At least from the standpoint of contemporary cultural and ethical resources, physicians have argued eloquently and exhaustively both for and against physician-assisted suicide. If one avoids the temptation to ruthlessly simplify either position to immorality or error, then a strange dilemma arises. How is it that well educated and intelligent physicians, committed strongly and compassionately to the care of their patients, argue adamantly for opposing positions? Thus rather than simply rehashing old arguments, this essay attempts to rethink the nature (...) of human morality as both a source and a fracturing of human rationality – and with morality, the question of human nature in the context of violence, oppression, service, and obligation. This interpretation of moral life is laid out roughly along the lines of the Jewish philosopher Emmanuel Levinas, and further clarified through a discussion of the Hippocratic Oath. These resources are then brought to bear on the specific arguments and recommendations concerning physician-assisted suicide. (shrink)

At least from the standpoint of contemporary cultural and ethical resources, physicians have argued eloquently and exhaustively both for and against physician-assisted suicide. If one avoids the temptation to ruthlessly simplify either position to immorality or error, then a strange dilemma arises. How is it that well educated and intelligent physicians, committed strongly and compassionately to the care of their patients, argue adamantly for opposing positions? Thus rather than simply rehashing old arguments, this essay attempts to rethink the nature (...) of human morality as both a source and a fracturing of human rationality – and with morality, the question of human nature in the context of violence, oppression, service, and obligation. This interpretation of moral life is laid out roughly along the lines of the Jewish philosopher Emmanuel Levinas, and further clarified through a discussion of the Hippocratic Oath. These resources are then brought to bear on the specific arguments and recommendations concerning physician-assisted suicide. (shrink)

In this paper, I supplement T. A. Cavanaugh’s arguments against physician-assisted suicide in his book, Hippocrates’ Oath and Asclepius’ Snake, by focusing more specifically on the dangers of the misuse of physician power and on the virtues essential to restrain such power. Since Cavanaugh’s starting point is similar to Edmund Pellegrino’s views on the fundamental ends of medicine, I start with the question of the proper ends of medicine. Cavanaugh’s interpretation of the Hippocratic Oath as the limitation of (...) physician power to heal and to kill raises the issue of the proper use of physician power over the patient. In order to support and strengthen Cavanaugh’s case, I use Richard Zaner’s discussion of physician power over the patient and the attendant duty to use such power in a responsible way. Finally, I supplement Cavanaugh’s discussion with a fuller account of physician virtues as they relate to physician-assisted suicide. I first discuss the ends of medicine, medical power, and physician-assisted suicide. Second, I discuss the relationship between virtue and physician-assisted suicide. Third, I draw some final conclusions. (shrink)

The euthanasia literature typically discusses the difference between “active” and “passive” means of ending a patient’s life. Physician-assisted suicide differs from both active and passive forms of euthanasia insofar as the physician does not administer the means of suicide to the patient. Instead, she merely prescribes and dispenses them to the patient and lets the patient “do the rest” – if and when the patient chooses. One supposed advantage of this process is that it maximizes the patient’s autonomy with (...) respect to both her decision to die and the dying process itself. Still, despite this supposed advantage, Oregon is the only state to have legalized physician-assisted suicide. After summarizing the most important Supreme Court opinions on euthanasia (namely, Cruzan v. Director, Missouri Dep’t of Health; Vacco v. Quill; Washington v. Glucksberg; and Gonzales v. Oregon), this paper argues that while there are no strong ethical reasons against legalizing physician-assisted suicide, there are some very strong policy reasons for keeping it criminal in the other forty-nine states. (shrink)

