The case for active voluntary euthanasia.
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1,208 adult Norwegians constituting a representative sample of the population (above 20 years of age), were interviewed about doctors' right to practice euthanasia upon request for a dying and suffering patient. 56% were in favour (with varying degrees of agreement), 19% against, and 25% undecided. With regard to a non-terminal suffering patient, 31% were in favour (with varying degrees of agreement), 36% against, and 33% undecided. A sample of 541 graduate students proved to be more restrictive. The attitude towards voluntary euthanasia, towards suicide, and towards abortion proved to be positively intercorrelated, and at the same time negatively correlated to religious faith. A positive attitude to euthanasia was more strongly related to concern for the patient than for the relatives, while concern for health personnel seemed almost irrelevant.
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Public sentiment in favor of permitting voluntary active euthanasia creates a dilemma for a bioethics rooted in a libertarian notion of autonomy. At stake in the active euthanasia debate is actually a question of power--the individual's assertion of sovereignty over the timing and circumstances of his or her own death. Also at stake is society's unwillingness to impose a conception of the good--and a good dying--on individuals whose personal values and conceptions of the good may differ. In order both to reject voluntary active euthanasia and to affirm the patient's right to forgo life-sustaining treatment, some societal conception of the good must be developed and agreed upon to counter unbridled claims of individual self-sovereignty over dying. Pragmatic arguments alone, such as the need to maintain confidence in the doctor-patient relationship, will not be sufficient.
Although the Netherlands, Germany, and the United States are alike in having aging populations who die primarily of deteriorative diseases, they face end-of-life dilemmas quite differently. In the United States, withholding and withdrawing of treatment are the only legally recognized means for easing dying. In Holland, voluntary active euthanasia is also practiced; in (West) Germany, assisted suicide is a legal option, usually outside the medical setting. This paper examines objections to these three practices, and observes the differences in the background cultures. Rather than reliance on any of the three, it argues that physician-assisted suicide in terminal illness is the practice most compatible with the United States' special characteristics.
We report the results of a survey of the attitudes and practices of doctors in Victoria with respect to requests for active help in dying from patients who were suffering from a terminal or incurable disease. Questionnaires were sent to 2000 Victorian doctors who had been selected at random, 869 of whom returned completed questionnaires. The survey indicates that a clear majority of those who responded to the questionnaire support active voluntary euthanasia and that many doctors have provided active help in dying. Forty per cent of doctors indicated that they would practise active voluntary euthanasia if it were legal. We compare the results of our survey with a recent telephone survey of British general practitioners.