Practice Of Physician-assisted Suicide Research Articles

Pastoral Therapy on Euthanasia: Christian Humanism and Ubuntu Embracing Openness

The debate over practices of physician-assisted suicide, euthanasia and other end-of-life questions is still ongoing in many countries around the world. At least, as of 2024, only 15 countries had varyingly legalised it under very specific, regulated conditions, while many more still view it as an extremely complex issue that, amongst other things, conflicts with their deeply held religious beliefs. Premised on their belief in the image of God as the source of human life, most monotheistic religions, but Christians in particular believe in the preservation of human life to its natural end. However, the unquestionable reality of this traditionally-held Christian belief does not preclude the rare reality where terminally ill Christians themselves, upon suffering excruciating pain, begin either to desire some form of a hastened death overtly or covertly. Under such conditions, however, pastoral therapists in particular lack the aptitude to openly initiate practical dialogues with patients, be it in the spirit of Ubuntu or to concretise the Christian position. That being said, the purpose of this article is to prepare Christian pastoral therapists in particular and the counselling profession in general to openly handle cases where agonising human suffering leads to suicidal thoughts or actions. In order to achieve this, the paper, through the use of literature reviews and desktop studies, draws on literature encompassing specific biblical instances in which not only physical suffering, but also mental suffering somehow led to suicidal events. The African concept of Ubuntu is then integrated into Christian humanism to promote pastoral therapeutic dialogue which may enrich Christian self-knowledge about the sacredness of human life, despite the urge of suicide or euthanasia. As per Christian humanism framework, Christian self-knowledge is inspired by the excruciating suffering of Jesus Christ on the cross. All things considered, pastoral therapy is endowed with the ability to present the image of God in human suffering while rejecting the urge for euthanasia or suicide.

The Right to Die in the United States

This review article is intended to introduce clinicians in Japan to the four types of medical procedures associated with the right to die in the United States and their ethical background. The four types of procedures are as follows: forgoing life-sustaining medical treatment, palliative sedation and intensive symptom management, physician-assisted suicide, and euthanasia. This article discusses the difference between negative and positive rights and how they apply to these four procedures. In addition, it discusses the reason why withdrawing ventilation is considered ethically equal to its withholding. Other topics that are covered include the principle of double effect and proportionality in palliative sedation, the practice of physician-assisted suicide in the US, and controversies regarding euthanasia. Additionally, this article mentions the voluntary stopping of eating and drinking (VSED) as another category of the right to die. Ethics and laws are specific to the region and the culture. The author encourages Japan, where the withdrawal of life-sustaining treatments is still not part of usual practice, to advance ethical discussions among its population so that more options for the right to die will be available to the patients in its society.

Physician-Assisted Suicide in Dementia: Paradoxes, Pitfalls and the Need for Prudence.

There has been an increasing drive towards the legalization of physician-assisted suicide (PAS) in patients with dementia, particularly in patients with advanced disease and severe cognitive impairment. Advocacy for this position is often based on utilitarian philosophical principles, on appeals to the quality of life of the patient and their caregiver(s), or on economic constraints faced by caregivers as well as healthcare systems. In this paper, two lines of evidence against this position are presented. First, data on attitudes towards euthanasia for twenty-eight countries, obtained from the World Values Survey, is analyzed. An examination of this data shows that, paradoxically, positive attitudes towards this procedure are found in more economically advanced countries, and are strongly associated with specific cultural factors. Second, the literature on existing attitudes towards PAS in cases of dementia, along with ethical arguments for and against the practice, is reviewed and specific hazards for patients, caregivers and healthcare professionals are identified. On the basis of these findings, the author suggests that the practice of PAS in dementia is not one that can be widely or safely endorsed, on both cultural and ethical grounds. Instead, the medical field should work in collaboration with governmental, social welfare and patient advocacy services to ensure optimal physical, emotional and financial support to this group of patients and their caregivers.

