ABSTRACTPerhaps no American state has seen more legal activity on assisting suicide than Michigan, but despite legislation, a study Commission, several legal cases and a state Supreme Court ruling, the state seems much further from a humane resolution of the question than when the activities of Dr. Jack Kevorkian began in June of 1990. This note summarizes major legal events over a twelve‐month period , which included jury acquittal of Dr. Kevorkian, the inconclusive report of the Michigan Commission on (...) Death and Dying, the failure of the state legislature to enact legislation to replace the expired absolute but temporary prohibition, and the decision of the Michigan Supreme Court in Mich v. Kevorkian declaring assisting suicide a common law felony and ruling that in certain circumstances a person assisting suicide can be prosecuted for murder. The Commission's model decriminalization proposal and the bills subsequently introduced in the legislature , as well as the decision of the Supreme Court, are discussed. Certain puzzling features of the latter, especially with regard to the kind of causation that can turn helping another commit suicide into murder, are noted. (shrink)

Kevin Yuill goes straight to the heart of a difficult issue. Critical of both sides of the discussion, this book presents an up-to-date analysis of the direction discussion is taking, showing that atheists, libertarians, those favouring abortion rights and stem-cell research should stand beside their religious compatriots in opposing legalization of assisted suicide. The author shows that the real issue behind the debate is not euthanasia but suicide. Rather than focusing on tragic cases, he indicates the real (...) damage that will be done if we affirm the suicidal wishes of even a small segment of the population. Analyzing the movement for the right to die in historical terms, Yuill shows that, though many proponents of a change in the law believe they are rationalist heirs of such thinkers as John Stuart Mill, legalizing assisted suicide will reduce privacy and freedom. Finally, Yuill suggests a radical alternative to legalization of assisted suicide that would embrace both the cause of freedom and the anxieties of many about securing good deaths. (shrink)

BackgroundAssisted dying has wide support among the general population but there is evidence that those providing care for the dying may be less supportive. Senior doctors would be involved in implementing the proposed change in the law. We aimed to measure support for legalising physician assisted dying in a representative sample of senior doctors in England and Wales, and to assess any association between doctors' characteristics and level of support for a change in the law.MethodsWe conducted a postal survey (...) of 1000 consultants and general practitioners randomly selected from a commercially available database. The main outcome of interest was level of agreement with any change in the law to allow physician assisted suicide.ResultsThe corrected participation rate was 50%. We analysed 372 questionnaires. Respondents' views were divided: 39% were in favour of a change to the law to allow assisted suicide, 49% opposed a change and 12% neither agreed nor disagreed. Doctors who reported caring for the dying were less likely to support a change in the law. Religious belief was also associated with opposition. Gender, specialty and years in post had no significant effect.ConclusionMore senior doctors in England and Wales oppose any step towards the legalisation of assisted dying than support this. Doctors who care for the dying were more opposed. This has implications for the ease of implementation of recently proposed legislation. (shrink)

En 1994, Sue Rodriguez se suicide avec l’aide d’un médecin après une intense bataille judiciaire en Cour suprême du Canada dont l’objet était la décriminalisation du suicide assisté. À la suite de ce suicide, aucune accusation criminelle ne fut portée contre la ou les personnes ayant présumément aidé Sue Rodrigues à mettre fin à ses jours, et ce malgré le fait que le suicide assisté est un acte criminel au Canada. Cette non-intervention du droit pénal est (...) examinée en fonction du rôle que l’affaire Rodriguez a pu jouer dans la transformation des moralités au Canada. Dans ce livre, le suicide assisté de Sue Rodriguez est envisagé comme un « crime » utile (au sens durkheimien du terme), car il met en évidence une inconsistance entre les moralités dominantes inscrites dans le droit pénal et les conditions sociales qui ont rendu ce « crime » possible. Apparenté au crime de Socrate, le « crime » de Sue Rodriguez est analysé comme un héraut annonciateur de nouvelles moralités, comme un prélude préparant directement la voie à des changements dans le poids accordé aux moralités dominantes. Dans ce contexte, le rôle du droit pénal comme mode privilégié de régulation morale est remis en question. (shrink)

