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Euthanasia and related practices worldwide.

The present paper examines the occurrence of matters relating to the ending of life, including active euthanasia, which is, technically speaking, illegal worldwide. Interest in this most controversial area is drawn from many varied sources, from legal and medical practitioners to religious and moral ethicists. In some countries, public interest has been mobilized into organizations that attempt to influence legislation relating to euthanasia. Despite the obvious international importance of euthanasia, very little is known about the extent of its practice, whether passive or active, voluntary or involuntary. This examination is based on questionnaires completed by 49 national representatives of the International Association for Suicide Prevention (IASP), dealing with legal and religious aspects of euthanasia and physician-assisted suicide, as well as suicide. A dichotomy between the law and medical practices relating to the end of life was uncovered by the results of the survey. In 12 of the 49 countries active euthanasia is said to occur while a general acceptance of passive euthanasia was reported to be widespread. Clearly, definition is crucial in making the distinction between active and passive euthanasia; otherwise, the entire concept may become distorted, and legal acceptance may become more widespread with the effect of broadening the category of individuals to whom euthanasia becomes an available option. The "slippery slope" argument is briefly considered.

Ethics, Medical↗

Euthanasia in The Netherlands: facts and moral arguments.

Some facts about euthanasia practices in The Netherlands are given. It is shown that there are several possible courses of action at the end of life, of which active euthanasia is the most problematic. Euthanasia is related to respect for the patient and the patient's right to refuse medical treatment. Some moral arguments against and in favour of euthanasia are discussed.

Beneficence↗

Legalizing physician-assisted suicide: some thoughts and concerns.

Surveys show that most Americans favor the decriminalization of physician-assisted suicide in certain circumstances. Several states are now considering legislation to bring this about and make the United States the first place in the civilized world where physician aid in dying is sanctioned. In the Netherlands, where physician-assisted suicide is practiced but officially remains illegal, 85% of assisted suicides occur in the elderly, and most involve the help of general practitioners. In the United States, family physicians provide health care to many older adults with chronic or terminal illness whose numbers will increase as the elderly population expands. The legalization of physician-assisted suicide would affect the way American physicians practice medicine in unpredictable ways, yet physicians are participating relatively little in deliberations concerning this issue. The problem of suffering in persons with chronic and terminal illness cannot be ignored. Compassionate, effective, and ethical solutions must be found. As a former family physician and now geriatric psychiatrist, I review the pros and cons of physician-assisted suicide (emphasizing arguments against legalization) and encourage family physicians to debate this matter.

Aged↗

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↗

Anencephalics as organ sources.

In recent years, the need for infant organs for transplantation has increased. There is a growing recognition of the potential use of anencephalics as sources of organs. Prevalent arguments defending the use of live anencephalics for organ sources are identified and criticized. I argue that attempts to deny the applicability of the "dead-donor rule" are either question-begging or based on false premises and that attempts to skirt the Kantian dictum against treating others as a means only are not successful. I contend that the apparent utilitarian justification for live anencephalics as organ sources is unsatisfactory for two reasons: first, because it ignores the undermining effect the policy would have on parental values and sentiments central to social welfare; and second, because attempts to respond adequately to the slippery slope argument against live anencephalic use are unconvincing.

Anencephaly↗

Ethical implications of pharmacogenetics--do slippery slope arguments matter?

Pharmacogenetics is a rapidly expanding area of research exploring the relationship between inter-individual genetic variation and drug response, with the goal of developing genetically optimised therapies. Slippery slope arguments claim that a particular action should be rejected (or supported) because it might be the first step onto a slippery slope leading to undesirable (or desirable) consequences. In this article, several slippery slope arguments relevant to the context of pharmacogenetics are evaluated under consideration of underlying reasons for their popularity. The author concludes that although the examined arguments are unconvincing as slippery slope arguments, they do matter in this context. While positive slippery slope arguments serve as a driving force to fuel the development of pharmacogenetics, their negative counterparts play an important role to sensitise policy makers and the public to potential problems.

Databases, Genetic↗

Can human genetic enhancement be prohibited?

This article seeks to reframe the ethical discussion of genetic enhancement, which is the use of genetic engineering to supply a characteristic that a parent might want in a child that does not involve the treatment or prevention of disease. I consider whether it is likely that enhancement can be successfully prohibited. If genetic enhancement is feasible, it is likely that there will be demand for it because parents compete to produce able children and nations compete to accumulate human capital in skilled workers. If some parents or nations begin using genetic enhancement, this will change these competitions in ways that increase the incentives for others to use it. Therefore, a ban on genetic enhancement would be unstable, because once the ban was breached by defectors the motivation of others to uphold it would weaken, making the ban liable to collapse. The argument provides a new perspective on slippery slopes to dangerous technology.

Adult↗

The dilemma of withholding or withdrawing nutrition.

Recently, societal concerns have developed about the artificial prolongation of dying. Life extension is not always viewed as humanitarian. Artificial nutrition and hydration are seen frequently as necessary comfort measures and not merely life extenders. Now debate is rising about whether or not even these basic life support measures are not merely prolonging dying. In this paper, the issue of withholding or withdrawing nutrition and hydration from certain patients is discussed, including the competing ethical arguments, the nursing perspective and the implications of this dilemma for nursing, health care and society.

Beneficence↗

Euthanasia.

