[So-called passive euthanasia, is it really euthanasia?].
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Ethics, Medical↗
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["Euthanasia" for handicapped children, for demented and chronic mentally sick patients. The latest aims of euthanasia].
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Age Factors↗
Pediatric euthanasia.
Pediatric euthanasia is currently practiced in the Netherlands on newborns, infants, children, and adolescents, although exact numbers are not known. Euthanasia in the Netherlands is generally assumed to be active and voluntary, but some cases of pediatric euthanasia would have to be characterized as nonvoluntary. Much of the motivation behind the euthanasia movement and the performance of pediatric euthanasia in the Netherlands is a genuine, compassionate desire to alleviate pain and suffering. In this study, we review the Dutch experience, with particular attention to the current practice of euthanasia on newborns, infants, children, and adolescents. We discuss pediatric euthanasia from an ethical point of view. We assert that more effective pain control, better symptom management, and psychosocial support of the dying and their families would alleviate the perception of suffering, and reduce the perceived need to resort to euthanasia.
Adolescent↗
Euthanasia and abortion: personality correlates for the decision to terminate life.
The study addresses three research questions: (a) How well do level of conservatism and religiosity predict attitudes toward passive and active euthanasia? (b) What is the relationship between attitudes toward abortion and attitudes toward euthanasia? (c) How do personality variables relate differentially to these attitudes? Subjects were 168 Australian adults (68 men, 100 women). Initial analysis indicated no sex differences in attitudes toward the study's criterion variables. Descriptive statistics indicated general support for active and passive euthanasia and for abortion, although the majority of the respondents were found to be more accepting of passive than of active euthanasia. Multiple regression analyses indicated that level of conservatism was the most consistent predictor of attitudes toward euthanasia and abortion, whereas religiosity was found significantly to predict attitudes toward abortion only.
Abortion, Induced↗
Attitudes of medical students, housestaff, and faculty physicians toward euthanasia and termination of life-sustaining treatment.
OBJECTIVES: Medical decisions concerning the prolongation of life, the right to die, and euthanasia are among the most extensively discussed decisions within medicine and law today. The responses of 360 physicians, housestaff, and medical students to a questionnaire were analyzed to identify attitudes toward these issues. DESIGN: Case vignettes were utilized to simulate the clinical context within which to survey decisions regarding whether or not to allow and assist patients requesting to die. MEASUREMENTS AND MAIN RESULTS: The majority of respondents (76%) consider withholding and withdrawing life-support therapy consistent with passive euthanasia. Passive euthanasia is more acceptable to the majority of the respondents (77%) and all three groups (physicians, housestaff, and students) are similarly more disturbed by active euthanasia. Of all respondents, 51% would accede to the patient's wishes when lifesaving treatment is refused, but only 16% would do so when a patient requested assistance in dying. Despite the fact that a majority (68%) agree that there is a moral justification for assisting patients to die and feel "understanding" for a physician who assists a patient in dying, only 6% of those persons surveyed were willing to deliberately terminate the life of a patient by administering medication to cause respiratory arrest, and only 1.1% of those persons surveyed were willing to do so to cause cardiac arrest. In the case vignettes, the faculty placed their highest value on disease-based information as strongly determinative to their decisions, while students and housestaff preferred quality-of-life factors. Respondents uniformly found it easier to perform "passive" actions; they were more willing to perform "active" actions in case vignettes where patients had terminal illnesses. CONCLUSIONS: Socially and legally created "shades of gray" have blurred the distinctions between withholding or withdrawing therapies and euthanasia and have left physicians without guidelines. Health ethics education should focus on case-based teaching and on reducing the uncertainty at the bedside.
Adult↗
A good death: is euthanasia the answer?
Euthanasia--particularly active voluntary euthanasia--and assisted suicide are subjects of continuing controversy. Historical attitudes, current concerns, the situation in the Netherlands, and the positions of various medical associations are reviewed. Major arguments for and against active euthanasia are presented, with special consideration to the role that health care providers might be asked to perform should active euthanasia and assisted suicide be given societal sanction. The authors conclude that better pain management and A willingness to provide care within already established ethical and legal guidelines, not the legalization of active euthanasia and assisted suicide, are the appropriate responses to current proposals for assistance in dying.
Attitude↗
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↗
Medical aspects of euthanasia.
The practice of euthanasia in the Netherlands is often cited as an example of progressive social reform. While the Dutch penal code outlaws active euthanasia, the courts have interpreted the law in such a way as to allow doctors to kill their patients under certain conditions, chiefly when the patient has asked to die in preference to enduring unbearable suffering. Current practice in the Netherlands now includes the killing of patients who do not have a terminal disease, the killing of older children without the consent of their parents, and the killing of patients without their consent in circumstances where consent could have been sought. Estimates of the number of euthanasia killings range up to 20,000 per year, but there is no accurate information because of the common medical practice of falsely certifying the cause of death to avoid the need to justify euthanasia. Euthanasia in the Netherlands is now an alarming practice that oversteps ethical bounds and administrative controls, compromising doctors' moral commitment to healing by allowing them to become medical killers.
