ABSTRACT In a recent issue of this journal, David Silver and Gerald Dworkin discuss the physicians' role in execution by lethal injection. Dworkin concludes that discussion by stating that, at that point, he is unable to think of an acceptable set of moral principles to support the view that it is illegitimate for physicians to participate in execution by lethal injection that would not rule out certain other plausible moral judgements, namely that euthanasia is (...) under certain conditions legitimate and that organ‐donation surgery is sometimes permissible. This article draws attention to some problems in the views of Silver and Dworkin and suggests moral principles which support the three moral views just mentioned. (shrink)

Several states systematically collect data to assess whether the anesthesia administered was sufficient—the same data used by researchers to show that the concentration of sodium thiopental in the blood of executed prisoners was not enough to ensure loss of consciousness and that these inadequate levels of anesthesia were not the result of pharmacokinetic changes after death. This activity could constitute human subjects research under existing law.

Gerald Dworkin has argued that it is inconsistent with the proper ends of medicine for a physician to participate in an execution by lethal injection. He does this by proposing a principle by which we are to judge whether an action is consistent with the proper ends of medicine. I argue: (a) that this principle, if valid, does not show that it is inconsistent with the proper ends of medicine for a physician to participate in an (...) class='Hi'>execution by lethal injection; and (b) that this principle is not valid, and this is because it mistakenly views the promotion of patient autonomy as one of the proper ends of medicine. Rather, I propose, we should view respect for a patient's autonomy as a constraint on the pursuit of the proper ends of medicine, rather than as one of the proper ends itself. With this revised understanding of the proper ends of medicine, we can conclude that it is inconsistent with the proper ends of medicine for a physician to participate in an execution by lethal injection. (shrink)

This article constitutes excerpts of a videotaped discussion hosted by the New England Journal of Medicine on January 14, 2008, concerning a range of topics on lethal injection prompted by the United States Supreme Court's January 7 oral arguments in Baze v. Rees. Dr. Atul Gawande moderated the roundtable that included two anesthesiologists - Dr. Robert Truog and Dr. David Waisel - as well as law professor Deborah Denno. The discussion focused on the drugs used in lethal (...) injection executions, whether physicians should participate, potential alternatives, and some of the legal parameters of Baze. (shrink)

When lethal injection was first legalized in the late 1970s, many people viewed it as safe, reliable, and humane. Today, however, lethal injection does not always perform as promised. Due to difficulties with sourcing lethal injection drugs, states are utilizing untested lethal injection protocols, with little knowledge or experience to guide them. This article argues that lethal injection reform requires regulation similar to that for human subject research, and that the (...) practice of utilizing untested lethal injection methods comes very close to falling under the federal statutory definition of “human subject research“ formulated in the Common Rule. This article argues further that even if one decides that it does not, the practice of lethal injection today is the type of conduct that the human subject research regulations were designed to correct. Moreover, society has an interest in ensuring that executions are conducted in a way that reduces pain and suffering to the lowest extent possible. As such, lethal injection ought to receive further review and oversight to ensure that it comports with reasonable notions of humanity. (shrink)

To circumvent objections that the death penalty was “cruel and unusual punishment” and therefore a violation of the Eighth Amendment to the Constitution, advocates proposed lethal injection and the involvement of physicians to overcome the negative perceptions associated with the death penalty, and to increase public acceptability of the practice. Initiated in 1982, lethal injection is now the primary method of execution in 37 of the 38 states with the death penalty. “To be exact, this (...) method has been used to kill 788 of the 956 men and women who have been executed in the United States since 1976, when the death penalty was reinstated by the Supreme Court.” More recently, of the 191 executions performed in the United States since 2001, 189 have been by lethal injection.This “medicalization” of the death penalty has ignited a debate, by those within the medical profession and by others outside it, about the appropriateness of physicians participating in executions. (shrink)

This essay exposes how recent attempts at lethal injection reform have involved unethical and illegal research on prisoners. States are varying the doses and types of drugs used, developing methods designed for non-medical professionals to administer medical procedures, and gathering data or making provisions for the gathering of data to learn from executions gone wrong. When individual prisoners are executed under these conditions, states are conducting research on them. Conducting research or experimentation on prisoners in the process of (...) reform is problematic because it violates ethical frameworks and state laws. The Supreme Court has recently taken up the challenge of elucidating the standard for determining the constitutionality of lethal injection. If the Court suggests an approach to lethal injection reform that is akin to some of the more thoughtful and cautious approaches other courts have proposed, the Court's decision may also contravene state laws or ethical precepts regarding research with prisoners. Thus, this paper provides important limitations on the kinds of reform that may be permissible and outlines the open questions that must be addressed before it can be determined whether the risks and uncertainties involved in lethal injection can be remedied. (shrink)

