Euthanasia Cases Research Articles

Canine Euthanasia's Trend Analysis during Thirty Years (1990-2020) in Italy: A Veterinary Hospital as Case Study.

This study aimed to investigate changes in the number of, and reasons for, requests for dogs' euthanasia over the last thirty years. Data (breed, age, gender, neuter status, manner, and cause of death) from dogs' euthanasia registered between 1990 and 2020 in a small animals' veterinary hospital were analyzed. The overall period examined has been split into two terms (T1 = 1990-2004 and T2 = 2005-2020) considering the introduction and enforcement of Law 189/2004. During the whole period examined, a significant increasing trend in euthanasia cases has been recorded (p = 0.027). Comparing the two terms, we observed significant differences regarding variables such as age, breed, reproductive status, and ownership. The number of euthanized dogs was significantly higher in T1 than in T2. Dogs euthanized in T2 were older than dogs in T1. A high percentage of the euthanized dogs were crossbred and stray dogs. Additionally, the number of neutered/spayed dogs was significantly higher. Regarding the cause of death, a significantly higher percentage of neoplastic processes was detected in T2. The data here reported suggest a potential influence of Law 189/2004. This law in Italy has proven to be a legal milestone that has influenced the decision-making process between euthanasia and natural death.

The prospects of using AI in euthanasia and physician-assisted suicide: a legal exploration

AbstractThe Netherlands was the first country to legalize euthanasia and physician-assisted suicide. This paper offers a first legal perspective on the prospects of using AI in the Dutch practice of euthanasia and physician-assisted suicide. It responds to the Regional Euthanasia Review Committees’ interest in exploring technological solutions to improve current procedures. The specific characteristics of AI – the capability to process enormous amounts of data in a short amount of time and generate new insights in individual cases – may for example alleviate the increased workload of review committees due to the continuous increase of euthanasia cases. The paper considers three broad categories for the use of AI in the Dutch euthanasia practice: (1) the physician’s assessment of euthanasia requests, (2) the actual execution of euthanasia, and (3) the retrospective reviews of cases by the Regional Euthanasia Review Committees. Exploring the legal considerations around each avenue, both in the EU AI Act and the Dutch legal framework, this paper aims to facilitate the societal discussion on the role of technology in such deeply human decisions. This debate is equally relevant to other countries that legalized euthanasia (e.g. Belgium and Canada) or physician-assisted suicide (e.g. Switzerland and numerous states in the US).

Euthanasia in human beings versus companion animals

This article argues in favour of voluntary active euthanasia in human beings on the grounds that we (society in general) perform euthanasia on valued companion animals when their suffering is considered great. I argue that suffering is a morally relevant criterion that should be considered in all cases (human and animal) of euthanasia. I further argue that human beings possess autonomy, a morally relevant difference to companion animals, that allows them to reason about their futures in a way that animals cannot, which gives us more reason to grant euthanasia, if requested autonomously by terminally ill patients who are experiencing extreme suffering. I consider objections around the sanctity of human life and sufficient palliation. I argue that neither of these objections give sufficient reason to deny competent human beings euthanasia if autonomously requested.

Trends in Rescue and Rehabilitation of Marsupials Surviving the Australian 2019-2020 Bushfires.

