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)

No law in any jurisdiction that permits physician assisted dying offers individuals a medically assisted death without the need to comply with certain criteria. The Netherlands is no exception. There is evidence to suggest that physicians are averse to providing an assisted death even when the Dutch ‘due care criteria’ have been met and the unbearable pain and suffering requirement is especially difficult to satisfy. Some individuals with an enduring desire to die who do not meet the ‘due care’ criteria (...) under the Dutch legislation turn to other means of achieving a self-appointed death. This paper explores two alternative methods of securing a self-determined death (an assisted death involving lay assistors or a self-hastened death by stopping eating and drinking), and raises the question of how far the law should recognise autonomy in the context of physician assisted death. (shrink)

It is a funny thing with the Dutch. On one hand, they seem preoccupied with death and adamant that patients be allowed to decide for themselves in what way they want to die. On the other, contrary to popular belief, the Dutch physician is allotted a very influential role in treatment decisions, far more prominent than in many other Western countries. From an American perspective Dutch professional ethics may seem quite paternalistic: a patient’s freedom to decide to have a particular (...) medical treatment is limited by the physician’s professional assessment of the medical need of this treatment. The question arises: What is the relationship between the professional responsibility of Dutch physicians and the right of Dutch patients to decide for themselves? This question is illustrated by the ongoing national debate in The Netherlands on euthanasia and the growing demand for a further reaching right to self-determination concerning ending one’s life. However, contrary to popular belief, not all Dutch ethical debate concerns end-of-life questions. (shrink)

It has been suggested that neuroenhancements could be used to improve the abilities of criminal justice authorities. Judges could be made more able to make adequately informed and unbiased decisions, for example. Yet, while such a prospect appears appealing, the views of neuroenhanced criminal justice authorities could also be alien to the unenhanced public. This could compromise the legitimacy and functioning of the criminal justice system. In this article, I assess possible solutions to this problem. I maintain that none of (...) them qualifies as a satisfactory general solution to it, a solution that could reasonably be taken to solve the problem or to suffice for dealing with it in at least most cases. Yet I also suggest that, depending on contingent empirical circumstances, the responses – either singly or together – can sometimes amount to a sufficient answer to it. (shrink)

It is commonly accepted that voluntary active euthanasia and physician-assisted suicide can be allowed, if at all, only in the cases of patients whose conditions are incurable. Yet, there are different understandings of when a patient’s condition is incurable. In this article, I consider two understandings of the notion of an incurable condition that can be found in the recent debate on physician-assisted dying. According to one of them, a condition is incurable when it is known that there is no (...) cure for it. According to the other, a condition is incurable when no cure is known to exist for it. I propose two criteria for assessing the conceptions and maintain that, in light of the criteria, the latter is more plausible than the former. (shrink)

To fulfill their crucial duty of relieving suffering in their patients, physicians may have to administer palliative sedation when they implement treatment-limitation decisions such as the withdrawal of life-supporting interventions in patients with poor prognosis chronic severe brain injury. The issue of palliative sedation deserves particular attention in adults with serious brain injuries and in neonates with severe and irreversible brain lesions, who are unable to express pain or to state their wishes. In France, treatment limitation decisions for these patients (...) are left to the physicians. Treatment-limitation decisions are made collegially, based on the presence of irreversible brain lesions responsible for chronic severe disorders of consciousness. Before these decisions are implemented, they are communicated to the relatives. Because the presence and severity of pain cannot be assessed in these patients, palliative analgesia and/or sedation should be administered. However, palliative sedation is a complex strategy that requires safeguards to prevent a drift toward hastening death or performing covert euthanasia. In addition to the law on patients' rights at the end of life passed in France on April 22, 2005, a recent revision of Article 37 of the French code of medical ethics both acknowledges that treatment-limitation decisions and palliative sedation may be required in patients with severe brain injuries and provides legal and ethical safeguards against a shift towards euthanasia. This legislation may hold value as a model for other countries where euthanasia is illegal and for countries such as Belgium and Netherlands where euthanasia is legal but not allowed in patients incapable of asking for euthanasia but in whom a treatment limitation decision has been made. (shrink)

