Legalization Of Euthanasia Research Articles

The Necessary Implications of Wrongful Life Claims: Lessons from France

On November 17, 2000, the Assemblee Pleniere of the Cour de Cassation, the highest civil court in France, allowed Nicolas Perruche, a 17 year old suffering from congenital rubella syndrome, to recover damages against the doctor and the laboratory who had negligently advised his mother that she was not infected with rubella while she was pregnant with Nicolas. Suspecting that she was infected with rubella, Nicolas’s mother had told her doctor that she would terminate her pregnancy if the test proved positive. Negligently reassured twice that she was not infected, she continued with the pregnancy and Nicolas was born suffering the effects of the rubella which included severe developmental delay, deafness, partial blindness, and heart problems. The case falls under the rubric of ‘wrongful life’ as Nicolas could not have been born healthy, rather, he was claiming that without the negligence, he would not have been born at all and thus would not have experienced the suffering produced by his exposure to rubella. The decision caused an outcry in France and was widely condemned by the media, academics, groups representing the disabled, doctors and politicians. There was pressure on the government to request an opinion on the matter from the National Bioethics Advisory Committee (CCNE), which it eventually did. The resulting opinion condemned the decision in Perruche. Nevertheless, in three similar cases in July 2001, the Cour de Cassation confirmed its earlier jurisprudence (although recovery was denied on the ground that the women involved would not have been able to terminate their pregnancies had they been correctly informed of the results of their ultrasound examinations due to the operation of the abortion law). In November 2001 Perruche was re-affirmed by the Cour de Cassation. Despite this reinforcement of the position of the Cour de Cassation, there was some resistance by the lower courts. After much debate in the Assemblee Nationale and the Senat during 2001 and the early part of 2002, Perruche was finally overturned by a law dated March 4, 2002, which denies legal redress to one “who is harmed solely by being born”. In this article I proceed on the basis that the arguments around causation, harm and damages are masks for the real questions which surround Perruche. Many of the arguments against Perruche are based on what commentators view as the ‘necessary implications’ of the decision, which inspired the CCNE report and the new law. I examine these ‘implications’ as a series of questions, to determine whether these implications really are inherent in the court’s holding: -does the acceptance of wrongful life claims recognise a right not to be born? -if there is a right not to be born, is this inconsistent with the right to life? -if there is a right not to be born, does this necessarily imply a right to prenatal euthanasia? -does allowing wrongful life claims move us down a slippery slope towards the legalisation of euthanasia? -does allowing wrongful life claims foster a discriminatory society?

Attitudes toward palliative care, conceptions of euthanasia and opinions about its legalization among French physicians

We assume that actors of the professionalization process of palliative care make a special effort to demarcate it from euthanasia, and that such an effort has a significant impact on beliefs and attitudes toward euthanasia among the whole medical profession. We investigated concurrently attitudes toward palliative care, conceptions of euthanasia and opinion toward its legalization among a sample of 883 French general practitioners, oncologists and neurologists. We found four contrasted profiles of attitudes toward palliative care, which were closely correlated with being in touch with palliative care providers. Attitudes toward palliative care were closely correlated with beliefs about which medical practices should be labelled euthanasia, and these beliefs were in turn strongly associated with opinions toward euthanasia legalization. Our results suggest that the relationship between palliative care and euthanasia mixes semantic and strategic aspects, beyond cognitive and conative ones.

Palliative care nurses' views on euthanasia.

In debates on euthanasia legalization in Belgium, the voices of nurses were scarcely heard. Yet studies have shown that nurses are involved in the caring process surrounding euthanasia. Consequently, they are in a position to offer valuable ideas about this problem. For this reason, the views of these nurses are important because of their palliative expertise and their daily confrontation with dying patients. The aim of this paper is to report a study of the views of palliative care nurses about euthanasia. A grounded theory approach was chosen, and interviews were carried out with a convenience sample of 12 palliative care nurses in Flanders (Belgium). The data were collected between December 2001 and April 2002. The majority of the nurses were not a priori for or against euthanasia, and their views were largely dependent on the situation. What counted was the degree of suffering and available palliative options. Depending on the situation, we noted both resistance and acceptance towards euthanasia. The underlying arguments for resistance included respect for life and belief in the capabilities of palliative care; arguments underlying acceptance included the quality of life and respect for patient autonomy. The nurses commented that working in palliative care had a considerable influence on one's opinion about euthanasia. In light of the worldwide debate on euthanasia, it is essential to know how nurses, who are confronted with terminally ill patients every day, think about it. Knowledge of these views can also contribute to a realistic and qualified view on euthanasia itself. This can be enlightening to the personal views of caregivers working in a diverse range of care settings.