The practice of health-care professional involvement in capital punishment has come under scrutiny since the implementation of lethal injection as a method of execution, raising questions of the goals of medicine and the ethics of medicalized procedures. The American Medical Association and other professional associations have issued statements prohibiting physician involvement in capital punishment because medicine is dedicated to preserving life. I address the three primary arguments against health-care professionals being involved in lethal injection and (...) argue that they are not strong enough to prohibit physician involvement in the lethal injection process. (shrink)

Though there are good arguments against physician participation in executions, physicians should be allowed to make their own decisions about whether they will participate, and professional medical organizations should not flatly destroy the careers of those who do.

A paper was published in 2003 discussing the ethics of nurses participating in executions by inserting the intravenous line for lethal injections and providing care until death. This paper was circulated on an international email list of senior nurses and academics to engender discussion. From that discussion, several people agreed to contribute to a paper expressing their own thoughts and feelings about the ethics of nurses participating in executions in countries where capital punishment is legal. While a range of (...) opinions were presented, these opinions fell into two main themes. The first of these included reflections on the philosophical obligations of nurses as caregivers who support those in times of great need, including condemned prisoners at the end of life. The second theme encompassed the notion that no nurse ever should participate in the active taking of life, in line with the codes of ethics of various nursing organisations. This range of opinions suggests the complexity of this issue and the need for further public discussion. (shrink)

An argument against the participation of physicians in capital punishment by means of lethal injection.

The death penalty by lethal injection is a legal punishment in the United States. Sodium Thiopental, once used in the death penalty cocktail, is no longer available for use in the United States as a consequence of this association. Anesthesiologists possess knowledge of Sodium Thiopental and possible chemical alternatives. Further, lethal injection has the look and feel of a medical act thereby encouraging physician participation and comment. Concern has been raised that the death penalty by (...) class='Hi'>lethal injection, is cruel. Physicians are ethically directed to prevent cruelty within the doctor-patient relationship and ethically prohibited from participation in any component of the death penalty. The US Supreme Court ruled that the death penalty is not cruel per se and is not in conflict with the 8th amendment of the US constitution. If the death penalty is not cruel, it requires no further refinement. If, on the other hand, the death penalty is in fact cruel, physicians have no mandate outside of the doctor patient relationship to reduce cruelty. Any intervention in the name of cruelty reduction, in the setting of lethal injection, does not lead to a more humane form of punishment. If physicians contend that the death penalty can be botched, they wrongly direct that it can be improved. The death penalty cocktail, as a method to reduce suffering during execution, is an unverifiable claim. At best, anesthetics produce an outward appearance of calmness only and do not address suffering as a consequence of the anticipation of death on the part of the condemned. (shrink)

In October 2003 the Supreme Court of the United States allowed Arkansas officials to force Charles Laverne Singleton, a schizophrenic prisoner convicted of murder, to take drugs that would render him sane enough to be executed. On January 6 2004 he was killed by lethal injection, raising many ethical questions. By reference to the Singleton case, this article will analyse in both moral and legal terms the controversial justifications of the enforced medical treatment of death-row inmates. Starting with (...) a description of the Singleton case, I will highlight the prima facie reasons for which this case is problematic and merits attention. Next, I will consider the justification of punishment in Western society and, in that context, the evolution of the notion of insanity in the assessment of criminal responsibility during the past two centuries, both in the US and the UK. In doing so, I will take into account the moral justification used to enforce treatment, looking at the conflict between the prisoner’s right to treatment and his right to refuse medication where not justified by outcomes that can be reasonably expected to be positive for the individual. Finally, in contrast with some retributivist arguments in favour of enforced treatment to enable execution, I will propose a possible alternative, necessary if we are to consistently uphold the notion of autonomy. (shrink)

