Voluntary Euthanasia Research Articles

Tipping Point: Pathogenic Stress and the Biopolitics of Euthanasia.

Hopelessness and demoralization following a terminal diagnosis can affect the capacity for self-governance. Such dispositions can increase the allostatic load-the cumulative burden of stress and anxiety-resulting in a neurophysiologic decline that can impair autonomy and influence the desire to end one's life deliberately. An allostatic overload is characterized by the inability to autoregulate stress and is associated with pathological changes to the hypothalamic-pituitary-adrenal axis and hippocampus. These changes raise concerns about the reliability of concepts of autonomy in extremis, potentially undermining arguments that are used to justify voluntary euthanasia and medically assisted death. Studies have associated depression and hopelessness with suicidal ideation in the general population. However, fewer studies have examined how patients without a history of depression or suicidal ideation may suddenly contemplate the act when facing a terminal prognosis. This paper will argue that an allostatic overload can help explain how the spectrum of physical and psychological comorbidities associated with the onset of a terminal illness can influence a decision to hasten death. Data show that patients with a terminal disease wishing to hasten death typically exhibit lower rates of clinical depression, higher rates of demoralization, and a greater likelihood of rational suicide. These differences indicate that suicidal ideation in the terminal disease patient population is different. Changes in autonomous decision-making secondary to pathological alterations in the brain may offer an explanation. Such changes have been shown to dysregulate executive control functions, specifically intentionality and voluntariness. Clinical evidence also indicates that spirituality and hopefulness can help manage the allostatic load during the palliative stages of a disease so that patients can better process end-of-life decisions. Based on these data, this paper will further argue that jurisdictions offering euthanasia are morally compelled to make mental and spiritual counseling available to patients seeking this course of action.

What do suicide loss survivors think of physician-assisted suicide: a comparative analysis of suicide loss survivors and the general population in Germany

BackgroundPhysician-assisted suicide (PAS) and voluntary euthanasia remain highly debated topics in society, drawing attention due to their ethical, legal, and emotional complexities. Within this debate, the loss of a loved one through suicide may shape the attitudes of survivors, resulting in more or less favorable attitudes towards this topic.AimsThis study aims to explore and compare the attitudes towards PAS and voluntary euthanasia in a population of suicide loss survivors and the general population, while also considering socio-demographic factors.MethodsA total of 529 participants, 168 of whom were survivors of suicide loss, completed an online questionnaire on their attitudes (NOBAS) and opinions (open response format) towards PAS and voluntary euthanasia, as well as regarding their legalization in Germany. The analysis consisted of both quantitative and qualitative components.ResultsThe entire sample showed positive attitudes towards PAS and voluntary euthanasia in terminally ill persons. Participants were more divided in their attitudes towards PAS in the case of a mental health disorder. Individuals without experienced suicide loss were more liberal regarding legalization in Germany and were more likely to understand the wish for PAS. Survivors of suicide loss were mainly concerned about the consequences for relatives. However, differences between both groups are small.DiscussionThe experience of a loss by suicide influences attitudes towards PAS and voluntary euthanasia. Both groups showed an accepting attitude towards PAS and voluntary euthanasia, but also expressed concerns and fears regarding easy accessibility and consequences for grieving relatives.

Best to possibly not be: A prudential argument for antinatalism.

This article starts by examining the present state of death ethics by attending to the euthanasia debate. Given that voluntary active euthanasia has seen strong support in the academic community, insights on the choiceworthiness of continued existence may be derived. Having derived cases of choiceworthy nonexistence (which I refer to as choiceworthy nonexistence [CNE] cases), I extend these intuitions to lives not worth starting, or choiceworthy nonexistence for potential people (which I refer to as foetal-CNE, or fCNE cases). Although I depart from Benatarian antinatalism by rejecting Benatar's claim that all existence is necessarily a harm, I posit a weaker argument that all existence is likely a harm since we cannot know until later in life if an existence is a harm. If I am right, then we have prudential reasons not to bear children, since they are more likely to suffer in lives not worth living than not.