T. A. Cavanaugh's Hippocrates' Oath and Asclepius' Snake: The Birth of the Medical Profession articulates the Oath as establishing the medical profession's unique internal medical ethic - in its most basic and least controvertible form, this ethic mandates that physicians help and not harm the sick. Relying on Greek myth, drama, and medical experience (e.g., homeopathy), the book shows how this medical ethic arose from reflection on the most vexing medical-ethical problem -- injury caused by a physician -- and argues (...) that deliberate iatrogenic harm, especially the harm of a doctor choosing to kill (physician assisted suicide, euthanasia, abortion, and involvement in capital punishment), amounts to an abandonment of medicine as an exclusively therapeutic profession. The book argues that medicine as a profession necessarily involves stating before others what one stands for: the good one seeks and the bad one seeks to avoid on behalf of the sick, and rejects the view that medicine is purely a technique lacking its own unique internal ethic. It concludes noting that medical promising (as found in the White Coat Ceremony through which U. S. medical students matriculate) implicates medical autonomy which in turn merits respect, including honoring professional conscientious objections. (shrink)

This is a review of a book by the physician Uwe-Christian Arnold pleading for the right to assisted suicide. Arnold who has accompanied several patients to their end opens his book with several case studies. In the second part A. discusses the arguments against assisted suicide. One of the arguments is based on a reading of the Hippocratic Oath which is shared also by A. As against this reading, I argue that in this text the doctor is (...) not committed to withholding a poison from his patient, but rather to be no part as an accomplice in a poisoning ordered or wished for by a third party. Given the very painful dying caused by the poisons known in antiquity it is in itself rather unlikely that a patient wanting to commit suicide did asked his doctor for a poison. In the third part of the book, A. argues against the slippery slope argument brought forward by people like the catholic philosopher R. Spaemann. Pointing to empirical evidence from US-states as Oregon, A. insists that allowing assisted suicide has helped to enhance palliative medical care and reduced the number of suicides. (shrink)

This is a condensed description of the contents and overarching argument found in Hippocrates’ Oath and Asclepius’ Snake: The Birth of the Medical Profession. In that work, I maintain that the basic medical ethical problem concerns iatrogenic harm. I focus particularly on what I refer to as ‘role-conflation’. This most egregious form of iatrogenic harm occurs when a physician deliberately adopts the role of wounder. A contemporary practice such as physician-assisted suicide exemplifies a doctor’s deliberate wounding. I argue that (...) the author of the Hippocratic Oath – aware of the chronic risk of role-conflation – responds to this threat by having the oath-taker specifically forswear signal acts that wound the sick, such as giving a deadly drug even if asked, giving an abortifacient, sexual predation, and gossiping. I argue that by means of the Oath, Hippocrates founds medicine as a profession, a practice intimately involving promising. (shrink)

In brief compass, I will touch on three of the central ethical and public policy issues that divide those who are opposed to physician-assisted dying from those who are supportive of this practice. These are: the moral distinction between actively hastening death and passively allowing to die; how to interpret the Hippocratic tradition in medicine with respect to physician-assisted death; and whether physician-assisted suicide can be effectively regulated. I shall summarize the arguments pro and con with (...) respect to each issue, and also indicate my own position. (shrink)

Euthanasia and rational suicide were acceptable practices in some quarters in antiquity. These practices all but disappeared as Hippocratic, Jewish, Christian, and Muslim beliefs took hold in Europe and the Near East. By the late nineteenth century, however, a political movement to legalize euthanasia and physician-assisted suicide (PAS) began in Europe and the United States. Initially, the path to legalization was filled with obstacles, especially in the United States. In the last few decades, however, several Western nations have (...) legalized euthanasia, and several US jurisdictions have now legalized PAS, giving state sanction to these once forbidden practices. With increasing social and political pressure to accept PAS, Christians need to understand how to think about this issue from an explicitly Christian perspective. Independent of the question of legalization, there are significant theological and ethical questions. This special issue aims to address those concerns, including: how does the practice of PAS or euthanasia impact our attitudes toward death, and what does it mean to “die well?” Should physicians, as healers, be involved in assisting patients who wish to bring about their own death? Are these methods significantly distinguished from other ethically justified practices in end-of-life care that also lead to a person’s death? Can Christians, both as patients and practitioners, justify the use of these methods to relieve suffering in this manner as compatible with the faith? Although these questions are not new to the debate, it is increasingly important that these controversies are addressed as the practice of PAS is popularized. (shrink)

