Euthanasia Cases Research Articles

Veterinary surgeon reprimanded in euthanasia case

Veterinary RecordVolume 158, Issue 19 p. 643-644 News & Report Veterinary surgeon reprimanded in euthanasia case First published: 13 May 2006 https://doi.org/10.1136/vr.158.19.643-aRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume158, Issue19May 2006Pages 643-644 RelatedInformation

The legalisation of euthanasia and assisted suicide: A tale of two scenarios

The legalising or decriminalising of certain behaviour ‘of ambiguous morality’ (Garland, 2001) is often not just a matter of erasing a law from the statute books. Instead it usually involves a shift in governance, so that the criminal justice system is no longer the locusof control but that other formsof governance come into play. The case of euthanasia and assisted suicide is good example. Its legalisation in the US state of Oregon, and in both the Netherlands and Belgium has meant that certain typesof medical life-ending behaviours (when criteria are met) are no longer the criminal justice system’s business. In addition, review bodies have come into play to oversee practice. Their composition and remit differs between the three jurisdictions, but all are examplesof what Boutellier might call transferral (Boutellier, 2000). Legalisation tends to mean that the control function is (partly) removed from the criminal justice system and transferred to other bodies.

Permissibly Encouraging the Impermissible

According to some moral theorists, including advocates of the doctrine of double effect, the permissibility of actions can turn on the intentions with which they are performed. Intention-focused theories are susceptible to an objection based on the following three premises. It is morally impermissible to encourage morally impermissible actions; there are certain actions that can permissibly be encouraged; intention-focused theories imply that a subset of such actions are impermissible. The objection rests on the claim that the best way to reconcile these premises is to conclude that intention-focused theories mistakenly deem these actions impermissible. But a better way to reconcile these premises is by rejecting the claim that it is necessarily morally impermissible to encourage morally impermissible acts. Judith Jarvis Thomson seems to deserve credit for devising this objection to intention-focused theories. Here is how she puts the point in the context of a euthanasia case in which it is clear that a patient’s pain is so bad that his request to be put out of his misery is worthy of respect:

Involvement of nurses in physician-assisted dying.

Death in modern societies is often preceded by medical end-of-life decisions. Empirical research on these end-of-life decisions focuses predominantly on the physicians' role. Little is known about the role of other health care workers, especially that of nurses. This paper reports the findings of a study that investigated how often nurses are consulted by physicians in the decision-making process preceding end-of-life decisions and how often nurses participate in administering lethal drugs in end-of-life decisions. Data were collected within a nationwide cross-sectional retrospective death certificate study in Flanders, the Dutch-speaking part of Belgium. We selected 3999 deaths, a 20% random sample of all those occurring during the first 4 months of 1998. Anonymous questionnaires were mailed to the physicians who signed the death certificates. Several questions concerned the involvement of nurses in end-of-life decisions. We received 1925 valid questionnaires. For all reported end-of-life decisions (39.3% of all deaths in Flanders), physicians provided information about the involvement of nurses. Physicians consulted at least one nurse in 52% of end-of-life decisions cases occurring in institutions, compared with 21.4% of such cases at home. Nurses administered lethal drugs in 58.8% of euthanasia cases occurring in institutions and in 17.2% at home. For cases in which life was ended without the patient's explicit request because, predominantly, they were too ill to do so, these percentages were respectively 82.7% and 25.2%. In institutions, nurses mostly administered drugs without the attendance of a physician who had prescribed the drugs. Nurses in Belgium are largely involved in administering lethal drugs in end-of-life decisions, while their participation in the decision-making process is rather limited. To guarantee prudent practice in end-of-life decisions, we need clear guidelines, professionally supported and legally controlled, for the assignment of duties between physicians and nurses regarding the administration of lethal drugs to reflect current working practice. In addition, we need appropriate binding standards governing mutual communication about all end-of-life decisions.

Consequences count: against absolutism at the end of life.