The United States Supreme Court recently ruled that execution by a commonly used protocol of drug administration does not represent cruel or unusual punishment. Various medical journals have editorialized on this drug protocol, the death penalty in general and the role that physicians play. Many physicians, and societies of physicians, express the opinion that it is unethical for doctors to participate in executions. This Target Article explores the harm that occurs to murder victims' relatives when an execution is (...) delayed or indefinitely postponed. By using established principles in psychiatry and the science of the brain, it is shown that victims' relatives can suffer brain damage when justice is not done. Conversely, adequate justice can reverse some of those changes in the brain. Thus, physician opposition to capital punishment may be contributing to significant harm. In this context, the ethics of physician involvement in lethal injection is complex. (shrink)

Dr. Garrett Johnson received a call from the Texas Department of Criminal Justice asking if he would be interested in filling prescriptions for pentobarbital. Suddenly he faced a controversial issue - providing a drug used for the lethal injection of convicted criminals. Apparently big pharma was discontinuing the manufacture and sale of drugs used for human executions - primarily due to mounting pressure from death penalty activists and shareholders, legal appeals by inmates, media reports of botched lethal (...) injections, etc. Texas saw the solution by using small local compounding pharmacies that were less visible to the public. Should Garrett fill this lucrative order knowing how the State would use the drugs? The case presents the ethical and strategic issues that Garrett faces - having just graduated and started his own compounding pharmacy - in making this decision. (shrink)

“What if the death penalty were a drug?” This question opens the essay and is pursued through two very different kinds of texts. On the one hand, Derrida's 1999–2000 Death Penalty Seminar is brought to bear for its analysis of what is called there the “anesthesial logic” of capital punishment. This logic, Derrida argues, has determined both pro– and anti–death penalty discourses since at least the mid-eighteenth century. On the other hand, the essay gathers evidence of events that led, in (...) 2010, to the unavailability in the United States of sodium thiopental—the anesthetic component of the three-drug protocol of the lethal injection—which forced many death penalty states to halt executions. Current events thus confirm the philosopher's analysis that anesthesia is indeed the lynchpin of the apparatus of state-sanctioned executions. But the analysis of this anesthesial logic also leads one to pose the further question of who is being anesthetized by this protocol and its discursive devices: the sentenced or the sentencers? (shrink)

In this newest installment in Chicago’s series of Jacques Derrida’s seminars, the renowned philosopher attempts one of his most ambitious goals: the first truly philosophical argument against the death penalty. While much has been written against the death penalty, Derrida contends that Western philosophy is massively, if not always overtly, complicit with a logic in which a sovereign state has the right to take a life. Haunted by this notion, he turns to the key places where such logic has been (...) established—and to the place it has been most effectively challenged: literature. With his signature genius and patient yet dazzling readings of an impressive breadth of texts, Derrida examines everything from the Bible to Plato to Camus to Jean Genet, with special attention to Kant and post–World War II juridical texts, to draw the landscape of death penalty discourses. Keeping clearly in view the death rows and execution chambers of the United States, he shows how arguments surrounding cruel and unusual punishment depend on what he calls an “anesthesial logic,” which has also driven the development of death penalty technology from the French guillotine to lethal injection. Confronting a demand for philosophical rigor, he pursues provocative analyses of the shortcomings of abolitionist discourse. Above all, he argues that the death penalty and its attendant technologies are products of a desire to put an end to one of the most fundamental qualities of our finite existence: the radical uncertainty of when we will die. Arriving at a critical juncture in history—especially in the United States, one of the last Christian-inspired democracies to resist abolition—_The Death Penalty_ is both a timely response to an important ethical debate and a timeless addition to Derrida’s esteemed body of work. (shrink)

The United States Supreme Court recently ruled that execution by a commonly used protocol of drug administration does not represent cruel or unusual punishment. Various medical journals have editorialized on this drug protocol, the death penalty in general and the role that physicians play. Many physicians, and societies of physicians, express the opinion that it is unethical for doctors to participate in executions. This Target Article explores the harm that occurs to murder victims' relatives when an execution is (...) delayed or indefinitely postponed. By using established principles in psychiatry and the science of the brain, it is shown that victims' relatives can suffer brain damage when justice is not done. Conversely, adequate justice can reverse some of those changes in the brain. Thus, physician opposition to capital punishment may be contributing to significant harm. In this context, the ethics of physician involvement in lethal injection is complex. (shrink)