The principles of self-determination and individual well-being support the use of voluntary euthanasia by those who do not have moral or professional objections to it. Opponents of this posture cite the ethical wrongness of the act itself and the folly of any public or legal policy permitting euthanasia. Positive consequences of making euthanasia legally permissible respect the autonomy of competent patients desiring it, expand the population of patients who can choose the option, and release the dying patient from otherwise prolonged suffering and agony. Potentially bad consequences of permitting euthanasia include the undermining of the "moral center" of medicine by allowing physicians to kill, the weakening of society's commitment to provide optimal care for dying patients, and, of greatest concern, the "slippery slope" argument. The evaluation of the arguments leads to support for euthanasia, with its performance not incompatible with a physician's professional commitment.

Beneficence↗

Reasonable care? Some comments on Gillett's Reasonable Care.

A discussion of some issues from Grant Gillett's book Reasonable Care. At the metaethical level, Gillett's views about the origin, scope and bindingness of morality are outlined and criticised. Against him it is argued that (a) moral capacity does not follow from linguistic abilitiy, (b) things can matter to non-concept-users and (c) universalisability arguments fail to show that immorality is irrational. At the first order level, Gillett's arguments against surrogacy and euthanasia are answered.

Animal Rights↗

Germ-line engineering: a few European voices.

We have surveyed various recent European opinions on germ-line engineering. The majority express more or less severe reservations about any interventions on the human germ-line, including therapeutic ones. However, they are divided over the pragmatic, or categorical-ethical nature of the relevant arguments. This split reflects two competing views of technology. The 'pessimistic' one is deeply concerned by the slippery slope leading from bona fide therapeutic applications of genetic engineering to eugenic practices. It insists that, if anything can defend us against these evils, it must be a set of strong, ethically-based prohibitions. The other, 'optimist' view is more confident in the discriminating powers of societal regulation. We argue for the latter view and suggest that the pragmatic arguments brought to this debate are less problematic than the ethical ones.

Advisory Committees↗

Transhumanism, medical technology and slippery slopes.

In this article, transhumanism is considered to be a quasi-medical ideology that seeks to promote a variety of therapeutic and human-enhancing aims. Moderate conceptions are distinguished from strong conceptions of transhumanism and the strong conceptions were found to be more problematic than the moderate ones. A particular critique of Boström's defence of transhumanism is presented. Various forms of slippery slope arguments that may be used for and against transhumanism are discussed and one particular criticism, moral arbitrariness, that undermines both weak and strong transhumanism is highlighted.

Attitude to Health↗

Killing and caring: is euthanasia incompatible with care?

The issue of euthanasia continues to be surrounded by controversy, particularly in relation to its moral status and more recently, the significance that health professionals should attach to the principle of respect for patient autonomy. Increasing knowledge and expertise in the field of palliative care has also led to claims that the provision of effective palliative care services render discussion about the introduction of euthanasia unnecessary. By reviewing and analysing the arguments put forward in support of the continued ban on voluntary active euthanasia, this paper suggests that these arguments largely fail to address the notion of patient autonomy and concludes that even with provision and access to palliative care service, euthanasia could be considered a moral option which is not necessarily incompatible with care.

Beneficence↗

Rational suicide among older adults: a cause for concern?

Society is collectively having to examine questions it has never had to face before and nurses are frequently confronted with the difficult issue of whether suicide can or should be a rational choice for older adults. They may be faced with the question of whether an older person should ever be restrained from suicide. Arguments for and against rational suicide are highlighted and the author makes the case for a rational approach to the affirmation of life, rather than its rejection, even to the very end.

Aged↗

Euthanasia. Historical, ethical, and empiric perspectives.

Debates about the ethics of euthanasia date from ancient Greece and Rome. In 1870, S. D. Williams, a nonphysician, proposed that anesthetics be used to intentionally end the lives of patients. Between 1870 and 1936, a debate about the ethics of euthanasia raged in the United States and Britain. These debates predate and invoke different arguments than do debates about euthanasia in Germany. Recognizing the increased interest in euthanasia, this article reviews the definitions related to euthanasia, the historical record of debates concerning euthanasia, the arguments for and against euthanasia, the situation in the Netherlands, and the empirical data regarding euthanasia in the United States.

Beneficence↗

Euthanasia.

This article provides a brief review of the history of euthanasia. The problems involved in withholding or withdrawing treatment, physician-assisted suicide, and arguments for or against euthanasia are discussed. Changes in both societal and physician attitudes and practices are presented.

Europe↗

Ethical constraints on rationing medical care by age.

In a statement published in this issue, the Public Policy Committee of the American Geriatrics Society endorses the view that chronological age should not be a criterion for exclusion of individuals from medical care. This article aims to amplify the Committee's position by placing it within a broader context and identifying its justification in ethical argument. The paper is divided into three parts. The first part clarifies the difference between allocation (the distribution of funds between categories) and rationing (the distribution of funds within a single category). It is argued that given the current allocation of funds to medical care, some form of rationing is unavoidable. As others have noted, rationing is already occurring in an informal and piecemeal fashion. However, ethically sound rationing requires publicly debated and defensible policies. The second section of the paper reviews a number of arguments advanced in favor of rationing medical care on the basis of age. Objections to these arguments are carefully set out. The final part of the paper details and defends a series of positive arguments establishing special duties to the elderly. The paper concludes that to the extent that scarcity forces rationing, older persons should not be excluded because they are old.

Age Factors↗