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Voluntary Active Euthanasia and the Doctrine of Double Effect: A View from Germany

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Abstract

This paper discusses physician-assisted suicide (PAS) and voluntary active euthanasia (VAE), 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

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REFERENCES

  • Angell, M. (1997) The Supreme Court and Physician-Assisted Suicide-The Ultimate Right. New England Journal of Medicine 336(1), 50–53.

    Google Scholar 

  • Aquinas, T. (1942) Summa Theologica, Art. 64, 2. Part of 2. Part, Vol 3. Ottawa: Institute of Medieval Studies.

    Google Scholar 

  • Bernat, J. L., Goldstein, M. L., and Viste, K. M. (1996) The Neurologist and the Dying Patient. Neurology(46),59–598.

    Google Scholar 

  • Brock, D. W. (1992) Voluntary Active Euthanasia. Hastings Center Report March-April, 10-22.

  • Bushnell, M. C. (1997) Commentary. European Journal of pain (1), 167.

    Google Scholar 

  • Cantor, N. L., and Thomas, G. C. (1996) Pain Relief, Acceleration of Death and Criminal Law. Kennedy Institute of Ethics Journal 6(2), 107–127.

    Google Scholar 

  • de Jong, B. M., Willemsen A. T., and Paans A. M. (1997) Regional cerebral blood flowchanges related to affective speech presentation in persistent vegetative state. Clin Neurol Neurosurg (99), 213–216.

    Google Scholar 

  • Emanuel, L. (2001) Ethics and Pain Management. An Introductory Overview. Pain and Medicine 2(2), 112–116.

    Google Scholar 

  • Fergueson, P. R. (1997) Causing Death or Allowing to Die? Developments in the Law. Journal of Medical Ethics 23(6), 368–372.

    Google Scholar 

  • Harris, J. (2003) Consent and End of Life Decisions. Journal of Medical Ethics 29(1), 10–15.

    Google Scholar 

  • Hedberg, K., Hopkins, D., and Kohn, M. (2003) Five Years of Legal Physician-Assisted Suicide in Oregon. New England Journal of Medicine (348), 961–964.

    Google Scholar 

  • Hoerster, N. (1998) Sterbehilfe im säkularen Staat [Assistance in Dying in the Secular State].Frankfurt: Suhrkamp. This book is in my view one of the most important concerning active euthanasia and many assumptions in my article are derived from it. Unfortunately there does not exist an English translation.

    Google Scholar 

  • Hume, D. (1978) A Treatise of Human Nature: III. Of Morals. Oxford: Clarendon Press. 455–621.

    Google Scholar 

  • Jansen, L.A., and Sulmasy, D. P. (2002) Sedation, Alimentation, Hydration, and Equivocation: Careful Conversation About Care at the End of Life. Annals of Internal Medicine 136(11), 845–849.

    Google Scholar 

  • Kassubek, J., Juengling, F. D., Els, T., Spreer, J., Herpers, M., Krause, T., Moser, E., and Lucking, C. H. (2003) Activation of a Residual Cortical Network During Painful Stimulation in Long-Term Postanoxic Vegetative State: A15O-H2OPET Study. Journal of Neurological Science (15), 85–91.

    Google Scholar 

  • Kennedy, I. (1997) Commentary 3: A Response to Lowe. Journal of Medical Ethics (23), 161–163.

    Google Scholar 

  • Keown, J. (2002)Euthanasia, Ethics and Public Policy. An Argument Against Legalization. Cambridge: University Press, pp. 52–57.

    Google Scholar 

  • Klein, M. (1997)Perception of Pain in the Persistent Vegetative State? European Journal of pain 1:165–168.

    Google Scholar 

  • Klein, M. (2002) Sterbehilfe und das Problem der Doppelwirkung [Assistance in Dying and the Doctrine of Double Effect]. Wien Klin Wochenschr (114), 415-421. See also a letter to the editor and author's reply in Wien Klin Wochenschr. 2002 (114), 878-880.

  • Kuhse, H. (1998) From Intention to Consent. In M.P. Battin, R. Rhodes, and A. Silvers (Eds.), Physician Assisted Suicide. Expanding the Debate (pp. 252–266). New York and London: Routledge

    Google Scholar 

  • Leichtentritt, R. D., Rettig, K. D., and Miles, S. H. (1999) Holocaust Survivors on the Euthanasia Debate. Social Science and Medicine (48), 185–196.

    Google Scholar 

  • Loewy, E. H. (1996) Textbook of Healthcare Ethics. New York: Plenum Press.

