Voluntary Euthanasia Research Articles

Evaluating the Pro-Euthanasia Position: An Analysis Based on Dignity and Autonomy

This project has the primary aim of investigating the hypothesis that ‘voluntary euthanasia should be legalised due to the importance of respecting patient autonomy and dignity’. A secondary aim is to suggest possible reasons for the apparently lower levels of support for legalisation among physicians compared to the general population. The possible consequences of including dignity as part of the justification for legalising voluntary euthanasia are evaluated, with a focus on the link between dignity and incontinence and the resultant implications on the disabled population. Factors influencing the degree of autonomy a patient can experience when making end-of-life decisions are also explored and applied to the initial hypothesis presented. It is suggested that there are significant safeguarding concerns associated with legalising voluntary euthanasia, with specific considerations of the risks presented to the disabled and terminally ill communities. It is argued that this may provide an explanation for the discrepancies between levels of support for legalising euthanasia between the public, who largely do not have a duty to consider these safeguards, and medical professionals, who largely do. The project makes a universally generalisable conclusion that legalising euthanasia on the grounds of autonomy and dignity presents too significant a risk of harm to vulnerable communities within society, and therefore legalisation should be rejected. This presents a bridge connecting Islamic medical ethics, which strictly prohibits suicide and euthanasia, with values it holds in common with the ‘four principles approach’ outlined by Beauchamp and Childress and develops a rich space for the exploration of how autonomy and dignity can be related to Islamic values of community and public interest, and the paralleled principle of Justice.

Legality of euthanasia concerning right to life

Article 21 of the Indian Constitution, which deals with the protection of life and personal liberty, has been interpreted in several landmark cases by the courts of law. Every one of those formulations has enlarged the scope of Article 21 to encompass those aspects of life that give meaning, purpose, and dignity to existence. The terms "life" and "liberty" are deeply linked. Liberty gives a person the freedom to make decisions freely, and life without liberty would be meaningless. Thus, Article 21 integrated the concepts of life and liberty distinctly and also connected them through the use of a legal mechanism for their deprivation. Due to this interpretation, the right to die was never construed as an important aspect of the right to life and personal liberty guaranteed by Article 21. The right to die is a notion that is predicated on the belief that a person has the right to make any choice about the termination of his or her life (this also includes undergoing voluntary euthanasia). The major issue is whether individuals should have the right to die and what may be the rationale for such a right.

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.

Death with Dignity in Canada

Death with Dignity in Canada

Killing in the name of: A merciful death?

"Mercy" holds a well-established place in the discourse on assisted death (AD), with mercy rhetoric used by both proponents and opponents of AD alike. In this paper, I interrogate the relationship between mercy, mercy killing and AD. Appeals to mercy introduce an ambiguity that carries implications for the enduring debate about healthcare professionals' participation in this controversial practice. The term "mercy killing" is used at different times to mean all of the following: killings that are acts of punitive leniency, killings motivated by pity, killings motivated by compassion, and acts of voluntary, involuntary and nonvoluntary euthanasia. I argue that killings that are acts of punitive leniency "track" a conceptually useful understanding of mercy and, by extension, mercy killing. However, if mercy is understood in this way, then "mercy killing" is a problematic way of characterizing physician-AD. While reference to mercy killing has been weeded out of AD legislation over time, the same cannot be said of public discourse, where the debate about physicians' character-and the locus of power with respect to who gets to decide when a life can rightly be ended-continues.

THE LOGICAL LINK BETWEEN VOLUNTARY AND NON-VOLUNTARY EUTHANASIA

AbstractThe logical “slippery slope” argument is of key relevance to the ongoing debate about “assisted dying”. The argument runs that if the principle of respect for autonomy and the principle of beneficence justify voluntary euthanasia, then the principle of beneficence justifies non-voluntary euthanasia. Several prominent scholars of medical law and medical ethics have either rejected or at least not accepted the argument, including Gerald Dworkin and Raymond Frey; Margaret Battin; Hallvard Lillehammer; Stephen Smith; Robert Young; Emily Jackson; and Steven Daskal. This paper analyses their reasoning and finds it wanting. It concludes that the logical argument stands unrebutted and merits much greater attention.