There has been a considerable amount of debate in the nursing literature about euthanasia, and especially the distinctions between acts and omissions, and killing and letting die. These distinctions are required by opponents of euthanasia to justify allowing some cases of passive euthanasia while forbidding all cases of active euthanasia. This paper adds to the debate by arguing that the position that absolutely forbids euthanasia is theoretically inconsistent. The paper first considers the place of moral theory in analysing moral problems, within the framework of the principles of biomedical ethics. It is argued that despite a moral pluralism that operates in many areas, the legal status of euthanasia is based upon an absolute deontological position against deliberate killing, which cannot be overridden by appeals to favourable consequences. In order that certain forms of passive euthanasia can be allowed, this position allows distinctions within three pairs of concepts--acts and omissions, killing and letting die, and ordinary and extraordinary means. A further method of justifying certain actions near the end of life is the doctrine of double effect. These paired concepts and the doctrine of double effect are analysed with special reference to their consequences. The application of the doctrine of double effect and the three distinctions relies on consideration of their consequences, allowing in practice what in theory is denied. This is important because it weakens the absolute case against euthanasia, which disallows any direct consequentialist appeal. If consequences count in the application of the doctrine and the distinctions, then they should also count directly prior to their application. This strengthens the argument for active euthanasia in certain cases.

Christian Conservatives Go to Court:Religion and Legal Mobilization in the united States and Canada

The American exceptionalism thesis holds that American political culture produces an unusually litigious society. The US Christian right has participated in litigation, especially in constitutional rights cases dealing with issues such as religious schools and abortion. However, since 1982 Canada has had a constitutional Charter of Rights and an increasingly active Christian right of its own. We compare data on Christian right involvement in education, abortion, and “right to die” (euthanasia, assisted suicide or mercy killing) cases at the Supreme Court level in both countries. Among North America’s Christian conservatives, exceptionalism has eroded, but not disappeared. We employ interviews and data on religious interest groups to analyze the sources of legal mobilization, and find that it is a matter not just of political culture, but also resource mobilization, political opportunity structures, and religious worldviews.

Il Rapporto 2001/2002 sulla prassi dell’eutanasia nei Paesi Bassi: considerazioni critiche

Nel mese di giugno di 2003 è stato pubblicato il terzo Rapporto sulla prassi di eutanasia nei Paesi Bassi. Lo scopo dell’indagine era, fra l’altro, di verificare se i medici rispettino la regolamentazione sull’eutanasia. Dal 1998 tutti i casi di eutanasia e suicidio medicalmente assistito devono essere denunciati dal medico alle Commissioni Regionali di Controllo sull’Eutanasia. Questa procedura è stata poi mantenuta nella Legge sul “Controllo della Cessazione della Vita a Richiesta e dell’Assistenza al Suicidio” (2001) secondo cui l’eutanasia e il suicidio medicalmente assistito sono legali a condizione che il medico abbia rispettato una serie di adempimenti. Uno di essi richiede che il medico denunci casi di eutanasia e suicidio medicalmente assistito.
 Dal Rapporto, invece, risulta che - sebbene la percentuale di casi di eutanasia e suicidio medicalmente assistito denunciati sia aumentata dal 41% nel 1995 fino al 54% nel 2001, il numero totale tende a calare dal 2000. Il numero dei casi di cessazione intenzionale della vita senza richiesta del malato è rimasto praticamente invariato nel 2001/2002. Siccome i medici denunciano appena questi casi, il controllo sociale su essi è praticamente escluso. Molti casi di cessazione intenzionale della vita sono velati come casi di sedazione terminale.
 Rimane inoltre la domanda se il 13% di tutti i decessi (circa 18.200 in totale) in cui una terapia non è stata iniziata o continuata allo scopo esplicito di accelerare la morte, non sia equivalente alla cessazione intenzionale della vita dal punto di vista etico. La prassi dell’eutanasia nei Paesi Bassi non risulta quindi essere controllata, contrariamente a quanto voluto dal legislatore.
 Un dato significativo è che l’introduzione delle cure palliative (CP) in Olanda ha avuto luogo abbastanza tardi (nella seconda meta degli anni Novanta del XX secolo), l’introduzione dell’eutanasia invece presto (cioè negli anni Settanta). Medici che svolgono il ruolo di consultatori in casi di eutanasia nei Paesi Bassi, hanno costatato che la frequenza di richieste di eutanasia è diminuita considerevolmente dopo l’introduzione delle CP. La conclusione è che l’applicazione delle CP costituisca la garanzia migliore per un trattamento adeguato della condizione di fine vita e un efficace antidoto contro la richiesta eutanasica.