Background: The Voluntary Assisted Dying Act 2017 passed into law in Victoria, Australia, on the 29 November 2017. Internationally, nurses have been shown to be intimately involved in patient care throughout the voluntary assisted dying process. However, there is a paucity of research exploring Australian nurses’ perspectives on voluntary assisted dying and, in particular, how Victorian nurses anticipate the implementation of this ethically controversial legislation will impact their professional lives. Objectives: To explore Victorian nurses’ expectations of the (...) ethical and practical impacts the voluntary assisted dying legislation will have on their professional lives. Research design: This qualitative study analysed nurses’ free text responses collected as part of a larger mixed methods online survey investigating staff views on the Voluntary Assisted Dying Act. Data were collected during the period between the passing of the voluntary assisted dying legislation and the start date and were analysed using inductive content analysis. Participants and research context: Free text survey responses were analysed from 1873 nurses employed across seven Victorian health services located in both metropolitan and regional areas of the state. Ethical considerations: The study obtained research ethics approval and all participants were informed of the voluntary and anonymous nature of their participation. Findings: This study identified three broad areas of Victorian nurses’ professional lives that they expected to be impacted by the implementation of voluntary assisted dying: professional identity, career development and workplace relationships. Conclusion: Participants anticipate diverse and nursing-specific impacts of the implementation of voluntary assisted dying in Victoria. Their insights can inform health services in jurisdictions considering or already implementing voluntary assisted dying, to develop policies, procedures and staff training programmes that safeguard the well-being and legal rights of their nursing staff. (shrink)

The legal treatment of physician-assisted suicide is in flux. Reform has been impelled by several forces, including the recent success of novel constitutional arguments in the Ninth and Second Circuit Courts of Appeals. I will review and discuss Compassion in Dying v. State of Washington and Quill v. Vacco, addressing the constitutional arguments, and then briefly considering the attractions and difficulties of these new constitutional theories.Before 1990, state criminal laws dealing with assisted suicide had reached a (...) remarkably stable consensus: suicide was not illegal, but assisting suicide was a criminal action with no distinction typically made between physicians and others who assisted. The details of the relevant criminal law varied from state to state. Some states had criminal statutes specifically addressing assisted suicide, while others treated the practice under more general homicide statutes. But in no state was it clearly legal for a physician to prescribe a lethal medication at the request of a dying patient. While remarkable legal developments took place during the 1970s and 1980s regarding other aspects of the rights of dying patients, there was relative quiescence regarding the law of PAS. (shrink)

In this chapter, we explore the issue of assisted dying for individuals with dementia at the nexus of ethics and law. We set out the basic medical realities of dementia and the available data about the desire for the option of assisted dying in the face of dementia. We then describe law and practice with respect to voluntary euthanasia and assisted suicide in jurisdictions that permit at least some assisted dying. We conclude that, because of (...) the peculiar ways in which some of the features of dementia interact with specific legislative provisions, less access to assisted dying for persons with dementia can be realized through the legislation than might have been intended or expected. We then describe draft assisted dying legislation that is before the federal Parliament of Canada. We conclude that, because of the peculiar ways in which some of the features of dementia interact with specific legislative provisions, more access to assisted dying for persons with dementia would be realized, if the legislation was passed as drafted, than might be intended or expected. This exercise reveals that very careful attention needs to be paid to the features of dementia if drafting assisted dying legislation in order to actually achieve the desired law reform effect (whatever that might be). The interplay of common ethical rationales for permitting assisted dying (e.g., autonomy and alleviation of suffering) with common features of dementia (e.g., loss of competence before the terminal phase of the illness, loss of the capacity to communicate before the loss of the capacity to suffer) raises challenges for translating one’s ethical position on assisted dying for individuals with dementia into law. NB: This chapter is current up to 2015. (shrink)

Background In Switzerland, right-to-die organisations assist their members with suicide by lethal drugs, usually barbiturates. One organisation, Dignitas, has experimented with oxygen deprivation as an alternative to sodium pentobarbital. Objective To analyse the process of assisted suicide by oxygen deprivation with helium and a common face mask and reservoir bag. Method This study examined four cases of assisted suicide by oxygen deprivation using helium delivered via a face mask. Videos of the deaths were provided by (...) the Zurich police. Dignitas provided protocol and consent information. Results One man and three women were assisted to death by oxygen deprivation. There was wide variation in the time to unconsciousness and the time to death, probably due to the poor mask fit. Swiss law prevented attendants from effectively managing the face mask apparatus. Purposeless movements of the extremities were disconcerting for Dignitas attendants, who are accustomed to assisting suicide with barbiturates. None of the dying individuals attempted self-rescue. Conclusions The dying process of oxygen deprivation with helium is potentially quick and appears painless. It also bypasses the prescribing role of physicians, effectively demedicalising assisted suicide. Oxygen deprivation with a face mask is not acceptable because leaks are difficult to control and it may not eliminate rebreathing. These factors will extend time to unconsciousness and time to death. A hood method could reduce the problem of mask fit. With a hood, a flow rate of helium sufficient to provide continuous washout of expired gases would remedy problems observed with the mask. (shrink)

Brussen, Kerri Anne This paper is a brief history of suicide, euthanasia, and physician assisted suicide in the United States of America which aims to provide an understanding of the continued and persistent effort in the USA to legalise physician assisted suicide. Oregon and Washington State Dying with Dignity Laws are reviewed as examples of legalised physician assisted suicide.

