Euthanasia

I argue that Joseph Raz’s paper on euthanasia faces a problem of coherence with Joseph Raz’s paper addressing the question of “Why should I be moral?”.

I identify what appears to be a "glaring" inconsistency between what Joseph Raz says on euthanasia in a 2012 lecture and what he says on well-being within his most celebrated book, The Morality of Freedom. There also appears to be a subtler inconsistency between what he says and his endorsement of H.L.A. Hart’s opposition to a definitional project.

BackgroundThe Dutch Euthanasia Act applies to patients 12 years and older, which makes euthanasia for minors younger than 12 legally impossible. The issue under discussion specifically regards the capacity of minors to request euthanasia.ObjectiveGain insight in paediatric experts’ views about which criteria are important to assess capacity, from what age minors can meet those criteria, what an assessment procedure should look like and what role parents should have.MethodsA Delphi study with 16 experts (paediatricians, paediatric nurses and paediatric psychologists) who work (...) in Children Comfort Teams in Dutch academic hospitals. The questionnaire contained statements concerning criteria for capacity and procedural criteria. Consensus was defined as ≥80% agreement.ResultsThe experts agreed that five criteria for capacity, found in a previous literature study, are all important. They agreed that some children between ages 9 and 11 could meet all the criteria. Consensus was reached for the statements that the entire medical team should be involved in the decision making and that a second independent expert must assess the case. Experts agreed that the parents’ opinion is relevant and should always be taken into account, but it need not be decisive.ConclusionThis study shows that the age limit of 12 years in the Dutch Euthanasia Act is too strong according to paediatric experts. Letting go of the age limit or lowering the age limit combined with adequate capacity assessment for minors younger than 12 are options that should be discussed further. (shrink)

Does each of us have the right to terminate our own existence if we so decide? Can we delegate this task to others? With what methods can we decide these questions? With Michele Carter, John Loughney, and Patrick Sullivan.

Is it possible to donate unpaired vital organs, foreseeing but not intending one’s own death? We argue that this is indeed psychologically possible, and thus far agree with Charles Camosy and Joseph Vukov in their recent paper on “double effect donation.” Where we disagree with these authors is that we see double-effect donation not as a morally praiseworthy act akin to mar- tyrdom but as a morally impermissible act that necessarily disrespects human bodily integrity. Respect for bodily integrity goes beyond (...) avoiding the aim to kill; not all side effects of deliberate bodily interventions can be outweighed by intended benefits for another even if the subject fully consents. It is not any necessary intention to kill or harm another or oneself that makes lethal donation/harvesting illicit but the more immediate intention to accept or perform surgery on an (innocent) person combined with the foresight of lethal harm and no health-related good for him or her. Double-effect donation falls foul of the first condition of double-effect reasoning in that the immediate act is wrong in itself. We argue further that the wider effects of such don- ation would be socially disastrous and corrupting of the medical profession: doctors should retain a sense of nonnegotiable respect for bodily integrity even when they intervene on willing subjects for the benefit of others. (shrink)

Is it possible to donate unpaired vital organs, foreseeing but not intending one's own death? We argue that this is indeed psychologically possible, and thus far agree with Charles Camosy and Joseph Vukov in their recent paper on 'double effect donation.' Where we disagree with these authors is that we see double effect donation not as a morally praiseworthy act akin to martyrdom but as a morally impermissible act that necessarily disrespects human bodily integrity. Respect for bodily integrity goes beyond (...) avoiding the aim to kill: not all side effects of deliberate bodily interventions can be outweighed by intended benefits for another even if the subject fully consents. It is not any necessary intention to kill or harm another or oneself that makes lethal donation/harvesting illicit but the more immediate intention to accept or perform surgery on an (innocent) person combined with the foresight of lethal harm and no health-related good for him or her. Double effect donation falls foul of the first condition of double effect reasoning in that the immediate act is wrong in itself. We argue further that the wider effects of such donation would be socially disastrous and corrupting of the medical profession: doctors should retain a sense of nonnegotiable respect for bodily integrity even when they intervene on willing subjects for the benefit of others. (shrink)

Continuous deep sedation at the end of life is a practice that has been the topic of considerable ethical debate, for example surrounding its perceived similarity or dissimilarity with physician-assisted dying...