This paper evaluates the arguments against physician assisted suicide which contend that it violates the integrity of medicine and the physician-patient relation; i.e. that it contradicts the goal of seeking health and healing, violates an absolute prohibition against killing, and undermines the patient's trust in the physician. These arguments against physician assisted suicide (1) misuse notions of teleology and teleological explanation; (2) rely on inappropriate notions of "ideal medicine", for which death is a defeat; (3) turn on a (...) highly selective reading for the Hippocratic tradition; and (4) are unacceptably paternalistic. Keywords: Hippocratic ethics, integrity in medicine, physician assisted suicide, physician-patient relation CiteULike Connotea Del.icio.us What's this? (shrink)

According to Aristotle, the medical art aims at health, which is a virtue of the body, and does so in an unlimited way. Consequently, medicine does not determine the extent to which health should be pursued, and “mental health” falls under medicine only via pros hen predication. Because medicine is inherently oriented to its end, it produces health in accordance with its nature and disease contrary to its nature—even when disease is good for the patient. Aristotle’s politician understands that this (...) inherent orientation can be systematically distorted, and so would see the need for something like the Hippocratic Oath. (shrink)

Euthanasia and physician-assisted suicide are controversial issues in medical ethics and medical law. In the debate, several arguments against the moral acceptability and legal feasibility of active involvement of physicians in bringing about a patient’s death can be found.One argument refers back to the Ten Commandments: “Thou shall not kill”. Killing another human being is morally abject. According to the argument, this is certainly so for medical doctors, as can be seen in the Hippocratic Oath, which explicitly forbids (...) abortion and euthanasia. A less apodictic argument refers to the slippery slope: if euthanasia would be permitted, a downhill movement is set in motion. The end of this movement would be, on the one hand, that physicians will feel forced to assist people who ask for termination of life on whatever grounds. On the other hand, it might lead to a situation in which it becomes normal to kill people who are no longer useful for society.In the literature and in the public debate, there are also arguments in favour of euthanasia and physician-assisted suicide. One such argument invokes the right to die. According to this argument, decisions concerning life and death should be up to the individual who is concerned. In many countries, suicide is morally and legally accepted. If people are allowed to kill themselves, why should they be without rights when they are no longer able to perform the act themselves?In medical ethics and medical law, patient autonomy is a central pivot. Patients have the right to refuse treatment even if this leads to their death. Shouldn’t people also have the right to determine the moment of dying, if they are in a situation which is unbearable, and without prospect of improvement? Another argument focuses on the duty of the physician to alleviate pain and suffering. If there is no other option, the doctor, in fulfilling this duty, should be allowed to actively end the patient’s life. This argument is not based on autonomy, but on beneficence.The debate concerning euthanasia involves fundamentally different moral principles. This makes the debate interesting, if not central to medical ethics and medical law. Yet, the principles are normally presented in an abstract way. Discussants stick to very general ideas, which lack reference to specific social and historical conditions, and are not related to concrete experiences. To invoke the Ten Commandments, or plea for a right to die, implies the use of universal standards, which tend to be general and empty.From a philosophical perspective, this type of argumentation can be criticized. Following Aristotle, ethics should be based upon experience. Ethical knowledge requires participation in concrete practices. Central to ethics is a feeling for the concrete situation, which is always contingent and historical. From this perspective, it makes sense to consider how practitioners in specific situations deal with moral issues, for instance concerning euthanasia. What role do they give to notions such as autonomy and beneficence, how do they interpret them and apply them to the concrete situation?In this paper I will present the Dutch experience with euthanasia. I will focus upon the way in which during the past thirty years the arguments in favour of euthanasia have been developed, in interaction with euthanasia practice. I will show that patient autonomy has been a crucial pivot. Yet, the Dutch interpretation of autonomy is not purely liberal. It does not only involve rights, but also obligations. Next, I will make clear that the physician plays a central role, in that the moral and legal basis of euthanasia is a conflict of duties on the side of the physician.This brings in the issue of beneficence. Yet the Dutch interpretation of the duty to help is not simply paternalistic. In Dutch health care, the physician-patient relationship is based upon deliberation and mutual agreement. Therefore, my conclusion will be that the Dutch practice of euthanasia has a moral ground, which goes beyond the traditional opposition between autonomy and beneficence. (shrink)