The 2019-2020 Australian bushfire season had a devastating impact on native wildlife. It was estimated that 3 billion native animals were impacted by the fires, yet there are few estimates of the number of animals that were rescued and rehabilitated post-fire. Focusing on the state of New South Wales (NSW) and Kangaroo Island, South Australia, we used a case study approach to determine the number of marsupials that were reported rescued due to the 2019-2020 bushfires in these areas and analysed species-specific trends in rescue and release success. In NSW, we found 889 reports of fire-affected marsupials in 2019-2020, mostly comprising kangaroos and wallabies (macropods; n = 458), koalas (n = 204), and possums (n = 162), with a smaller number of wombats (n = 43) and other marsupial species. Most reports of fire-affected marsupials occurred 6-8 weeks after fire ignition, and there was no difference in temporal frequency of rescues between marsupial groups. For the three main groups, the probability of survival and subsequent release differed, with macropods having the lowest probability of release after rescue (0.15 ± 0.04) compared to koalas (0.47 ± 0.04) and possums (0.55 ± 0.10). The type of injury was the main predictor of survival during rehabilitation for all three marsupial groups, with those malnourished/moribund or with traumatic injuries less likely to survive rehabilitation. Death or euthanasia occurred on the day of rescue for 77% of macropods, 48% of possums and 15% of koalas. Koalas most often died during rehabilitation rather than on the day of rescue, with 73% either dying or being euthanised between day 1 and 30 post-rescue, representing a potential welfare concern. On Kangaroo Island, koalas were the most frequently rescued marsupial species; most euthanasia cases and deaths occurred in a hospital, whereas other marsupials were mostly euthanised at triage. In both jurisdictions, koalas were over-represented while possums were under-represented relative to baseline population densities and wildlife rescue trends in the years before the 2019-2020 bushfires. These species differences in presentation post-fire warrant further investigation, as do the differences in triage, survival and release outcomes. It is hypothesised that the high intensity and large scale of the 2019-2020 fires impeded marsupial fire evasion tactics, as evidenced by the small number of animals found for rescue, and the differing rates of presentation relative to underlying population densities for the main marsupial groups. Based on our findings, there is a need for detailed record keeping and data sharing, development of consistent and evidence-based triage, treatment and euthanasia guidelines and deployment of trained wildlife emergency rescue teams with advanced search techniques to minimise animal suffering where safe to do so.

Why the irremediability requirement is not sufficient to deny psychiatric euthanasia for patients with treatment-resistant depression

Treatment-resistant depression (TRD) holds centrality in many debates regarding psychiatric euthanasia. Among the strongest reasons cited by opponents of psychiatric euthanasia is the uncertainty behind the irremediability of psychiatric illnesses....

The implementation of euthanasia in Spain: a one-year balance and current challenges

In Spain there have been 180 cases of euthanasia in the past year, one year since the country's Euthanasia Law came into force. The new law established that euthanasia can be carried out if it is the wish of patients who are suffering from serious, chronic and debilitating conditions or serious and incurable illness which causes intolerable suffering. Up to now, the intent to end one's life was considered a sign of psychopathology; psychiatrists are trained to treat the underlying psychiatric disorder. Assessing the mental capacity of an individual making a death wish and acting as an agent for euthanasia is contrary to traditional training of a psychiatrist. The role of psychiatrists concerning Euthanasia in Spain, particularly as far as elderly patients is concerned, is reviewed.

The Moral Dilemma of Euthanasia Through the Eyes of the Medical Society in Bulgaria.