In this newest installment in Chicago’s series of Jacques Derrida’s seminars, the renowned philosopher attempts one of his most ambitious goals: the first truly philosophical argument against the death penalty. While much has been written against the death penalty, Derrida contends that Western philosophy is massively, if not always overtly, complicit with a logic in which a sovereign state has the right to take a life. Haunted by this notion, he turns to the key places where such logic has been (...) established—and to the place it has been most effectively challenged: literature. With his signature genius and patient yet dazzling readings of an impressive breadth of texts, Derrida examines everything from the Bible to Plato to Camus to Jean Genet, with special attention to Kant and post–World War II juridical texts, to draw the landscape of death penalty discourses. Keeping clearly in view the death rows and execution chambers of the United States, he shows how arguments surrounding cruel and unusual punishment depend on what he calls an “anesthesial logic,” which has also driven the development of death penalty technology from the French guillotine to lethal injection. Confronting a demand for philosophical rigor, he pursues provocative analyses of the shortcomings of abolitionist discourse. Above all, he argues that the death penalty and its attendant technologies are products of a desire to put an end to one of the most fundamental qualities of our finite existence: the radical uncertainty of when we will die. Arriving at a critical juncture in history—especially in the United States, one of the last Christian-inspired democracies to resist abolition—The Death Penalty is both a timely response to an important ethical debate and a timeless addition to Derrida’s esteemed body of work. (shrink)

In this essay I take up the question of how death can be a penalty, given that each of us will eventually die. I argue that capital punishment in the United States rests on contradictory demands for painless death delivered humanely through pharmaceuticals and yet denies the accused the possibility of natural death. The death penalty must be at once humane and punishing. Analyzing what we mean by ‘botched’ executions, along with the language of the Supreme Court in upholding (...) class='Hi'>lethal injection as a humane application of the death penalty, I argue that the fantasy of instant death is at the heart of the tension between death as painless and death as penalty. In the end, I turn to Derrida’s Death Penalty Seminar Volume One, particularly his discussion of Kant’s defence of the capital punishment, and the pivotal role of time in his discussion. Finally, I suggest that the fantasies of instantaneous death and our technological mastery of it result in the fantasy of the ‘good’ punishing death. (shrink)

In August 2012, the drug manufacturer, Fresenius Kabi, barred the sale of the anaesthetic, propofol, for use in lethal injections. The company announced that it would not accept orders for the drug from US departments of correction, and put in place similar requirements on all its wholesalers and distributors.1Propofol is one of the world's most widely used anaesthetics. Earlier in 2012, US states began to use propofol in executions following shortages of other drugs which had previously been used in (...) lethal injections. In May 2012, the state of Missouri decided to move to a one-drug protocol, using propofol alone for lethal injections, in place of the three-drug protocol that had been used by most states carrying out the death penalty. Missouri took this decision when supplies of thiopental sodium and pentobarbital, drugs used in the three-drug protocol, became unavailable.2Fresenius Kabi said that it had imposed the restrictions in order to ‘prevent Propofol from being used for purposes other than its approved medical indications’ and to ensure that ‘the immediate access to Propofol needed by medical professionals’ was not hindered. The company said that it objected to the use of its products in any manner that was not in full accordance with the medical indications for which they have been approved by health authorities.3 All forms of Fresenius Kabi propofol are manufactured in Europe. A European Union Council regulation prevents products that may reasonably be expected to be used in executions from being exported from the EU. The company said that, should propofol begin to be used in executions in the USA, inadequate access to the drug in the country was a likely consequence. At the time of writing, the US Food and Drug Administration was reporting shortages of the drug in the USA for …. (shrink)