A physician says, "I have an ethical obligation never to cause the death of a patient," another responds, "My ethical obligation is to relieve pain even if the patient dies." The current argument over the role of physicians in assisting patients to die constantly refers to the ethical duties of the profession. References to the Hippocratic Oath are often heard. Many modern problems, from assisted suicide to accessible health care, raise questions about the traditional ethics of medicine and (...) the medical profession. However, few know what the traditional ethics are and how they came into being. This book provides a brief tour of the complex story of medical ethics evolved over centuries in both Western and Eastern culture. It sets this story in the social and cultural contexts in which the work of healing was practiced and suggests that, behind the many different perceptions about the ethical duties of physicians, certain themes appear constantly, and may be relevant to modern debates. The book begins with the Hippocratic medicine of ancient Greece, moves through the Middle Ages, Renaissance and Enlightenment in Europe, and the long history of Indian and Chinese medicine, ending as the problems raised modern medical science and technology challenge the settled ethics of the long tradition. (shrink)

Among the oldest extant medical ethics, the Hippocratic Oath prohibits the giving of a deadly drug, regarding this act as an egregious violation of a medical ethic that is exclusively therapeutic. Proportionate palliative sedation involves the administration of a deadly drug. Hence it seems to violate the venerable Hippocratic promise associated with the dawn of Western medicine not to give a deadly drug. Relying on distinctions commonly employed in the analysis and evaluation of human actions, this article distinguishes (...) physician-assisted suicide and euthanasia, as acts that necessarily violate the prohibition against giving a deadly drug, from proportionate palliative sedation, as an act that does not. (shrink)

This short work examines what the Hippocratic Oath said to Greek physicians 2400 years ago and reflects on its relevance to medical ethics today. Drawing on the writings of ancient physicians, Greek playwrights, and modern scholars, each chapter explores one passage of the Oath and concludes with a modern case discussion. This book is for anyone who loves medicine and is concerned about the ethics and history of the profession.

This short work examines what the Hippocratic Oath said to Greek physicians 2400 years ago and reflects on its relevance to medical ethics today. Drawing on the writings of ancient physicians, Greek playwrights, and modern scholars, each chapter explores one passage of the Oath and concludes with a modern case discussion. This book is for anyone who loves medicine and is concerned about the ethics and history of the profession.

While the consequences of mathematically-based software, algorithms and strategies have become ever wider and better appreciated, ethical reflection on mathematics has remained primitive. We review the somewhat disconnected suggestions of commentators in recent decades with a view to piecing together a coherent approach to ethics in mathematics. Calls for a Hippocratic Oath for mathematicians are examined and it is concluded that while lessons can be learned from the medical profession, the relation of mathematicians to those affected by their work (...) is significantly different. There is something to be learned also from the codes of conduct of cognate but professionalised quantitative disciplines such as engineering and accountancy, as well as from legal principles bearing on professional work. We conclude with recommendations that professional societies in mathematics should sponsor an (international) code of ethics, institutional mission statements for mathematicians and syllabuses of ethics courses for incorporation into mathematics degrees. (shrink)

The Hippocratic Oath and the Declaration of Geneva of the World Medical Association are compared in terms of content and origin. Their relevance for current medical practice is investigated. The status which is ascribed to these documents will be shown and the status which they can reasonably claim to have will be explored. Arguments in favor of the Hippocratic Oath that rely on historical stability or historical origin are being examined. It is demonstrated that they get caught up (...) in paradoxes. Should doctors swear the Hippocratic Oath or the Declaration of Geneva? The Hippocratic Oath is a remarkable historic document, which contains important elements still relevant for medical ethics today. Its interpretation as a timeless, still valid medical code is unfounded. The historical arguments, that should justify its validity, are untenable. The Declaration of Geneva, and not the Hippocratic Oath, can legitimately claim to come close to representing the most important principles of professional medical conduct in today’s globalised world. (shrink)