Nursing prides itself on a commitment to caring for patients and their families. Daily, nurses support patients and their families as they face life-threatening disease and injury and help them through the painful decisions to initiate or remove ventilators, artificial nutrition and hydration, and other life-sustaining technology.The opinions of the Second and Ninth Circuit Courts of Appeals, in Compassion in Dying v. State of Washington and Quill v. Vauo, strike at the heart of the nursing value system. If the United (...) States Supreme Court upholds either opinion, physicians will be legally allowed to help patients die, and nurses will be called on to assist with this process, just as nurses have assisted with electroconvulsive treatment, abortion, and other controversial procedures. Advanced practice nurses, who are licensed to prescribe drugs, may also be allowed by law to assist patients to end their own lives. (shrink)

Background: Legislation on physician-assisted suicide is being considered in a number of states since the passage of the Oregon Death With Dignity Act in 1994. Opinion assessment surveys have historically assessed particular subsets of physicians.Objective: To determine variables predictive of physicians’ opinions on PAS in a rural state, Vermont, USA.Design: Cross-sectional mailing survey.Participants: 1052 physicians licensed by the state of Vermont.Results: Of the respondents, 38.2% believed PAS should be legalised, 16.0% believed it should be prohibited and 26.0% believed (...) it should not be legislated. 15.7% were undecided. Males were more likely than females to favour legalisation . Physicians who did not care for patients through the end of life were significantly more likely to favour legalisation of PAS than physicians who do care for patients with terminal illness . 30% of the respondents had experienced a request for assistance with suicide.Conclusions: Vermont physicians’ opinions on the legalisation of PAS is sharply polarised. Patient autonomy was a factor strongly associated with opinions in favour of legalisation, whereas the sanctity of the doctor–patient relationship was strongly associated with opinions in favour of not legislating PAS. Those in favour of making PAS illegal overwhelmingly cited moral and ethical beliefs as factors in their opinion. Although opinions on legalisation appear to be based on firmly held beliefs, approximately half of Vermont physicians who responded to the survey agree that there is a need for more education in palliative care and pain management. (shrink)

The Supreme Court, reluctant to find constitutional rights in areas marked by divisive social and legal debate, is not likely to constitutionalize a right to assisted suicide. The Court should cleave to the tradition of discouraging suicide and criminalizing its assistance.

Background: Due to recent legislations on euthanasia and its current practice in the Netherlands and Belgium, issues of end-of-life medicine have become very vital in many European countries. In 2002, the Ethics Working Group of the German Association for Palliative Medicine (DGP) has conducted a survey among its physician members in order to evaluate their attitudes towards different end-of-life medical practices, such as euthanasia (EUT), physician-assisted suicide (PAS), and terminal sedation (TS). Methods: An anonymous questionnaire was sent to (...) the 411 DGP physicians, consisting of 14 multiple choice questions on positions that might be adopted in different hypothetical scenarios on situations of “intolerable suffering” in end-of-life care. For the sake of clarification, several definitions and legal judgements of different terms used in the German debate on premature termination of life were included. For statistical analysis t-tests and Pearson-correlations were used. Results: The response rate was 61% (n=251). The proportions of the respondents who were opposed to legalizing different forms of premature termination of life were: 90% opposed to EUT, 75% to PAS, 94% to PAS for psychiatric patients. Terminal sedation was accepted by 94% of the members. The main decisional bases drawn on for the answers were personal ethical values, professional experience with palliative care, knowledge of alternative approaches, knowledge of ethical guidelines and of the national legal frame. Conclusions: In sharp contrast to similar surveys conducted in other countries, only a minority of 9.6% of the DGP physicians supported the legalization of EUT. The misuse of medical knowledge for inhumane killing in the Nazi period did not play a relevant role for the respondents’ negative attitude towards EUT. Palliative care needs to be stronger established and promoted within the German health care system in order to improve the quality of end-of-life situations which subsequently is expected to lead to decreasing requests for EUT by terminally ill patients. (shrink)