Getting Real About Killing and Allowing to Die: A Critical Discussion of the Literature

The moral significance of the distinction between killing and allowing to die has played a key role in debates about euthanasia and physician assisted suicide. Since the withdrawal of life-sustaining treatment is held as morally permissible in the medical community, it follows that if there is no morally significant difference between killing and allowing to die, then there is no morally significant difference between withdrawing life-sustaining treatment or administering a lethal injection to end a patient’s life. Consistency then requires that voluntary active euthanasia (VAE) is also morally permissible. The debates over whether the distinction is morally significant have carried on for decades with little hope of consensus. We begin by surveying the literature to identify common argumentative strategies used in defending or rejecting the distinction’s significance. We observe, based on our review, that many of these strategies operate in ways that are conceptually removed from the concrete clinical situation of physicians involved in practices that lead to patient death (by withdrawal of treatment or VAE). We conclude by arguing for a novel way of moving the debate forward indicated by our reading of the literature, namely, by paying careful attention to the moral experience of physicians involved in end-of-life interventions to understand how they experience these practices. Exploring physician experience can reveal how the distinction may or may not be useful for moral deliberation and can provide the needed context to theorize about the distinction in a more empirically informed and practically useful way.

Death Anxiety, Immortality Projects and Happiness: A Utilitarian Argument Against the Legalization of Euthanasia

The current, utilitarian debate on the relation between euthanasia and happiness focusses primarily on the subject of dying patients. Where some utilitarians stress how euthanasia may relieve suffering in the process of dying, others emphasize the importance of respecting the autonomy of others to make decisions like these themselves. However, less attention has been paid to how legalizing euthanasia may impact the human decision-making processes of those still in a healthy and mentally sound state. This paper aims to shed light on this relatively underdeveloped subject within utilitarian theory. In particular, I focus on euthanasia’s most contested form: active, voluntary euthanasia. I draw on Ernst Becker, who argues that moderate death anxiety stimulates people to work on ‘immortality projects,’ decisions that help them cope with the concept of death. Subsequently, I draw on several studies to defend the notion that immortality projects are indirectly conducive to happiness because they stimulate healthy decisions and long-term, human progress. Additionally, immortality projects counterbalance decisions that are based on an excessive drive for short-term pleasure. As euthanasia can make dying less painful, I argue it may diminish death anxiety to significant degree, and thereby also an incentive to work on immortality projects. This brings me to the conclusion that legalizing euthanasia is problematic from a utilitarian point of view, considering the observation that immortality projects are indirectly conducive to happiness.

IS THE RIGHT TO DIE WITH DIGNITY CONSTITUTIONALLY GUARANTEED? BAXTER V MONTANA* AND OTHER DEVELOPMENTS IN PATIENT AUTONOMY AND PHYSICIAN ASSISTED SUICIDE

This article examines the question of whether the right to life encompasses the right to die with dignity. It looks at the concepts of autonomy and paternalism as they exist as major themes on either side of the debate. Physician Assisted Suicide (Voluntary Euthanasia) has come under the spotlight in several jurisdictions, not just our own. Most recently in Montana, USA, the issue came before the Supreme Court for deliberation. The states of Washington and Oregon have legislations specific to PAS, legitimizing assisted suicide and removing wrongfulness from the actions of a physician who assists in the prescribed manner. Montana does not have specific legislation, but instead relied on the clauses of its Constitution, and it was held that the right to die with dignity is constitutionally guaranteed in that state. Here, argument is made suggesting that the right to die with dignity, in other words, to seek and easy passing through PAS, is also guaranteed in our Constitution.

Examining the religiosity of nursing caregivers and their attitudes toward voluntary and involuntary euthanasia.

Nurses play an important role in taking care of people who have a terminal illness. To examine nursing caregivers' religiosity as the mediator between voluntary and involuntary euthanasia, and to compare nursing caregiver religiosity groups and the voluntary and involuntary euthanasia attitudes of nurses and nursing students. A cross sectional design was applied and 298 nursing caregivers voluntarily participated and completed the questionnaire. Religiosity partially contributes as mediator between voluntary and involuntary euthanasia. All nursing caregiver religiosity groups show more support for voluntary euthanasia. Moreover, nursing students and nurses differ with respect to support for euthanasia in extreme situations, such as patients that are clinically brain-dead. Findings may be attributed to the clash of religious values, due to the common injunction against taking a life especially as regards involuntary euthanasia.

Disability and the Complexity of Choice in the Ethics of Abortion and Voluntary Euthanasia

Abstract In the polarized debates about abortion and voluntary euthanasia, disability advocates, who normally align with left-wing social forces, have tended to side with conservative and religious voices in expressing concerns about the impact of technological and sociopolitical developments on disabled futures. This paper draws on the social model of disability and the virtue ethics tradition to explain the alignment between the religious and disability perspectives, and the theory of transformative choice to highlight the limits and biases of the pro-choice logic. Yet, it also recognizes the inherent contradiction of disabled advocates taking a paternalistic position against the personal agency of women and people facing terminal illnesses. A disability perspective serves the discussion of abortion and euthanasia as an encouragement to work together for the building of a society that enables people with diverse disabilities to exist and flourish, and helps pregnant women, people facing disabling and terminal illnesses, and politicians and social influencers to make informed choices.