Adult↗
Euthanasia, the right to die and the law in South Africa.
In this article euthanasia is defined and classified. Each of the classification is examined in relation to the relevant South African law as are the possible defences to criminal charges flowing from a euthanasia situation. Further, the validity of the so-called 'living will' is examined. While most declarations or bills of human rights seek to protect an individual's right to life, this article shows that an individual enjoys no right (from a human right point of view) enabling him to choose the time and condition of his death, irrespective of whether he is terminally ill. The reason for this negative attitude to euthanasia by society is considered. In conclusion it is observed that due to the plurality of society in South Africa, it will be no easy task for the legislature to pass acceptable laws regarding euthanasia, however limited. Finally, positive suggestions are made for the implementation of a valid 'living will'.
Cross-Cultural Comparison↗
[Attitudes towards active euthanasia and its legislation in Spain].
BACKGROUND: The present forms of carrying out public health care have lead to probably more effective medicine but which at the same time has led to greater risks in violating patients' rights and welfare. At present, a series of arguments are been debated for soliciting the legalization of euthanasia as a form of avoiding possible abuses. Thus, the opinions and attitudes concerning legislation for active euthanasia in terminally ill patients were herein investigated. METHODS: An anonymous survey was elaborated in which 1,109 subjects from three sectors of the population participated: a) hospital personnel (doctors n = 346 and nurses n = 346) of the University Hospital San Carlos in Madrid, b) students (n = 261) of the University Complutense of Madrid, and c) retired people (n = 156) in an old age residence in the province of Madrid (Pinto). The sample was made up of a total of 446 males and 657 females with ages of between 20 and 90 years. RESULTS: Most of those surveyed were in agreement in determined circumstances or totally in agreement with legislation for active euthanasia in terminally ill patients (63%). With respect to acceptation to the practice of legislation for active euthanasia 63% were in agreement in determined circumstances or totally in agreement. Significant differences were found (p less than 0.05) in relation to age, sex, marital status, religion and political ideology of the subjects. CONCLUSIONS: Although the results found in this study concerning the opinions and attitudes on legislation for active euthanasia in terminally ill patients coincided when compared with other existing studies with respect to acceptation for legislation, a less favorable tendency to the same was evident.
Adult↗
Euthanasia and assisted suicide. I. How often is it practised by family doctors in The Netherlands?
A survey was conducted among family doctors to determine the frequency with which they were requested to administer euthanasia or assist in suicide, and how often they actually applied these procedures. Two random samples (in each n = 521) were taken from the population of Dutch family doctors (n = 6300) and requested to complete an anonymous questionnaire. The response was 67%. The entire body of Dutch family doctors practices euthanasia or assisted suicide about 2000 times per annum; 48% have never engaged in these practices. An average of 40% of all requests are complied with. We conclude that far fewer family doctors are involved in euthanasia and assisted suicide than was previously supposed. Euthanasia or assisted suicide was administered to 1 in 25 persons who died in their own homes.
Communication↗
Euthanasia and assisted suicide. II. Do Dutch family doctors act prudently?
We conducted a survey among two random samples of Dutch doctors in order to determine whether they acted prudently with regard to euthanasia and assisted suicide. The doctors completed an anonymous questionnaire and those who at one time or another had applied euthanasia or assisted suicide (52%) were asked about several aspects of the requirements for prudent practice. 'Pointless suffering' was the most important and most common reason for requesting euthanasia or assisted suicide; 'pain' was rarely the most important reason. In 7% of the cases alternative forms of treatment were still available; these were hardly ever therapeutic. A total of 12% of the doctors had applied euthanasia or assisted suicide without having had any kind of consultation or discussion with a colleague, a nurse or any other health care professional; 26% had not issued a certificate testifying to death from natural causes. We conclude that some of the family doctors do not observe the procedural requirements, but that the majority satisfies the material requirements for prudent practice.
Clinical Protocols↗
Killing, letting die and euthanasia.
Medical ethicists debate whether or not the moral assessment of cases of euthanasia should depend on whether the patient is 'killed' or 'allowed to die'. The usual presupposition is that a clear distinction between killing and letting die can be drawn so that this substantive question is not begged. I contend that the categorisation of cases of instances of killing rather than as instances of letting die depends in part on a prior moral assessment of the case. Hence is it trivially rather than substantively true that the distinction has moral significance. But even if a morally neutral (ie non-question begging) distinction could be drawn, its application to the euthanasia controversy is problematic. I illustrate the difficulties of employing this distinction to reach moral conclusions by critically discussing Philippa Foot's recent treatment of euthanasia. I conclude that even if an act of euthanasia is an instance of killing, and there exists a prima facie moral duty not to kill, and no more stringent duty overrides this duty, one still cannot determine such an act to be morally impermissible.