``What Does a Right to Physician-Assisted Suicide (PAS) Legallyentail?''''Much of the bioethics literature focuses on the morality ofPAS but ignores the legal implications of the conclusions thereby wrought. Specifically, what does a legal right toPAS entail both on the part of the physician and the patient? Iargue that we must begin by distinguishing a right to PAS qua``external'''' to a particular physician-patient relationship from a right to PAS qua ``internal'''' to a particular physician-patientrelationship. The former constitutes a negative (...) claim right inrem that prohibits outside interference with the exercise of aright to PAS while the latter can provide the patient witha positive claim right in personam to obligatory assistancefrom his physician. Importantly, I argue that the creation of sucha patient right, however, originates with the physician who may exercise an unqualified right of first refusal prior to promisingto help her patient commit suicide. In doing so, I hope to establishthat explicit physician promises of assistance in dying shouldbecome legally binding. As such, current PAS law in both theNetherlands and Oregon is in need of substantive modification. (shrink)

The legalization of physician-assisted suicide remains a hotly debated issue throughout the United States, and continues to capture the attention of government officials at both the state and federal levels. While the practice is currently legal in Oregon, some federal lawmakers and officials from the U.S. Department of Justice have attempted to outlaw that state's practice through legislation, or through a strained interpretation of the federal Controlled Substances Act. And while several citizen groups throughout the United States have (...) attempted but failed to legalize PAS through popular initiative, several state lawmakers have succeeded in specifically outlawing the practice. Yet even though physician-assisted suicide remains unlawful in every state except Oregon, there is ample evidence that American physicians throughout the United States have participated in PAS by providing their terminally ill patients with lethal prescriptions. (shrink)

At the heart of the debate over assisted suicide is the recognition that not all persons can be healed and not all suffering can be relieved. This article addresses the ethical, professional and legal issues to be considered by the nurses in the United States who are facing patients’ requests for assisted suicide. Both personal and professional risks, and the consequences of an action must be evaluated. Ultimately, a decision is based on some ranking of: patient (...) values; personal values and beliefs; professional codes, standards and other guidelines; and societal laws and regulations. (shrink)

The legalisation of physician assisted suicide in Oregon and physician assisted death in the Netherlands has revitalised the debate over whether and under what conditions individuals should be able to determine the time and manner of their deaths, and whether they should be able to enlist the help of physicians in doing so. Although the change in the law is both dramatic and recent, the basic arguments for and against have not really changed since the issue was (...) debated by Glanville Williams and Yale Kamisar nearly 50 years ago. In this paper, the author argues in favour of Kamisar’s consequentialist framework. Any change in law and social policy should not be based solely on individual cases, heart wrenching though these may be. Instead, we need to assess the need for PAS, and weigh this against the risks of mistake and abuse. (shrink)

Motivated by Lord Joffe’s Assisted Dying for the Terminally Ill Bill, but with one eye on any possible future legislation, I consider the justifications that might be offered for limiting assistance in dying to those who are suffering unbearably from terminal illness. I argue that the terminal illness criterion and the unbearable suffering criterion are not morally defensible separately: that a person need be neither terminally ill (or ill at all), nor suffering unbearably (or suffering at all) to have (...) a right to assisted dying. Indeed: I shall suggest that the unbearable suffering criterion undermines the Bill (or any proposal like it) wholesale. On the other hand, the criteria taken together are defensible, and this defence would be built on a concern for the protection of the vulnerable. However, I also claim that this implies that the law might justifiably—and maybe even properly—aim to prevent a person from gaining access to that to which they have a serious moral right. This seems paradoxical, and, towards the end of the paper, I seek to tease apart the paradox. (shrink)

Objectives: To discover what factors affect lay people’s judgments of the acceptability of physician assisted suicide and euthanasia and how these factors interact.Design: Participants rated the acceptability of either physician assisted suicide or euthanasia for 72 patient vignettes with a five factor design—that is, all combinations of patient’s age ; curability of illness ; degree of suffering ; patient’s mental status , and extent of patient’s requests for the procedure .Participants: Convenience sample of 66 young adults, (...) 62 middle aged adults, and 66 older adults living in western France.Main measurements: In accordance with the functional theory of cognition of N H Anderson, main effects, and interactions among patient factors and participants’ characteristics were investigated by means of both graphs and ANOVA.Results: Patient requests were the most potent determinant of acceptability. Euthanasia was generally less acceptable than physician assisted suicide, but this difference disappeared when requests were repetitive. As their own age increased, participants placed more weight on patient age as a criterion of acceptability.Conclusions: People’s judgments concur with legislation to require a repetition of patients’ requests for a life ending act. Younger people, who frequently are decision makers for elderly relatives, place less emphasis on patient’s age itself than do older people. (shrink)