The Slippery Slope Argument in the Context of Euthanasia and Assisted Suicide

This article analyzes the slippery slope argument and its application to the problem of legalizing euthanasia and physician-assisted suicide. The argument is often referred to in discussions of abortion, in vitro fertilization, etc., but it has been little developed in the Russian-language literature. This explains the relevance and novelty of this article. The focus is on the ways of representation of the argument in research. It distinguishes its main types: logical (disintegrating into no-principle distinction argument and the soritical argument), empirical (or psychological argument), and non-logical (metaphorical). Each of these types of argument is constructed according to a certain principle and has a number of features and critiques. A common place for criticism of an argument is its focus on the future so that it makes reasoning probabilistic. The logical type of argument is centered around denoting the transition between the original event and its adverse consequences and denotes the action of social factors to accelerate the transition. The no-principal distinction argument implies that there is no moral distinction between the events at the beginning and the end of the slope. The soritical argument involves intermediate steps between questionable and unacceptable practices. The conceptual slope is another variant of the logical kind of argument. The empirical argument illustrates a situation of changing societal values which results in an easier acceptance of morally disapproved practices. The metaphorical argument is used to illustrate the metaphor of slope and the situation of the accumulation of small problems that lead to serious undesirable results. The non-logical kind of argument centers around the routinization of practice, desensitization, and exploitation of unprotected groups in society. Exploitation can be called the victims' slope. It grounds its consideration on the abuse of the practice being administered. Application of the ethical methodology (theoretical-logical and empirical-historical) to the types of arguments and ways of their application allows us to highlight the value component of the argument, to determine its dilemma nature and to correlate it with bioethical principles. The application of bioethical principles to suppress the transition to undesirable consequences is critiqued on the basis of particularly difficult cases in which one is unable to articulate one's decision. The criticism of the argument is built on the probabilistic nature of the reasoning, the lack of reflection on the underlying premise and the lack of empirical evidence. It concludes that the slippery slope argument is incapable of being the only valid justification for rejecting the practices of physician-assisted suicide and euthanasia.

Physician-Assisted Suicide and Euthanasia: Theological and Ethical Responses

AbstractEuthanasia and rational suicide were acceptable practices in some quarters in antiquity. These practices all but disappeared as Hippocratic, Jewish, Christian, and Muslim beliefs took hold in Europe and the Near East. By the late nineteenth century, however, a political movement to legalize euthanasia and physician-assisted suicide (PAS) began in Europe and the United States. Initially, the path to legalization was filled with obstacles, especially in the United States. In the last few decades, however, several Western nations have legalized euthanasia, and several US jurisdictions have now legalized PAS, giving state sanction to these once forbidden practices. With increasing social and political pressure to accept PAS, Christians need to understand how to think about this issue from an explicitly Christian perspective. Independent of the question of legalization, there are significant theological and ethical questions. This special issue aims to address those concerns, including: how does the practice of PAS or euthanasia impact our attitudes toward death, and what does it mean to “die well?” Should physicians, as healers, be involved in assisting patients who wish to bring about their own death? Are these methods significantly distinguished from other ethically justified practices in end-of-life care that also lead to a person’s death? Can Christians, both as patients and practitioners, justify the use of these methods to relieve suffering in this manner as compatible with the faith? Although these questions are not new to the debate, it is increasingly important that these controversies are addressed as the practice of PAS is popularized.

The Legitimacy of Prohibiting Euthanasia

John Arras argues against the legalization of physician-assisted suicide and active euthanasia on the basis of social costs that he anticipates will result from legalization. Arras believes that the legalization of highly restricted physician-assisted suicide will result in the legalization of active euthanasia without special restrictions, a prediction I grant for the sake of argument. Arras further anticipates that the practices of physician-assisted suicide and euthanasia will be abused, so that many patients who engage in these practices will lose out as a result. He refers to these losses as social costs to legalization. But the social costs at play in typical public policy debates are borne by individuals other than the agent who engages in the controversial activity, specifically by people who cannot be held responsible for enduring those costs. Even if plausible interpretations of Arras’ predictions about the abuse of the practice are granted, legalization of physician-assisted suicide or euthanasia brings no social costs of this latter sort. For this reason, and also because a ban on euthanasia is unfair to those who would profit from it, the losses in utility brought about by legalization would have to be very great to justify a ban.

