In this article, I assess the position that voluntary euthanasia and physician-assisted suicide ought not to be accepted in the cases of persons who suffer existentially but who have no medical condition, because existential questions do not fall within the domain of physicians’ professional expertise. I maintain that VE and PAS based on suffering arising from medical conditions involves existential issues relevantly similar to those confronted in connection with existential suffering. On that basis I conclude that if VE and PAS (...) based on suffering arising from medical conditions is taken to fall within the domain of medical expertise, it is not consistent to use the view that physicians’ professional expertise does not extend to existential questions as a reason for denying requests for VE and PAS from persons who suffer existentially but have no medical condition. (shrink)

I contrast Robert Veatch's recent liberal vision of medical decision‐making with a more rationalist liberal model. According to Veatch, physicians are biased in their determination of what is in their patient's overall interests in favour of their medical interests. Because of the extent of this bias, we should abandon the practice of physicians offering what they guess to be the best treatment option. Patients should buddy up with physicians who share the same values —‘deep value pairing’. The goal of choice (...) is maximal promotion of patient values. I argue that if subjectivism about value and valuing is true, this move is plausible. However, if objectivism about value is true — that there really are states which are good for people regardless of whether they desire to be in them — then we should accept a more rationalist liberal alternative. According to this alternative, what is required to decide which course is best is rational dialogue between physicians and patients, both about the patient's circumstances and her values, and not the seeking out of people, physicians or others, who share the same values. Rational discussion requires that physicians be reasonable and empathic. I describe one possible account of a reasonable physician. (shrink)

This paper argues that doctors ought to make all things considered value judgments about what is best for their patients. It illustrates some of the shortcomings of the model of doctor as 'fact-provider'. The 'fact-provider' model fails to take account of the fact that practising medicine necessarily involves making value judgments; that medical practice is a moral practice and requires that doctors reflect on what ought to be done, and that patients can make choices which fail to express their autonomy (...) and which are based on mistaken judgments of value. If doctors are properly to respect patient autonomy and to function as moral agents, they must make evaluations of what their patients ought to do, all things considered. This paper argues for 'rational, non-interventional paternalism'. This is a practice in which doctors form conceptions of what is best for their patients and argue rationally with them. It differs from old-style paternalism in that it is not committed to doing what is best. (shrink)

In this article we discuss the validity of previous preferences and advance directives in cases of severe mental illness.

Jukka Varelius1 ,2 and others3 have advocated that medically assisted dying should be made available on request to competent individuals experiencing ‘existential suffering’. Unlike Cassell and Rich, Varelius believes that existential sufferers do not have to be terminally ill before being helped to die. He does not regard ‘existential suffering’ on its own as sufficient to justify voluntary medically assisted dying, but believes it to be one of a set of jointly sufficient conditions . In ‘Medical expertise, existential suffering and (...) ending life’, however, he aims only to show that if physicians have the expertise required to assess when suffering consequent upon illness or injury is unbearable, that they can equally have that expertise when confronted with ‘existential suffering’. In what follows, I will neither be endeavouring to refute his more general claim , nor his argument in the present paper. Rather, I will offer two reasons for thinking that even if it is sound it is of limited practical significance.First, Varelius outlines his position without reference to relevant political considerations. He distances himself from what he terms the ‘conventional view’, namely, that voluntary medically …. (shrink)