In opposing the legalization of physician-assisted suicide and voluntary euthanasia, Peter Harrell '02 in his April 3 column claims that the example of the Netherlands — so far the only country in the world where both of these practices take place openly and without fear of prosecution — shows that this would be a dangerous course to follow. But none of the evidence that he offers allows him to draw this conclusion.

It might seem counterintuitive to think transhumanists, who are typically characterized by extreme techno-optimism and hope for radical life-extension, would be interested in assisted dying. Because the technological enhancements they long for will probably not be available during their natural lifetimes, many transhumanists at least entertain the idea of having themselves cryonically preserved to buy some additional time for real-world technology to catch up to their dreams. However, since an ideal preservation would take place before serious cellular deterioration sets in, (...) controlling the time and manner of death would be very attractive for transhumanist cryonicists. This chapter identifies some circumstances under which they might be justified in seeking assistance in dying (even though they would describe it as something more akin to hibernating). After providing a fundamental overview of both transhumanism and cryonics, and then making my case for what some scholars have called “cryothanasia” (i.e. assisted dying for the purpose of improved preservation quality), I proceed to consider some scenarios meant to test the limits of this justification. While things are admittedly murkier when considering the possibility of cryothanasia outside the context of imminent medical collapse, I can see no insurmountable criticisms of cryothanasia as a last resort in cases of (currently) terminal and irreparable neurodegeneration or other forms of progressive brain damage. (shrink)

Relying on euthanasia’s definitionally derived set of propositions to provide its purpose, claims, and benefit, we obtain the core concept. Nonetheless, given its core concept, euthanasia is demonstrated to provide no benefit to the animal to justify its use. Euthanasia 1) cannot possibly, and therefore does not, end unbearable suffering, 2) it fails to hasten death, and 3) it, therefore, provides no perceptible relief to the patient. These findings are significant because the argument’s validity does not permit euthanasia to satisfy (...) its definitionally derived purpose, claims, or benefit on logical grounds. In other words, the argument is that as a form of legalized assisted suicide, euthanasia is wrong but not in the way principled arguments would suggest. Additionally, irrespective of euthanasia actually doing what it claims, if it is allowed to be provisioned, then euthanasia will affect vulnerable populations exactly like nonprincipled arguments claim. Therefore, despite sharing aspects with each type of argument in the extant literature, my argument against euthanasia can be categorized as neither principled nor nonprincipled, which makes it significant because it may be the first of a new category of argument against the concept and practice to enter the discourse on euthanasia. As a corollary, since we prove that unbearable suffering logically entails death, when it is authentic signifying that death is imminent, because euthanasia’s only purpose is to end unbearable suffering by inducing death, euthanasia is completely obviated. (shrink)

Ethical debates about assisted dying typically assume that only medical professionals should be able to provide patients with assisted dying. This assumption partially rests on the unstated principle that assisted dying providers may not be motivated by pecuniary considerations. Here I outline and defend a mixed provider model of assisted dying provision that contests this principle. Under this model, medically competent non-physician professionals could receive fees for providing assisted dying under the same terms and conditions as physicians can in those (...) juris- dictions where medically assisted dying is lawful. The mixed provider model blunts objections to assisted dying rooted in supposed clashes with medical values. In addition to generating a market likely to expand access to assisted dying, the mixed provider model would not create markets that are unjust because they are “noxious” in Satz’ sense or because they raise “semiotic” concerns about the value of human life. (shrink)

This book provides novel perspectives on ethical justifiability of assisted dying in the revised edition of New Directions in the Ethics of Assisted Suicide and Euthanasia. Going significantly beyond traditional debates about the value of human life, the ethical significance of individual autonomy, the compatibility of assisted dying with the ethical obligations of medical professionals, and questions surrounding intention and causation, this book promises to shift the terrain of the ethical debates about assisted dying. The novel themes discussed in the (...) revised edition include the role of markets, disability, gender, artificial intelligence, medical futility, race, and transhumanism. Ideal for advanced courses in bioethics and healthcare ethics, the book illustrates how social and technological developments will shape debates about assisted dying in the years to come. (shrink)