The Practice of Euthanasia

John Keown's informed and powerful argument against euthanasia features both an excellent exposition of its pitfalls and a strong confrontation with a question that remains controversial abroad: Are there circumstances in which withdrawal of treatment should be considered euthanasia? American readers of this book, who consider the question settled and are unfamiliar with cultural and legal differences in the way European countries and the United States have dealt with end-of-life issues, may be puzzled at first as to why this University of Cambridge lecturer in the law and ethics of medicine wants to address this question. But Keown's exposition will make even such readers, who believe we have wisely avoided many of the dilemmas Great Britain and other European countries are forced to face, realize that there are some dilemmas we have not escaped. To evaluate euthanasia, Keown examines its actual practice. He carefully provides evidence to show that legalization of voluntary euthanasia cannot be regulated and that it leads increasingly to involuntary euthanasia and to patients who are not ready to die or whose suffering could be alleviated by palliative medicine. Such a study relies heavily on the Dutch experience, since not only has the practice been legal in the Netherlands for some time, but two Dutch government-sanctioned studies (in 1990 and 1995), in which physicians participated anonymously and with impunity, have shown us what the actual practice entails. The Dutch studies play down a fact they cannot help but reveal, namely, that thousands of patients have their lives ended without their consent. The studies report 3,600 deaths in 1995 from assisted suicide and euthanasia and officially acknowledge between 900 and 1,000 involuntary deaths. But they refuse to describe as euthanasia, or involuntary (when a competent patient does not give consent) or nonvoluntary (when the patient is deemed unable to give consent) euthanasia, the 1,350 patients in 1990 or the close to 2,000 patients in 1995 whose physicians gave them large doses of pain-killing medication with the primary aim of ending their lives. In the course of my own studies of euthanasia in the Netherlands, I asked Paul Van Der Maas, the principal investigator of the Dutch government-sanctioned studies, why, if patients had consented to the drug overdose, these should not be considered euthanasia cases. He conceded they could be--the only difference was that the patients took longer to die. When asked why, if patients were put to death who had not consented (about a third of the patients), these cases were not considered nonvoluntary or involuntary euthanasia, Van der Maas could not give a reason, but he was not willing to consider recategorizing them. When one realizes that in one-quarter of the cases in which Dutch physicians give medications intending to end patients' lives, they do so without the patient's consent, that a third of Dutch doctors admit to having done so, that half of Dutch doctors feel free to suggest euthanasia to their patients, and that 60 percent of Dutch euthanasia cases are not reported to the authorities, one is inclined to agree with Keown that this is a system out of control. Keown is also concerned, however, that the data on the many thousands of Dutch cases where treatment (including tube feeding) was withdrawn without patient consent do not permit us to know whether the doctor was merely stopping a futile or burdensome treatment or intended instead to end the patient's life--referred to as This is an issue that has also troubled Keown in his own country because British law since the landmark Bland case has condoned passive euthanasia. Most of the concluding chapters of Keown's book deal with his concern with passive euthanasia and reflect some of the differences in approach to end of life care between Europe and the United States. In 1989, Tony Bland was left in a persistent vegetative state after being crushed by a crowd at a soccer game. …

Drugs used for euthanasia in Flanders, Belgium.

Our aim was to describe and assess the medicinal products and doses used for euthanasia in a series of cases, identified within an epidemiological death certificate study in Belgium, where euthanasia was until recently legally forbidden and where guidelines for euthanasia are not available. In a random sample of the deaths in 1998 in Belgium, the physicians who signed the death certificates were identified and sent an anonymous mail questionnaire. The questionnaires of the deaths classified as euthanasia cases were reviewed by a multi-disciplinary panel. A total of 22 among 1925 questionnaires pertained to voluntary euthanasia. In 17 cases, detailed information on the euthanatics (medicinal substances used for euthanasia) used was provided. Opioids were used in 13 cases (in 7 as a single drug). Time between last dose and expiry ranged from 4 to 900 min. The panel judged that only in 4 cases effective euthanatics were used. In the end-of-life decision cases perceived by Belgian physicians as euthanasia, pharmacological practices were disparate, although dominated by the use of morphine, in the very late phase of dying, in doses which were unlikely to be lethal. Most physicians clandestinely engaging in euthanasia in Belgium seemed unaware of procedures for guaranteeing a quick, mild and certain death. Information on the pharmacological aspects of euthanasia should be included in the medical curriculum and continuing medical education, at least in countries with a legal framework permitting euthanasia under specified conditions.

