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PubMed2001

Ethical and legal issues in palliative care.

This article reviews the ethical principles underlying palliative care, stressing the importance of respecting patient's rights to withdraw or withhold life-sustaining treatment, including artificial hydration and nutrition. There is no ethical or constitutional right to receive physician-assisted suicide or voluntary active euthanasia. This article discusses current ethical controversies in palliative care, including futility, medication dosage and double-effect, terminal sedation, legalization of physician-assisted suicide and euthanasia, and patient refusal of hydration and nutrition. Relevant legal issues are discussed in tandem with the ethical issues.

Ethics, Medical↗
PubMed2000

The view of religions toward euthanasia and extraordinary treatments in Japan.

388 Japanese religious groups--143 Shinto, 157 Buddhist, 58 Christian and 30 others--were asked to answer questions regarding several forms of euthanasia and extraordinary treatment during the dying process. Passive euthanasia and indirect euthanasia were accepted by around 70% of the respondents. Active euthanasia was favored by less than 20% of them. Christians were less supportive of euthanasia than practitioners of other religions. Shinto and Buddhist corporations advocated "being natural," when medical treatment became futile at the terminal stage. Religionists' views may deepen the discussion of end-of-life issues.

Attitude↗
PubMed1998

Acts, omissions, intentions and motives: a philosophical examination of the moral distinction between killing and letting die.

Health care professionals frequently justify moral decisions by appealing to the acts and omissions distinction and the principle of double effect. These principles are often quoted and criticised in the nursing literature, particularly in relation to active and passive euthanasia. Authors are, however, inclined to acknowledge the fact that they are a philosophical minefield, but fall short of providing a substantial critical analysis. Those who uphold the acts and omissions distinction claim that we are morally less responsible for our omissions than for our acts. The principle of double effect suggests that there is a moral distinction between direct and indirect intention and that we are morally less responsible for that which we intend indirectly. This article offers an examination of these often quoted, but sometimes little understood, principles and it is hoped that it will serve as a basis for debate. Since the intention is to challenge assumptions which can lull us into believing that our moral decisions can be justified by appealing to principles such as these, it is necessary to examine them critically and to go beyond a superficial grasp of the implications of such distinctions. There is a tendency to appeal to the acts and omissions doctrine and the principle of double effect in life and death situations such as euthanasia, infanticide and abortion, but are they valuable tools which should be used in moral decision making, or are they so flawed that they can seriously mislead us when it comes to hard cases? The conclusion reached in this paper is that there is no significant moral difference between an act and an omission, particularly within the context of killing and letting die, and that the principle of double effect encourages hypocrisy rather than honesty.

Double Effect Principle↗
PubMed1999

Allowing and assisting patients to die: the perspectives of oncology practitioners.

The moral distinctions between prolonging life, allowing for a dignified death, and assisting patients to die (hastening death) are troublesome to health practitioners. On 26 June 1997 the United States Supreme Court ruled that individuals do not have a constitutional right to physician-assisted suicide, but that individual states can legislate their preferences. Given this ruling it becomes important to ascertain the opinions of practitioners caring for persons who are at the end of their life. The data from interviews with 11 nurses and 10 physicians, who practice in the field of oncology, revealed issues associated with the care of dying persons. How health professionals integrated their perspectives of science/data with their perspectives on persons and personal goals affected the vigour with which they would institute treatment for the terminal patient. Further, ethical uncertainty dominated the decision making of all participants in this study when they were confronted with the question of assisting/hastening patients' dying.

Aged↗
PubMed1996

Euthanasia, physician-assisted suicide, and other medical practices involving the end of life in the Netherlands, 1990-1995.

BACKGROUND: In 1991 a new procedure for reporting physician-assisted deaths was introduced in the Netherlands that led to a tripling in the number of reported cases. In 1995, as part of an evaluation of this procedure, a nationwide study of euthanasia and other medical practices concerning the end of life was begun that was identical to a study conducted in 1990. METHODS: We conducted two studies, the first involving interviews with 405 physicians (general practitioners, nursing home physicians, and clinical specialists) and the second involving questionnaires mailed to the physicians attending 6060 deaths that were identified from death certificates. The response rates were 89 percent and 77 percent, respectively. RESULTS: Among the deaths studied, 2.3 percent of those in the interview study and 2.4 percent of those in the death-certificate study were estimated to have resulted from euthanasia, and 0.4 percent and 0.2 percent, respectively, resulted from physician-assisted suicide. In 0.7 percent of cases, life was ended without the explicit, concurrent request of the patient. Pain and symptoms were alleviated with doses of opioids that may have shortened life in 14.7 to 19.1 percent of cases, and decisions to withhold or withdraw life-prolonging treatment were made in 20.2 percent. Euthanasia seems to have increased in incidence since 1990, and ending of life without the patient's explicit request to have decreased slightly. For each type of medical decision except those in which life-prolonging treatment was withheld or withdrawn, cancer was the most frequently reported diagnosis. CONCLUSIONS: Since the notification procedure was introduced, end-of-life decision making in the Netherlands has changed only slightly, in an anticipated direction. Close monitoring of such decisions is possible, and we found no signs of an unacceptable increase in the number of decisions or of less careful decision making.

Data Collection↗