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PubMed1994

Euthanasia--definition, dangers and alternatives.

There is as yet (1992) no law specifically allowing euthanasia, the active intervention to end a patient's life. The discussion has so far been restricted to such action as taking place at a patient's request, but evidence from the Netherlands appears to show that the move to involuntary euthanasia is a real danger. Palliative medicine offers appropriate treatment for relief and support where limits are set on interventions that would no longer be in a patient's best interests. It is possible to relieve distress by using the increasing knowledge in this field. It is important to distinguish this from euthanasia and the term "passive euthanasia" is confusing and unfortunate. Those with extensive experience in the treatment of advanced cancer have much to share with practitioners in other specialties, not least in the possible achievements of both patient and family at the end of life. Society has the responsibility for including them in its concern to the end of life and for supporting those who find it difficult to believe in any meaning in their existence.

Euthanasia↗
PubMedDate not supplied

Allied health students' attitudes toward euthanasia.

Euthanasia, whether active or passive, remains a controversial issue in health care, and allied health professionals are likely to encounter situations of potential active or passive euthanasia during their careers. This survey of allied health students sought to determine their attitudes toward euthanasia and whether their self-reported euthanasia ideology corresponded with their behavioral endorsement of euthanasia actions. Disciplines and educational levels were also compared to determine differences between the program groups and their pro- or anti-euthanasia beliefs. Differing attitudes about euthanasia were found from group to group, and a significant correlation was found between the euthanasia ideology scores and the euthanasia behavioral scores.

Allied Health Personnel↗
PubMedDate not supplied

Euthanasia: a need for reform.

Recent high profile right-to-die cases have served to heighten the confusion surrounding euthanasia, particularly in relation to active and passive euthanasia. It is apparent that the underlying philosophical basis of the active-passive distinction has led to distortions in the law surrounding this issue, which further compounds the confusion. It is time for a more honest approach to assistance in dying. In the long-term, reform is inevitable and may involve reclassifying passive and active euthanasia as life-terminating acts. Nurses need to have an understanding of the ethical and legal basis of euthanasia to acknowledge and define their possible future role in relation to the provision of life-terminating acts.

Ethics, Medical↗
PubMed2005

A scale to assess attitudes toward euthanasia.

The topic of euthanasia has been a matter of public debate for several decades. Although empirical research should inform policy, scale measurement is lacking. After analyzing shortcomings of previous work, we offer a systematically designed scale to measure attitudes toward euthanasia. We attempt to encompass previously unspecified dimensions of the phenomenon that are central to the euthanasia debate. The results of our pretest show that our attitude towards euthanasia (ATE) scale is both reliable and valid. We delineate active and passive euthanasia, no chance for recovery and severe pain, and patient's autonomy and doctor's authority. We argue that isolating these factors provides a more robust scale capable of better analyzing sample variance. Internal consistency is established with Cronbach's alpha=.871. Construct external consistency is established by correlating the scale with other predictors such as race and spirituality.

Attitude↗
PubMed2002

[Ethics problems at the end of life. Terminal care--euthanasia].

The present discussion on active and passive euthanasia is characterised by the polarisation of various approaches deeply rooted in ideologies: quality of life versus sanctity of life. Autonomy, dignity, instrumentalization of human life are discussed. Furthermore the question of differentiation of active, direct and indirect euthanasia is raised. The author pleads for a reduction of dogmatic positions and recommends a moderate way between the general liberalisation and the general verdict of euthanasia on the moral and legal levels.

Austria↗
PubMed1995

Reflections on the state of current debate over physician-assisted suicide and euthanasia.

This paper is part of a larger project. My overall aim is to argue that the evolution of familiar forms of termination of life sustaining treatment, constituting so called passive euthanasia, has severely undercut the logic of every form of reasoning that has traditionally been used to oppose active euthanasia and assistance in suicide. Basically, there are two such forms of traditional opposition, each represented in a range of different versions. There is the inevitable argument concerning social utilities -- that permitting euthanasia and assisted suicide will have bad social consequences. But more fundamentally, the idea persists that killing is intrinsically worse than letting-die in some sense that justifies the current practice of prohibiting the first while allowing the latter. In this paper, I first consider this latter claim. My ultimate strategy, as I have said, is to show that the nature of certain things we have all come to approve regarding termination of treatment makes it next to impossible to convincingly explain, in either of these ways, what is wrong with certain forms of assistance in suicide and euthanasia. In the second part of this paper I take another step in this direction by discussing, in a preliminary way, a special case of the argument from social risks.

Enteral Nutrition↗
PubMed1995

[Ethical and clinical decisions in a terminally ill cancer patient with metastatic cancer. The problem of euthanasia].

The easiness of medical technology to prolong life in patients with severe cognitive or biological deterioration, the existence of cultural tendencies that underscore the importance of patient's self determination and economical considerations have posed the problem of euthanasia among patients, their families, society and medical teams. A propos of an exemplary patient, the ethical principles that allow the distinction between passive euthanasia and withdrawal of life support measures are analyzed. The analysis of active euthanasia, leads to the conclusion that it is not compatible with the ethical principles that classically have inspired medical actions.

