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PubMed1992

The legal consensus about foregoing life-sustaining treatment: its status and its prospects.

The legal consensus that has evolved through adjudication and legislation since the Karen Quinlan case in 1976 is founded on the premise that there is a bright line between passive euthanasia and active euthanasia. Indeed, the term passive euthanasia is often eschewed in favor of less emotionally-laden terminology such as "forgoing life-sustaining treatment" or "terminating life support" so as to further sever any possible connection with active euthanasia. Legal approval has been bestowed upon passive euthanasia under certain circumstances while active euthanasia is routinely condemned. This consensus was put to a test in 1990 when the United States Supreme Court ruled on the Cruzan case. However, the Court's narrow decision did not upset the consensus, and in the most significant appellate decisions handed down by state courts since Cruzan, there has been a reaffirmation--and possibly even an extension--of the consensus. Two other threats to the legal consensus about forgoing life-sustaining treatment have begun to manifest themselves: the increasing pressure for mercy killing and "futility" cases. Both of these challenge the fundamental premises on which the consensus is grounded.

Advance Directives↗
PubMed2002

Euthanasia, assisted suicide, and cessation of life support: Japan's policy, law, and an analysis of whistle blowing in two recent mercy killing cases.

Issues pertaining to euthanasia, assisted suicide, and cessation of life support continue to be a subject of worldwide interest. Euthanasia- particularly "active" euthanasia- is not considered legally or socially acceptable in most countries. In Japan, the first judgment of a case involving euthanasia took place in 1949. Since then there have been another five cases that reached the point of sentencing in 1990. All six cases were examples of so called "active euthanasia", in which the termination of life was performed by family members. However, the focus of discussion has been changed dramatically in recent years, owing to two prominent cases of mercy killing in 1995 (Yokohama) and 1996 (Kyoto), respectively. Medical doctors were involved in both of these cases, and euthanasia moved from being a theoretical problem to a practical dilemma. These cases also drew attention to the fact that assisted suicide could be distinguished from euthanasia. The first part of this paper will summarize the current status of euthanasia and the cessation of life support in Japan, focusing on its historical background and policy. The second part will briefly sketch the characteristics of Japanese law and then will examine the two recent cases of mercy killing mentioned above to try and determine the roles of whistle blowing in the medical practice arena, with particular reference to Japanese culture. This analysis is a challenge to elucidate how ethics and the law interact, and influence medical practice in a specific cultural context.

Culture↗
PubMed1993

[The current panorama of euthanasia in Spain].

Due to the fact of the continuous advances of medical technology, physicians are able to prolong life even in those patients who suffer from a terminal illness to whom no hope to recover from it is left. Frequently the use or not of different therapies on these type of patients is questioned, who demand the autonomy over the self person to decide the cessation of a treatment. That is why it was proposed to investigate on the opinions and attitudes on the omission or cessation of treatments which could prolong life (passive euthanasia) or active euthanasia in terminal patients. A survey, which preserved the confidentiality of patients, was done in which 1,109 individuals took part coming from three different sectors of the population: hospital health professionals (physicians n = 346 and nurses n = 346) from San Carlos University Hospital, Madrid; students (n = 261) from Madrid Complutense University, and retired individuals (n = 156) from an elderly people club located at the Madrid province (Pinto). Sample was formed by 40% of males and 60% of females, with ages between 20 and 90 years. Most of the surveyed people agreed in certain circumstances or totally agree with omission or cessation of drugs which could prolong life (passive euthanasia) in terminal patients (70%). Regarding active euthanasia more than half (55%) opposed to it, 34% agreed in certain circumstances and 10% agreed completely. Significant differences were detected (p < 0.05) related to age, religious beliefs and political thoughts of the subjects. These results are compared to others already available.

Adult↗
PubMed1995

Attitudes of Dutch general practitioners and nursing home physicians to active voluntary euthanasia and physician-assisted suicide.

OBJECTIVE: To gain insight into the attitudes of Dutch general practitioners and nursing home physicians to voluntary active euthanasia and physician-assisted suicide. DESIGN: Descriptive study. METHOD: Data were collected by means of anonymous postal questionnaires to be completed by a random sample of 521 general practitioners from the province of North Holland, 521 general practitioners from the rest of the Netherlands, and 713 Dutch nursing home physicians who were members of the Dutch Association of Nursing Home Physicians. RESULTS: The written responses of general practitioners and nursing home physicians to six statements about voluntary active euthanasia and physician-assisted suicide showed that a large majority had a fairly positive attitude to euthanasia and suicide. This finding also emerged from the scores obtained on a scale compiled on the basis of the statements. General practitioners and nursing home physicians were more opposed to euthanasia and physician-assisted suicide if they had never performed it, if they belonged to a religious group, or if they were older. CONCLUSION: Dutch general practitioners and nursing home physicians have a fairly positive attitude toward euthanasia and physician-assisted suicide. However, the majority of these physicians favor a policy of voluntary active euthanasia and physician-assisted suicide under strict conditions.