Killing Times begins with the deceptively simple observation—made by Jacques Derrida in his seminars on the topic—that the death penalty mechanically interrupts mortal time by preempting the typical mortal experience of not knowing at what precise moment we will die. Through a broader examination of what constitutes mortal temporality, David Wills proposes that the so-called machinery of death summoned by the death penalty works by exploiting, or perverting, the machinery of time that is already attached to human existence. Time, Wills (...) argues, functions for us in general as a prosthetic technology, but the application of the death penalty represents a new level of prosthetic intervention into what constitutes the human. Killing Times traces the logic of the death penalty across a range of sites. Starting with the legal cases whereby American courts have struggled to articulate what methods of execution constitute “cruel and unusual punishment,” Wills goes on to show the ways that technologies of death have themselves evolved in conjunction with ideas of cruelty and instantaneity, from the development of the guillotine and the trap door for hanging, through the firing squad and the electric chair, through today’s controversies surrounding lethal injection. Responding to the legal system’s repeated recourse to storytelling—prosecutors’ and politicians’ endless recounting of the horrors of crimes—Wills gives a careful eye to the narrative, even fictive spaces that surround crime and punishment. Many of the controversies surrounding capital punishment, Wills argues, revolve around the complex temporality of the death penalty: how its instant works in conjunction with forms of suspension, or extension of time; how its seeming correlation between egregious crime and painless execution is complicated by a number of different discourses. By pinpointing the temporal technology that marks the death penalty, Wills is able to show capital punishment’s expansive reach, tracing the ways it has come to govern not only executions within the judicial system, but also the opposed but linked categories of the suicide bombing and drone warfare. In discussing the temporal technology of death, Wills elaborates the workings both of the terrorist who produces a simultaneity of crime and “punishment” that bypasses judicial process, and of the security state, in whose remote-control killings the time-space coordinates of “justice” are compressed and at the same time disappear into the black hole of secrecy. Grounded in a deep ethical and political commitment to death penalty abolition, Wills’s engaging and powerfully argued book pushes the question of capital punishment beyond the confines of legal argument to show how the technology of capital punishment defines and appropriates the instant of death and reconfigures the whole of human mortality. (shrink)

"In this newest installment in Chicagos series of Jacques Derridas seminars, the renowned philosopher attempts one of his most ambitious goals: the first truly philosophical argument against the death penalty. While much has been written against the death penalty, Derrida contends that Western philosophy is massively, if not always overtly, complicit with a logic in which a sovereign state has the right to take a life. Haunted by this notion, he turns to the key places where such logic has been (...) established - and to the place it has been most effectively challenged: literature. With his signature genius and patient yet dazzling readings of an impressive breadth of texts, Derrida examines everything from the Bible to Plato to Camus to Jean Genet, with special attention to Kant and postWorld War II juridical texts, to draw the landscape of death penalty discourses. Keeping clearly in view the death rows and execution chambers of the United States, he shows how arguments surrounding cruel and unusual punishment depend on what he calls an 'anesthesial logic, ' which has also driven the development of death penalty technology from the French guillotine to lethal injection. Confronting a demand for philosophical rigor, he pursues provocative analyses of the shortcomings of abolitionist discourse. Above all, he argues that the death penalty and its attendant technologies are products of a desire to put an end to one of the most fundamental qualities of our finite existence: the radical uncertainty of when we will die. Arriving at a critical juncture in history - especially in the United States, one of the last Christian-inspired democracies to resist abolition - The Death Penalty is both a timely response to an important ethical debate and a timeless addition to Derridas esteemed body of work"--Unedited summary from book jacket. (shrink)

Over the past several years, the most widely publicized issue in capital litigation has been the constitutional status of states’ lethal injection protocols. Death row inmates have not challenged the constitutionality of lethal injection itself, but rather execution protocols and their potential for maladministration. The inmates’ concern is due to the three-drug protocol used in the vast majority of capital jurisdictions: if the anesthetic, which is administered first, is ineffectively delivered, then the second and third (...) drugs — the paralytic and heartbeat-ceasing agents — will cause torturous pain and suffering in violation of the Eight Amendment. Inmates have argued that the participation of anesthesiologists or other highly trained medical professionals is constitutionally required to minimize the risk of unnecessary suffering. This litigation, in conjunction with evidence that some executed inmates suffered torturous pain, has reinvigorated the ethical debate about physician participation in executions. Even though the United States Supreme Court has signaled that physician participation is not constitutionally required, lawmakers in death penalty states must consider the ethics of physician involvement. (shrink)

Hybrid metaethical theories attempt to incorporate essential elements of expressivism and cognitivism, and thereby to accrue the benefits of both. Hybrid theories are often defended in part by appeals to slurs and other pejoratives, which have both expressive and cognitivist features. This paper takes far more seriously the analogy between pejoratives and moral predicates. It explains how pejoratives work, identifies the features that allow pejoratives to do that work, and models a theory of moral predicates on those features. The result (...) is an expressivist theory that, among other advantages, is immune to embedding difficulties and avoids an overlooked difficulty concerning attitude ascriptions that is lethal to most other hybrid theories. (shrink)

Anthony Ellis argues that institutional punishment occurs automatically in a way analogous to mechanical deterrents, and given that issuing real threats is justified for self-defence, institutional punishment, intended to protect society via deterrence, can be justified without violating the Kantian constraint against using persons as means only. But institutional punishments are not in fact executed automatically: they must be carried out by moral agents. Ellis fails to provide a basis for those agents to justify the performance of their legal duties.