EPA-1542 - Physician-assisted suicide and the role of the psychiatrists. a medical ethical analysis

Physician-assisted suicide (PAS) is currently the subject of controversial discussion in many European countries, albeit only a few of them have legalized this end-of-life practice under certain conditions. For the main part, the people who ask for assistance in suicide suffer from incurable physical diseases. In rare cases, however, the suicide of patients who additionally or solely suffer from mental disorders is also assisted. The aim of this contribution is to describe potential roles of the psychiatrists in the context of PAS and to formulate ethical arguments for or against the respective involvement of psychiatrists in PAS. Some authors argue that psychiatrists, invoking the social responsibility for suicide prevention, should strictly reject any involvement in PAS and offer a psychiatric treatment to patients with suicide plans. Others see the role of the psychiatrists in assessing the patients’ competence, which constitutes a fundamental prerequisite for PAS from an ethical point of view. Moreover, others deem a medical prescription of a lethal drug and the assistance in suicide by psychiatrists for ethically acceptable under certain conditions. We argue that psychiatrists are particularly well-suited to differentiate autonomous and non-autonomous suicide plans based on their expertise in the field of suicidology and in competence assessment. From an ethical point of view, the involvement of psychiatrists can thus contribute to quality assurance of a legalized practice of PAS, benefit the patient autonomy at the end of life and minimize risks of abuse.

Ethics, the Illegality of Physician Assisted Suicide in the United States, and the Role and Ordeal of Dr. Jack Kevorkian before His Death

The paper tries to argue that physician-assisted suicide (PAS), which is opposed by the AMA and all US states except Oregon, is a moral and ethical dilemma that faces physicians, ethicists, legal experts, and others. To demonstrate this, the various dimensions of the debate are explored. This is accomplished by discussing the legal, ethical, medical and political ordeals of its most infamous practitioner, Dr. Jack Kevorkian of Michigan (1928-2011). As the paper argues, Dr. Kevorkian’s belief in the practice of PAS led him to assist in the suicide of James Adkins in 1998. This began his legal problems, which lasted for about ten years (while continuing this practice, causing the state of Michigan to pass stricter laws against PAS). However, it was his more active administration of the suicide of Thomas York (who had Lou Gehrig’s disease), and its demonstration on CBS’ 60-Minutes program, that led to his most severe legal ordeal in 1998 that landed him a prison sentence of 10 to 25 years (of which he served 8).In the paper, various ethical, moral, and legal arguments, evoked by ethicists, philosophers and legal experts are presented. However, the paper begins with the ordeal of Dr. Kevorkian and the reaction to the 60-Minutes piece by the media, religious authors, and others are presented.

Doctor-cared dying instead of physician-assisted suicide: a perspective from Germany

The current article deals with the ethics and practice of physician-assisted suicide (PAS) and dying. The debate about PAS must take the important legal and ethical context of medical acts at the end of life into consideration, and cannot be examined independently from physicians' duties with respect to care for the terminally ill and dying. The discussion in Germany about active euthanasia, limiting medical intervention at the end of life, patient autonomy, advanced directives, and PAS is not fundamentally different in content and arguments from discussions led in other European countries and the United States. This must be emphasized, since it is occasionally claimed that in Germany a thorough discussion could not be held with the same openness as in other countries due to Germany's recent history. Still, it is worthwhile to portray the debate, which has been held intensively both among experts and the German public, from the German perspective. In general, it can be stated that in Germany debates about questions of medical ethics and bioethics are taking place with relatively large participation of an interested public, as shown, for instance, by the intense recent discussions about the legalisation of advanced directives on June 18 2009, the generation and use of embryonic stem cells in research or the highly difficult challenges for the prioritizing and rationing of scarce resources within the German health care system. Hence, the current article provides some insights into central medical and legal documents and the controversial public debate on the regulation of end-of-life medical care. In conclusion, euthanasia and PAS as practices of direct medical killing or medically assisted killing of vulnerable persons as "due care" is to be strictly rejected. Instead, we propose a more holistically-oriented palliative concept of a compassionate and virtuous doctor-cared dying that is embedded in an ethics of care.

