To describe the content of practice guidelines on euthanasia and assisted suicide (EAS) and to compare differences between settings and guidelines developed before or after enactment of the euthanasia law in 2002 by means of a content analysis. Most guidelines stated that the attending physician is responsible for the decision to grant or refuse an EAS request. Due care criteria were described in the majority of guidelines, but aspects relevant for assessing these criteria were not always described. Half of the (...) guidelines described the role of the nurse in the performance of euthanasia. Compared with hospital guidelines, nursing home guidelines were more often stricter than the law in excluding patients with dementia (30% vs 4%) and incompetent patients (25% vs 4%). As from 2002, the guidelines were less strict in categorically excluding patients groups (32% vs 64%) and in particular incompetent patients (10% vs 29%). Healthcare institutions should accurately state the boundaries of the law, also when they prefer to set stricter boundaries for their own institution. Only then can guidelines provide adequate support for physicians and nurses in the difficult EAS decision-making process. (shrink)
Genomics provides information on genetic susceptibility to diseases and new possibilities for interventions which can fundamentally alter the design of fair health policies. The aim of this paper is to explore implications of genomics from the perspective of equal opportunity ethics. The ideal of equal opportunity requires that individuals are held responsible for some, but not all, factors that affect their health. Informational problems, however, often make it difficult to implement the ideal of equal opportunity in the context of healthcare. (...) In this paper, examples are considered of how new genetic information may affect the way individual responsibility for choice is assigned. It is also argued that genomics may result in relocation of the responsibility cut by providing both new information and new technology. Finally, how genomics may affect healthcare policies and the market for health insurance is discussed. (shrink)
Background: Legislation on physician-assisted suicide is being considered in a number of states since the passage of the Oregon Death With Dignity Act in 1994. Opinion assessment surveys have historically assessed particular subsets of physicians.Objective: To determine variables predictive of physicians’ opinions on PAS in a rural state, Vermont, USA.Design: Cross-sectional mailing survey.Participants: 1052 physicians licensed by the state of Vermont.Results: Of the respondents, 38.2% believed PAS should be legalised, 16.0% believed it should be prohibited and 26.0% believed it should (...) not be legislated. 15.7% were undecided. Males were more likely than females to favour legalisation . Physicians who did not care for patients through the end of life were significantly more likely to favour legalisation of PAS than physicians who do care for patients with terminal illness . 30% of the respondents had experienced a request for assistance with suicide.Conclusions: Vermont physicians’ opinions on the legalisation of PAS is sharply polarised. Patient autonomy was a factor strongly associated with opinions in favour of legalisation, whereas the sanctity of the doctor–patient relationship was strongly associated with opinions in favour of not legislating PAS. Those in favour of making PAS illegal overwhelmingly cited moral and ethical beliefs as factors in their opinion. Although opinions on legalisation appear to be based on firmly held beliefs, approximately half of Vermont physicians who responded to the survey agree that there is a need for more education in palliative care and pain management. (shrink)
These essays deal with central and controversial issues in jurisprudence. This volume emphasizes legal theory, and the collection will be of interest to students of and others involved with political philosophy as well as law students and philosophers.
The late Jacob Klein’s important book is, remarkably, a lucid presentation of esoteric argument. Dealing with the famed Platonic triad, Theaetetus, Sophist, and Statesman, Klein settles the dispute about the missing dialogue, "The Philosopher," by first denying that it is missing and second showing that it is unnecessary. He argues, in short, that the triad is a dyad. That argument is reinforced by the distinction Klein strongly implies between the Socratic Theaetetus and the Eleatic Sophist and Statesman. "We can now (...) understand why the conversations of the ‘trilogy’ occur in two, not three, days and why the Sophist, the Statesman, and the Philosopher are dealt with in two, not three, dialogues". (shrink)
"The drama Nietzsche has written is for the future Greeks." This somber note is the tonic both for the major and minor elements of Alderman’s Nietzsche’s Gift. The "drama" refers to Also Sprach Zarathustra, the central text in Alderman’s interpretation. The intention of placing Nietzsche centrally in the stream of philosophic creation is the minor theme.
An illuminating guide to the pervasiveness and intricacies of law and an ideal invitation for those interested in its mechanics, purposes and functions. It is a thorough guide to a mysterious and complex institution and profession.