Like being able to drive a car, being autonomous is a socially attributed, claimed, and contested status. Normative debates about criteria for autonomy (and what autonomy entitles one to) are best understood, not as debates about what autonomy, at core, really is, but rather as debates about the relative merits of various possible packages of thresholds, entitlements, regulations, values, and institutions. Within different “regimes” of autonomy, different criteria for (degrees of) autonomy become authoritative. Neoliberal, solidaristic, and perfectionist regimes entail conflicting (...) understandings of what gets you autonomy and what autonomy gets you—for example, in relation to policies regarding physician-assisted suicide or financial support for senior citizens. In light of this, justifying a particular understanding of autonomy is inseparable from the task of arguing for the context-specific merits of a regime of autonomy as a whole and in relation to other ethical and political commitments. (shrink)

In this Critical Notice of Emily Jackson and John Keown’s Debating Euthanasia , the respective lines of argument put forward by each contributor are set out and the key debating points identified. Particular consideration is given to the points each contributor makes concerning the sanctity of human life and whether slippery slopes leading from voluntary medically assisted dying to non-voluntary euthanasia would be established if voluntary medically assisted dying were to be legalised. Finally, consideration is given to the positions adopted (...) by the contributors in relation to the legalisation of voluntary medically assisted dying. (shrink)

The relatively new practice of continuous sedation at the end of life (CS) is increasingly being debated in the clinical and ethical literature. This practice received much attention when a U.S. Supreme Court ruling noted that the availability of CS made legalization of physician-assisted suicide (PAS) unnecessary, as CS could alleviate even the most severe suffering. This view has been widely adopted. In this article, we perform an in-depth analysis of four versions of this ?argument of preferable alternative.? Our goal (...) is to determine the extent to which CS can be considered to be an alternative to PAS and to identify the grounds, if any, on which CS may be ethically preferable to PAS. (shrink)

There has been contentious debate over the years about whether there are morally relevant similarities and differences between the three practices of continuous deep sedation until death, physician-assisted suicide, and voluntary euthanasia. Surprisingly little academic attention has been paid to a comparison of the uses of these practices in the two types of circumstances in which they are typically performed. A comparative domains of ethics analysis methodological approach is used in the paper to compare 1) the use of the three (...) practices in paradigm circumstances, and 2) the use of the practices in paradigm circumstances to their use in non-paradigm circumstances. The analytical outcomes suggest that a bright moral line cannot be demonstrated between any two of the practices in paradigm circumstances, and that there are significant, morally-relevant distinctions between their use in paradigm and non-paradigm circumstances. A thought experiment is employed to illustrate how these outcomes could possibly inform the decisions of hypothetical deliberators who are engaged in the collaborative development of assisted dying regulatory frameworks. (shrink)

Amongst other countries, the Netherlands currently allows euthanasia, provided the physician performing the procedure adheres to a strict set of requirements. In 2016, Second Chamber member Pia Dijkstra submitted a law proposal which would also allow euthanasia without the reason necessarily having any medical foundation; euthanasia on the basis of a completed life. The debate on this topic has been ongoing for over two decades, but this law proposal has made the discussion much more immediate and concrete. This paper considers (...) the moral permissibility of Pia Dijkstra’s law proposal, focusing on the ethics of the implementation Dijkstra describes in her proposal. I argue that, at present, Dijkstra’s law proposal is unsuitable for implementation, due to a number of as of yet unaddressed problems, including the possible development of an ageist stigma and undue pressure on the profession of end-of-life coordinator. Perhaps adequate responses can be conceived to address these issues. However, the existence of a radically different, yet currently equally unacceptable position regarding the implementation of euthanasia for a completed life as proposed by fellow party member Paul Schnabel suggests it may be difficult to formulate an ethically acceptable implementation for this, in principle, ethically acceptable concept. (shrink)

Medicine has undergone substantial changes in the way medical dilemmas are being dealt with. Here we explore the attitude of Israeli physicians to two debatable dilemmas: disclosing the full truth to patients...