The chief executive of the Law Society proposes that the Mental Capacity Bill is a progressive initiative enhancing personal autonomy. Laing replies to this by showing that the Bill, for from enhancinging personal autonomy explodes it by inviting homicide by unaccountable third parties, allowing non-therapeutic research and organ-removal without consent and creating a secret and unaccountable court with a lethal power over the vulnerable incapacitated.

The nationally-famous advocate of physician-assisted suicide did not die by his own hand. Dr. Jack Kevorkian died the old-fashioned way in America: in a hospital, with multiple disorders undercutting his life. Kevorkian took up interest in assisted suicide early in his medical career, and he wanted prisoners on death row to volunteer for experiments just before their execution. Kevorkian saw individual consent as the wheel, axle, and grease for all decisions in these matters. He helped many people die, but (...) it is unclear what moral principle guided his decisions to say yes and no to requests for help in dying. His spree in helping people die came to an end, when he himself injected a man with a lethal substance. Because of his single-minded focus on the value of assisted suicide and experimentation before execution, he had little impact on the broader ethical analysis of assisted-suicide and the rights of prisoners. He leaves little legacy in ethics for the analysis of assisted-suicide or in vivo experimentation. (shrink)

Court of appeal ruling on assisted dyingIn July 2013, the Court of Appeal ruled on an assisted dying case brought by Paul Lamb, a 58-year-old man who has been quadriplegic and without function in any of his limbs, apart from a little movement in his right hand, since a car accident in 1990.1 Mr Lamb was permitted by the Court to take over the legal case of Tony Nicklinson, who died in August 2012, less than a week after his request (...) for judicial review was rejected by the High Court.2 Like Mr Nicklinson, the severity of Mr Lamb's injuries means that he is unable to take his own life, other than by starvation. He would like his life to be ended, preferably by lethal injection administered at home, and does not want to travel to Switzerland for an assisted suicide.Mr Lamb's case was heard, along with that of Mr Nicklinson's wife and that of another man, ‘Martin’, in the Court of Appeal in May.The Court identified three issues from the parties’ submissions: The common law should provide a defence to murder where that takes the form of euthanasia in circumstances where another party is giving effect to the settled wish of a competent person. The legal prohibitions on those providing assistance constitute a disproportionate interference with Article 8 rights to a private and family life. The Director of Public Prosecution's policy statement on factors which he will take into account when considering whether or not to exercise his discretion in favour of prosecuting does not satisfy the …. (shrink)

Recently, Canada’s National Post described in detail the death by lethal injection of a 94-year-old man, living alone, who had multiple medical problems but was not terminally ill. His son helped find a physician willing to administer lethal medication soon after his father told him he “wasn’t planning on adding another digit” to his age. The physician who complied with the request is a leading advocate for assisted death in Canada, who reportedly has been responsible for more (...) than 30 life-terminating acts within the few months since the law was passed in June 2016. The son of the man who died by active euthanasia declared, “Dad got the death he wanted.” Should a legal option of... (shrink)