As an example of Aristotle's genre of epideictic, or ceremonial rhetoric, the Hippocratic Oath has the capacity to persuade its self-addressing audience to appreciate the value of the medical profession by lending an element of stability to the shifting ethos of health care. However, the values it celebrates do not accurately capture communally shared norms about contemporary medical practice. Its multiple and sometimes conflicting versions, anachronistic references, and injunctions that resist translation into specific conduct diminish its longer-term persuasive force. (...) Only when expunged of these elements and reconstructed using values over which there is widespread agreement can the Oath succeed in moving its audience from core values located in past discussions to principled action in the future. (shrink)

Medicine was until recently a greatly respected profession supported by trust and faith on one side and compassion and care on the other. However, over the years, the relationship between doctors and patients has suffered. Doctors now find themselves in the news for all the wrong reasons. Labelled as 'murderers', 'knife happy', 'organ stealing thieves' or touts of pharmaceutical giants, they have now lost respect in the eyes of society. When and how did this happen? When did doctors go from (...) being 'Next to God' to maut ke saudagar, as the media is so fond of labelling them? Hippocratic Oath or Hypocrisy?: Doctors at Crossroads is the author's journey as a doctor over three decades, from a young medical student to an experienced paediatrician. She has used her experience to highlight serious issues--demanding patients, prescribing of unnecessary investigations, hospitals run like business houses, the role of big pharmaceutical industries and so on from the point of view of both doctors and patients. (shrink)

The Hippocratic Oath, the Hippocratic tradition, and Hippocratic ethics are widely invoked in the popular medical culture as conveying a direction to medical practice and the medical profession. This study critically addresses these invocations of Hippocratic guideposts, noting that reliance on the Hippocratic ethos and the Oath requires establishingwhat the Oath meant to its author, its original community of reception, and generally for ancient medicine what relationships contemporary invocations of the Oath and the tradition have (...) to the original meaning of the Oath and its original reception what continuity exists and under what circumstances over the last two-and-a-half millenniums of medical-moral reflections what continuity there is in the meaning of professionalism from the time of Hippocrates to the 21st century, and what social factors in particular have transformed the medical profession in particular countries. This article argues that the resources for a better understanding of medical professionalism lie not in the Hippocratic Oath, tradition, or ethos in and of themselves. Rather, it must be found in a philosophy of medicine that explores the values internal to medicine, thus providing a medical-moral philosophy so as to be able to resist the deformation of medical professionalism by bioethics, biopolitics, and governmental regulation. The Oath, as well as Stephen H. Miles' recent monograph, The Hippocratic Oath and the Ethics of Medicine, are employed as heuristics, so as to throw into better light the extent to which the Hippocratic Oath, tradition, and ethics can provide guidance and direction, as well as to show the necessity of taking seriously the need for a substantive philosophy of medicine. (shrink)

In this paper I ask whether mathematicians should swear an oath similar to the Hippocratic oath sworn by some medical professionals as a means to foster morally praiseworthy engagement with the ethical dimensions of mathematics. I individuate four dimensions in which mathematics is ethically charged: (1) applying mathematical knowledge to the world can cause harm, (2) participation of mathematicians in morally contentious practices is an ethical issue, (3) mathematics as a social activity faces relevant ethical concerns, (4) mathematical knowledge (...) itself may be ethically charged. I present a conceptual framework for oaths and discuss some empirical results on the effectiveness of oath-taking to foster morally praiseworthy behaviour. My findings suggest that enforcing oath-taking practices in mathematics is not currently a suitable means to foster ethically praiseworthy behaviour amongst mathematicians. Oaths can, however, provide needed edifying narratives about how to act ethically when acting as a mathematician. (shrink)

This article specifies the place of the Hippocratic Oath in the programme of bioethical education on graduate schools where future medical and healthcare workers are being educated. The presented conceptualization of contents and described methodology of work show how the curriculum contents, dominated by historical facts, are being actualized by the use of knowledge students have acquired earlier, and problematized by an active inclusion of students in collecting new information relevant for the content, and then using the acquired knowledge (...) to solve a concrete bioethical issue or problem. The offered activity of students and teacher has the purpose to demonstrate a collaborative relationship between students and teacher and a communication in which students and teacher mutually takeover tasks for the realisation of the curriculum content. (shrink)

Contributors explore the social, medical, and ethical dilemma of assisted suicide in this revised edition that includes international as well as domestic viewpoints. The federal government's continued challenges to Oregon's Death with Dignity Act, the disabled community's response to assisted suicide, and the slippery slope argument are all examined.