French Physicians’ Attitudes toward Legalisation of Euthanasia and the Ambiguous Relationship between Euthanasia and Palliative Care

In 1999, the French Parliament established a "right to palliative care", which reactivated public debate about euthanasia. In order to investigate jointly physicians' attitude toward palliative care and euthanasia, we conducted a cross-sectional survey of a national sample of French GPs, oncologists, and neurologists. Overall, 917 physicians participated in the survey. Significant proportions of respondents, especially among GPs and neurologists, considered that palliative sedation and withdrawing life-sustaining treatments (WLST) were euthanasia. Multivariate analysis showed that the physicians who had special medical training in palliative care, and those who distinguish palliative sedation and WLST from euthanasia were more likely to oppose legalisation of euthanasia. Thus, French physicians' attitude to the legalisation of euthanasia is strongly influenced by whether or not they distinguish palliative care from euthanasia. Improved palliative care requires better training of the entire medical profession, and clearer guidelines about which end-of-life care practices are legally and ethically acceptable.

Tolerance and Pragmatism in the Netherlands: Euthanasia, Coffeeshops and Prostitution in the ‘Purple Years’, 1994–2002

The Netherlands is traditionally regarded as a tolerant nation. In criminal justice matters such tolerance was usually evidenced by low prison rates, and a rehabilitation and social welfare-oriented criminal justice system. In other words, the tolerance had a focus on wrongdoers. During the ‘purple years' (1994–2002) when a neoliberal government that consisted of the Labour Party and two liberal democratic parties, took office, a shift in tolerance emerged. New legislation included the legalisation of euthanasia and of brothels, and same sex marriages were authorised too. Meanwhile the policy of soft drugs decrimin-alisation via coffeeshops has remained intact. In a climate of rising prisoner numbers, we observe an increased level of tolerance towards certain lifestyles or life choices. This article discusses the causes and effects of these developments.

Many French doctors want the legalisation of euthanasia

Many French doctors want the legalisation of euthanasia

932 French physicians' attitudes toward legalisation of euthanasia and the ambiguous relation between euthanasia and palliative care

The aim of this work is to discuss the photocatalytic performance of the titania-zirconia porous photocatalyst layers synthesized via micro arc oxidation technique. An attempt was also made to put forward the basic formation mechanism of the layers. Impedance and optical properties of the photocatalyst layers were studied by electrochemical impedance spectroscopy (EIS), Photoluminescence spectroscopy and UV–vis absorption spectroscopy, in order to assess their intrinsic catalytic properties. The results of the EIS were correlated with the microstructural characteristics along with measurements of Methylene Blue (MB) photocatalytic degradation. The results show enhanced photocatalytic activity of TiO2-ZrO2 composite layers compared to pure TiO2 layer. It was revealed that the photocatalytic activity of the layers prepared at different duty cycles is influenced by characteristics of microdischarge regime imposed by working electrolytes with varying additive concentration. The results of photocatalytic degradation of methylene blue were in good agreement with those obtained from electrochemical analysis.

National survey of medical decisions at end of life made by New Zealand general practitioners

Several attempts have been made in New Zealand to liberalise laws prohibiting euthanasia. Surveys in other countries where legalisation of euthanasia was being considered have found illegal provision of physician...

Palliative care on the 'slippery slope' towards euthanasia?