Withdrawing Artificial Nutrition and Hydration in the neonatal intensive care units has long been controversial. In France, the practice has become a legal option since 2005. But even though, the question remains as to what the stakeholders’ experience is, and whether they consider it ethically appropriate. In order to contribute to the debate, we initiated a study in 2009 to evaluate parental and health care professionals perspectives, after they experienced WAHN for a newborn. The study included 25 cases from 5 (...) different clinical neonatology departments. We interviewed both the parents and some of the HCP who cared for the baby, at least 6 months after this latter deceased. We proceeded through in-depth individual qualitative interviews. Content was analyzed for themes and patterns that emerged from the data. Some parents expressed that WANH offered an opportunity to the family to spend a few demedicalized days with the baby before she dies, without any tubes and machines, and to be well supported by the HCP during this palliative stage. But others evaluated the practice in retrospect as a terrible ordeal. All said that, at least, the time of waiting for death to ensue should not last too long. After a few days, it becomes unbearable because of the transformation of the baby’s appearance and because they, as parents, began to wonder if she was not dying from starvation rather than from her initial disease. An important proportion of HCP also expressed some kind of ethical unease. This was due to the psychological violence involved in the decision for a human being to stop feeding a little one, and also to the difficulty to deal with the fundamental intention behind the decision of WANH: indeed, could it be claim that it does not presuppose the intention of provoking the infant’s death? The discussion focuses on the point to know if WANH can be considered as a source of progress from an ethical point of view, particularly in comparison with earlier practices—that in France could involve active euthanasia by lethal injection. We argue that when HCP are merely focused on avoiding that WAHN could be construed as a way of intending to hasten the baby’s death, the practice is at risk to be implemented in a way that becomes ethically counterproductive. Focusing on this intention easily distract the clinical teams from what should be their ultimate concern, namely the baby’s comfort during the dying process, as well as the support owned to her parents. To conclude, we suggest that the ethical priorities, when WANH is decided, should be the support due to the patient and her family on the one hand, and, on the other hand to implement it in such a way that at least the baby seems to have died of her initial disease and never of starvation. This means that HCP have a duty to control the timing of death, even though this might be incompatible with the worry to avoid the intention of hastening the baby’s death. (shrink)

Bioethicists involved in end‐of‐life debates routinely distinguish between ‘killing’ and ‘letting die’. Meanwhile, previous work in cognitive science has revealed that when people characterize behaviour as either actively ‘doing’ or passively ‘allowing’, they do so not purely on descriptive grounds, but also as a function of the behaviour’s perceived morality. In the present report, we extend this line of research by examining how medical students and professionals (N = 184) and laypeople (N = 122) describe physicians’ behaviour in end‐of‐life scenarios. (...) We show that the distinction between ‘ending’ a patient’s life and ‘allowing’ it to end arises from morally motivated causal selection. That is, when a patient wishes to die, her illness is treated as the cause of death and the doctor is seen as merely allowing her life to end. In contrast, when a patient does not wish to die, the doctor’s behaviour is treated as the cause of death and, consequently, the doctor is described as ending the patient’s life. This effect emerged regardless of whether the doctor’s behaviour was omissive (as in withholding treatment) or commissive (as in applying a lethal injection). In other words, patient consent shapes causal selection in end‐of‐life situations, and in turn determines whether physicians are seen as ‘killing’ patients, or merely as ‘enabling’ their death. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Sanctity of Life—The Sanctity of ChoiceKristina HallettWhat do you do when helping someone means advocating for his death?I am a Board Certified Clinical Psychologist and have been in practice since 1993. I entered the field, as most do, to be of assistance and support to people in dealing with the difficult, the unimaginable, and the often painful circumstances of life. The goal has always been simple: to help. (...) The manner may differ, but the central goal is the same: to help. I have encountered many challenging situations in my work: times when I felt unbelievably sad upon hearing someone’s story; when I felt righteous indignation at injustices encountered; when I worried for someone’s safety; when I laughed and rejoiced in someone’s experience. In each of these situations the path to helping was clear of moral dilemma. But what about when helping results in execution – the state enforcing the legally imposed punishment of the death penalty? While some decisions involve the potential for moral and emotional distress, there is usually a way of understanding “helping” as giving voice to an individual’s right to choose. What do you do when helping someone means advocating for his death as punishment?Several years ago while I worked for a state Department of Corrections (DOC), an inmate on death row was executed. The state had not conducted an execution for decades. I was the Supervising Psychologist for the DOC facility, and as such it was my role to facilitate mental health treatment for this inmate. I was also the liaison to DOC custody staff regarding policies, treatment, and the impact of the process of an execution on staff, the involved inmate and other inmates in the facility. The DOC staffers were split in their views of the situation. Some staff were adamantly opposed to the death penalty, a portion were relatively neutral and the largest number of staff were strong proponents of the death penalty—some to the point of relishing the execution.He had confessed and been convicted of heinous crimes, including the rapes and murders of several young women. Innocence was not a question. He readily admitted his responsibility for these crimes. The legal process was long and involved, including several different trials and penalty hearings, all with the same result: he was sentenced to death. Now all mandatory appeals associated with the death penalty were exhausted. Having already spent a great many years on death row, he did not want to pursue further appeals. He made the “choice” to [End Page 95] not file a voluntary appeal and instead to proceed with the death penalty process.It is a curious thing, but when the required appeals (the checks and balances of the legal system) were completed and this man said, “I want to proceed with the imposition of my sentence,” all the rules changed. This individual, who had been competent to assist in his defense and his appeals to fight his sentence for over twenty years, was suddenly seen as “incompetent” to choose to accept his sentence. Opponents of the death penalty viewed execution as “state–assisted suicide” and believed the inmate had “death row syndrome,” and therefore was not competent to make the decision to move forward with his sentence. Those who agreed with the death penalty believed he was fully competent and supported the completion of his sentence through lethal injection. And then there was me.I had always been against the death penalty. From a moral perspective, I believed in the sanctity of life, that we do not have the right to take the life of another human being. I shared in others’ horror and outrage at horrific crimes, but felt justice belonged to the legal system (through incarceration) and to God. I did not believe in retribution or revenge, although I supported consequences and accountability. I argued against the death penalty in high school debates, college round–table discussions and in theoretical conversations with my peers, family and friends.When faced with this situation as a psychologist, I found myself splitting a very fine hair. I did not support the death penalty, but I did support the ability of... (shrink)