PHYSICIAN ASSISTED SUICIDE: A NEW LOOK AT THE ARGUMENTS

In this paper, I examine the argumens agains physician assisted suicide (PAS). Many of these arguments are consequentialist. Consequentialist arguments rely on empirical claims about the future and thus their strength depends on how likely it is that the predictions will be realized. I discuss these predictions against the backdrop of Oregon's Death with Dignity Act and the practice of PAS in the Netherlands. I then turn to a specific consequentialist argument against PAS - Susan M. Wolfs feminist critique of the practice. Finally, I examine the two most prominent deontological arguments against PAS. Ultimately, I conclude that no anti-PAS argument has merit. Although I do not provide positive arguments for PAS, if none of the arguments against it are strong, we have no reason not to legalize it.

Gonzales versus Oregon

The decision of the U.S. Supreme Court in the case of Gonzales v. Oregon represents the most recent battle in a long war of attrition waged by the opponents of the practice of physician-assisted suicide in general and the Oregon Death with Dignity Act in particular. The history of the Oregon law and the many challenges to it provide pertinent background to understanding important elements of the majority and dissenting opinions in this case and suggest where this seemingly intractable societal debate may be headed.

Assessing Physician Compliance With the Rules for Euthanasia and Assisted Suicide

When any state or country considers permitting physician assisted suicide or euthanasia, one of the most important questions to be faced is how to make sure that physicians comply with the rules and stay within the allowed limits. Data suggest that the Dutch system for assuring physician compliance has thus far worked poorly, as that system relies largely on physician self-report. The Oregon system also relies largely on physician self-report. Oregon has created no mode of data collection to assess what proportion of cases are actually being reported. Oregon’s annual assessment of practice under its statute permitting physician-assisted suicide fails to capture cases that physicians do not report. Thus, we have no way at present to evaluate Oregon’s statistics and reported practice of physician-assisted suicide. In the Netherlands, after a patient dies from euthanasia or assisted suicide, the physician must complete a report and notify the municipal pathologist of a death from nonnatural causes. The pathologist then performs an autopsy and prepares a report, which goes to the public prosecutor. Thus, physician reporting is the trigger for review. To the credit of the Dutch, their researchers have repeatedly assessed whether this system works - whether physicians in the Netherlands comply with requirements to report performing assisted suicide and euthanasia. In 1990 and 1995 less than half of physicians reported. By 2001, the percentage of physicians reporting was still only 54%. In this issue of the Archives of Internal Medicine, Jansen-van der Weide and colleagues report on a survey of Dutch general practitioners conducted 2000-02. The written questionnaire asked these physicians about the number of requests for assisted suicide and euthanasia received in the last year, how the physician handled them, and characteristics of the last explicit request received in the past 18 months. Remarkably, this study finds high levels of physician compliance with the rules. Sadly, there are substantial reasons to doubt this reassurance. All physicians being surveyed were either recently trained in the rules as consultants or the target of a project to encourage them to use these consultants and follow the rules. There was no control group, and retrospective self-report was the only data collection method. This is not an adequate basis for assessing whether physician practice actually complies with the rules. Persuasive assessment cannot rest on physician retrospective self-reports after training in the rules as consultants or encouragement to use such consultants and follow the rules. The ultimate question remains - if you permit physicians to take life deliberately by assisting suicide or performing euthanasia, can you control the practice? Can you keep it within agreed boundaries? Can you avoid sliding down the slippery slope? These are questions of great importance that demand sophisticated study. We do not yet know the answers.

"Death was a blessing"--should it ever be pharmaceutically hastened? British pharmacists' views.

