In this article I intend to describe an issue of the Dutch euthanasia practice that is not common knowledge. After some general introductory descriptions, by way of formulating a frame of reference, I shall describe the effects of this practice on patients, physicians and families, followed by a more philosophical reflection on the significance of these effects for the assessment of the authenticity of a request and the nature of unbearable suffering, two key concepts in the procedure towards euthanasia or (...) physician-assisted suicide. This article does not focus on the arguments for or against euthanasia and the ethical justification of physician-assisted dying. These arguments have been described extensively in Kimsma and Van Leeuwen (Asking to die. Inside the Dutch debate about euthanasia, Kluwer Academic Publishers, Dordrecht, 1998). (shrink)

We applaud Brown, Elliott, and Paine (2013) for their overarching goal of providing ethical justification for decisions to withdraw nonfutile life-sustaining medical treatments in some cases after...

[opening paragraph] -- Clark: The `astonishing hypothesis' which you put forward in your book, and which you obviously feel is very controversial, is that `You, your joys and sorrows, your memories and ambitions, your sense of personal identity and free will are, in fact, no more than the behaviour of a vast assembly of nerve cells. As Lewis Carroll's Alice might have phrased it: `You're nothing but a pack of neurons'.' But it seems to me that this is not so (...) astonishing a statement for a scientist to make. Isn't this what reductionist science has always believed? (shrink)

Whether treatment decision-making capacity can be meaningfully applied to patients with a diagnosis of “personality disorder” is examined. Patients presenting to a psychiatric emergency clinic with threats of self-harm are considered, two having been assessed and reviewed in detail. It was found that capacity can be meaningfully assessed in such patients, although the process is more complex than in patients with diagnoses of a more conventional kind. The process of assessing capacity in such patients is very time-consuming and may become, (...) in itself, a therapeutic intervention. (shrink)

The traditional view that having a personality disorder, unlike other mental disorders, is not usually reason enough to consider a person incompetent to make healthcare decisions is challenged. The example of a case in which a woman was treated for a physical disorder without her consent illustrates that personality disorder can render a person incompetent to refuse essential treatment, particularly because it can affect the doctor–patient relationship within which consent is given.