Cost-Benefit Analysis↗
PubMedDate not supplied

Medical murder by omission? The law and ethics of withholding and withdrawing treatment and tube feeding.

When is it lawful and ethical to withhold or withdraw treatment and tube feeding? In recent years, the courts have handed down important decisions and medical bodies have issued professional guidelines on withholding and withdrawing treatment and tube feeding. A major criticism of these decisions and guidelines has been that while they prohibit the intentional hastening of a patient's life by an act ('active euthanasia'), they permit the intentional hastening of a patient's death by omission ('passive euthanasia'); and they prohibit actively assisting suicide, but permit passively assisting suicide. By focusing on the landmark decision of the Law Lords in the Tony Bland case, and on the guidelines on withholding and withdrawing treatment and tube feeding issued by the British Medical Association, this paper considers whether this criticism is sound, and concludes that it is.

Advance Directives↗
PubMed1996

[Euthanasia and the Dakar medical staff].

DEROBERT defines euthanasia as an "ability to get painless death for incurable patients, who are suffering from a fatal illness with unbearable bodily aches that can't be mitigated by any means". Passive euthanasia fits with doctor's abstention of any curative therapy for non curable patients at the end of life. It is different from active euthanasia in which physicians themselves get quick death for patients by giving them any drugs. This work was done in the main hospital centers in Dakar; the aim is to determine the position of medical staff about euthanasia and it's legislation. For this purpose an anonymous questionnaire was dispatched to 126 workers choosen at random in these hospitals. The result of this inquiry is that most of them (84%) are against euthanasia and agree with the idea of waiting for death at home. Religious reasons explain non practice of euthanasia.

Attitude to Death↗
PubMed1982

Death education and attitudes toward euthanasia and terminal illness.

The attitudes of a random sample of Cleveland clergy toward the experience of terminal illness and the circumstances justifying euthanasia are presented and analyzed. The clergy response patterns revealed that, although eager to prolong life as long as possible, terminally ill patients fear a prolonged period of illness more than death itself. They also agreed that most patients favor the disclosure of terminal illness. The clergy's response to a questionnaire exhibited a definite ranking (i.e., scaling) in the order of priority of the different circumstances justifying passive euthanasia. Using training in death counseling as a control variable produced sharper division in the response categories for each statement. The controversial nature of euthanasia and the problem of ascertaining the psychological needs of the terminally ill became more apparent with the group who had more training in death counseling. Interpretations of the findings are presented, and a need for a careful reexamination of the effects of death education on attitudes toward controversial subjects in death and dying is stressed.

Attitude to Death↗
PubMed2001

[Euthanasia in the Netherlands--and the debate in Norway].

The Netherlands is about to change the penal code so that starting in the autumn of 2001, euthanasia and physician-assisted suicide, will be lawful acts, provided that certain conditions are met. The concepts of "euthanasia" and "physician-assisted suicide" are defined in a detailed manner, congruent with Dutch theory and practice. In connection with these definitions, a sharp distinction is drawn between medicalized killing and withholding or withdrawing treatment, and it is demonstrated why so-called "active" and "passive" euthanasia are notions that make no sense in a Dutch context. The basic criteria for granting requests for euthanasia and physician-assisted suicide are introduced. The physician-patient relationship in the light of these practices is also a topic. It is pointed out that it is not uncommon that Dutch physicians find it emotionally burdensome to perform euthanasia. The claim that proper palliative treatment and care will work against patients' wish for euthanasia or physician-assisted suicide is discussed. From the public debate in Norway, one gets the impression that all humanists defend euthanasia and physician-assisted suicide. Yet there are prominent humanists amongst doctors who are distinctly opposed to these practices. On the other hand, in the Netherlands, we find hospital chaplains who defend euthanasia and physician-assisted suicide.

Ethics, Medical↗
PubMed1983

Abortion and euthanasia of Down's syndrome children--the parents' view.

A study of 78 parents of Down's syndrome children shows that, while most were in favour of abortion for a handicapped fetus, they were divided equally on whether euthanasia (no distinction made between active and passive euthanasia) was an acceptable practice. Only a third considered an average Down's syndrome child could be a suitable candidate for euthanasia. While parents argued that the degree of handicap of the child was the crucial factor in making this decision, in fact the social class of the parents themselves was the only variable which was statistically significantly related to their opinions. Differences arose from the parents' lack of agreement on what constituted a sufficiently severe handicap.

Abortion, Induced↗
PubMed1996

Physicians' attitudes regarding Down syndrome.

We conducted a representative survey to obtain current information about attitudes of pediatricians, child neurologists, and pediatric surgeons in Hungary regarding Down syndrome. The findings are compared to those of a similar study from Canada. In the treatment of mentally handicapped newborns, none of the Hungarian doctors would choose active euthanasia; only a few percent would perform passive euthanasia. Hungarian doctors give priority to the hospital-based ethical committee in the decision-making process regarding the treatment versus nontreatment of a newborn with major congenital anomalies. In contrast to the Canadians, only a few doctors would discuss this question with parents and nurses. Most Hungarian physicians are not aware of legal regulations in this field. These attitudes can be explained by religious and cultural traditions different from the Canadian and Western European standards. The Hungarian medical community, like other Eastern European countries, is much more authoritative than the Canadian system. Furthermore, the appropriate legal regulations are not yet properly codified.