The response to our position paper on palliative care and euthanasia i/ 55 commentaries, from 32 countries, in the March 2003 issue of Palliative Medicine i/ has been remarkable in its breadth and variety. Moreover, a most welcome side effect’, as it were, is that many commentators also take the opportunity to provide important information about the development and recent state of palliative care services in their home country as well as giving an overview of the euthanasia debate, or lack of such, in their own context. The reactions are as diverse as there are authors, one could say. Some think we have made a contribution at the conceptual level that will greatly help the debate worldwide as well as in their own country. Others see a contribution that is relevant to clinical practice (the paper `will help our day-to-day practice’, Malas, p. 150). Whilst a further group think our definitions simply mess things up. To illustrate, van der Wal values our contribution concerning concepts and clarity, saying that I am glad that the Task Force suggests, with regard to euthanasia, that the adjectives `voluntary’, `active’ and `passive’ should no longer be used . . . The argumentation is valid. In the spoken and written word this will avoid many unnecessary misunderstandings’ (p. 110). On the other hand, Billings is of the opinion that we have `confused some important definitions and distinctions’ (p. 105). While HaEnninen states: I do not think that the Task Force’s report brings anything new to the discussion’ (p. 166). In other words, to him, we neither make things clearer nor more muddy! Interestingly, support comes both from those who favour the legalisation of euthanasia and from those who oppose that i/ as does attack and rejection of our stance. The EAPC Ethics Task Force‘s reply to critics

From the West Indies

This paper is an extremely welcome addition to the debate on euthanasia and physician-assisted suicide. The definitions offered are particularly clear and leave no room for doubt, and I found the phrase `at that person’s voluntary and competent request’ particularly pertinent. It is my experience that some members of the public still believe that euthanasia is a term that can be interchanged with `mercy killing’, and that the patient may therefore be at the mercy of health professionals, who could make a decision independently as to whether that patient’s life is worth living or not, and then act accordingly. I agree wholeheartedly with the suggestion that the term `voluntary euthanasia’ should be abandoned; its use gives credence to the idea that there may be such a thing as involuntary euthanasia’, i.e., mercy killing, as mentioned above, doubtless a fear of many vulnerable people. The fact that this paper represents a viewpoint from the palliative care perspective means that it is undoubtedly biased, and takes the position that the widespread provision of palliative care services will reduce the calls for euthanasia and physician-assisted suicide. This may indeed be so; however, I do wonder at either the arrogance or overoptimism of this position. Do we, as palliative care physicians really believe that the availability of good palliative care will solve the problem for all those who perceive that their life has become intolerable and not worth living? There may be many people with nonmalignant life-threatening diseases, such as the neuromuscular wasting disorders, for whom palliative care may offer very little in terms of relief from the progressive debilitating nature of their illness. There may be others, who find themselves completely paralysed and utterly dependent, perhaps secondary to trauma, for whom palliative care may offer little, and for whom an early death at a time of their own choosing may be a preferable outcome. While the establishment of palliative care within mainstream healthcare systems is an admirable goal, we should not be deluded into thinking it will be a `cure all’ with respect to requests for euthanasia. The paper acknowledges on at least two occasions that individual requests for euthanasia or physician-assisted suicide should be treated sensitively and with respect and understanding, but it does not go as far as acknowledging that some of these requests may be justified despite the best and most excellent provision of palliative care for that individual. The potential problems that may arise following the legalization of euthanasia are eloquently listed, and it is my view that the EAPC should be assisting the countries where it is legal to monitor prospectively in order to see whether any of the proposed potential problems become a reality for those societies. This writer has recently moved from Europe to a developing Caribbean country. Palliative care is essentially an unknown art here, and pain control in malignant disease is poor at best. Despite this, it appears that the prevailing opinion of both patients and healthcare professionals alike is that euthanasia has no place in this society. Life, it seems, is very precious here, and suffering at the end of it is seen as part of the journey. To escape from it early is seen either as murder (by health professionals) or as deeply unChristian (by the patients). I wonder whether indulging in a debate regarding euthanasia is a privilege of living in a sophisticated and developed society. Ultimately there is no absolute position to be held on anything, and there will always be individuals for whom euthanasia seems to be a persuasive option. However, the EAPC Task Force has done an excellent job in producing a well-written paper presenting an ethical stance against euthanasia, and I believe that the nonprofessional public should have access to the views represented here. Palliative Medicine 2003; 17: 155