With the development of human society, the question of the value and inviolability of human life begins to occupy a central place in the various social strata and social structures. With the adoption of the Universal Declaration of Human Rights after the Second World War, the basic postulates protecting the right to inviolability of human life were laid. The question focused on euthanasia has been discussed in several European countries, such as Germany, Ireland, France, and Italy, leading to considerable interest in the medical community in Bulgaria. A prospective study was performed using approved sample cards, analyzing the general knowledge of the medical community in the Republic of Bulgaria about euthanasia and assisted suicide over a period of four months, between January 2023 and May 2023. In this process, 623 people were surveyed, and the questionnaire included several targeted questions through electronically generated samples on the Microsoft Forms platform. The target group had doctors with and without a specialty in various fields of hospital and pre-hospital care, dentists, and students from the fields of medicine and dentistry. The results show that the majority of medical professionals clearly state their positive opinion on the adoption of a law to legalize euthanasia in the Republic of Bulgaria, clearly taking into account the fact that the right to life has always been and always will be the most absolute and fundamental human right. Contrary to the above, it is implied that it is inevitably linked to a quality and fulfilling life without suffering. Identically, they also answered that a person should have the right to know exactly when to end his own life. The medical society in Bulgaria clearly shows its positive opinion regarding the idea that the different forms of euthanasia (active euthanasia and assisted suicide) should be defined as morally and legally permissible. Our research confirms the Bulgarian medical community's opinion that the subject of the problems of euthanasia and its legal regulation are already ripe for public discussion, similar to many other European countries. The actual issue of euthanasia as a conclusion raises several questions related to the process of acceptance of standard algorithms for action in such cases where the same action is legalized by law. It also includes the process of acceptance of strict regulations by the countries for the so-called negative phenomenon "death tourism" and several other administrative actions related to the mandatory registration of every case of euthanasia, the implementation of mandatory consultations with a psychiatrist and psychologist for patients seeking euthanasia as the only possible option, and providing possible alternatives regarding their illness. This is the unchangeable cornerstone for standardizing the legalization process and acceptance of "good death" in Bulgaria. In its essence, euthanasia creates both a social and an ethical conflict in our modern society, appearing at the same time as a kind of "stress test" for the health system.

End-of-life decisions and involvement of Physical and Rehabilitation Medicine Physicians in Europe

Objective: As Physical and Rehabilitation Medicine physicians are experts in functional prognoses of disabling health conditions, the aim of this study was to gain insight into their involvement in end-of-life decisions in patients with neurological or terminal diseases in European countries.Design: Exploratory cross-sectional survey.Subjects: Delegates of the Union of European Medical Specialists, Physical and Rehabilitation Medicine Section.Methods: In July 2020, a self-constructed survey was sent to 82 delegates from 38 European countries, who were asked to answer from the point of view of their country. Topics included the legal status of end-of-life decisions and the involvement of Physical andRehabilitation Medicine physicians in these decisions.Results: Between July 2020 and December 2020, 32 delegates from 28 countries completed the survey (response rate country level of 74%). If legal frameworks allow for these specific end-of-life decisions, involvement of Physical and Rehabilitation Medicine physicians was reported in 2 of 3 countries in euthanasia cases, 10 of 17 countries in non-treatment decision cases, and 13 of 16 countries in cases of intensified symptom management by the administration of drugs using potentially life-shortening doses.Conclusion: Estimated involvement of Physical and Rehabilitation Medicine physicians in end-of-life decisions varied between European countries, even when legal frameworks allow for these decisions. LAY ABSTRACTEnd-of-life considerations may arise after severe disabling health conditions and lead to end-of-life decisions. As Physical and Rehabilitation Medicine physicians are experts in functional prognosis for patients with these health conditions, their expertise could be of value to consider in these decisions. Legal frameworks and attitudes towards end-of-life decisions differ between European countries. However, there is a lack of information on the involvement of Physical and Rehabilitation Medicine physicians in these decisions. Therefore, delegates of Physical and Rehabilitation Medicine physicians in European countries were surveyed on the legal status of end-of-life decisions and the involvement of Physical and Rehabilitation Medicine physicians. The responses of delegates from 28 countries suggested differences in involvement of Physical and Rehabilitation Medicine physicians in end-of-life decisions between European countries, even between countries with a legal status of these end-of-life decisions. In the light of the ageing population and a general tendency toward more liberal attitudes concerning end-of-life decisions in Europe, these findings could be of interest in order to optimize end-of-life care in the coming years.