Ein Argument gegen die ärztliche Beihilfe zum Suizid lautet, Patienten könnten sich um Suizidassistenz bemühen, weil sie sich als Belastung empfinden. Dabei wird die Selbstbestimmtheit eines so motivierten Todeswunsches in Frage gestellt. Ist dieses Argument überzeugungskräftig? Empirische Daten zeigen, dass die ärztliche Beihilfe zum Suizid auf der Grundlage dieses Motivs den ethischen Prinzipien der Sorge um das Patientenwohl und des Respekts vor der Autonomie des Patienten nicht widersprechen muss. Denn das Empfinden, anderen zur Last zu fallen, kann trotz adäquater palliativmedizinischer (...) Betreuung wesentlich zu einem Leidensdruck am Lebensende beitragen. Zudem ist dieses Motiv eng verknüpft mit der Sorge um das Wohl der Angehörigen, die einer erheblichen Belastungssituation ausgesetzt sein können. Da aber das Wohlergehen der Familie zu den elementaren Werten von schwerstkranken Patienten am Lebensende gehört, kann der Wunsch nach ärztlicher Beihilfe zum Suizid auch auf der Basis dieses Motivs Ausdruck eines selbstbestimmten Patientenwillens sein. Andererseits korreliert das Empfinden, anderen zur Last zu fallen, mit einer depressiven Verstimmung. Dieser Zusammenhang ist deshalb relevant, da bei depressiven Störungen eine Einschränkung der Selbstbestimmungsfähigkeit vorliegen kann. Vor diesem Hintergrund sind Zweifel an der Selbstbestimmtheit eines so motivierten Sterbewunsches durchaus begründet. Aufgrund des bestehenden Wissensdefizits bei der Feststellung der Selbstbestimmungsfähigkeit ist die Mitwirkung des Arztes bei einem so motivierten Todeswunsch daher ethisch fragwürdig. (shrink)

In 2017, Italy passed a law that provides for a systematic discipline on informed consent, advance directives, and advance care planning. It ranges from decisions contextual to clinical necessity through the tool of consent/refusal to decisions anticipating future events through the tools of shared care planning and advance directives. Nothing is said in the law regarding the issue of physician assisted suicide. Following the DJ Fabo case, the Italian Constitutional Court declared the constitutional illegitimacy of article 580 of the criminal (...) code in the part in which it does not exclude the punishment of those who facilitate the suicide when the decision has been freely and autonomously made by a person kept alive by life-support treatments and suffering from an irreversible pathology, the source of physical or psychological suffering that he/she considers intolerable, but fully capable of making free and conscious decisions. Such conditions and methods of execution must be verified by a public structure of the national health service, after consulting the territorially competent ethics committee. This statement admits, within strict and regulated bounds, physician assisted suicide, so widening the range of end-of-life decisions for Italian patients. Future application and critical topics will be called into question by the Italian legislator. (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.

Ein Argument gegen die ärztliche Beihilfe zum Suizid lautet, Patienten könnten sich um Suizidassistenz bemühen, weil sie sich als Belastung empfinden. Dabei wird die Selbstbestimmtheit eines so motivierten Todeswunsches in Frage gestellt. Ist dieses Argument überzeugungskräftig? Empirische Daten zeigen, dass die ärztliche Beihilfe zum Suizid auf der Grundlage dieses Motivs den ethischen Prinzipien der Sorge um das Patientenwohl und des Respekts vor der Autonomie des Patienten nicht widersprechen muss. Denn das Empfinden, anderen zur Last zu fallen, kann trotz adäquater palliativmedizinischer (...) Betreuung wesentlich zu einem Leidensdruck am Lebensende beitragen. Zudem ist dieses Motiv eng verknüpft mit der Sorge um das Wohl der Angehörigen, die einer erheblichen Belastungssituation ausgesetzt sein können. Da aber das Wohlergehen der Familie zu den elementaren Werten von schwerstkranken Patienten am Lebensende gehört, kann der Wunsch nach ärztlicher Beihilfe zum Suizid auch auf der Basis dieses Motivs Ausdruck eines selbstbestimmten Patientenwillens sein. Andererseits korreliert das Empfinden, anderen zur Last zu fallen, mit einer depressiven Verstimmung. Dieser Zusammenhang ist deshalb relevant, da bei depressiven Störungen eine Einschränkung der Selbstbestimmungsfähigkeit vorliegen kann. Vor diesem Hintergrund sind Zweifel an der Selbstbestimmtheit eines so motivierten Sterbewunsches durchaus begründet. Aufgrund des bestehenden Wissensdefizits bei der Feststellung der Selbstbestimmungsfähigkeit ist die Mitwirkung des Arztes bei einem so motivierten Todeswunsch daher ethisch fragwürdig. (shrink)

Slippery-slope arguments typically question a course of action by estimating that it will end in misery once the first unfortunate step is taken. Previous studies indicate that estimations of the long-term consequences of certain debated actions, such as legalizing physician-assisted suicide, may be strongly influenced by tacit personal values. In this paper, we suggest that to the extent that slippery-slope arguments rest on estimations of future events, they may be mere rationalizations of personal values. This might explain why there are (...) proponents even for strikingly poor slippery-slope arguments. (shrink)