From New York City

The EAPC Ethics Task Force calls for the establishment of palliative care within the mainstream healthcare systems of all European countries supported by appropriate finance, education and research’ (paragraph 4.10). While I strongly support this goal, I do not agree that its realization is one of the most powerful alternatives to calls for the legalization of euthanasia and physicianassisted suicide’ (paragraph 4.10). Where high-quality palliative care is available, many terminally ill patients prefer it over physician-assisted suicide and euthanasia. But it does not follow that the availability of such care is a superior alternative to the availability of physician-assisted suicide or euthanasia. For while good pallia tive care is the best option for many, some patients may nonetheless prefer one of the two alternatives. Moreover, while each patient’s treatment must exemplify one option to the exclusion of the others, society need not make an exclusive choice. It can make all three options available concurrently to patients for whom they are appropriate. I think it should. Persons in affluent countries must reckon with the possibility that their lives will be prolonged in a modern medical care facility well beyond the point when they will be able to lead this life in anything like a full and active way. Some welcome this extra time of life; and we should be glad for them to have it and help make it as worthwhile and pain free as possible. But some do not welcome this extra time. I may not want to witness the further unstoppable decay of my mental and physical faculties. I may not want the older memories my loved ones have of me displaced and distorted by long hours they spend with what is left of me in a sterile hospital setting. Like Rear Admiral Chester Nimitz, I may want to die still competent and capable of settling my own affairs. In advance and from the outside, it is hard to know how one would think and feel about extra months or years of life within a modern medical care facility. One may therefore find it most important that checking into such a facility as a frail old person, one has the assurance that one retains control over the most fundamental aspect of one’s life / whether to go on with it or not. One may want to be sure that one’s voluntary and competent request for physician-assisted suicide or (should one be unable to co-operate) euthanasia will be honored. Unlike physician-assisted suicide, euthanasia requires that the physician intends the patient’s death. This is not a substantial moral difference when the death is, in both cases, triggered by the patient’s own voluntary and competent request . Morally, the event is then suicide assisted by another. The extent to which the patient can physically co-operate makes no moral difference. The Ethics Task Force suggests that, for patients deprived of the suicide option, `an alternative is to take action through the use of living wills’ and advance directives, contributing to improved communication and advanced care planning and thereby enhancing the autonomy of the patient’ (paragraph 4.8). These good options should indeed be encouraged, but they are in no way a substitu te for the option of ending one’s life. Focusing on euthanasia alone, the Ethics Task Force opposes legalization (paragraph 7). The six reasons it gives are underdeveloped and not compelling. Pressure by doctors and insurance providers should be outlawed and punished. There may be economic pressure as continued treatment could bankrupt the patient’s family. But may society force him to spend his family’s savings on extra time in hospital at the expense of his daughter’s college education? No. But society may encourage him to make this choice. A society that does not force patients but tries to convince them to stay alive has strong incentives to ensure that their treatment costs are covered and that good palliative care is developed and valued. The values of healthcare professionals can and should be fully respected by allowing anyone to opt out. The three slippery slope concerns, finally, seem empirically far-fetched and morally dubious. What evidence is there that allowing terminally ill patients to choose death would cause `killing to become accepted in society’ (whatever this means) or `an increase in the incidence of non-voluntary or involuntary medicalized killing’? And even if there were such a causal link, the right response would surely be to attack this link: to stress / much more forcefully than the Ethics Task Force has done / that killing patients is morally worlds apart from allowing them to choose death. Palliative Medicine 2003; 17: 119

Euthanasia and physician-assisted suicide: a review of the empirical data from the United States.

For more than a decade, there has been an intense debate about the ethics and legality of euthanasia and physician-assisted suicide (PAS) in the United States. 1-5 In June 1997, the US Supreme Court unanimously ruled that there is neither a constitutional right nor a constitutional prohibition to euthanasia or PAS. 6,7 This permitted Oregon to experiment with legalizing PAS. During this decade, most other states have consistently opposed legalization. In the weeks after the US Supreme Court decision, the Florida Supreme Court also ruled that there is no constitutional right to PAS. 8 At least 7 state legislatures have voted to explicitly prohibit euthanasia and PAS. 9 Indeed, a bill to legalize euthanasia or PAS has been considered by a full chamber of a state legislature in only one state, Maine, and that bill was defeated 99 to 42. 10 In November 1998, 70% of the voters of Michigan resoundingly defeated a referendum to legalize PAS, while in November 2000 Maine voters also rejected legalizing PAS. 11