Adult↗
PubMed1999

[Limits to the duty to treat in intensive care. 1. Explanation of the guidelines in the DGAI].

Every form of active euthanasia is a punishable offence under sections 216 of the Penal Code; nor is there any ethical justification for it from a medical point of view. The many strands of the movement in favour of making "death on demand" exempt from punishment in Germany as it is in The Netherlands cannot change this. In the area of passive euthanasia the limits of the intensive care team's duty to treat depends on various factors: The patient's declared or assumed wishes. It is not permissible to carry out procedures refused by the patient, even when these alone would make an extension of life possible. The indications for medical treatment. In the twilight zone between life and death, procedures with no prospect of success can no longer help the patient. In these circumstances they are pointless and are not medically indicated. According to Supreme Court rulings, the medical decision on whether to implement procedures designed to extend life or whether to withhold such procedures is based almost exclusively on the wishes or the assumed wishes of the patient, even though interpretation of the "assumed wishes" can be difficult and is quite often liable to subjective influences. The question of using the presence or absence of medical indications for treatment as an objective criterion, in contrast, has so far been disregarded in rulings. If no life-extending procedures are implemented the physician's duty to provide suitable basic care for the patient, in the sense of palliative care, remains. To make decisions easier, the authors discriminate between the essential "ordinary" remedies that must be provided to all patients and the "extraordinary" remedies of intensive care that are available for patients who can still benefit from them. There is some controversy over the correct assignment of artificial nutrition; according to German legislation it belongs in the category of extraordinary remedies. The palliative procedures that make up basic care include adequate pain relief, which can be a form of indirect euthanasia. The Supreme Court has ruled that it is the physician's duty to prescribe adequate pain relief even when it might have the unavoidable side effect of unintentionally accelerating the patient's death.

Critical Care↗
PubMed2003

[Euthanasia, the magic of a word].

SOME ABUSE: The problem of euthanasia is one of the greatest subjects of ethical controversy of our time, controversy enhanced by the ambiguity of the word. Up until the Seventeenth century, the word evoked the easing of terminal suffering by a physician. At the end of the Nineteenth century the abuse is total--the word means the deliberate ending of a patient's life to spare the suffering. The various qualifications added later (active or passive euthanasia, direct or indirect, voluntary or non-voluntary, involuntary...) have certainly not helped to clarify the situation. AMBIGUITY AND PROBLEMS OF INTERPRETATION: Even worse, the word itself is not unambiguous, biased etymologically by the prefix "eu" that provides it with a positive connotation. A survey among the general public has shown that the notion of euthanasia is interpreted in different ways by the population, which would therefore discredit a public referendum preceding its legalisation, which is undesiderable because of the risks of abuses. It is unlikely that even the best efforts for clarification would ever be able to eliminate the intrinsic ambiguity that now contaminates the word. TO IMPROVE THE SITUATION: Since it appears difficult to banish the word euthanasia from the medical vocabulary, it should at least be accompanied by the objective characterisation of the behaviour corresponding to each situation. Hence in difficult situations, the place of life-saving measures, of palliative care and of analgesic sedation could be reasonably decided on by a group, made up on a case by case basis, by persons having known, cared for and accompanied the patient.

Attitude to Death↗
PubMed1994

Euthanasia: the Dutch experience.

Although rules about euthanasia have been developed in the Netherlands, euthanasia has not been legalized. We review the historical aspects of euthanasia, its definition and why no distinction is now made between active and passive euthanasia in the Netherlands. The guidelines for euthanasia, in use in the Utrecht University Hospital, are presented and the result of some studies on euthanasia is discussed. Non-treatment decisions were taken in 17.5% of all deaths in 1990 but only 1.8% of all deaths were the result of euthanasia. Life-terminating acts without explicit and persistent request of the patients occurred in 0.8% of all deaths. The most common reasons for requests for euthanasia were loss of dignity in 57%, pain in 46%, distressing mode of dying in 46% and being dependent on others in 33%. Of all medical decisions concerning the end of life 79% related to patients older than 65 years. The guidelines for euthanasia developed in the Netherlands support both patient and physician in the request for euthanasia.

Aged↗
PubMedDate not supplied

Medical killing--an Evangelical perspective.

Evangelicals are unconditionally opposed to active euthanasia. Indirect euthanasia is seen as simply belonging to the risks inherent in any medical intervention. Passive euthanasia is accepted if used in order to save the dignity of the dying and is seen as merely ceasing to interfere with an irreversible dying process. The basis of evangelical ethics is the Bible supplemented by science and experience as a kind of natural law. Even though natural law comes under Biblical revelation, its acceptance is the reason for the similarity of the Evangelical and the Roman-Catholic position of Evangelicals. Evangelicals stress the necessity of a better counseling and investment for the deadly ill patient.

Bible↗