Epicurus seems to have thought that death is not bad for the one who dies, since its badness cannot be located in time. I show that Epicurus’ argument presupposes Presentism, and I argue that death is bad for its victim at all and only those times when the person would have been living a life worth living had she not died when she did. I argue that my account is superior to competing accounts given by Thomas Nagel, Fred Feldman and (...) Neil Feit. (shrink)

If a person is competent to consent to a treatment, is that person necessarily competent to refuse the very same treatment? Risk relativists answer no to this question. If the refusal of a treatment is risky, we may demand a higher level of decision-making capacity to choose this option. The position is known as asymmetry. Risk relativity rests on the possibility of setting variable levels of competence by reference to variable levels of risk. In an excellent 2016 article inJournal of (...) Medical Ethics(JME), Rob Lawlor defends asymmetry of this kind by defending risk relativity, using and developing arguments and approaches found in earlier work such as that of Wilks. He offers what we call the two-scale approach: a scale of risk is to be used to set a standard of competence on a scale of decision-making difficulty. However, can this be done in any rational way? We argue it cannot, and in this sense, and to this extent, risk relativity is a nonsense. (shrink)

Bioethics, Volume 36, Issue 6, Page 680-686, July 2022.

Florijn’s analysis of the Dutch Supreme Court ruling on the Albert Heringa case demonstrates that the Dutch approach to justifying physician-assisted death is based primarily on the physician...

In their comprehensive article, Bayefsky and Berkman outline a framework for limiting access to certain types of fetal genetic information through professional self-regulation. Given the rap...

Florijn’s helpful discussion of the Heringa case illustrates the difficulties in drawing a boundary on eligibility conditions for EAS. In Heringa, the Dutch Supreme Court reaffirmed...

Auch unter Befürwortern der Zulässigkeit einer Suizidassistenz durch Ärzte unter bestimmten Bedingungen besteht weitgehendes Einverständnis darüber, dass kein Arzt zu einer Suizidassistenz rechtlich oder berufsrechtlich verpflichtet sein sollte. Auch das Bundesverfassungsgericht hat in seinem Urteil vom Februar 2020 Suizidwilligen unter bestimmten Bedingungen nicht mehr als ein ungerichtetes in rem-Recht auf Suizidhilfe zugesprochen, das keinen Anspruch gegen einen einzelnen Arzt begründet. Mit dem letzten Satz seines Urteils hat es vielmehr die Freiheit jedes einzelnen Arztes – wie auch jedes anderen potenziellen Helfers (...) –, Nein zu sagen, nachdrücklich bekräftigt. Auf dem Hintergrund einer empirischen Untersuchung der Gründe, die in der Schweiz für die Ablehnung entsprechender Patientenanfragen gegeben werden, untersucht und gewichtet der Beitrag die Gründe, die für diese Freiheit sprechen, unter ethischen Gesichtspunkten und verteidigt ein bedingtes Recht auf Ablehnung gegen dessen jüngste Kritiker. In Fällen, in denen die Bedingungen erfüllt sind, durch die das Bundesverwaltungsgericht in seinem Urteil vom März 2017 „extreme Notlagen“ definiert hat, sollte jedoch zumindest eine moralische Pflicht anerkannt werden, den Patienten an einen Arzt zu verweisen, der zu einer Unterstützung bereit ist. (shrink)

In 2002, the Dutch Euthanasia Act was put in place to regulate the ending of one’s life, permitting a physician to provide assistance in dying to a patient whose suffering the physician assesses as...

Philip Reed’s interesting and welcome comparison of the expressivist case against, on the one hand, prenatal testing and abortion and, on the other, physician-assisted suicide and voluntary active euthanasia, indicates the relevance of the expressivist case against the latter and its resilience to criticisms of the expressivist case against the former. Advocates of PAS/VAE commonly argue that they should be lawful out of respect for autonomy: everyone has the right to choose a physician-hastened death if they meet specified conditions such (...) as ‘terminal illness’ or ‘unbearable suffering’. The focus on autonomy is distracting, for the real work of justifying PAS/VAE is done by the argument that life with the conditions specified is not ‘worth living’. Legalisation endorses, and expresses, the judgement that it is reasonable for people with those conditions to think their lives no longer worth living and obtain medical help to end them. Were the justification to respect autonomy, why limit the choice? It is small wonder, in light of the discriminatory nature of such a judgement, that disability groups have been outspoken opponents of legalisation. As society’s ‘canaries in the coalmine’ they have warned of the …. (shrink)