The Kuhse-Singer Euthanasia Survey: Why it Fails to Undermine the Slippery Slope Argument — Comparing Apples and Apples

AbstractA survey published in the Medical Journal of Australia in 1997 showed that the incidence of non-voluntary euthanasia in Australia was higher than in the Netherlands. Euthanasia is illegal in Australia, while it is openly practiced in the Netherlands. It has been suggested that the results of the survey undermine the slippery slope argument against legalising euthanasia. This is wrong. Although at the time of the survey, euthanasia was formally prohibited by the law in Australia, the medical and legal culture was such that doctors could practice euthanasia with impunity — in certain circumstances euthanasia by doctors was effectively condoned. This is in fact supported by the findings of the survey. The survey suggests that there were approximately 6,700 cases of euthanasia in Australia in the year from July 1994 to June 1995 — not one of which was prosecuted, let alone resulted in a conviction. Ultimately the survey merely shows that in a climate where voluntary euthanasia is tolerated, wide scale abuses (in the form of non-voluntary euthanasia) occur. Paradoxically the results of the survey give further support to the slippery slope argument.

Using Controversial Mock Trials in “Psychology and Law” Courses: Suggestions from Participants

We discuss the use of a mock trial of the controversial Jack Kevorkian euthanasia case in an undergraduate psychology and law course. We provide an overview of the project, student feedback, and recommendations for improving the exercise. Based on feedback from students, we conclude that constructing a trial around a controversial topic with psychosocial issues as the foundation of a course can increase the utility of a mock trial and make the course a better learning experience.

The emotional impact on physicians of hastening the death of a patient.

To investigate the emotional feelings reported by physicians in The Netherlands after having performed euthanasia or other medical end-of-life decisions. Nationwide interview study in The Netherlands, November 1995 through February 1996. A random sample of 405 physicians (general practitioners, nursing home physicians, and clinical specialists). Subsequent feelings of physicians about their most recent cases (if any) of euthanasia, assisted suicide, life-ending without an explicit request from the patient, and alleviation of pain and other symptoms with high doses of opioids. The response rate was 89%. In 52% of all cases of hastening death, physicians had feelings of comfort afterwards, which included feelings of satisfaction in 44% and of relief in 13%. Feelings of discomfort were reported in 42%, most frequently referred to as emotional (28%) or burdensome (25%). Feelings of discomfort were highest for euthanasia (75%; P<0.000). 95% of physicians were willing to perform euthanasia or assisted suicide again in similar situations. Afterwards, 5% had doubts, but none had regrets, about performing euthanasia. Hastening the death of a patient evokes different feelings among physicians. Although performing euthanasia is often experienced as burdensome and emotional, granting the ultimate wish of a competent patient may also give physicians a feeling of having contributed to the quality of the dying process.

A Comparison of Characteristics of Kevorkian Euthanasia Cases and Physician-Assisted Suicides in Oregon

The sociodemographic and clinical characteristics of Kevorkian euthanasia cases were compared with Oregon physician-assisted suicide (PAS) cases and U.S. mortality data. Two hundred variables were coded from medical examiner reports on all 69 Kevorkian euthanasia cases who died and were autopsied by the Oakland County Medical Examiner. Data on the 43 Oregon PAS cases in the first two years and U.S. mortality data were obtained from published sources. Only 25% of patients euthanized by Kevorkian were terminally ill as compared to 100% of Oregon PAS cases. PAS cases were significantly more likely to have cancer (72%) than euthanasia cases (29%). Women and those who were divorced or had never married were significantly more likely to seek euthanasia than would have been predicted by national mortality statistics. Gender and marital status appeared to influence decisions to seek an assisted death, and research on the role of these factors in end-of-life decision making is merited.