Clinical, pathological and genetic aspects of laryngeal paralysis in dogs

The review article discusses the main clinical signs of paralysis of the larynx and pathological changes associated with it and other neurological pathologies. These hereditary canine neuropathies form a group of degenerative diseases affecting motor and/or sensory and autonomic peripheral nerves and have similar symptoms.Axonal forms associated with generalized polyneuropathy and paralysis of the larynx have been described in several dog breeds: Dalmatians, Alaskan Malamutes, Rottweilers, Labrador Retrievers, Leonbergers, St. Bernards, Italian Spinols, Pyrenean Mountain Dogs, Podhale Sheepdogs, Cocker Spaniels, Great Danes, American Staffordshire Terriers, Staffordshire Bull Terriers, Bouvier de Flandres, Siberian Huskies and Siberian Husky crosses. Candidate genes for association with the disease are considered: ARHGEF10, RAPGEF6, ADAMTS3, CNTNAP1, DCTN1. The age of onset of the disease can be different, the manifestation of signs of paralysis of the larynx occurs both in young dogs, and the geriatric form also occurs. The prognosis of the complex of paralysis of the larynxpolyneuropathy is from cautious to unfavorable. One case of euthanasia due to intractable regurgitation and aspiration pneumonia has been described. Some authors point to a possible association of the disease with white coat color. Two main types of inheritance of paralysis of the larynx in dogs have been established - autosomal recessive and X -linked recessive. In humans, the dominant type of inheritance of this anomaly is known. Early diagnosis will make it possible to identify the hereditary nature of paralysis of the larynx, reduce the incidence of severe forms of the disease with timely surgical correction of the cartilage of the larynx and symptomatic treatment, as well as the spread of carriers of mutant alleles in dog populations. This is relevant today in connection with the spread of this anomaly in many breeds.

Analisis Yuridis Terkait Penerapan Euthanasia Yang Dilakukan di Indonesia Berdasarkan Perspektif Hukum Pidana

As a result of the advancement of science and technology, which has had a significant impact on altering human life, patients or families can now request the assistance of a doctor or medical staff in order to hasten a loved one's demise. However, the request for death was made because there was no medical treatment that could foretell or lessen the patient's illness, all attempts to cure the patient by the doctor had failed, and the patient and his family were unable to pay for the patient's care. Based on the author's findings on euthanasia research, it can be concluded that both in terms of the legal order in Indonesia, the practice of euthanasia itself has not yet found a place for regulation to regulate both specifically and clearly. Whereas as explained in the discussion, even though there are various articles in various laws such as the Criminal Code and UUDNRI 1945 there are several articles that slightly intersect with euthanasia, regarding the existence of euthanasia in Indonesia, it still does not have a special place legally and legally . Whereas the implementation of euthanasia in Indonesia itself, there have been several cases of euthanasia that have occurred in Indonesia, and several of these cases in their application to the realm of the Courts in Indonesia have not been given space in practice, in contrast to several other countries which have legalized the practice of euthanasia, such as the Netherlands and America. However, in carrying out the euthanasia practice itself, there are several conditions for carrying out the euthanasia practice itself.

Quantification of a shelter cat population: Trends in intake, length of stay and outcome data of cats in seven Dutch shelters between 2006 and 2021.

Shelter metrics can be used by shelters for self-assessment to optimise the health of their animal population and to identify risk factors for disease outbreaks. However, there is a need for a wider scope of these shelter metrics, as evidenced by the interest from shelters in the benchmarking of shelter progress and the development of national best practices. For the first time, Dutch shelter data were used retrospectively to signal trends using potentially reliable metrics for the analysis of shelter data. The aims of this study were to apply relevant metrics describing the different phases of shelter management for shelter cats (i.e., intake, stay and outcome) and a retrospective analysis of shelter data over the period between 2006 and 2021. Seven of the approximately 120 Dutch animal shelters participated in this study. Quantitative data on the intake of more than 74,000 shelter cats (e.g., stray cats, cats surrendered by their owners and cats obtained from other sources) and their outcomes (i.e., cats rehomed, returned to their owners, deceased, or otherwise lost) have been analysed. Metrics such as rehoming rate, return to owner rate, rates for mortality and euthanasia, length of stay and risk-based live release rate were determined. The main findings of the study during this 16-year period were that, over time, the number of cats per 1000 residents admitted to Dutch shelters was reduced by 39%, the number of feline euthanasia cases decreased by approximately 50%, the length of stay showed a reducing trend, while the return to owner and the risk-based live release rate increased. The shelter metrics examined in this study could be helpful in monitoring and evaluating the management, consequent health, and well-being of cats in shelters and eventually measuring progress of shelters both in the Netherlands and at a European level.