    Google Scholar 

  • Loewy, E. H., and Loewy, R. S. (2003) The Ethics of terminal care: orchestrating the end of life. New York, NY; Kluwer Plenum. See in particular the discussion about the problems of autonomy pp. 23-54.

    Google Scholar 

  • Macklin, R. (2003) Dignity Is a Useless Concept. BMJ 327(7429), 1419–1420.

    Google Scholar 

  • Marquis, D. B. (1991) Four Versions of Double Effect. Journal of Medical Philosophy 16(5), 515–544.

    Google Scholar 

  • Menon, D.K., Owen, A.M., Williams, E.J., Minhas, P. S., Allen, C.M.C., Boniface, S.J., Pickard, J. D., and the Wolfson Brain Imaging Centre team. (1998) Cortical Processing in Persistent Vegetative State. Lancet 352(9123), 200.

    Google Scholar 

  • New Catholic Encyclopedia (1967), New York, Vol 4, pp. 1020-1022.

  • Preston, T. A. (1998) The Rule of Double Effect. New England Journal of Medicine 338(19), 1389.

    Google Scholar 

  • Quill, T. E. (2000) Perspectives on Care at the Close of Life. Initiating End of Life Discussions with Seriously Ill Patient: Addressing the Elephant in the Room. JAMA (284), 2502–2507.

    Google Scholar 

  • Quinn, K. P. (1997) Assisted Suicide and Equal Protection: In Defense of the Distinction Between Killing and Letting Die. Issues in Law and Medicine (13), 145–171.

    Google Scholar 

  • Rachels, J. (1986) The End of Life. New York: Oxford University Press.

  • Rousseau, P. (1996) Terminal Sedation in the Care of Dying Patients. Archives of Internal Medicine 156(16), 1785–1786.

    Google Scholar 

  • Sullivan, A. D., Hedberg, K., and Fleming, D. W. (2000) Legalized Physician-Assisted Suicide in Oregon-The Second Year. New England Journal of Medicine 342(8), 598–604.

    Google Scholar 

  • Sulmasy, D. P., and Pellegrino, E. D. (1999) The Rule of Double Effect. Clearing Up the Double Talk. Archives of Internal Medicine 159(6), 545–550.

    Google Scholar 

  • Thorns, A. (1998) Doctrine of Double Effect Means That Death Is Not Intended. BMJ(316), 391.

    Google Scholar 

  • Cherny, et al. (1994) Sedation in the Management of Refractory Symptoms. Guidelines for Evaluation and Treatment. J Palliative Care (10), 31–38.

    Google Scholar 

  • Sulmasy, D. P., et al. (1999) The Rule of Double Effect. Clearing Up the Double Talk. Archives of Internal Medicine (159), 545–550.

    Google Scholar 

  • Bernat, J.L., et al. (1996) The Neurologist and the Dying Patient. Neurology (46), 598–599.

    Google Scholar 

  • Kendall, C.E. (2000) A Double Dose of Double Effect. Journal of Medical Ethics (26), 204–205.

    Google Scholar 

  • Jansens, R.J.P.A., et al. (1999) Hospice and Euthanasia in the Netherlands: An Ethical Point of View. Journal of Medical Ethics (25), 408–412.

    Google Scholar 

  • Krakauer, E. l., et al. (2000) The Schwartz Center Rounds. Sedation for Intractable Distress of a Dying Patient. Acute palliative Care and the Principle of Double Effect. Oncologist (5), 53–62.

    Google Scholar 

  • Jansen, L. A., et al. (2002) Sedation, Alimentation, Hydration, and Equivocation: Careful Conversation About Care at the End of Life. Annals of Internal Medicine (36), 845–849.

    Google Scholar 

  • Truog, R. D., Berde, C.B., Mitchell, C., and Grier, H. E. (1992) Barbiturates in the Care of the Terminally Ill. New England Journal of Medicine 327(23), 1678–1681.

    Google Scholar 

  • van Delden. (1999) JJM Slippery Slopes in Flat Countries-A Response. Journal of Medical Ethics (25), 22–24.

    Google Scholar 

  • Vatican City (1980) Sacred Congregation for the Doctrine of the Faith: Declaration on Euthanasia.

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  1. Neurologist, Wirsbergstr. 10, 97070, Wuerzburg, Germany

    Martin Klein

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Klein, M. Voluntary Active Euthanasia and the Doctrine of Double Effect: A View from Germany. Health Care Analysis 12, 225–240 (2004). https://doi.org/10.1023/B:HCAN.0000044929.45563.4f

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