To investigate the views and experiences of British pharmacists in physician-assisted suicide (PAS) and voluntary active euthanasia (VAE) and to examine whether differences in views were associated with personal characteristics. A postal questionnaire was mailed to a random sample of 500 registered pharmacists, with addresses in England or Wales, stratified according to sex and community/hospital working environments. Pharmacists' reports of their views and experiences of PAS and VAE. Completed questionnaires were received from 295 respondents (response rate: 59%). The majority of respondents (83%) reported that at times, a person had the right to choose their own manner of death; 61% and 53% thought that there should be changes in the Law to legalise VAE and PAS, respectively. If it were legal to do so, 63% stated that they would be willing to dispense medication for VAE and 64% for PAS. However, only 45% agreed that the pharmacist should have a role in advising the prescriber on the choice and dose of drugs used. Sex, age, and years registered as a pharmacist were not found to be significantly associated with views on the practices of PAS and VAE. However, pharmacists who reported having a religion were significantly less likely to favour such practices. On comparing the views of community and hospital pharmacists, community pharmacists were significantly less likely than expected to want to be informed about the intended purpose of lethal drugs. In this survey, while over half of British pharmacists did not disagree in principle to the legalisation of VAE and/or PAS, they were less supportive of direct involvement in such procedures. Religion was a discriminatory factor associated with negative views of VAE and PAS. The significant minority of pharmacists not wanting to know the purpose of drugs they suspected might be for PAS or VAE is not in accordance with professional accountability, reflecting the complex and sometimes conflicting legal and moral aspects of such practices when deciding upon a course of action.

MSJAMA. The legal and political future of physician-assisted suicide.

IN 1997, THE US SUPREME COURT RULED THAT THERE IS NO federal constitutional right to physician-assisted suicide (PAS) but implied that individual states could nevertheless enact statutes permitting its practice. The lower federal courts promptly upheld the constitutionality of the Oregon Death With Dignity Act, the only US state statute authorizing PAS. Many observers of the court’s opinions thought that state legislatures would determine the future of PAS. Instead, the legal consequences for physicians and pharmacists in Oregon who assist in the deaths of terminally ill patients will be determined by litigation concerning the scope of federal drug laws now working its way through the federal appellate courts. The debate over PAS has thus been transformed into a fundamental question: Which level of government should be the primary regulator of drugs in this country—federal or state? In November 2001, the US attorney general stated that physicians legally prescribing lethal doses of drugs to terminally ill patients under Oregon’s state law would nonetheless be violating federal drugs laws. He did not, however, threaten criminal prosecution of physicians who used the Oregon statute to assist the death of terminally ill patients. Rather, he instructed Drug Enforcement Agency officials to revoke the permission of these physicians to prescribe medications. This interpretation of the federal statute took account specifically of the need of health care professionals to prescribe drugs to alleviate pain, especially of terminally ill patients. The attorney general has stated that the use of controlled substances to control pain, even if it could lead to the death of a patient, was not prohibited under the statute. In addition, he described how federal officials could enforce the federal drug laws without examining the medical records of individual patients. Federal officials were instructed instead to gather their information about violations from the state registry of physician-assisted deaths that was established under the requirements of the Oregon Death With Dignity Act. Critics have argued that this interpretation will hamper efforts to provide aggressive palliative care in Oregon. The state of Oregon and some Oregon physicians promptly filed a lawsuit seeking to block the implementation of the attorney general’s ruling, thereby once again shifting the debate back to the federal courts. (In the current round of litigation, the state of Oregon has so far prevailed in the district court.) The district court judge ruled that state legislatures, not federal officials, can define the meaning of dispensing controlled substances “in the course of professional practice,” and determine when the use of a controlled substance is used for “a medical purpose.” The district court judge reasoned that the regulation of medical practice in the United States has traditionally been the province of the states rather than the federal government—and should remain so. As such, he concluded that Oregon’s legislative declaration that prescribing a lethal dosage of drugs to terminally ill patients is legitimate professional practice should prevail over the federal government’s interest in a particular drug enforcement policy. The federal government is currently appealing the district court’s ruling to the federal appeals court, arguing that the federal government can define “medical purpose” without reference to specific state statutes. The federal government’s argument is that no single state legislature can unilaterally change the definition of “medical purpose,” as this definition provides guidelines for federal officials and prosecutors. It is unclear how the US Supreme Court will decide the issue of access to barbiturates in Oregon for PAS. The court has previously allowed the federal government to limit access to marijuana for pain relief even when a state has declared such use legal. If the federal government is ultimately successful in its suit to use federal regulation to discourage, if not halt, the practice of PAS in Oregon, this will essentially end the political debate over legalizing PAS at the state level. Proponents of legalizing PAS could then try to persuade Congress to modify the federal Controlled Substances Act. It is not clear that Congress would be willing to assist Oregon’s attempt to be the only US state to allow PAS. In 1997, for instance, Congress enacted a statute prohibiting the use of federal Medicare and Medicaid funds for PAS. No state has in fact followed Oregon’s lead in enacting PAS statutes. At least 2 states, Maine and Michigan, have defeated ballot measures that would have allowed PAS. If these votes represent the current political sentiment on this issue, any new initiative to legalize assisted suicide seems unlikely to succeed.