With breathtalung speed, traditional criminal prohibitions against assisted suicide have been declared unconstitutional in twelve states, including California and New York. This poses great promise and great peril. The promise is that competent terminally ill patients, as a compassionate measure of last resort, will have the option of putting an end to their suffering by physician-assisted suicide. More sigmficant, legally permitting this controversial option may be a catalyst for doctors, health care institutions, and society to improve (...) the care of the dying. PAS should be limited only to those relatively few competent patients who continue to suffer intolerably despite unrestrained efforts to palliate and who face a continued existence that they regard as worse than death. When dying patients know they will not be abandoned to miserable and pointless suffering if palliative care fails, they will be fortified to cope better with the process of dying.The immediate peril is that PAS will become a quick fix, available on demand to any patient diagnosed as terminally ill, thus bypassing palliative care and producing premature deaths. (shrink)

In several jurisdictions, irremediable suffering from a medical condition is a legal requirement for access to assisted dying. According to the expressivist objection, allowing assisted dying for a specific group of persons, such as those with irremediable medical conditions, expresses the judgment that their lives are not worth living. While the expressivist objection has often been used to argue that assisted dying should not be legalised, I show that there is an alternative solution available to its proponents. (...) An autonomy-based approach to assisted suicide regards the provision of assisted suicide (but not euthanasia) as justified when it is autonomously requested by a person, irrespective of whether this is in her best interests. Such an approach has been put forward by a recent judgment of the German Federal Constitutional Court, which understands assisted suicide as an expression of the person’s right to a self-determined death. It does not allow for beneficence-based restrictions regarding the person’s suffering or medical diagnosis and therefore avoids the expressivist objection. I argue that on an autonomy-based approach, assisted suicide should not be understood as a medical procedure but rather as the person’s autonomous action. (shrink)

Providing a thorough, well-researched investigation of the socio-legal issues surrounding medically assisted death for the past century, this book traces the origins of the controversy and discusses the future of policymaking in this arena domestically and abroad.

The question of legalizing physician-assisted suicide has become a serious public debate. Growing interest in assisted suicide reflects a public increasingly fearful of the process of dying, particularly the prospect of dying a painful, protracted, or undignified death. PAS has been proposed as a compassionate response to unrelievable suffering, designed to give terminally or incurably ill individuals direct control over the timing, manner, and circumstances of their death. Although the American Medical Association remains firmly opposed to (...) legalizing PAS, many physicians have begun to express support for the practice, and some have acknowledged that they have helped patients commit suicide despite the existing legal ban.As support for PAS grows, it becomes increasingly likely that the practice will be legalized in at least some states in the not-too-distant future. In 1994, Oregon voters approved a referendum legalizing PAS for competent, terminally ill patients; a federal court injunction preventing the referendum from going into effect is currently on appeal, and it is widely expected that the injunction will be lifted. (shrink)

This commentary explores the background to, and implications of, the recently published Director of Public Prosecutions guidelines for prosecutors in respect of cases of encouraging or assisting suicide. It considers the extent of the provisions and questions the legitimacy of their focus on the compassionate motivation of the assistant, and the apparent prohibition on healthcare professionals providing such help. It concludes by suggesting that a permissive change in the law would provide better safeguards for those who seek assisted (...) dying. (shrink)

Physician-assisted dying is currently an intensely discussed topic in several countries. Despite differences in legislation and application, countries with end-of-life laws have similar eligibility criteria for assistance in dying: individuals must be in a hopeless situation and experience unbearable suffering. Hopelessness, as a basic aspect of the human condition, is a central topic in Albert Camus’ philosophical work The Myth of Sisyphus, which addresses the question of suicide. Suffering in the face of a hopeless situation, and the way (...) doctors approach this suffering, is the topic of his novel The Plague, which describes the story of a city confronted with a plague epidemic. In this paper, I draw philosophical and ethical conclusions about physician-assisted dying based on an analysis of central concepts in the work of Camus—specifically, those treated in The Myth of Sisyphus and The Plague. On the basis of my interpretation of Camus’ work, I argue that hopelessness and unbearable suffering are useless as eligibility criteria for physician-assisted dying, given that they do not sufficiently elucidate where the line should be drawn between patients who should to be eligible for assistance and those who should not. (shrink)