In October 2013, Missouri officials abandoned a plan to execute a convicted murderer using a novel method—an injection of propofol. The name of this drug became a household word after propofol played a role in singer Michael Jackson's death, but this has been a popular therapeutic drug for many years. Clinicians use it in intensive care, surgery, and common procedures like colonoscopy. After deciding to halt the execution, Missouri governor Jay Nixon told corrections officials to come up with (...) a different lethal injection protocol. But that was not a simple assignment. Missouri had proposed using propofol because officials had faced barriers to obtaining the drugs previously used for executions. Corrections officials in death penalty states are finding it harder to secure drugs for lethal injection. (shrink)

The present study evaluates the cognitive representation of a kicking movement performed by a human and a humanoid robot, and how they are represented in experts and novices of soccer and robotics, respectively. To learn about the expertise-dependent development of memory structures, we compared the representation structures of soccer experts and robot experts concerning a human and humanoid robot kicking movement. We found different cognitive representation structures for both expertise groups under two different motor performance conditions . In general, the (...) expertise relies on the perceptual-motor knowledge of the human motor system. Thus, the soccer experts’ cognitive representation of the humanoid robot movement is dominated by their representation of the corresponding human movement. Additionally, our results suggest that robot experts, in contrast to soccer experts, access functional features of the technical system of the humanoid robot in addition to their perceptual-motor knowledge about the human motor system. Thus, their perceptual-motor and neuro-functional machine representation are integrated into a cognitive representation of the humanoid robot movement. (shrink)

Conventional medical ethics and the law draw a bright line distinguishing the permitted practice of withdrawing life-sustaining treatment from the forbidden practice of active euthanasia by means of a lethal injection. When clinicians justifiably withdraw life-sustaining treatment, they allow patients to die but do not cause, intend, or have moral responsibility for, the patient's death. In contrast, physicians unjustifiably kill patients whenever they intentionally administer a lethal dose of medication. We argue that the differential moral assessment of (...) these two practices is based on a series of moral fictions – motivated false beliefs that erroneously characterize withdrawing life-sustaining treatment in order to bring accepted end-of-life practices in line with the prevailing moral norm that doctors must never kill patients. When these moral fictions are exposed, it becomes apparent that conventional medical ethics relating to end-of-life decisions is radically mistaken. (shrink)

On 26 February 2020, the German Constitutional Court rejected a law from 2015 that prohibited any form of ‘business-like’ assisted suicide as unconstitutional. The landmark ruling of the highest federal court emphasised the high priority given to the rights of autonomy and free personal development, both of which constitute the principle of human dignity, the first principle of the German constitution. The ruling echoes particularities of post-war Germany’s end-of-life debate focusing on patient self-determination while rejecting any discussion of active assistance (...) to die through a lethal injection administered by a doctor. This brief report discusses the ruling in the light of the broader sociopolitical and historical context of the German end-of-life debate. (shrink)