Three Arguments Against Institutional Conscientious Objection, and Why They Are (Metaphysically) Unconvincing.

The past decade has seen a burgeoning of scholarly interest in conscientious objection in healthcare. While the literature to date has focused primarily on individual healthcare practitioners who object to participation in morally controversial procedures, in this article we consider a different albeit related issue, namely, whether publicly funded healthcare institutions should be required to provide morally controversial services such as abortions, emergency contraception, voluntary sterilizations, and voluntary euthanasia. Substantive debates about institutional responsibility have remained largely at the level of first-order ethical debate over medical practices which institutions have refused to offer; in this article, we argue that more fundamental questions about the metaphysics of institutions provide a neglected avenue for understanding the basis of institutional conscientious objection. To do so, we articulate a metaphysical model of institutional conscience, and consider three well-known arguments for undermining institutional conscientious objection in light of this model. We show how our metaphysical analysis of institutions creates difficulties for justifying sanctions on institutions that conscientiously object. Thus, we argue, questions about the metaphysics of institutions are deserving of serious attention from both critics and defenders of institutional conscientious objection.

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.

Assisted Dying and Voluntary Euthanasia: Exploring Healthcare Professionals’ Perceptions in a Tertiary Care Setting in South India

Background: Globally, with the increased focus on palliative care of adding life to years, the need for the right to refuse and dignified death has also commenced. Objective: To explore the perceptions of doctors and nurses about performing assisted dying and voluntary euthanasia. Methods and Material: Participants were selected purposively to include nine health care professionals to attain information saturation. Results: The factors justifying euthanasia were the rights to choose or refuse and exclusive medical conditions. With limited medical insurance coverage, there is a thought that these factors might bring the idea of euthanasia amongst Indian people. Overall, though the healthcare professionals are not willing to perform euthanasia, they agreed to make assisted dying possible in the future but exclusively for terminally ill patients. Conclusion: It would be beneficial to standardise the terminology, have lawmakers re-examine Supreme Court of India rulings and consult medical and relevant experts on the unique situations of defining the terminally ill and what type of euthanasia may be considered.

The Extent to Which the Wish to Donate One’s Organs After Death Contributes to Life-Extension Arguments in Favour of Voluntary Active Euthanasia in the Terminally Ill: An Ethical Analysis

In terminally ill individuals who would otherwise end their own lives, active voluntary euthanasia (AVE) can be seen as life-extending rather than life-shortening. Accordingly, AVE supports key pro-euthanasia arguments (appeals to autonomy and beneficence) and meets certain sanctity of life objections. This paper examines the extent to which a terminally ill individual’s wish to donate organs after death contributes to those life-extension arguments. It finds that, in a terminally ill individual who wishes to avoid experiencing life he considers to be not worth living, and who also wishes to donate organs after death, AVE maximizes the likelihood that such donations will occur. The paper finds that the wish to donate organs strengthens the appeals to autonomy and beneficence, and fortifies the meeting of certain sanctity of life objections, achieved by life-extension arguments, and also generates appeals to justice that form novel life-extension arguments in favour of AVE in this context.

Ongoing Debate on Medically-Assisted Death in Canada

In 2016, Canada introduced Bill C-14, the Medical Assistance in Dying (MAiD) Act, providing an end-of-life care option for a rapidly increasing number of Canadians. MAiD includes active and passive methods, known as voluntary euthanasia – administered by a designated medical professional – and assisted suicide – the provision of medication by a medical professional to self-administer. The House of Commons and Senate passed Bill C-14 following The Supreme Court’s unanimous decision in Carter v Canada. This case challenged the prohibition of physician-assisted death, decreeing it an infringement on the Canadian Charter of Rights and Freedoms.

Euthanasia, consensual homicide, and refusal of treatment.

