During the summer of 1999, twenty-eight interviews with some of the leading authorities on the euthanasia policy were conducted in the Netherlands. They were asked about cases of non-voluntary (when patients are incompetent) and involuntary euthanasia (when patients are competent and made no request to die). This study reports the main findings, showing that most respondents are quite complacent with regard to breaches of the guideline that speaks ofthe patient’s consent as prerequisite to performance of euthanasia.

Conflicts surrounding the provision of life-sustaining treatment create difficult ethical and interpersonal challenges for providers, patients, and families or other surrogates alike. These conflicts implicate a constellation of ethical concepts, including distributive justice, harms and wrongs to patients, fiduciary obligations to patients, standards for surrogate decision-making, and medical futility. Recently, several critical care societies published a policy statement on conflicts at the end of life, and advocated for a new concept, “potentially inappropriate treatment”. They argued that in some circumstances, after (...) due process, physicians and hospitals should have the authority to... (shrink)

A number of influential reports on influenza pandemic preparedness include recommendations for extra-autonomous decisions to withdraw mechanical ventilation from some patients, who might still benefit from this technology, when demand for ventilators exceeds supply. An unintended implication of recommendations for nonvoluntary and involuntary termination of life support is that it make pandemic preparedness plans vulnerable to patients’ claims for assisted suicide and active euthanasia. Supporters of nonvoluntary passive euthanasia need to articulate why it is both morally different (...) and morally superior to voluntary active euthanasia if they do not wish to invite expansion of end-of-life options during health system catastrophe. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Active Euthanasia and Assisted SuicidePat Milmoe McCarrick (bio)Although the President's Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research in its 1983 report, Deciding to Forego Life-Sustaining Treatment, described the words and terms "euthanasia," "right to die," and "death with dignity" as slogans or code words—"empty rhetoric," (I, p. 24), the literature reviewed for this Scope Note continues to use these terms. (...) Therefore, to discuss the termination of a patient's life by a physician at the patient's request, the phrase active euthanasia is used, and the supplying of a means by a physician whereby a patient can end his or her life is referred to as assisted suicide.Euthanasia, either as the "good death" from classical Greek or "mercy killing" to end unbearable suffering in the dying, has long been a topic of interest in western civilization (III, Brody 1989). In recent years, public awareness of this discussion about control over the time of one's death has been informed by a series of well-publicized events. They include the November 1991 rejection by a vote of 54 percent to 46 percent of the Washington state Initiative 119, which would have allowed the option of requesting one's physician to "aid-in-dying" for adult patients in a "medically terminal condition" (V, Gross 1991); two medical journal articles describing physician's actions in helping bring death to two patients (V, Anonymous 1988; V, Quill 1991); Dr. Jack Kevorkian's assistance in the suicide of three women (V, Belkin 1990; V, Wilkerson 1991); and the best seller status of a how-to book on committing suicide with opiates obtained from a physician (III, Humphry 1991).For the most part, material included in the annotated bibliography in Scope Note 18 has been chosen from works published in the four years since "It's Over, Debbie" (V, Anonymous 1988) appeared in early January 1988 in the Journal of the American Medical Association.Dr. Edmund D. Pellegrino (V, 1991, pp. 3118-19) presented opposing views about active voluntary euthanasia as follows:Those who favor voluntary euthanasia argue that it is a beneficent and compassionate act; it respects autonomy by preserving the patient's control of the manner, method, [End Page 79] and timing of death; it takes the matter outside the reach of "medical power" (accessed in this Scope Note's bibliography at V, Fletcher 1973; V, Nowell-Smith 1989) and scrupulosity; and it prevents the injustice that allows some patients to choose death by refusal of life-support measures, while denying others the right to do so by active euthanasia....The opponents of active euthanasia argue that it undermines the value of, and respect for, all human life (V, Kass 1989; V, Coyle 1990; V, Singer 1990). They fear that guidelines cannot avoid sliding down the "slippery slope" to involuntary euthanasia and selective devaluation of the lives of the most vulnerable among us.... If euthanasia is legal, it is predicted that patients will feel subtle pressure to conform so as to relieve the economic and emotional burdens they impose on family and friends.Euthanasia, its opponents further argue, is socially destructive: it undermines trust in physicians, desensitizes society to killing, and imperils the ground already gained in legitimating passive euthanasia(IV, Wolf 1989).Physicians were not particularly involved with a patient's death until after World War II when participation grew in proportion to the growth of technology. Since the complex, life-sustaining equipment that could forestall death was located in a hospital, death itself became almost completely medicalized (V, Dagi 1991). For terminally ill persons who would like to die a painless death, either by their own hand or with assistance, physicians have almost a monopoly on obtaining strong drugs for distribution to patients (V, Abrams 1990).Active euthanasia for human beings is not legalized anywhere in the world (V, VonDrehle 1991). It is classified as homicide or murder in all fifty states and in Great Britain, Canada, Australia, and the Phillippines (V, Nerland 1989). Twentysix states in the United States prohibit assisted suicide by statute (V, Rosenblum 1990).In 1969 in the Netherlands, a physician named Jan Hendrik van... (shrink)