Belgium is one of very few countries where euthanasia on the basis of psychiatric illness is legally possible. Three physicians involved in the euthanasia of a 38-year-old woman suffering from psychiatric illness recently faced a criminal trial for “murder by poisoning”, for allegedly having failed to comply with several requirements of the Belgian Euthanasia Law. Although none of the physicians were convicted, the case generated extensive debate, in the media and the general public as well as in the medical profession (...) and among policy makers. In this chapter, we take this trial as the starting point for a critical analysis of the clinical-psychiatric, ethical, and legal issues involved in evaluating euthanasia requests in cases of complex psychiatric disorders. In these cases, the requirements of the Belgian Euthanasia Law could be improved by mandating the advice of two psychiatrists, who are experts in the treatment of the specific condition of the person requesting euthanasia. Simultaneously with the process of evaluating the euthanasia request, there should be a parallel treatment track in which all therapeutic and recovery-oriented options are explored. These two tracks should not be in the hands of the same physician. (shrink)

Several countries have legalized euthanasia on the basis of medically diagnosable suffering over the last decennial; the criteria to which they adhere differ. The topic of this article is euthanasia on the basis of existential suffering. This article presents a recent proposal to legalize euthanasia for people who experience such suffering and then discusses the issue of what the value of life may be, and whether the standard that life is normally something positive should be accepted. This provides the foundation (...) to answer the question of whether euthanasia on the basis of existential suffering should be allowed. (shrink)

This chapter provides empirical evidence about everyday attitudes concerning euthanasia. These attitudes have important implications for some ethical arguments about euthanasia. Two experiments suggested that some different descriptions of euthanasia have modest effects on people’s moral permissibility judgments regarding euthanasia. Experiment 1 (N = 422) used two different types of materials (scenarios and scales) and found that describing euthanasia differently (‘euthanasia’, ‘aid in dying’, and ‘physician assisted suicide’) had modest effects (≈3 % of the total variance) on permissibility judgments. These (...) effects were largely replicated in Experiment 2 (N = 409). However, in Experiment 2, judgments about euthanasia’s moral permissibility were best predicted by the voluntariness of the treatment. Voluntariness was a stronger predictor than some demographic factors and some domain general elements of moral judgments. These results help inform some debates about the moral permissibility of euthanasia (e.g., the slippery slope argument) suggesting that some of the key premises of those arguments are unwarranted. (shrink)

In this chapter, we explore the issue of assisted dying for individuals with dementia at the nexus of ethics and law. We set out the basic medical realities of dementia and the available data about the desire for the option of assisted dying in the face of dementia. We then describe law and practice with respect to voluntary euthanasia and assisted suicide in jurisdictions that permit at least some assisted dying. We conclude that, because of the peculiar ways in which (...) some of the features of dementia interact with specific legislative provisions, less access to assisted dying for persons with dementia can be realized through the legislation than might have been intended or expected. We then describe draft assisted dying legislation that is before the federal Parliament of Canada. We conclude that, because of the peculiar ways in which some of the features of dementia interact with specific legislative provisions, more access to assisted dying for persons with dementia would be realized, if the legislation was passed as drafted, than might be intended or expected. This exercise reveals that very careful attention needs to be paid to the features of dementia if drafting assisted dying legislation in order to actually achieve the desired law reform effect (whatever that might be). The interplay of common ethical rationales for permitting assisted dying (e.g., autonomy and alleviation of suffering) with common features of dementia (e.g., loss of competence before the terminal phase of the illness, loss of the capacity to communicate before the loss of the capacity to suffer) raises challenges for translating one’s ethical position on assisted dying for individuals with dementia into law. NB: This chapter is current up to 2015. (shrink)

The chapter focuses on cases of assisted suicide and voluntary euthanasia in relation to the rarely discussed notion of indirect paternalism. Indirect paternalism involves not just a paternalistic intervener and a person whose welfare is supposed to be protected, but also another party, whom I call “assistant.” Indirect paternalism interferes with an assistant in order to prevent harm to another person. I will introduce a strategy that paternalists can pursue to justify indirect paternalism. It specifically targets an element of assistance (...) cases, namely the fact that people do not necessarily have a justified claim or entitlement to demand such assistance. To prevent people from providing assistance seems normatively different from preventing a person to do something to herself by her own means. I critically discuss arguments from the goals of medicine and from the conscientious objection. These aspects are not deemed decisive when considering the case of indirect paternalistic intervention. Finally, I argue against the rationale of indirect paternalism by showing that there are at least two situations where it does not succeed. One such situation that undermines the justification of indirect paternalism is present when the offered service is itself harmless, another pertinent situation consists of a person necessarily requiring assistance to be really free. At least in some cases, these very conditions are given when contemplating assistance to die. (shrink)