Das Thema Sterbehilfe gilt zu Recht als eines der typischen Themen im Medizinrecht, wird jedoch meistens vor allem unter dem Aspekt des Strafrechts analysiert. Das ist auch in dieser Arbeit nicht anders, in der die Autorin in erster Linie versucht, auf gewisse Schwächen der traditionellen de facto strafrechtlichen Systematik der Sterbehilfe zu verweisen, sowie auch deren üblicher Terminologie. Der Schwerpunkt der gesamten Arbeit liegt in der ausführlichen Analyse der strafrechtlichen Verantwortlichkeit des Arztes bei der Realisierung von Sterbehilfe und Suizidbeihilfe. Vorgestellt (...) werden rechtliche Regelungen einiger europäischen Ländern und Oregon. Größter Wert wird jedoch in der gesamten Arbeit eindeutig auf die praktischen Probleme gelegt, seien es bedingt straffreie Hilfe zum Sterben, Tötung auf Verlangen, Suizidbeihilfe, terminale Sedierung oder Beendigung der weiteren Therapie (inkl. Abschalten der Geräte aufgrund einer Patientenverfügung). Leitmotiv der gesamten Arbeit ist dann das Bemühen, auf Sterbehilfe als Thema zu verweisen, in dessen Rahmen der Respekt vor der Patientenautonomie und der paternalistische Schutz von Leben wertmäßig aufeinander treffen, die oftmals zweifellos in einem Gegensatz zueinander stehen. (shrink)

The Director of Public Prosecutions has recently released the Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide. These guidelines provide information on the factors that shall be considered when contemplating whether to bring a prosecution in the public interest in cases concerning assisting and encouraging suicide. While intended to clarify the potential liability of those engaged in or considering such practices, the guidelines have also stumbled into controversial and murky areas of law. As such (...) any potential positive outcomes the guidelines may produce must be weighed against the potential confusion they may also cause. (shrink)

This article focuses on the legality of euthanasia and assisted suicide in the Netherlands. Euthanasia and assisted suicide are allowed in certain cases, but there is no consensus with respect to the extent of the situations in which physicians should not be prosecuted. I argue that the individual, and, more specifically, his/her suffering, should be the focal point, and that the present legislation falls short in this respect; no solution can as yet be offered to individuals (...) whose suffering cannot be resolved through medical means and which cannot be subsumed under the terms the law specifies. (shrink)

The article presents the judgment of the German Federal Constitutional Court from 26 February 2020 on assisted suicide. The statements regarding human dignity, human rights and the relationship between citizens and the state are examined. Furthermore, the consequences resulting from this interpretation of human dignity for states that are pluralistic and based on human rights will be laid out. The court’s judgment limits the power of parliaments and poses a challenge to many laws in states that see themselves (...) as pluralistic, human rights-based states. There are no data in this work. (shrink)

On 26 February 2020, the German Constitutional Court rejected a law from 2015 that prohibited any form of ‘business-like’ assisted suicide as unconstitutional. The landmark ruling of the highest federal court emphasised the high priority given to the rights of autonomy and free personal development, both of which constitute the principle of human dignity, the first principle of the German constitution. The ruling echoes particularities of post-war Germany’s end-of-life debate focusing on patient self-determination while rejecting any discussion of (...) active assistance to die through a lethal injection administered by a doctor. This brief report discusses the ruling in the light of the broader sociopolitical and historical context of the German end-of-life debate. (shrink)

But as Harvard ethicist Arthur J. Dyck shows in this powerful work, there are solid moral and practical bases for the existing laws against assisted suicide in ...

Objective: To explore the experiences of people with a “terminal illness”, focusing on the patients’ perspective of euthanasia and assisted suicide.Method: A qualitative study using narrative interviews was conducted throughout the UK. The views of the 18 people who discussed euthanasia and assisted suicide were explored. These were drawn from a maximum variation sample, who said that they had a “terminal” illness, malignant or non-malignant.Results: That UK law should be changed to allow assisted suicide (...) or voluntary euthanasia was felt strongly by most people. Those who had seen others die were particularly convinced that this should be a right. Some had multiple reasons, including pain and anticipated pain, fear of indignity, loss of control and cognitive impairment. Those who did not want to be a burden also had other reasons for wanting euthanasia. Suicide was contemplated by a few, who would have preferred a change in the law to allow them to end their lives with medical help and in the company of family or friends. The few who opposed a change in UK law, or who felt ambivalent, focused on involuntary euthanasia, cited religious reasons or worried that new legislation might be open to abuse.Conclusion: Qualitative research conducted on people who know they are nearing death is an important addition to the international debate on euthanasia and assisted suicide. Those who had seen others die were particularly convinced that the law should be changed to allow assisted death. (shrink)

Guidelines provided by the Director of Public Prosecutions suggest that anyone assisting another to commit suicide in England and Wales, or elsewhere, will not be prosecuted provided there are no self-seeking motives and no active encouragement. This reflects the position in Switzerland. There, however, no difference is made between assistance and inducement. In addition, the Swiss approach makes it possible to establish organisations to assist the suicides of both their citizens and foreign visitors. It should not be assumed that (...) this approach is without controversy in Switzerland. Proposals for reform continue to be debated there, not least because of the concern about some of the actual practices of certain end-of-life organisations. It is likely that a few English citizens will continue to avail themselves of these services in Switzerland if they cannot find the help they require here. This paper explores the legitimacy of the current restrictive position adopted towards assisted suicide in England. It argues that the provisions within the guidelines prohibiting organisations that assist suicides, leaves some without the help they need. While legislative decriminalisation of assisted suicide and the establishment of state-sponsored suicide centres would represent the most permissive regime, this paper proposes that this would be a step too far. The preference here is for decriminalisation but adopting a ‘middle way’ between the two extremes: the more permissive approach provided by the ‘Swiss model’ is one that could be employed here, albeit within a more robust regulatory regime. (shrink)