Consensual homicide remains a crime in jurisdictions where active voluntary euthanasia has been legalized. At the same time, both jurisdictions, in which euthanasia is legal and those in which it is not,recognize that all patients (whether severely ill or not) have the right to refuse or withdraw medical treatment (including life-saving treatment). In this paper, I focus on the tensions between these three norms (the permission of active euthanasia, the permission to reject life-saving treatment, and the prohibition of consensual homicide), assuming a justification of euthanasia based on the right to (personal) autonomy. I argue that the best way to provide a coherent account of these norms is to claim that patients have two distinct rights: the right to autonomy and the right to bodily integrity. This solution has some relevant implications for the discussion of the legalization of active euthanasia.

Euthanasia and/or assisted suicide: for or against?

In the face of serious and untreatable health problems, a person may start thinking that the best and probably the only way out is death. In this case, it is not a natural death, but a death caused by someone. Death can be caused either by other people or by the sick person. If the death is caused by another person, it is important that the person’s actions do not contravene existing legislation. In the case of the subject in question, this can take the form of euthanasia or assisted suicide. In this article, the authors outline the legal and ethical aspects of euthanasia and assisted suicide in different countries, including cases in Estonian practice. The article presents points of departure from a debate that has been going on in Estonian society for years, some of which emphasise the need to legalise euthanasia and/or assisted suicide, while others support the belief that Estonia is not yet ready to legalise voluntary euthanasia. At present, the latter view prevails, which may also be the reason for the lack of political will. Keywords: a dignified departure; euthanasia; assisted suicide.

Euthanasia and faith-based aged-care organisations: The right not to kill?

In this paper we focus on an important specific issue which has not received serious attention in the scholarly literature on euthanasia, namely, that of the coercive imposition (by way of sanction-backed regulations) of the practice of voluntary active euthanasia (in particular) on faith-based, aged-care organizations. In Section 1 we outline the relevant conceptual background drawing on existing literature. In Section 2, we consider two conflicting ethical standpoints on voluntary active euthanasia. In Section 3 we outline the nature and extent of the push to impose the practice of voluntary active euthanasia on Catholic-run aged-care organizations. In Section 4 we argue that the argument for coercively imposing the practice of voluntary active euthanasia on faith-based, aged-care organizations, is not well-made, especially in the context of liberal democracies committed to pluralism.

The wrong of mercenarism: a promissory account

The wrong of mercenarism: a promissory account

Analyzing the Spanish Euthanasia Law: Achievements and inconsistencies of the legal assistance to die

The Spanish government recently passed legislation that legalized euthanasia. This article analyzes the Organic Law on the Regulation of Voluntary Euthanasia by exploring its procedural aspects, the various methods of providing assistance to die and the medical role under the law. After this examination, the article points out three potential problems with respect to the law’s practical implementation. The first potential problem is the lack of explicit regulation regarding the assistance to die as provided to patients with mental disorders. Second, the law is unclear concerning the permissible extent of the legal assistance to die for patients self-administrating the lethal drug. Third, the ambiguous role assigned to medical staff during the final phases of euthanasia, especially concerning the duty of “observation and support”. This study concludes that the new law, despite its proponents’ thorough effort to guarantee the right to receive euthanasia, contains significant loopholes that may generate future controversies.

Prohibition of euthanasia as a duty to live

In this article, we consider the problem of euthanasia as a form of realization of the human right to die. The historical aspects of euthanasia are discussed along with its legal aspects. Thus, modern Russian legislation bans implementation of euthanasia by medical workers under the threat of criminal punishment. An analysis of government policies on human euthanasia was conducted, including in countries where this procedure is legalized. The results show that euthanasia is applied within strict limits, in accordance with the established order. Euthanasia was found to have no effect on mortality and suicide tendencies. In addition, the authors propose an approach to the multi-stage practical implementation of euthanasia, which is carried out by independent and disinterested specialists. At each stage, a large number of interrelated procedures is performed, each of which confirms the validity of the previous step. The patient must make a voluntary euthanasia decision based on comprehensive information about his or her health. In turn, the government should provide an alternative to euthanasia in the form of palliative care. In conclusion, the need to enshrine the principles, conditions, and mechanisms of euthanasia in Russian legislation is substantiated, which would ensure the human right to die with dignity.

