasia and assisted suicide as written by Nigel Biggar (2004), Arthur J. Dyck (2002), Neil M. Gorsuch (2006), and John Keown (2002). (...) They share a concern that legalization will undermine a society's respect for the inviolability and sanctity of life. Moreover, the Report of the House of Lords Select Committee on the Assisted Dying for the Terminally Ill Bill (2005) is analyzed. All studies use ethical, theological, philosophical, and legal sources. All these documents include references to experiences from the Netherlands. In addition, two recent Dutch documents are analyzed which advocate further liberalization of the Dutch euthanasia practice, so as to include infants (Groningen Protocol, NVK 2005) and elderly people "suffering from life" (Dijkhuis Report, KNMG 2004). (shrink)