Age Factors↗
PubMed1998

Advance directives and other medical decisions concerning the end of life in cancer patients in Japan.

The purpose of our survey was to investigate the experience of physicians regarding advance directives and other medical decisions concerning the end of life. A postal questionnaire was sent to 500 Japanese physicians who were most involved in medical care of terminal patients. A total of 339 (68%) physicians responded. In dealing with terminal patients, approximately half gave priority to their patients' wishes for medical care, if known, regardless of the patient's competency. Of the respondents, 149 had been presented with advance directives by their patients and 35% followed all advance directives presented in their practice. Cardiopulmonary resuscitation (CPR) for arrested patients to enable their family to be at the bedside at the time of the death was common. More than 60% of the respondents thought that active euthanasia and assisted suicide were never ethically justified. Our study indicates that the wishes of patients are currently not always given top priority in medical decisions concerning the end of life.

Adult↗
PubMed1992

In support of Initiative 119.

A Seattle internist analyzes why voters in Washington rejected a proposal that would have made their state the first place in the world to legalize active euthanasia. Though initiative 119 failed, similar proposals may find greater acceptance from patients who desire a dignified death.

Euthanasia↗
PubMed1998

Physician-assisted suicide reconsidered: dying as a Christian in a post-Christian age.

The traditional Christian focus concerning dying is on repentance, not dignity. The goal of a traditional Christian death is not a pleasing, final chapter to life, but union with God: holiness. The pursuit of holiness requires putting on Christ and accepting His cross. In contrast, post-traditional Christian and secular concerns with self-determination, control, dignity, and self-esteem make physician-assisted suicide and voluntary active euthanasia plausible moral choices. Such is not the case within the context of the traditional Christian experience of God, which throughout its 2000 years has sternly condemned suicide and assisted suicide. The wrongness of such actions cannot adequately be appreciated outside the experience of that Christian life. Traditional Christian appreciations of death involve an epistemology and metaphysics of values in discordance with those of secular morality. This difference in the appreciation of the meaning of dying and death, as well as in the appreciation of the moral significance of suicide, discloses a new battle in the culture wars separating traditional Christian morality from that of the surrounding society.

Attitude to Death↗
PubMed1996

The legislation of active voluntary euthanasia in Australia: will the slippery slope prove fatal?

At 2.00 am on the morning of May 24, 1995 the Northern Territory Legislative Assembly Australia passed the Rights of the Terminally Ill Act by the narrow margin of 15 votes to 10. The act permits a terminally ill patient of sound mind and over the age of 18 years, and who is either in pain or suffering, or distress, to request a medical practitioner to assist the patient to terminate his or her life. Thus, Australia can lay claim to being the first country in the world to legalise voluntary active euthanasia. The Northern Territory's act has prompted Australia-wide community reaction, particularly in South Australia, Tasmania and the Australian Capital Territory where proposals to legalise euthanasia have already been defeated on the floor of parliament. In New South Wales (NSW) the AIDS Council of NSW has prepared draft euthanasia legislation to be introduced into the Upper House as a Private Member's Bill some time in 1996. In this paper, we focus on a brief description of events as they occurred and on the arguments for and against the legalisation of euthanasia which have appeared in the media.

Adult↗
PubMed1992

Physician-assisted dying: theory and reality.

...[T]here appears to be a conflation of physician-assisted suicide (the doctor makes the means of suicide available by, for example, writing a prescription for barbiturates) with active euthanasia (the doctor actively intervenes to kill the patient). I believe that these two entities are quite distinct in terms of several factors: they require very different roles for the physician, they involve distinct and disparate power relationships between physician and patient, and they would likely have a substantially different impact on the ethos of the medical profession. Thus, I would argue that it may be reasonable to support easing constraints on physician-assisted suicide while retaining them for active euthanasia, and that the distinction between the two entities should be addressed, particularly in discussions of legalization.

Capital Punishment↗
PubMed2001

Nancy B and Nancy F.

In this article I provide a virtuous slippery slope argument which shows that there is no morally significant difference between passive and active euthanasia. At the top of the slope is an example of passive euthanasia; at the bottom, an example of active euthanasia. For each pair of cases down the slope there is nothing that sensibly makes a morally significant difference between the pair of cases. Thus, there is no morally significant difference between passive euthanasia and active euthanasia.

Ethics↗
PubMed1996

Alberta Euthanasia Survey: 3-year follow-up.