Legalización de la eutanasia como opción a una muerte digna. Consulta de expertos a través de la técnica Delphi

The current study presents various opinions from different professional fields on the controversial topic arisen by the media on the legalization or no legalization of euthanasia, as an option to a death in dignity, requested in previous years by a person. Delphi techniques have been used. The participans in the survey are all professionals from various means: Sanitary professionals, Law professionals, Anthopologists, and Religious ones. After questionaries were answered, and results obtained, a final report was issued, and all the professionals reached a general agreement: euthanasia legalization would mean a social in- favour/ against debate, which would end in occasional social conflicts, unless performances and application in all cases is extremely well controlled. Even those professionals inclined to accept euthanasia only legally approved, feel that there is always a risk in the hundred per cent of the control. In that sense, their proposal is that a Medical-legal Committe would always act in all cases so therapeutic aggression is avoided. A valid, written vital will should be considered as the terminal ill patient last will.

Intensive care - palliative care. Contradiction or supplement? Considerations on ethical issues and principles in the treatment of dying patients

Over the last five decades the progress in intensive care has extended the limitations of controlling the process of dying and given doctors more influence in determining the time of death. More recently, palliative care has emerged as a new approach in response to the ethical dilemmas of modern medicine, which accepts that dying is a natural process that should not be hastened or delayed through medical interventions. While in Germany in 1999 more than 50 000 people have died in intensive care units, only a small number of 8000 patients have died in palliative care. In comparison to the highly-developed intensive care sector, palliative care is a much neglected area. The public debate following the legalisation of euthanasia in the Netherlands has highlighted concerns in Germany that intensive care has the potential of inappropriately prolonging life and raised expectations about the alternative therapies offered by palliative care. Doctors in intensive care and in palliative care face similar ethical dilemmas, though with a different weighting: the dilemma between professional judgement and patient autonomy, between traditional medical roles and patient self-determination and the dilemma of extending the span of life at the expense of quality of life. The approach of palliative care with its strong focus on alleviating the suffering of the terminally ill, has influenced the ethical debate of dying in intensive care. Although intensive care and palliative care have different aims and priorities, there are common problems of decision-making which could benefit from a shared orientation and interdisciplinary debate. Both the interpretation of a dying parent's will as well as withdrawing or withholding treatment in patients who are unable to decide for themselves should not merely be guided by the debate on active and passive euthanasia, but rather take into account the appropriateness or inappropriateness of medical actions in the specific situation.

Euthanasia: from the perspective of HIV infected persons in Europe.

In the debate about legalization of euthanasia very little attention has so far been given to the opinion of the patient. To assess the opinion of persons with HIV infection in Europe. A cross-sectional survey of persons with HIV infection attending HIV/AIDS treatment centres or HIV support organizations in 11 European Union Member States was performed. A total of 2751 anonymous patient self-administered questionnaires were distributed between August 1996 and September 1997. The questionnaire contained 108 questions concerning a variety of topics about HIV care, including five questions on euthanasia. One thousand three hundred and seventy-one people with HIV infection completed the questionnaire, of whom 1341 (98%) responded to the questions concerning euthanasia. Seventy-eight percent of respondents agreed with the legalization of euthanasia in case of severe physical suffering, 47% if there was severe psychological suffering and 24% simply at the patient's request. For physical suffering and at a clear patient's request, accepted practices were: alleviation of pain with double effect (81%), medical euthanasia (62%) and physician assisted suicide (45%). Fifty percent would consider euthanasia for themselves if all treatment options were exhausted. Social indicators such as educational level and employment seemed to play a more significant role in determining attitudes towards legalization, and personal interest in, euthanasia than indicators related to disease status. In this study a majority of HIV infected persons in Europe favoured the legalization of euthanasia.