Serious concerns about pervasive, persistent, and unjustified social inequalities have prompted a small—but growing—number of academic commentators to raise some hard and troubling questions for those who would like to legalize physician-assisted suicide. In various ways, these commentators have asked: In light of existing social inequalities—inequalities that operate, for example, along sometimes intersecting lines of race, class, age, sex, and disability—how persuasive are autonomy-based arguments in favor of legalization of assisted suicide when those arguments depend on (...) a conception of autonomy that either presupposes social equality or does not expressly account for its absence? How compelling are arguments that we ought to legalize assisted suicide out of feelings of mercy for the sick and dying, when such affective expressions may actually be the socially acceptable manifestation of private ambivalence that includes merciless discrimination? (shrink)

In 2017, Italy passed a law that provides for a systematic discipline on informed consent, advance directives, and advance care planning. It ranges from decisions contextual to clinical necessity through the tool of consent/refusal to decisions anticipating future events through the tools of shared care planning and advance directives. Nothing is said in the law regarding the issue of physician assisted suicide. Following the DJ Fabo case, the Italian Constitutional Court declared the constitutional illegitimacy of article 580 of (...) the criminal code in the part in which it does not exclude the punishment of those who facilitate the suicide when the decision has been freely and autonomously made by a person kept alive by life-support treatments and suffering from an irreversible pathology, the source of physical or psychological suffering that he/she considers intolerable, but fully capable of making free and conscious decisions. Such conditions and methods of execution must be verified by a public structure of the national health service, after consulting the territorially competent ethics committee. This statement admits, within strict and regulated bounds, physician assisted suicide, so widening the range of end-of-life decisions for Italian patients. Future application and critical topics will be called into question by the Italian legislator. (shrink)

In “Should We Impose Quotas? Evaluating the ‘Disparate Impact’ Argument Against Legalization of Assisted Suicide,” Ronald Lindsay argues that it should make no difference to the debate over legalizing assisted suicide whether the risks associated with legalization would fall disproportionately on the poor, people with disabilities, racial minorities, or any other especially vulnerable social group. Even assuming such an inequitable distribution of risks would occur, he maintains, attempting to avoid such an outcome is not a good (...) reason to deny assisted suicide to “competent persons who truly voluntarily choose it.”Those of us who worry that legalization will differentially burden already disadvantaged segments of society have generally taken it for granted that the possibility of such disparities raises significant public policy concerns. By insisting on an explanation of this assumption — and, in so doing, making explicit the tension between autonomy and equality that underlies the assisted suicide debate — Lindsay has significantly advanced the ongoing conversation. While I disagree with his analysis, I commend him for a thoughtful, provocative, and important contribution to the literature. (shrink)

Prominent among the arguments against the legalization of assisted suicide is the contention that legalization will have a disproportionately adverse, or “disparate,” impact on various vulnerable groups. There are many versions of this argument, with different advocates of this argument focusing on different vulnerable groups, and some advocates confusedly blending slippery slope and social justice concerns. Also, the weight placed on this argument by its various advocates is not uniform, with some including the argument in a list of (...) multiple, apparently similarly persuasive, reasons for not legalizing assisted suicide, while others place significant reliance on it and yet others advance the argument without any clear indication of its importance. Nonetheless, the various versions share a common core: One reason assisted suicide should not be legalized is that members of certain vulnerable groups are more likely to be pressured into requesting it, whether directly by those hostile or indifferent to their interests, or indirectly by social circumstances, such as an inability to pursue other healthcare choices. (shrink)