The "California Compassionate Choices Act," AB 374, is inching its way into the voter's booth. Are you ready to vote for or against physician-assisted suicide? California is not the only state facing this issue, and as a responsible citizen you will not be able to escape taking a position on this important social and personal moral question. This collection of essays was gleaned from the Jack W. Provonsha Lecture Series on physician-assisted suicide. Representing a variety of religious perspectives, (...) the speakers address this topic in the hope that you will be more informed and better able to face this issue. (shrink)

ABSTRACTIn this paper, I examine the arguments against physician assisted suicide . Many of these arguments are consequentialist. Consequentialist arguments rely on empirical claims about the future and thus their strength depends on how likely it is that the predictions will be realized. I discuss these predictions against the backdrop of Oregon's Death with Dignity Act and the practice of PAS in the Netherlands. I then turn to a specific consequentialist argument against PAS – Susan M. Wolf's feminist critique (...) of the practice. Finally, I examine the two most prominent deontological arguments against PAS. Ultimately, I conclude that no anti‐PAS argument has merit. Although I do not provide positive arguments for PAS, if none of the arguments against it are strong, we have no reason not to legalize it. (shrink)

In this paper, we analyze the legal situation regarding physician-assisted suicide in the world. Our hypothesis is that the prohibitive stance on physician-assisted suicide in most societies in the world today seems to be related to our moral attitudes toward suicide. This brings us to a discussion about life itself. We claim that the total lack of legal protection for physician-assisted suicide from international organizations and most countries in the world lies in a philosophical assumption that supports (...) much of our common beliefs about what life really is. This assumption states that life must be thought of as not belonging exclusively to the individual. We argue that this assumption is a misconception that can be heard in the debate on suicide. Consequently we endorse a different conception of life which tends to favor a pro-choice stance towards suicide and assisted death in general. This position takes the patient’s decision about when to die more seriously. We conclude that there is no reason why physician-assisted suicide does not deserve legal protection as an individual right to die under international law. (shrink)

Assisting suicide is legal in Switzerland if it is offered without selfish motive to a person with decision-making capacity. Although the ‘Swiss model’ for suicide assistance has been extensively described in the literature, the formally and informally protected liberties and claims of assistors and recipients of suicide assistance in Switzerland are incompletely captured in the literature. In this article, we describe the package of rights involved in the ‘Swiss model’ using the framework of Hohfeldian rights as modified by Wenar. After (...) outlining this framework, we dissect the rights involved in suicide assistance in Switzerland, and compare it with the situation in England and Germany. Based on this approach, we conclude that in Switzerland, claim rights exist for those requesting suicide assistance, and for those who are considering providing such assistance, even though no entitlements exist toward suicide assistance. We then describe the implementation of the ‘Swiss model’ and difficulties arising within it. Clarifying these issues is important to understand the Swiss situation, to evaluate what features of it may or may not be worth correcting or emulating, and to understand how it can impact requests for suicide assistance in other countries due to ‘suicide tourism’. It is also important to understand exactly what sets Switzerland apart from other countries with different legislations regarding suicide assistance. (shrink)

Assisting suicide is legal in Switzerland if it is offered without selfish motive to a person with decision-making capacity. Although the ‘Swiss model’ for suicide assistance has been extensively described in the literature, the formally and informally protected liberties and claims of assistors and recipients of suicide assistance in Switzerland are incompletely captured in the literature. In this article, we describe the package of rights involved in the ‘Swiss model’ using the framework of Hohfeldian rights as modified by Wenar. After (...) outlining this framework, we dissect the rights involved in suicide assistance in Switzerland, and compare it with the situation in England and Germany. Based on this approach, we conclude that in Switzerland, claim rights exist for those requesting suicide assistance, and for those who are considering providing such assistance, even though no entitlements exist toward suicide assistance. We then describe the implementation of the ‘Swiss model’ and difficulties arising within it. Clarifying these issues is important to understand the Swiss situation, to evaluate what features of it may or may not be worth correcting or emulating, and to understand how it can impact requests for suicide assistance in other countries due to ‘suicide tourism’. It is also important to understand exactly what sets Switzerland apart from other countries with different legislations regarding suicide assistance. (shrink)