An exploratory pilot study of nurse-midwives' attitudes toward active euthanasia and abortion

Over the past three decades, active euthanasia and abortion have received increasing international attention. Since both these practices are relevant to the role of the nurse-midwife, it is important to know what influences their attitudes towards them. Therefore, the purpose of this study was: 1, to survey the attitudes of nurse-midwives' to active euthanasia and its legalization; 2, to determine the relationship between nurse-midwives' attitudes toward active euthanasia and its legalization, and attitudes toward abortion, self-reported religiosity and religious affiliation. The study setting was an international midwifery conference and the sample consisted of 139 nurse-midwives attending the conference. The majority of nurse-midwives displayed a positive attitude toward active euthanasia and its legalization. In addition, there was a positive relationship between their attitude to abortion and active euthanasia. Self-reported religiosity and religious affiliation were significantly related to attitudes toward active euthanasia and its legalization. An interesting positive relationship between country of practice and attitudes to euthanasia was also found. Nurse-midwives practicing in countries with more liberal euthanasia and assisted suicide legislation were more supportive of active euthanasia. With the increasing acceptance of active euthanasia's legalization, the results of this study pose some ethical questions that nurse-midwives internationally will have to consider.

Physicians’ Attitudes towards Euthanasia in Kuwait

Objectives: The attitudes of physicians in Kuwait towards euthanasia were examined. An additional objective was to examine whether physician characteristics such as nationality, qualifications, years of experience and/or religion affect their attitude toward euthanasia. A comparison was also made between the experience of physicians who generally treat terminally ill patients and those who generally treat non-terminally ill patients in terms of attitudes toward hastening death to alleviate suffering. Methods: A descriptive study using a self-administered questionnaire was conducted among 228 physicians working in 5 selected government hospitals. The response was 92%. Results: Nearly 92% of all the respondents did not support the provision of means for terminally ill patients to commit suicide while 8% did. A majority favored providing pain killers and comfort even if this hastens the patient’s death. About 20% of the physicians felt that the Ministry of Health should allow euthanasia under certain restricted conditions. About 47% of Hindu, 23% of Christian and 17% of Muslim physicians agreed to the legalization of euthanasia. Approximately 27% of physicians who were frequently exposed and 10% of those who were rarely exposed to terminally ill patients reported that they had been asked to hasten death. Physicians in Kuwait have not dealt with euthanasia as much as physicians in other countries such as Australia and are much less favorable towards it. Conclusion: The findings of this survey indicate that a minority of physicians in Kuwait believe that euthanasia should be legalized under certain conditions. Thus, there is a need for the medical community and the Ministry of Health to recognize and deal with this controversial topic.

The response of health care workers to AIDS patients' requests for euthanasia

This paper reports on research into the practice of euthanasia amongst Australian health care professionals specializing in HIV/AIDS. It draws on data from thirty-nine semi-structured interviews carried out in Sydney, Melbourne, Brisbane and Canberra with physicians, general practitioners, hospital and community nurses, therapists and community workers. Using a qualitative methodology, the study seeks to identify how (illegal) euthanasia is currently practised, the degrees of involvement, the various forms that involvement takes, and the social relations which provide the context for involvement. In this paper we outline three categories of 'doers' to illustrate the range of attitudes and practices concerning euthanasia. This 'typology' carries a number of implications for recent policy debates over the legalisation of euthanasia. In particular it illustrates, at least within the context of AIDS care, the fragmentation of consensus over euthanasia amongst health care workers, the reality of current illegal euthanasia practices, and the limitations of a prohibitionist policy. While the legalisation of euthanasia within a regulatory framework is sometimes portrayed as an extreme or 'radical' response to terminal illness, the data presented in this paper suggest that prohibitionism is also radical in its failure to control euthanasia practice.

The prospects for nursing if euthanasia is legalized.

As the debate about the legalization of euthanasia continues, Antoni Banaszak examines the professional and legal implications for nurses. He argues that the case of the Netherlands could be a model for a possible way forward for the UK, but that nurses would need to be appropriately trained and protected.

Euthanasia in The Netherlands: transparency and accountability.

The practice and regulation of euthanasia in the Netherlands is often used in debates concerning legalization of euthanasia (or physician assisted suicide). The situation in the Netherlands has both been used as a deterrent, and as a support for legal changes elsewhere [1, 2]. The scope of this contribution is not to influence these debates. The goal is to give an overview of the current situation in the Netherlands, without suggesting that the way euthanasia is regulated in the Netherlands is an export product. This, however, does not imply that euthanasia and physician assisted suicide are not an international issue. They are, because patients and physicians in many countries are confronted with it. Euthanasia and physician assisted suicide pose a clear challenge to the medical profession, since it is not to be expected that the issue will disappear by itself.