Роман-антиутопия Энтони Троллопа «Установленный срок»: взгляд на настоящее через будущее

The article analyzes one of the late novels of the English writer, which paints a very pessimistic picture of the future, moving the reader to 1980 and to the fictional country of Britannula, whose parliament at the dawn of independence from Britain adopted a law according to which every resident of the republic who has reached the age of 68 years is obliged to undergo voluntary euthanasia, so as not to burden a happy and a prosperous country with unnecessary material and other expenses and thus contribute to the prosperity of the motherland. However, the practice of implementing the law is difficult, since some representatives of society oppose its conduct and seek help from the former metropolis, which suspends not only the operation of the law by military pressure, but also colonizes Britannula again. The narrative is constructed as a manuscript of a book by the deposed president of the republic, in which he, a fanatic of such bringing everyone to happiness and prosperity, gives his interpretation of events. The work is a futuristic dystopian novel in which the genre and narrative experiments of the writer and his inherent psychologism and irony coexist in an interesting and original way, but not always successfully.

Cuestionario de actitudes hacia la eutanasia en personal médico (AHE-PM)

The right to die is an international dilemma. Some countries and states already have laws regulating one of the most common applications of this right, the active voluntary euthanasia. The evidence from these countries highlights the importance of a bioethical framework to limit some of its applications. In this regard, the evaluation of attitudes towards euthanasia in medical personnel will allow to understand the attitudes of these professionals and how they can deal with such requests, whether this assisted death is decided by the patients or their surroundings. Consequently, the aim of this study was to develop a brief scale to evaluate attitudes, as well as to determine their significance according to the gender and seniority of the professionals in this situation. A double design strategy was followed. On the one hand, a psychometric design with an exploratory and confirmatory factor analysis and, on the other, a descriptive analytical design for the comparison of groups. A six-item scale (AE-PM) and two factors were extracted. The first focuses on attitudes towards euthanasia to alleviate suffering for medical reasons and the second one to alleviate the patient’s emotional suffering. The scale (AHE-PM) is useful for the rapid exploration of attitudes towards euthanasia in physicians, a professional group with limited free time, who may also encounter relatively frequent requests for active voluntary euthanasia. The two factors obtained allow attitudes to be assessed from a bioethical perspective, providing information on the application under apparent medical justification and in situations based on the patient’s subjective emotional suffering. https://doi.org/10.16888/interd.2023.40.1.21

Ghost Writings

Three interlocutors; three deaths; more than three stories that multiply, entangle and unwind. Illness, suicide, voluntary euthanasia, and the slippages in between. Turning to other-than-human beings. Becoming a mistress of ceremonies. Embracing a methodology of sighs. Throwing us into that place where we matter to each other—where everything matters even as it falls away.

Response to Guay et al. (2022): The Issue Is . . . What If Deliberately Dying Is an Occupation?