Emergency physicians and physician-assisted suicide, part I: A review of the physician-assisted suicide debate

Physician-assisted suicide (PAS) has been one of the most hotly debated bioethics and health policy issues of the past decade. Part I of this 2-part article defines key terms in the debate, reviews the history of the debate, and articulates leading arguments for and against legalization of the practice of PAS. Part II of the article will examine the role of emergency physicians in caring for patients who present to the emergency department after an incomplete or unsuccessful attempt at PAS. [Moskop JC, Iserson KV. Emergency physicians and physician-assisted suicide, part I: a review of the physician-assisted suicide debate. Ann Emerg Med. November 2001;38:570-575.]

The role of guidelines in the practice of physician-assisted suicide. University of Pennsylvania Center for Bioethics Assisted Suicide Consensus Panel.

Oregon has legalized and implemented physician-assisted suicide, while observers argue about the moral import of attempting to formulate guidelines; the utility any set of guidelines can have for physician practice, health care providers, patients, or families; and whether guidelines can really protect against harm or abuse. What were once theoretical questions have taken on new urgency. The debate over the value and power of guidelines includes the following questions: What has been the experience of efforts to implement physician-assisted suicide using consensus guidelines? What goals are guidelines intended to serve? Who should formulate guidelines? What features should be reflected in any proposed guidelines to make them practical and to permit achievement of their goals? Are there any fundamental obstacles to the creation or implementation of guidelines? Is dying a process that is amenable to direction under guidelines, be they issued by physicians, departments of health, blue ribbon panels, or other regulatory bodies? This paper explores these questions as physician-assisted suicide becomes legal.

Physician-assisted suicide and euthanasia in the Netherlands: lessons from the Dutch

For 2 decades, both physician-assisted suicide and euthanasia have been given legal sanction in the Netherlands. In response to domestic and international concern about their policies, the Dutch government appointed a commission that oversaw a study of the practice of physician-assisted suicide and euthanasia in 1990.1That study, which was largely replicated in a 1995 study, was supported by the Royal Dutch Medical Association with the promise that physicians who participated would receive immunity from prosecution for anything they revealed. See also p 1705. In 1996, the investigators published a report of their new findings in Dutch2and summarized their work in 2 articles in theNew England Journal of Medicine,3,4which was supported by an editorial in that journal.5These reports have given a favorable interpretation to what could be seen as evidence of little or no improvement by declaring that since matters have not

The Nazi! accusation and current US proposals.

In contemporary ethical discourse generally, and in discussions concerning the legalization of physician-assisted suicide (PAS) and voluntary active euthanasia (VAE) specifically, recourse is sometimes had to the Nazi! accusation. Some disputants charge that such practices are or will become equivalent to the Nazi 'euthanasia' program in which over 73,000 handicapped children and adults were killed without consent. This paper reflects on the circumstances that lead to the use of this charge and offers reasons for putting the Nazi! charge aside in contemporary discussions of PAS and VAE. A number of the philosophical presuppositions common to both the Nazi 'euthanasia' program and the currently proposed practices of PAS and VAE are examined. Noting that racist ideology and violent coercion characterized the Nazi program, the paper concludes with a cautionary consideration of the current circumstances that would specify PAS and VAE in the US.