Euthanasia and physician-assisted suicide in people with intellectual disabilities and/or autism spectrum disorders: investigation of 39 Dutch case reports (2012-2021).

Euthanasia review committees (Regionale Toetsingscommissies Euthanasie, RTE) scrutinise all Dutch cases of euthanasia and physician-assisted suicide (EAS) to review whether six legal 'due care' criteria are met, including 'unbearable suffering without prospect of improvement'. There are significant complexities and ethical dilemmas if EAS requests are made by people with intellectual disabilities or autism spectrum disorders (ASD). To describe the characteristics and circumstances of people with intellectual disabilities and/or ASD who were granted their EAS request; investigate the main causes of suffering that led to the EAS request; and examine physicians' response to the request. The online RTE database of 927 EAS case reports (2012-2021) was searched for patients with intellectual disabilities and/or ASD (n = 39). Inductive thematic content analysis was performed on these case reports, using the framework method. Factors directly associated with intellectual disability and/or ASD were the sole cause of suffering described in 21% of cases and a major contributing factor in a further 42% of cases. Reasons for the EAS request included social isolation and loneliness (77%), lack of resilience or coping strategies (56%), lack of flexibility (rigid thinking or difficulty adapting to change) (44%) and oversensitivity to stimuli (26%). In one-third of cases, physicians noted there was 'no prospect of improvement' as ASD and intellectual disability are not treatable. Examination of societal support for suffering associated with lifelong disability, and debates around the acceptability of these factors as reasons for granting EAS, are of international importance.

De Belgische Euthanasiewet doorstaat de mensenrechtelijke toets, behalve voor de a posteriori-controle (Mortier tegen België (nr. 78017/17))

The Belgian euthanasia law passes the human rights test, except for the a posteriori control Mortier versus Belgium (no. 78017/17) On several occasions, the European Court of Human Rights (ECtHR) has ruled on the human rights compliance of national regulations regarding medical assistance in dying. However, ‘Mortier versus Belgium’ is the first decision of the court on a case of euthanasia and, more specifically, euthanasia for unbearable mental suffering of a person with a psychiatric disorder. The court finds that the substantive and procedural requirements that must be observed by the concerned physicians under the Belgian euthanasia law, do not violate the European Convention on Human Rights (ECHR). By contrast, the way in which the a posteriori control by the Federal Control and Evaluation Commission is regulated, does violate the ECtHR as it cannot guarantee that all members are independent. Since a ruling of the court is binding, the legislature will need to amend the euthanasia law so that the independence of the members of this commission is always assured.

The case of Geneviève Lhermitte's euthanasia between psychiatric evaluation, legal aspects and ethical reflection.

A recent euthanasia case in Belgium has garnered attention due to its particularly dramatic aspects, sparking clinical and ethical questions about end-of-life choices in cases of mental suffering. A 56-year-old woman, convicted of the murder of her five minor children and sentenced to life imprisonment, has been granted euthanasia for "irreversible psychological suffering". The clinical and psychodynamic aspects of the case, primarily deduced from press reports, are highly complex and give rise to numerous clinical, medico-legal, and bioethical questions. These include inquiries into the true nature of psychopathology, its actual irreversibility, its impact on the ability to express a euthanasia request with adequate awareness, the preserved capacity for self-determination, and broader issues related to end-of-life requests from patients with mental disorders. These aspects are considered in the context of the legislation in various European countries. The unique details of this case underscore the critical challenges associated with these complex issues.

Media coverage of Belgium's first criminal case concerning euthanasia for psychiatric patients: A content analysis of Flemish newspapers and magazines.