A recent “The Issue Is . . .” column by Guay et al. (2022) uses an occupational science and occupational therapy theoretical reflection to consider deliberately dying as a purposeful and meaningful occupation. The authors state that their argument will not include a full exploration of the ethics involved in their discourse about deliberately dying. Although we appreciate the authors’ challenge to Western perspectives of occupation, we believe their premise is faulty and potentially detrimental precisely because of the omission of bioethics and disability studies insights.The term deliberately dying is a euphemism used for assisted suicide and voluntary euthanasia, concepts that we feel cannot be separated from the ethical implications of considering deliberately dying as an occupation. Similarly, the authors recognize the legal definitions and distinguish between suicide and deliberately dying, but then dismiss this context as irrelevant to discussions of occupations. Omitting the ethical, and potentially legal, implications of classifying deliberately dying as an occupation has the potential to devalue living as a disabled person.The perspectives of bioethics and disability studies must be included to challenge Western perspectives of what lives are worth living and the perspectives of ableism, sanism, and the medicalization of disabled people. Although the authors include disabled people in their examples, they fail to explore the cultural, political, and economic contexts of disabled people’s experiences. The importance of discussing these experiences is illustrated in the case of Larry McAfee, a quadriplegic man who legally won the right to die but elected to continue living when given adequate supports to live in the community rather than a nursing home (Shapiro, 1990). The authors speak to the ethical and disability justice concerns in their argument; however, dead people cannot experience the justice-oriented goal of experiencing full citizenship.The authors also appear to abandon their challenge to Western concepts of occupation when choosing definitions that are embedded in ableist influences that fuel bias and discrimination toward disabled people. The clearest example is their choice to describe occupation as connected to community obligations (Guay et al., 2022). By including “to offer release from family disgrace or torment, to fulfill social obligations, or to have a moral or ritual purpose” (Guay et al., 2022, p. 7) as reasons to pursue deliberately dying, the authors perpetuate ableist notions that disabled people are a burden and that the world would be better off without them.Finally, the authors appear to blur the line between managing a natural progression of dying versus intentionally electing to facilitate death. Palliative care focuses on achieving the best possible quality of life at any stage of a disease or condition. Occupational therapy practitioners do play a vital role in the context of palliative care (Cooper & Kite, 2015). The authors suggest deliberately dying as an option when there is lack of access to palliative care services. We would argue that lack of access is an occupational injustice and encourage occupational therapy practitioners to work at individual and systems levels of advocacy when faced with this scenario (Bailliard et al., 2020).It is our stance that the failure to include the voices of the disabled in this examination reinforces the historical social consciousness that living with disability is worse than death. We stress that any discourse on occupation must answer the call from McArthur and Gill (2021) and reflect on how disability studies theories can enrich the ethical and bioethical reasoning of occupational science and occupational therapy. We agree that the definition of occupation must be critiqued, but using the example of deliberately dying as an occupation is not an appropriate example. Failure to include the voice of the disabled in any discussion of issues that concern the disability community is a dangerous path and one that academic and professional conversations must avoid at all costs.We acknowledge the support and editorial assistance received from the following Disability Studies + Occupational Therapy Network members: Aster Harrison, PhD, OTR/L, Jenna Heffron, PhD, OTR/L, Jacqueline Kish, PhD, OTR/L, and Danbi Lee, PhD, OTR/L.

Externalist argument against medical assistance in dying for psychiatric illness

Medical assistance in dying, which includes voluntary euthanasia and assisted suicide, is legally permissible in a number of jurisdictions, including the Netherlands, Belgium, Switzerland and Canada. Although medical assistance in...

Medical assistance in dying in rural communities: A review of Canadian policies and guidelines

In June 2016, the Canadian Parliament passed Bill C-14, legalizing medical assistance in dying (MAiD), elsewhere known as voluntary euthanasia or physician-assisted suicide. Related legislation and policies continue to evolve. However, there is a paucity of scholarship regarding their distinct implications for rural communities. This is significant given that rurality is an underrecognized but important determinant of health. In order to address this gap, we conducted a rural-focused scan of policies, guidelines, and legislation that govern the practice of MAiD in Alberta, Canada (N = 16). Drawing from rural health scholarship, we reviewed these documents with a focus on three key rural considerations (place, community, and relationships) and identified potential implications. Through an analysis of these findings, we identified four opportunities where policy can better serve rural communities. These included addressing geographic location, continuity of care, dual relationships, and systemic barriers. In light of this, we offer several recommendations for how future policy and guidelines can better support rural residents.