OBJECTIVE: To determine whether the opinions of Alberta physicians about active euthanasia had changed and to assess the determinants of potential changes in opinion. DESIGN: Follow-up survey (mailed questionnaire) of physicians included in the 1991 Alberta Euthanasia Survey. SETTING: Alberta. PARTICIPANTS: Of the 1391 physicians who participated in the 1991 survey 1291 (93%) had indicated that they were willing to take part in a follow-up survey. A follow-up questionnaire was mailed in 1994 to 1146 physicians who could be traced through the 1994 Medical Directory of the provincial college of physicians and surgeons; 25 questionnaires were returned because they could not be delivered. OUTCOME MEASURES: Physicians' opinions about (a) the morality of active euthanasia, (b) changes in the law to permit active euthanasia and (c) the practice of legalized euthanasia. RESULTS: Of the 1121 physicians sent a follow-up questionnaire 866 (77%) returned it completed. The responses of these same 866 physicians in 1991 provided a basis for comparison. Of the 866, 360 (42%) stated in the 1994 survey that it is sometimes right to practise active euthanasia; a similar proportion (384 [44%]) gave this response in 1991. However, other opinions changed significantly. In 1991, 250 of the respondents (29%) indicated that they would practise active euthanasia if it were legalized, as compared with 128 (15%) in 1994 (p < 0.01). In 1991, 429 (50%) of the respondents thought that the law should be changed to permit active euthanasia, as compared with 316 (37%) in 1994 (p < 0.01). Religious activity was the most important characteristic associated with changes in opinion. Despite the decrease in support for the practice and legalization of active euthanasia between 1991 and 1994, in both surveys at least 70% of those who responded to this question indicated that active euthanasia, if it were legalized, should be performed only by physicians and should be taught at medical sites. CONCLUSION: Alberta physicians' support for the practice and legalization of active euthanasia decreased considerably between 1991 and 1994. However, most physicians remain in favour of restricting active euthanasia, if it were legalized, to the medical profession. These results suggest a need for caution and deliberation when changes in the law concerning active euthanasia are examined.

Adult↗
PubMed1995

A Dutch report on the ethics of neonatal care.

The Dutch Paediatric Association reports consensus among its members regarding the necessity to take the future quality of life into account when reaching decisions regarding the continuation or dis-continuation of life-prolonging treatment. The paramount importance of the discussion with the parents is stressed. Dissension exists regarding active euthanasia in the newborn, both opinions being respected. If dissension exists within the profession parents should be informed and if necessary referred to a doctor who shares their moral views.

Decision Making↗
PubMed1981

Ethical problems in the management of some severely handicapped children.

This paper examines some of the arguments advanced and acted upon by doctors concerned in decisions about whether severely handicapped patients should live or die. It criticises the view that 'selective treatment' is morally preferable to infanticide and shows how the standard arguments advanced for this preference fail to sustain it. It argues that the self-deception, which is sometimes cited as a sign of humanity in these cases, and which is implicit in the term 'selective treatment' is more dangerous than is the remote chance of brutalisation which is often cited as the danger of active euthanasia.

Child↗
PubMedDate not supplied

Letting die and mercy killing.

We are all called to make moral decisions, not only about preserving life and health, but also about accepting our death and dying. There are situations, when it is morally right, and indeed obligatory, to allow a dying person to die in peace and dignity. But there is a world of difference between allowing a peaceful death, and deliberately setting out to bring death of the person either by acts of commission (s.c. 'active euthanasia'), or by acts of omission (s.c. 'passive euthanasia'). The word "killing" seems proper for euthanasia, because "to kill" does mean " to intentionally cause the death of someone." It can be morally acceptable to withhold or withdraw a treatment precisely because it is reasonably judged as inefficacious (futile), or excessively burdensome for the patient. One's reason for withholding such treatment must not be a judgement about the desirability of putting an end to the patient's life, but a judgement about the desirability of putting an end to the treatment, which is futile or burdensome.

Catholicism↗
PubMed1989

Ethical reasoning concerning the feeding of terminally ill cancer patients. Interviews with registered nurses experienced in the care of cancer patients.

In the terminal phase of life, some cancer patients have problems eating. Caregivers then have to decide whether or not to provide the patients with food by artificial means. Taped interviews concerning the treatment of terminally ill, mentally alert, old cancer patients who refuse food were conducted with 20 registered nurses who were regarded as "experienced and good nurses." Not one of these nurses considered using force or violence against the patients. It seemed that the question about whether to feed the patient was not as urgent as the question of whether to accept active euthanasia. The interviewees seemed quite certain about how they would treat the patient in different circumstances, but found it difficult to justify their judgements. Several stressed the importance of their personal experience with dying persons, and thought that one should act according to the Golden Rule.

Adult↗