As medical technology advances and severely injured or ill people can be kept alive and functioning long beyond what was previously medically possible, the debate surrounding the ethics of end-of-life care and quality-of-life issues has grown more urgent. In this lucid and vigorous book, Craig Paterson discusses assisted suicide and euthanasia from a fully fledged but non-dogmatic secular natural law perspective. He rehabilitates and revitalises the natural law approach to moral reasoning by developing a pluralistic account of just why (...) we are required by practical rationality to respect and not violate key demands generated by the primary goods of persons, especially human life. Important issues that shape the moral quality of an action are explained and analysed: intention/foresight; action/omission; action/consequences; killing/letting die; innocence/non-innocence; person/non-person. Paterson defends the central normative proposition that ’it is always a serious moral wrong to intentionally kill an innocent human person, whether self or another, notwithstanding any further appeal to consequences or motive’. (shrink)

The debate about physician-assisted suicide has long been entwined with the nature of the doctor–patient relationship. Opponents of physician-assisted suicide insist that the traditional goals of medicine do not and should not include intentionally bringing about or hastening a patient’s death, whereas proponents of physician-assisted suicide argue that this practice is an appropriate tool for doctors to relieve a patient’s suffering. In this article, I discuss these issues in light of the relevance of a Christian account of (...) the doctor–patient relationship. I argue that Christians typically object to assist suicide independently of the doctor–patient relationship. I argue that a focus on the Christian virtues of charity, compassion, and humility helps to explain why doctors should not assist their patients in suicide. (shrink)

According to the “discrimination argument,” it would be discriminatory and hence impermissible to categorically exclude people with mental illness (PMI) from access to assisted suicide (AS) if AS is accessible to people with somatic illnesses. In objection to this, it could be argued that excluding PMI is not discriminatory, but rather based on their inability to meet certain eligibility criteria for AS. Which criteria are deemed necessary depends on the approach taken to justifying AS. In this article, we describe (...) two distinct ethical approaches to justifying AS and the eligibility criteria they entail and examine whether PMI can fulfill these criteria. A widespread “joint” approach based on beneficence and autonomy assumes that AS is justified when it alleviates the severe and irremediable suffering of a person who autonomously requests AS. An alternative, exclusively autonomy‐based approach assumes that providing AS is justified when a person's request is autonomous, regardless of whether AS is in her best interests. The latter approach underlies an important judgment of the German Federal Constitutional Court from 2020. We argue that PMI can in principle fulfill both beneficence‐ and autonomy‐based eligibility criteria for AS, and that a blanket exclusion of all PMI from AS is thus discriminatory on either approach. However, depending on which approach is taken, there are differences regarding the subgroups of PMI that would be eligible for AS. Whether the exclusion of specific PMI is discriminatory therefore depends on how we understand and justify AS. (shrink)

Assisted suicide, many argue, honors self‐determination in returning control of their dying to patients themselves. But physician assistance and measures proposed to safeguard patients from coercion in fact return ultimate authority over this “private and deeply personal” decision to medicine and society.

Kevin Yuill goes straight to the heart of a difficult issue. Critical of both sides of the discussion, this book presents an up-to-date analysis of the direction discussion is taking, showing that atheists, libertarians, those favouring abortion rights and stem-cell research should stand beside their religious compatriots in opposing legalization of assisted suicide. The author shows that the real issue behind the debate is not euthanasia but suicide. Rather than focusing on tragic cases, he indicates the real damage that (...) will be done if we affirm the suicidal wishes of even a small segment of the population. Analyzing the movement for the right to die in historical terms, Yuill shows that, though many proponents of a change in the law believe they are rationalist heirs of such thinkers as John Stuart Mill, legalizing assisted suicide will reduce privacy and freedom. Finally, Yuill suggests a radical alternative to legalization of assisted suicide that would embrace both the cause of freedom and the anxieties of many about securing good deaths. (shrink)