EUTHANASIA: AIMING TO KILL WITH A COUNTER FULL OF OPTIONS?

Euthanasia or assisted suicide has been a matter of contention for many years with various types of euthanasia including voluntary, non-voluntary, involuntary, active and passive euthanasia being argued for around the world. This article highlights the types of euthanasia while analyzing the ethical, legal, economical and spiritual dilemmas surrounding them. It also compares euthanasia laws of countries around the world with the Indian stand taken by the Supreme Court in legalizing passive euthanasia. There exists a ne line between life and death. It is the duty of a medical practitioner to assess these situations critically while preserving a patient's autonomy. To deny a person the right to end their life with dignity is equivalent to depriving them of a meaningful existence.

The Logical Link between Voluntary and Non-Voluntary Euthanasia

The Logical Link between Voluntary and Non-Voluntary Euthanasia

The Irrevocability of Capital Punishment and Active Voluntary Euthanasia1

AbstractOne argument often made against capital punishment is that it would involve the risk of killing innocent people and that such a mistake cannot be corrected in ways that other punishments can. I call this the ‘Irrevocability Argument’. In this article, I argue that the Irrevocability Argument is symmetrical with respect to capital punishment and active voluntary euthanasia. If the Irrevocability Argument works against capital punishment, then it also works against active voluntary euthanasia and vice versa. The main upshot of this is that it means at least some of the moral positions that people hold to treat them differently are untenable. Those who rely on the Irrevocability Argument as an argument against capital punishment are also committed to it as an argument against active voluntary euthanasia.

A Parapsychological Naturalist: A Tribute to Mary Rose Barrington (January 31, 1926 – February 20, 2020)

Mary Rose Barrington was born in London; her parents were Americans with Polish-Jewish roots who decided to settle in England. By her own account (she very considerately left a biographical note for her obituary writer), her childhood was idyllic, mostly spent riding her pony and playing tennis, as well as reading her older brother’s science fiction. Later she became interested in classical music (she was an accomplished musician, playing cello in a string quartet and singing alto in a local choir) and in poetry, obtaining a degree in English from Oxford University. She then studied law, qualified as a barrister and a solicitor, and spent most of her professional life as a lawyer; her duties included acting as charity administrator for a large group of almshouses. Having a career in the law helped in pursuing two interests of special significance to her, animal protection and the right to voluntary euthanasia. She was responsible for drafting three parliamentary Bills relating to these subjects; none of them passed, but they produced some useful discussions. However, her main interest was in psychical research. When she was 15 she read Sir Oliver Lodge’s Survival of Man, and at Oxford she joined the Oxford University Society for Psychical Research, at that time headed by the philosopher H.H. Price and ran by Richard Wilson, later physics professor at Harvard. The society was very active and hosted knowledgeable invited speakers such as Robert Thouless, Mollie Goldney, and Harry Price. Eventually Mary Rose herself became the Oxford society’s President.

Psychiatric Euthanasia and the Ontology of Mental Disorder

AbstractIn the Netherlands and Belgium, it is lawful for voluntary euthanasia to be offered on the grounds of psychiatric suffering. A recent case that has sparked much debate is that of Aurelia Brouwers, who was helped to die in the Netherlands on account of her suffering from borderline personality disorder. It is sometimes claimed that whether or not a mentally ill person’s wish to die is valid hinges on whether or not that wish is a symptom of the person’s mental disorder. This article addresses the philosophical problems raised by this claim, with a specific focus on the diagnosis of borderline personality disorder. After considering descriptivist and causal conceptualizations of mental disorder, I argue that the current approach to borderline personality disorder in psychiatry precludes the possibility of dissociating the wish to die from the disorder. I then examine the implications of this analysis for the question of whether or not the request for voluntary euthanasia in the case of borderline personality disorder can be considered valid. Ultimately, I conclude that the inability to dissociate the wish to die from the disorder does not invalidate the wish in the case of borderline personality disorder.

Assessment of patient decision-making capacity in the context of voluntary euthanasia for psychic suffering caused by psychiatric disorders: a qualitative study of approaches among Belgian physicians

ObjectiveIn Belgium, people with an incurable psychiatric disorder can file a request for euthanasia claiming unbearable psychic suffering. For the request to be accepted, it has to meet stringent legal...

Author's Response.