Ethics, Medical↗
Euthanasia: a challenge for the forensic toxicologist.
People die daily in the hospital. Mostly, they die because their illnesses were no longer treatable (natural death). Unfortunately, some people die an unnatural death, in particular, as the result of euthanasia. In contrast to the situation in most countries, in the Netherlands euthanasia is accepted by the courts under strict conditions. It can be very difficult for the legal authorities to establish whether a person has died from natural causes or from suicide, euthanasia, or murder. In addition to the pathologist and the lawyer, the toxicologist also has a number of problems in showing whether euthanasia has been carried out. These can consist of the following analytical problems: (a) interactions--the patients involved have frequently been receiving a large number of toxic and nontoxic drugs simultaneously; (b) identification--not all drugs administered are included in general screening procedures; (c) metabolites--a large number of metabolites may have accumulated toward the end of a long therapeutic regimen; and (d) determination--determination of quaternary muscle relaxants and their various metabolites, as well as other drugs, can be problematic. There are also toxicokinetic problems; because of poor kidney and liver function, low serum albumen, general malaise, and interactions between these factors and other drugs, the kinetics of a given drug can differ from normal. This makes it all the more difficult to determine whether the patient died from an accumulation of medication or from a so-called "euthanetic" drug mixture.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
[The new euthanasia-discussion from the psychiatric viewpoint].
The practice to kill terminally ill patients on their own demand has resulted in the Netherlands in a decriminalisation of active euthanasia which thus has fundamentally changed the way to deal with dying patients. Sooner or later this development will extend to other European countries as well as to the USA. Involuntary euthanasia of severely handicapped newborn children or of demented persons is propagated by the practical ethics of P. Singer and other representatives of utilitarianistic philosophy. According to the standpoint of utilitarianism a human being should only have the right to live as long as he or she is a person, i. e. has rationality and self-consciousness. The next step toward the elimination of elderly people can easily be predicted. For economical reasons these persons may be withheld from life-saving medical treatment or may be supposed to commit suicide. A moral pressure is created to make a decision for suicide as soon as severe invalidity occurs. The consideration of such ideas shows that in today's debate on euthanasia the issue is no longer the right of a few severely and terminally ill human beings to their "own death". Instead, the right to live of a large group of handicapped and "socially useless" or "unproductive" persons is at stake. This is the danger of today's discussion of euthanasia.
Persons with Disabilities↗
Active euthanasia and forgoing life-sustaining treatment: can we hold the line?
Public sentiment in favor of permitting voluntary active euthanasia creates a dilemma for a bioethics rooted in a libertarian notion of autonomy. At stake in the active euthanasia debate is actually a question of power--the individual's assertion of sovereignty over the timing and circumstances of his or her own death. Also at stake is society's unwillingness to impose a conception of the good--and a good dying--on individuals whose personal values and conceptions of the good may differ. In order both to reject voluntary active euthanasia and to affirm the patient's right to forgo life-sustaining treatment, some societal conception of the good must be developed and agreed upon to counter unbridled claims of individual self-sovereignty over dying. Pragmatic arguments alone, such as the need to maintain confidence in the doctor-patient relationship, will not be sufficient.
Beneficence↗
The Voluntary Euthanasia (Legalization) Bill (1936) revisited.
In view of the continuing debate on euthanasia, the restrictions and safeguards which were introduced into the Voluntary Euthanasia (Legislation) Bill 1936 are discussed. Proposals for a new Terminal Care and Euthanasia Bill are suggested, based on some of the principles of the Mental Health Act 1983.
Euthanasia↗
[Euthanasia--Polish scientistś viewpoint and in the light of the laws of the people's Republic of Poland].
Euthanasia has for a long time been the object of very lively discussions in Poland. This article contains the views of scientists from various fields of science, especially medical doctors of different specialities. All of them have very serious objections to euthanasia and are against its practical application not only from the medical point of view but first of all for purely humanitarian reasons. Polish penal law regards murder on request as delictum sui generis, i.e., as a kind of privileged crime as compared with common murder. Article No. 150 of the Polish penal law demands two features to characterise euthanasia: (1) the delinquent must act on grounds of compassion towards his victim, and (2) on the victim's request. The patient must be in such a state that gives reason for compassion. The request to shorten somebody's life must be very distinct, direct, firm, conscious and convincing. Perosns under age, mentally defective or unconscious cannot express such a wich. Polish penal law punishes with utmost severtity perpetrators of active euthanasia even in such cases in which the delinquent was moved by the most noble feelings. Only when it comes to penalty is distinction made between such a delinquent and a common murderer.
Ethics, Medical↗