USING THE YOUK–KEVORKIAN CASE TO TEACH ABOUT EUTHANASIA AND OTHER END-OF-LIFE ISSUES

Dr. Jack Kevorkian's actions have generated much controversy and press coverage during the past decade. His appearance on a nationally televised newsprogram with a videotape showing him deliberately causing the death of a man led to his imprisonment. This article discusses how Kevorkian's euthanasia case can be used to teach undergraduate students about end-of-life issues, especially psychosocial aspects of the debate over hastened death.

USING THE YOUK–KEVORKIAN CASE TO TEACH ABOUT EUTHANASIA AND OTHER END-OF-LIFE ISSUES

Dr. Jack Kevorkian's actions have generated much controversy and press coverage during the past decade. His appearance on a nationally televised newsprogram with a videotape showing him deliberately causing the death of a man led to his imprisonment. This article discusses how Kevorkian's euthanasia case can be used to teach undergraduate students about end-of-life issues, especially psychosocial aspects of the debate over hastened death.

USING THE YOUK–KEVORKIAN CASE TO TEACH ABOUT EUTHANASIA AND OTHER END-OF-LIFE ISSUES

Dr. Jack Kevorkian's actions have generated much controversy and press coverage during the past decade. His appearance on a nationally televised newsprogram with a videotape showing him deliberately causing the death of a man led to his imprisonment. This article discusses how Kevorkian's euthanasia case can be used to teach undergraduate students about end-of-life issues, especially psychosocial aspects of the debate over hastened death.

Dr. Jack Kevorkian and cases of euthanasia in Oakland County, Michigan, 1990-1998.

To the Editor: Analyses of data from Oregon1,2 and elsewhere3–5 have begun to clarify the characteristics of patients who seek a physician's assistance with suicide or euthanasia. We report on a de...

Case Presentation: A Case of Euthanasia, The Northern Territory, Australia

Case Presentation: A Case of Euthanasia, The Northern Territory, Australia

Palliative care, assisted suicide and euthanasia: nationwide questionnaire to Swedish physicians.

The objective of this study was to investigate what actually happens between physicians and adult patients in difficult end-of-life situations. We circulated an anonymous questionnaire to a randomized sample of 952 Swedish physicians registered in specialties comprising care of dying adult patients, 122 palliative care physicians, and 130 physicians from the Swedish Association for the Study of Pain. Of special interest were themes in conversations between the physicians and the patients, desires expressed by the patients, and actions performed by the physicians that might affect the patients' expected survival. The overall response rate was 79%. Of these, 63% of the randomized physicians, 95% of the palliative care physicians, and 43% of the Association for the Study of Pain physicians had more than occasionally treated dying adult patients during the past year. About half of them had discussed palliative care with all their dying patients, and more than half of the physicians had heard their patients expressing a wish to die. About one-third of all the physicians had given analgesic or other drugs in such doses that some of their patients' deaths were hastened. The same proportion had also been asked for active euthanasia, while 10% had been asked to assist suicide. No case of euthanasia and only a few cases of assisted suicide were reported. By implication, the study suggests that improving patients' awareness of the possibilities to relieve pain, anxiety and dyspnoea during the final days of life is an important way to reduce requests for active euthanasia.

Dispensing death, desiring death: an exploration of medical roles and patient motivation during the period of legalized euthanasia in Australia.

A qualitative case study was conducted to explore the clinical decision making processes that underpinned the practice of euthanasia under the Rights of the Terminally Ill (ROTI) Act. The key informant for this research was Philip Nitschke, the general practitioner responsible for the legal cases of euthanasia. His information was supported by extensive document analysis based on the public texts created by patients in the form of letters and documentaries. Further collaborating sources were those texts generated by the media, rights groups, politicians, the coroner's cort, and the literature on euthanasia and assisted suicide. A key study finding was that the ROTI legislation did not adequately provide for the specific medical situation in the Northern Territory, Australia. The medical roles, as proscribed by the legislation, carried many inherent assumptions about the health care context and the availability of appropriately qualified medical staff committed to providing euthanasia. These assumptions translated into difficulties in establishing clinical practices for the provision of euthanasia. A further finding concerned the motivations of those who requested euthanasia. This article addresses the medical roles and the motivations of those seeking euthanasia.