Belgium is one of the few countries worldwide where euthanasia on the grounds of unbearable suffering caused by a psychiatric disorder is legally possible. In April 2010 euthanasia was carried out on a 38-year-old Belgian woman with borderline personality disorder and/or autism. After a complaint by the family, three physicians were referred to the Court of Assizes on the charge of "murder by poisoning". A content analysis of print and online news coverage of the euthanasia case in a selected sample of Flemish newspapers and magazines, published between December 1, 2019 and March 1, 2020, was conducted to analyze the prominence and framing of the euthanasia case, as well as the portrayal of key figures in this case. A quantitative analysis, as well as an in-depth qualitative analysis (with the aid of NVivo 1.0 software) was performed. One thousand two hundred fifteen news articles were identified through database searching. Of these, 789 articles were included after screening for relevance and eligibility. Mean prominence scores were moderate and did not statistically significantly differ between newspapers with a different historical ideological background or form (elite versus popular). The most frequent headline topics featured legal aspects (relating to the Belgian Euthanasia Law or the course of the trial). Headlines and content of most articles (90 and 89%, respectively) did not contain an essential standpoint on the euthanasia case itself or, if they did, were neutral. Historical ideological background, nor form of newspaper (elite versus popular) significantly influenced headline tone or article direction toward the euthanasia case. Despite this, our qualitative analysis showed some subtle differences in selection, statement or tonality of reports between certain newspapers with a different historical ideological background. Although major Flemish newspapers and magazines generally were neutral in their coverage of the judicial case, major points of contention discussed were: the need for an evaluation and possible amendments to the existing Euthanasia Law, including a revision of the Belgian Control Commission and the system of penalties for physicians, and the absence of any consensus or guidance on how to define psychological suffering.

ПРИРОДА ОТКАЗА ОТ МЕДИЦИНСКОГО ВМЕШАТЕЛЬСТВА В СРАВНЕНИИ С ПРОЦЕДУРОЙ ПАССИВНОЙ ЭВТАНАЗИИ

The article is dedicated to the problem of establishing differences between patient’s refusal of medical aid and passive euthanasia. While the right to refuse any medical aid is fully established in the Russian laws, euthanasia on the other hand is prohibited in any and all forms, including passive euthanasia. That creates a problem of establishing which one is which in a specific situation. There are examples of people refusing treatment up to the point of death being in sound mind — can it be considered a case of passive euthanasia? The author arrives to the conclusion that while some may believe that passive euthanasia is the same thing as refusal of medical aid these two institutions shall be considered different. While euthanasia can be prohibited by the state, because it involves relations with the state about actualisation of the right to life, refusal of medical aid is different as it involves assessment of personal values that is beyond the control of any State, so prohibiting refusal of medical aid shall be considered impossible.

EUTANASIA DALAM PANDANGAN AL-QUR’AN

Humans never know the time of their death because life and death are Allah's provisions. However, death has causes such as disease, war, etc. This fact proves that Allah does not act arbitrarily on His creatures. Ironically, there are deaths caused by suicide both by self and by medical procedures for certain reasons, namely euthanasia. Suicide is mentioned four times in the Qur'an surah al-Nisā': 29, al-Baqarah: 53, al-Baqarah: 85, and al-Nisā': 66. This research used a qualitative approach, the library research method by collected several literature sources such as books, journals, and previous scientific research that discussed euthanasia. The Maqāsidy Tafsir method was applied to study verses regarding euthanasia to derive wisdom from a verse. The results pointed out that the verses of suicide from the Tafsir Maqāsid perspective provide two understandings, first is the prohibition of suicide in surah al-Nisā': 53 and second is the suicide order in surah al-Baqarah: 53. The suicide command is in the context of repentance, as happened to the people of the Prophet Mūsa. The suicide prohibition is the wisdom of Allah to signify His majesty that only Him has the right to bring humans to life and death. Eventually, this verse also has a contradiction with the euthanasia case.