Background: Issues concerning legislation and regulation with respect to the role of nurses in euthanasia and physician-assisted suicide gave the Minister for Health reason to commission a study of the role of nurses in medical end-of-life decisions in hospitals, home care and nursing homes.Aim: This paper reports the findings of a study of the role of nurses in euthanasia and physician-assisted suicide, conducted as part of a study of the role of nurses in medical end-of-life decisions. (...) The findings for hospitals, home care and nursing homes are described and compared.Method: A questionnaire was sent to 1509 nurses, employed in 73 hospitals, 55 home care organisations and 63 nursing homes. 1179 responses were suitable for analysis. The questionnaire was pilot-tested among 106 nurses, with a response rate of 85%.Results: In 37.0% of cases, the nurse was the first person with whom patients discussed their request for euthanasia or physician-assisted suicide. Consultation between physicians and nurses during the decision-making process took place quite often in hospitals and nursing homes and less frequently in home care situations . In some cases , nurses administered the euthanatics.Conclusions: The results show substantial differences between the intramural sector and the extramural sector , which are probably linked to the organisational structure of the institutions. Consultation between physicians and nurses during the decision-making process needs improvement, particularly in home care. Some nurses had administered euthanatics, although this task is by law exclusively reserved to physicians. (shrink)

At the end of 2015, the German parliament passed a new law, entitled "Business-like Suicide Assistance", that effectively ended a rather liberal legal take on assisted suicide in Germany. §217 of the German Criminal Code was based on a proposal drafted by members of the parliament Michael Brand, Kerstin Griese, et all., The drafters’ goal was to prohibit Right-to-Die organisations such as Sterbehilfe Deutschland e.V. as well as repeatedly acting individuals from assisting people in ending their lives. (...) The goal of this article is to outline the new law in broad brushstrokes and raise some concerns. (shrink)

If the Supreme Court affirms either Compassion in Dying v. State of Washington or Quill v. Vacco, state legislatures will be presented with a new and unwelcome task: regulating physician-assisted suicide. This article focuses on the states task of specific policy making in light of the due process reasoning in Compassion in Dying and the equal protection reasoning in Quill. Policy makers must try to predict whether a particular regulation would in practice achieve its intended objective. They must (...) also try to predict whether the regulation would survive constitutional review if challenged. Finally, they must consider the extent to which they could, or should, maintain two different regulatory regimes: a more permissive one for decisions to forgo life-sustaining medical treatments, and a more restrictive one for decisions to obtain a prescription for a lethal dose of medication. This last issue will be especially challenging if the equal protection analysis in Quill prevails. (shrink)

“[A] murder prosecution is a poor way to design an ethical and moral code for doctors,” observed the California Court of Appeal in 1983. Yet, physicians who have chosen to help terminally ill patients to commit suicide have trespassed on illegal ground. When skilled medical care fails to relieve the pain of terminally ill patients, some people believe that physicians may assist in these suicides. Others reject any kind of physician involvement. The debate on assisted suiczide and active (...) euthanasia has focused on whether these acts can ever be acceptable. We propose to shift the debate to a less divisive issue: whether a caring physician who provides a suffering and ill patient with a prescription for a lethal dose of medication should be prosecuted as a felon. Even assisted suicide's opponents may object to such criminal prosecution. We propose to modify existing criminal laws to give physicians who assist their terminally ill patients in suicide, under carefully defined circumstances, a legal defense against criminal charges. (shrink)

This article explores attempts at legalization of the practice of euthanasia and assisted suicide. Although in many countries there have been high levels of public support for euthanasia and assisted suicide, in most of them, no legislative activity has taken place concerning these practices, and there is a lack of clarity about what is permitted and what is not. I argue that accurate definition of the relevant concepts and a clear delineation of the territory of the (...) debate would help draw a coherent roadmap for legalization. To this end, I analyze five legal approaches to the legalization euthanasia: maintenance of the status quo, legal defenses, de-prioritization, de-criminalization, and legislation. I conclude with a discussion of the moral and legal implications of the foregoing analysis. (shrink)

In each US state that has legalized physician-assisted suicide, the law stipulates that it may be pursued only by terminally ill patients with a prognosis of six months or less to live. It appears that this requirement makes euthanasia laws more palatable for the general public. However, this restriction is not justified by the reasoning commonly used to support assisted suicide. The desire to alleviate suffering and uphold personal autonomy should require that assisted suicide (...) be allowed for individuals who do not have a six-month prognosis. The author concludes that a moral contradiction arises for individuals who support limited assisted suicide but oppose unrestricted suicide because acceptance of the former logically leads to acceptance of the latter. (shrink)

The mental competence of people requesting aid-in-dying is a key issue for the how the law responds to cases of assisted suicide. A number of cases from around the common law world have highlighted the importance of competence in determining whether assistants should be prosecuted, and what they will be prosecuted for. Nevertheless, the law remains uncertain about how competence should be tested in these cases. This article proposes a test of competence that is based on the existing (...) common law but which is tailored to cases of assisted suicide. The test will help doctors, other health professionals and lawyers determine whether the suicidal person was able to competently request assistance. Such knowledge will help to reduce some of the current uncertainty about criminal liability in cases of assisted suicide. (shrink)