We appreciate the commending remarks by Weiss and Chaudhary on the algorithm showing the process of donation following the determination of death by neurological and circulatory criteria via clinical conditions of a pathway of end-of-life care: the transition from death to organ recovery and transplantation. The clinical conditions detailed in the algorithm did not include voluntary euthanasia as a pathway to organ donation. Although Weiss and Chaudhary noted that this approach has been undertaken in Quebec, Canada, the Netherlands, and Belgium, the legal permissibility, ethical acceptance, and international experience of voluntary euthanasia followed by organ recovery has not reached a sufficient threshold to become a standard practice—and thus, not included in the algorithm. THE LEGAL BARRIERS THAT PRECLUDE INTERNATIONAL STANDARDIZATION Voluntary euthanasia including euthanasia followed by organ donation remains illegal in the majority of European countries and in the United States (where some states do permit medically assisted suicide). In contrast, withdrawal of life-sustaining treatment under the circumstances of controlled donation after circulatory death is legally permissible and widely accepted internationally. This distinction regarding legal permissibility is the primary reason for omission of voluntary euthanasia and organ recovery into the algorithm. THE LACK OF INTERNATIONAL EXPERIENCE TO STANDARDIZE A SUCCESSFUL PRACTICE OF ORGAN TRANSPLANTATION AFTER EUTHANASIA There is insufficient data and experience to recognize a standard protocol for euthanasia followed by organ donation. The 2019 reference cited by Weiss and Chaudhary identifies the issue of insufficient data to develop further standardization in practice: “…although some authors have suggested that organ donation after medical assistance in dying might have a substantial impact on organ availability, the practice of organ donation after medical assistance in dying in Canada is still rare. More data about this practice must be collected to determine whether this guidance document is helpful or needs to be updated.”1 Without a recognized standard protocol with understood outcomes, the pathway of organ donation following euthanasia is not sufficiently developed to include into the algorithm. THE ETHICAL CONTROVERSY REGARDING EUTHANASIA COULD UNDERMINE PUBLIC TRUST IN THE SYSTEM OF DONATION Significant controversy remains regarding the ethical propriety of sanctioning voluntary euthanasia as a standardized practice. Until such ethical concerns regarding euthanasia are adequately addressed, introduction of a pathway to organ recovery following euthanasia may serve to amplify these ethical issues and erode the public trust in donation. Specifically, the public trust that the donation of organs remains independent of a decision to facilitate ending a patient’s life. Introducing these concepts together in the midst of unresolved significant ethical controversy over euthanasia might undermine public trust in donation. Given these legal, ethical, and experiential limitations, we conclude that the threshold for considering voluntary euthanasia to organ recovery as an international standard has not been sufficiently achieved and therefore it is appropriately excluded in an algorithm designed to derive consensus regarding recognized standard donation practices.

Response to Bernat and Delmonico.

We read with interest the recent commentary by Bernat and Delmonico1 entitled “Restoring Activity of Pig Brain Cells After Death Does Not Invalidate the Determination of Death by Neurologic Criteria or Undermine the Propriety of Organ Donation After Death.” We were particularly interested in the algorithm that outlines the entirety of donation progress possibilities (Figure 11 of that publication). While we feel that this algorithm offers a generally comprehensive and cohesive overview of donation pathways, we would like to suggest 1 addition. As first pioneered in Belgium and the Netherlands, and later in Canada, there is an additional entry point onto the donation after circulatory determination of death pathway: donation after medical assistance in dying (MAID)—often referred to as voluntary euthanasia.2,3 In our province of Québec, we have increasingly incorporated this pathway to donation into end–of–life care, with over 20 completed cases of donation after MAID since 2017 resulting in 64 transplanted organs (internal Transplant Québec reports). This currently represents 5%–10% of our total donation activity. This practice has been met with general acceptance from stakeholders including MAID providers, donation professionals, and the general public, including several favorable media reports.4 As other countries consider MAID legislation, it is important not to forget that this pathway can provide a source of transplanted organs while fulfilling the patient’s intent to help others at the end of their own life. We thus suggest that this pathway be added to future editions of your otherwise extremely informative algorithm.

Euthanasia in Serbia: Attitudes of Students of Law and Medicine.

Voluntary active euthanasia represents one of the key topics in the contemporary world medicine, law, religious, ethical and moral issues. Serbia considers legalization of this procedure. Between the others, it is important to examine the student's attitudes regarding this issue. Data were obtained from the faculties of law and medicine, from the universities of Kragujevac and Niš, Serbia. Data were collected during the second half of 2017. The research included 214 students. Due to the nature, subject and hypothesis of the research, the authors used descriptive method and the method of the theoretical content analysis. Generally, 54% of the students are in favor of legalization of the voluntary active euthanasia. 62, 4% would take part in the referendum on the legalization euthanasia. The results obtained in the survey on euthanasia on a sample of law and medical students in Niš and Kragujevac indicate that choice of the faculty (law or medicine) influences the structure (share) of responses to particular questions to some extent. However, this influence does not provide ground for conclusion that students' opinion on legalization and application of euthanasia depends on fact they study law or medicine.