In this chapter, I consider the idea that physician-assisted death might come into question in the cases of psychiatric patients who are incapable of making autonomous choices about ending their lives. I maintain that the main arguments for physician-assisted death found in recent medical ethical literature support physician-assisted death in some of those cases. After assessing several possible criticisms of what I have argued, I conclude that the idea that physicianassisted death can be acceptable in some cases of psychiatric patients (...) who lack autonomy ought to be taken into account in assessing the moral and legal acceptability of physician-assisted death. (shrink)

This paper investigates connections between procreative ethics and the ethics of suicide and euthanasia. While there are good reasons for distinguishing between lives worth starting and lives worth continuing, I argue that those reasons provide no reason for denying that there is a relationship between procreative and end of life ethics. Regarding euthanasia/assisted suicide, we might think it too demanding to ask parents to help euthanize their terminally ill, suffering child, but had the parents not procreated, thereby exposing their child (...) to life's risks, their child wouldn't need euthanizing. If you need help killing yourself, shouldn't your parents, who got you into life in the first place – without your consent – help you out of it? Yet knowing that your parents would help you kill yourself may increase your desire to die. A conundrum. Regarding suicide, the fact that we are forced into life should bolster the right to suicide, even for reasons that others might find wanting. The ways in which we are brought into life have moral implications for the ways in which we are entitled to get out of it. (shrink)

What does the Chilean Constitution say about euthanasia? When we read the Chilean Constitution we cannot find the word “euthanasia” in the text, and there is no such thing as a right to die, therefore the answer should apparently be that the Constitution does not say anything about euthanasia and, in short, euthanasia is not allowed. However, on a second reading we can find out some statements from which we can infer another answer. My aim is to show that there (...) is room for the acceptance of euthanasia in the Chilean Constitution, and in other similar Constitutions and international regulations in which freedom of conscience is granted. (shrink)

I offer a principled objection to arguments in favour of legalizing non-voluntary euthanasia on the basis of the principle of beneficence. The objection is that the status of death as a benefit to people who cannot formulate a desire to die is more problematic than pain management care. I ground this objection on epistemic and political arguments. Namely, I argue that death is relatively more unknowable, and the benefits it confers more subjectively debatable, than pain management. I am not primarily (...) referring to the claim that it is difficult to make comparisons between live and post-mortem states, but rather to the fact that it is epistemically and metaphysically problematic to impute a “life-worse-than-death” or a state of “suffering-calling-for-death” to people who cannot subjectively wish to die, as though this kind of suffering were a medically observable fact rather than a belief- and value-laden notion. On the contrary, people enduring similar causes of pain may have different experiences of suffering and views on how it affects the worthwhileness of their existence or the desirability of death or of continuing their lives. The projection of a “suffering-calling-for-death” onto infants or people with severe intellectual disabilities may not be indefensible, but it is more controversial than judging that pain management will improve their well-being from the perspective of beneficence. My argument also relies on our society’s liberal endeavour to avoid endorsing unverifiable beliefs about life and death or controversial conceptions of the good life. My goal is not to suggest we should not attend the suffering of cognitively disabled people. On the contrary, I only cast doubt on too quick an assumption that ending their lives is the best way of caring for them, when robust palliative treatments are available. Moreover, I express the concern that a lack of attention to distinctions between “pain-calling-for-relief” and “suffering-calling-for-death” may be based on ableist projections and assumptions. I conclude that it is imperative to continue research into the nature of pain and suffering experienced by individuals with mental or cognitive impairments preventing them from expressing autonomous wishes about the kind of treatment that would most benefit them. (shrink)

Euthanasia and physician-assisted suicide are common practice in the Netherlands. In response to increasing requests from patients to end their lives, physicians are finding themselves placed in particularly precarious situations because of advance directives written by patients suffering from severe dementia. In April 2020, the Supreme Court of the Netherlands issued two judgments in the so-called Dormicum case: a case involving the deliberate termination of the life of a 74-year-old woman suffering from advanced dementia by a geriatrician in a nursing (...) home in The Hague. The judgment of the lower criminal court was upheld, but the sanction imposed by the appellate disciplinary court was quashed. In this paper, the author reviews the two Supreme Court rulings, argues that both are fundamentally flawed and raises questions as to what they mean for Dutch criminal law, physicians, and patients going forward. (shrink)