Slippery slope argumentation features prominently in debates over assisted suicide. The jurisdiction of Oregon features prominently too, especially as regards parliamentary scrutiny of assisted suicide proposals. This paper examines Oregon’s public data (including certain official pronouncements) on assisted suicide in light of the two basic versions of the slippery slope argument, the empirical and moral-logical versions. Oregon’s data evidences some normatively interesting shifts in its assisted suicide practice which in turn prompts consideration of two elements of (...) moral-logical slippage that are not widely discussed. One is slippage from an initial autonomy-based public justification for assisted suicide which does not include burden-based concerns within its operative account of voluntariness to an evolved public justification that does. The other is an expansion of a terminal illness ground to include chronic illnesses effectively rendered terminal via a refusal of treatment. (shrink)

Euthanasia and assisted suicide have proved to be very contentious topics in medical ethics. Some ethicists are particularly concerned that allowing physicians to carry out these procedures will undermine their professional obligations and threaten the very goals of medicine. However, I maintain that the fundamental goals of medicine not only do not preclude the practice of euthanasia and assisted suicide by physicians, but can in fact be seen to support these practices in some instances. I look at two (...) influential views of the goals of medicine, one based on the broad guiding principles of autonomy, beneficence and nonmaleficence, and the other focusing on several more concrete aims, concluding that both approaches can be seen to support euthanasia and assisted suicide. I then turn to the popular concern that allowing physicians to carry out euthanasia and assisted suicide will lead to widespread abuse. I argue that the possibility for abuse can be minimised if we make the patient's autonomous consent an essential requirement of the practice. (shrink)

Brussen, Kerri Anne This paper is a brief history of suicide, euthanasia, and physician assisted suicide in the United States of America which aims to provide an understanding of the continued and persistent effort in the USA to legalise physician assisted suicide. Oregon and Washington State Dying with Dignity Laws are reviewed as examples of legalised physician assisted suicide.

In the United States, judicialrulings that unrealistically addressed the complexityof cases and demonstrated limited understanding ofprinciples, helped to create a legal quagmire whichlegislatures had to confront. Moreover, thelegislative response was often slow and inadequate interms of both the scope and clarity of the laws. However, since the 1970s, progress has been made onmany fronts, particularly in regard to advancedirectives dealing with end-of-life decisions. Thedebate over physician-assisted suicide has spawned arepetition of moral and legal arguments. Thoseagainst legalization have failed to (...) make a realisticappraisal of the dilemmas facing patients and theirfamilies in an age of technological medicine deliveredin the context of the marketplace. The underlyingproblem is a system in dire need of reform that willno longer treat health care as a commodity of themarketplace and provide universal health care. Terminal care as an integral part of health care willsubstantially benefit from such reforms because amajor obstacle to comprehensive palliative care is thecondition of the present system. (shrink)

In an age of rapid advances inlife-prolonging treatment, patients and caregivers areincreasingly facing tensions in making end-of-lifedecisions. An examination of the history of healthcare in the United States reveals technological,economic, and medical factors that have contributed tothe problems of terminal care and consequently to themovement of assisted suicide. The movement has itsroots in at least two fundamental perceptions andexpectations. In the age of technological medicineenergized by the profit motive, dying comes at a highprice in suffering and in personal economic (...) loss. Thefailure to provide affordable resources for terminalcare is the result of the marketplace in health care. The medical profession has been painfully slow inresponding to the challenges of terminal care, mainlybecause of the pressures of the marketplace and lackof adequate training. This has occurred at a time ofrapid advances in life-sustaining treatment and ofexpanding public awareness of personal rights underthe law. Overly aggressive treatment in the finalstages of terminal illness has enhanced anxieties overa painfully prolonged and expensive dying. Thesefactors have promoted the movement to assistedsuicide. In the U.S. debate of the issues, ethiciststend to argue abstractly without examiningadequately the context of terminal care that is thehealth care system. It is a system in dire need of areform that will remove it from the marketplace. (shrink)