Some disability rights advocates criticise prenatal testing and selective abortion on the grounds that these practices express negative attitudes towards existing persons with disabilities. Disability rights advocates also commonly criticise and oppose physician-assisted suicide (PAS) and euthanasia on the same grounds. Despite the structural and motivational similarity of these two kinds of arguments, there is no literature comparing and contrasting their relative merits and the merits of responses to them with respect to each of these specific medical practices. This paper (...) undertakes such a comparison. My thesis is that a number of potentially significant weaknesses of the expressivist argument against reproductive technologies are avoided when the argument is used against PAS. In particular, I try to show that three common criticisms of the expressivist argument applied to reproductive technologies, whatever merit they have, have even less merit when they are used to reply to the expressivist argument applied to PAS. This is important because the expressivist argument applied to the end of life scenario does not get as much attention as the argument applied to the beginning of life scenario, and yet it has a relatively stronger position. (shrink)

In this paper, we argue that promoting patient values is a legitimate goal of medicine. Our view offers a justification for certain current practices, including birth control and living organ donation, that are widely accepted but do not fit neatly within the most common extant accounts of the goals of medicine. Moreover, we argue that recognising value promotion as a goal of medicine will expand the scope of medical practice by including some procedures that are sometimes rejected as being outside (...) the scope of acceptable medical practice, such as certain forms of physician-assisted death. We then rebut some common and possible objections to this view. Our aim is not to argue that other accounts are mistaken—except when they argue for a single goal that does not include patient values—but rather to show that value promotion should play a more central role in discussions about the goals of medicine. (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)

Drawing the line on physician assistance in physician-assisted death continues to be a contentious issue in many legal jurisdictions across the USA, Canada and Europe. PAD is a medical practice that occurs when physicians either prescribe or administer lethal medication to their patients. As more legal jurisdictions establish PAD for at least some class of patients, the question of the proper scope of this practice has become pressing. This paper presents an argument for restricting PAD to the terminally ill that (...) can be accepted by defenders as well as critics of PAD for the terminally ill. The argument appeals to fairness-based paternalism and the social meaning of medical practice. These two considerations interact in various ways, as the paper explains. The right way to think about the social meaning of medical practice bears on fair paternalism as it relates to PAD and vice versa. The paper contends that these considerations have substantial force when directed against proposals to extend PAD to non-terminally ill patients, but considerably less force when directed against PAD for the terminally ill. The paper pays special attention to the case of non-terminally ill patients who suffer from treatment-resistant depression, as these patients present a potentially strong case for extending PAD beyond the terminally ill. (shrink)

I argue that the concept ‘physician-assisted suicide’ covers two procedures that should be distinguished: giving someone access to humane means to end his own life, and taking co-responsibility for the safe and effective execution of that plan. In the first section I explain the distinction, in the following sections I show why it is important. To begin with I argue that we should expect the laws that permit these two kinds of ‘assistance’ to be different in their justificatory structure. Laws (...) that permit giving access only presuppose that the right to self-determination implies a right to suicide, but laws that permit doctors to take co-responsibility may have to appeal to a principle of mercy or beneficence. Actually this difference in justificatory structure can to some extent be found in existing regulatory systems, though far from consistently. Finally I argue that if one recognizes a right to suicide, as Oregon and other American states implicitly do, and as the European Court of Human Rights has recently done explicitly, one is committed to permit the first kind of ‘assistance’ under some conditions. (shrink)

Noninvasive, prenatal whole genome sequencing may be a technological reality in the near future, making available a vast array of genetic information early in pregnancy at no risk to the fetus or mother. Many worry that the timing, safety, and ease of the test will lead to informational overload and reproductive consumerism. The prevailing response among commentators has been to restrict conditions eligible for testing based on medical severity, which imposes disputed value judgments and devalues those living with eligible conditions. (...) To avoid these difficulties, we propose an unrestricted testing policy, under which prospective parents could obtain information on any variant of known significance after a careful informed consent process that uses an interactive decision aid to deliver a mandatory presentation on the purposes, techniques, and limitations of genomic testing, as well as optional resources for reflection and consultation. This process would encourage thoughtful, informed deliberation... (shrink)

Although physician‐assisted death can be a great benefit both to those who are terminally ill and those who are not, the risks for patients in these two categories are quite different. For now it is reasonable to make the benefit available only for those near death, and to await better evidence about the risks before making it more broadly available.