Many books have been published about physician-assisted death. This book offers a comprehensive and in-depth examination of that subject, but it also extends the discussion to a broader range of end-of-life decisions including suicide, palliative care and sedation until death. In every jurisdiction that has laws permitting some kind of physician-assisted death, a central point of controversy is whether such assistance should only be available to dying patients, or to everyone who wants to end his life. The right to determine (...) the manner and time of one's own death, however, does not necessarily mean that physicians should be permitted to cooperate in ensuring a quick and peaceful death. In this book, Govert den Hartogh considers the fundamental and practical matters-including concrete issues of legal regulation-related to end-of life decision making. He proposes a two-tiered system. Everyone should have access to humane means of ending his life, if his decision to end it is voluntary, well-considered and durable. But doctors should only participate in a joint action of ending the patient's life on his request if they also are convinced of acting in the patient's best interests, in particular by ending intolerable and unrelievable suffering. And perhaps there is reason to restrict that second service to dying patients. The whole argument, however, depends on the extent to which, in both tiers of the system, we can design legal safeguards that will enable us to trust judgments about the requesting person's request and about his suffering. The book considers much new evidence in regard to this issue. What Kind of Death will appeal to researchers and advanced students working in bioethics, applied ethics, philosophy of law and health law. (shrink)

BackgroundThere has been no in-depth research of public attitudes on withholding or withdrawing life-prolonging treatment, euthanasia, assisted suicide and physician assisted suicide in Croatia. The aim of this study was to examine these attitudes and their correlation with sociodemographic characteristics, religion, political orientation, tolerance of personal choice, trust in physicians, health status, experiences with death and caring for the seriously ill, and attitudes towards death and dying. MethodsA cross-sectional study was conducted on a three-stage random sample of adult citizens of (...) the Republic of Croatia, stratified by regions, counties, and locations within those counties. In addition to descriptive statistics, ANOVA and Chi-square tests were used to determine differences, and factor analysis, correlation analysis and multiple regression analysis for data analysis.Results38.1% of the respondents agree with granting the wishes of dying people experiencing extreme and unbearable suffering, and withholding life-prolonging treatment, and 37.8% agree with respecting the wishes of such people, and withdrawing life-prolonging treatment. 77% of respondents think that withholding and withdrawing procedures should be regulated by law because of the fear of abuse. Opinions about the practice and regulation of euthanasia are divided. Those who are younger and middle-aged, with higher levels of education, living in big cities, and who have a more liberal worldview are more open to euthanasia. Assisted suicide is not considered to be an acceptable practice, with only 18.6% of respondents agreeing with it. However, 40.1% think that physician assisted suicide should be legalised. 51.6% would support the dying person’s autonomous decisions regarding end-of-life procedures.ConclusionsThe study found low levels of acceptance of withholding or withdrawing life-prolonging treatment, euthanasia, assisted suicide and physician assisted suicide in Croatia. In addition, it found evidence that age, level of education, political orientation, and place of residence have an impact on people’s views on euthanasia. There is a need for further research into attitudes on different end-of-life practices in Croatia. (shrink)

Background: Euthanasia is a controversial issue in many countries. However, there is little evidence about attitudes of nurses and nursing students toward euthanasia. Research aims: The present study aimed to compare nurses and nursing students' attitudes toward euthanasia. Research design: This is a descriptive cross-sectional study. Participants and research context: Using census sampling, 390 nurses and 125 nursing students were enrolled in this study. Methods: Data were collected using a socio-demographic questionnaire and Euthanasia Attitude Scale that included 20 items that (...) sought to record participants’ level of agreement with euthanasia based on a Likert-type scale. Ethical considerations: Objectives of the study were stated for all samples, and emphasized the confidentiality of their specifics and responses, and informed written consent was obtained from all participants. Findings: The mean score of nurses and nursing students’ attitudes about euthanasia was 3.14 ± 0.26 and 3.22 ± 0.24 out of 5, respectively. The majority of nurses and nursing students had a positive attitude toward euthanasia. There was a significant statistical difference between the attitudes of nurses and nursing students to euthanasia. Discussion: The results indicated that the majority of students and nurses had a positive attitude regarding euthanasia. Conclusion: It was recommended to conduct more studies on euthanasia in Iran. (shrink)

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...