On the Authority of Advance Euthanasia Directives for People with Severe Dementia: Reflections on a Dutch Case.

In 2016, a Dutch physician complied with the advance euthanasia directive of a patient with severe dementia. In the ensuing lawsuit, the physician was charged principally with termination of life on request, with euthanasia, that is, and alternatively with murder. A district court acquitted her of both charges, a decision later upheld by the Dutch Supreme Court. Euthanasia is still a criminal offense in the Netherlands, but in 2002, a new euthanasia act came into effect allowing a physician to perform euthanasia if she has fulfilled six due-care criteria, the two most important of which are that she must be satisfied that the patient's request is voluntary and well considered and that the patient's suffering is unbearable, with no prospect of improvement. Neither of these two criteria is controversial; particular cases are controversial when it is disputed that these criteria were fulfilled. Other euthanasia cases, however, are controversial because they belong to a category that is contentious for independent reasons. One such disputed category is euthanasia performed on incompetent patients with an advance directive. Since determining whether these criteria are fulfilled in a particular case depends on the particular circumstances, we describe this 2016 case in detail. We then focus on three general philosophical reasons for doubting the validity of advance euthanasia directives for incompetent patients: the someone else problem, the problem of response shift, and the problem of normative authority. These problems have been discussed before, but our primary aim is to show how they are connected. Taken together, we believe that our two lines of argument make a strong moral case for supporting the Dutch Supreme Court's decision.

Voluntary assisted death in present-day Japan: A case for dignity

No laws or official guidelines govern medical assistance for dying in Japan. However, over the past several years, cases of assisted suicide or voluntary euthanasia, rarely disclosed until recently, have occurred in close succession. Inspired by these events, ethical, legal, and social debates on a patient’s right to die have arisen in Japan, as it has in many other countries. Several surveys of Japanese people’s attitudes towards voluntary assisted dying suggest that a certain number of Japanese prefer active euthanasia. Against this background, it is important to discuss voluntary assisted dying cases in Japan and the Japanese views on them and to consider their implications. We review three recent Japanese voluntary assisted dying cases and discuss the various objections to voluntary assisted dying that have been published in response to these in various media outlets. Our counterarguments include the double suffering of people who are unable to give up their desire to die, individuality of death, variability of culture, problem of being an annoyance to (burden on) others, a slippery slope argument supporting voluntary assisted dying, and unfair claims about responsibility and excessive burden on people who are unable to give up their desire to die. We also point out the psychocultural and social problems in Japanese society that these objections reflect, and argue that voluntary assisted dying can be ethically acceptable under certain conditions. We conclude that Japanese society must change in order to enable those who sincerely wish to die to do so in a better way.

Euthanasia in Dementia: A Narrative Review of Legislation and Practices in the Netherlands and Belgium.

Euthanasia was first legalized in the Netherlands and Belgium in 2001 and 2002, respectively. Currently they are among the few countries that also allow euthanasia on the basis of dementia, which is still considered controversial, both from a scientific and societal perspective. To date, euthanasia in dementia constitutes a small proportion of all Dutch and Belgian euthanasia cases. However, instances are rising due to a growing awareness among the general public about the possibilities of a self-chosen end-of-life and the willingness among medical professionals to perform euthanasia in individuals diagnosed with dementia. In both countries euthanasia is allowed under strict conditions in patients with dementia and decisional capacity regarding euthanasia, while in the Netherlands an advance euthanasia directive can also replace an oral request for euthanasia in those with late-stage dementia. Judging euthanasia requests from patients with dementia is complex and the assessment of the due care criteria (especially those related to decisional capacity and unbearable suffering) requires caution and great care. In this narrative review, we reflect on the legal regulation, clinical guidelines and societal debate regarding euthanasia in dementia in the Netherlands and Belgium. By discussing the 20 years of experience with the ethical dilemmas and controversial aspects surrounding this delicate topic, we hope to inform the preparation or implementation of new legislation on euthanasia in dementia in other countries.