Slippery slope arguments appear regularly whenever morally contested social change is proposed. Such arguments assume that all or some consequences which could possibly flow from permitting a particular practice are morally unacceptable.Typically, “slippery slope” arguments claim that endorsing some premise, doing some action or adopting some policy will lead to some definite outcome that is generally judged to be wrong or bad. The “slope” is “slippery” because there are claimed to be no plausible halting points between the initial commitment to (...) a premise, action, or policy and the resultant bad outcome. The desire to avoid such projected future consequences provides adequate reasons for not taking the first step.Thus the legalization of abortion in limited circumstances is asserted to lead down the slippery slope towards abortion on demand and even infanticide; and the legalization of assisted suicide to lead inexorably to the acceptance of voluntary euthanasia and subsequently to the sanctioning of the practice of nonvoluntary euthanasia – even involuntary euthanasia of “undesirable” individuals. (shrink)

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)

I question whether, in those cases where physician-assisted suicide is invoked to alleviate unbearable pain and suffering, there can be such a thing as voluntary euthanasia. The problem is that when a patient asks to die under such conditions there is good reason to think that the decision to die is compelled by the pain, and hence not freely chosen. Since the choice to die was not made freely it is inadvisable for physicians to act in accordance with it, (...) for this may be contrary to the patient's genuine wishes. Thus, what were thought to be cases of voluntary euthanasia might actually be instances of involuntary euthanasia. (shrink)

The word euthanasia, meaning a peaceful, gentle, or easy death, has been traced back to Roman times. But the "good" in a good death is obviously open to interpretation. Good for whom? The individual? The family of the individual? The society? And, who decides? The individual? The doctor? The family of the individual? The legal system? These questions are constantly raised throughout the literature with diametrically opposed answers given from the earliest times to the present. And, unfortunately, one word (...) is used for all the positions, with two subcategories, voluntary and involuntary, both of which are perceived as good for someone.Death is universal but whether or not a person should have a choice about when to... Read More. (shrink)

This study tests how various kinds of trust impact attitudes toward euthanasia among the general public. The indication that trust might have an impact on euthanasia attitudes is based on the slippery slope argument, which asserts that allowing euthanasia might lead to abuses and involuntary deaths. Adopting this argument usually leads to less positive attitudes towards euthanasia. Tying in with this, it is assumed here that greater trust diminishes such slippery slope fears, and thereby increases (...) euthanasia acceptance. (shrink)

The slippery slope argument has been the mainstay of many of those opposed to the legalisation of physician-assisted suicide and euthanasia. In this paper I re-examine the slippery slope in the light of two recent studies that examined the prevalence of medical decisions concerning the end of life in the Netherlands and in Australia. I argue that these two studies have robbed the slippery slope of the source of its power--its intuitive obviousness. Finally I propose that, contrary to the (...) warnings of the slippery slope, the available evidence suggests that the legalisation of physician-assisted suicide might actually decrease the prevalence of non-voluntary and involuntary euthanasia. (shrink)

The term “euthanasia” is used in conflicting ways in the bioethical literature, as is the term “assisted suicide,” resulting in definitional confusion, ambiguities, and biases which are counterproductive to ethical and legal discourse. I aim to rectify this problem in two parts. Firstly, I explore a range of conflicting definitions and identify six disputed definitional factors, based on distinctions between (1) killing versus letting die, (2) fully intended versus partially intended versus merely foreseen deaths, (3) voluntary versus nonvoluntary versus (...) involuntary decisions, (4) terminally ill versus non-terminally ill patients, (5) patients who are fully conscious versus those in permanent comas or persistent vegetative states, and (6) patients who are suffering versus those who are not. Secondly, I distil these factors into six “building blocks” and combine them to develop an unambiguous, value-neutral taxonomy of “end-of-life practices.” I hope that this taxonomy provides much-needed clarification and a solid foundation for future ethical and legal discourse. (shrink)

sirDr Campbell presents proponents of euthanasia with a dilemma.1 Only voluntary euthanasia is permissible; involuntary euthanasia is always impermissible. The question of allowing euthanasia arises most frequently when patients are terminally ill and experiencing great pain. But in these cases, he argues, if patients request euthanasia, their decision “is not freely chosen but is compelled by the pain”.2 It is easy to exaggerate the problem here; patients may have periods when they are pain-free and (...) affirm repeatedly their desire that death be hastened. Putting this aside, however, what should we conclude if euthanasia performed on patients who are suffering greatly is not voluntary?Dr Campbell concludes: “If the request to end one's life is not made freely, then it is doubtful that such requests ought to be followed”.2 An advance directive will not help, we are …. (shrink)

Euthanasia and assisted dying are illegal in India according to Sections 306 and 309 of the Indian Penal Code, and Article 21 of the Constitution of India. There have been a number of cases where the Indian High Courts and Indian Supreme Court issued differing verdicts concerning the right to life and the right to die. Nevertheless, on 7 March 2011, a paradigm shift happened as a result of the Indian Supreme Court's judgment on involuntary passive euthanasia (...) in the case of Aruna Shanbaug. In its judgment, the Supreme Court requested the government to prepare a law on euthanasia. Accordingly, the 241st Report of the Law Commission of India proposed a bill to permit passive euthanasia. In May 2016 the Ministry of Health and Family Welfare issued the draft bill for public comment in order to create an informed decision. The Indian people are divided on the issue of euthanasia. The majority of the scientific community welcome it, while some religious groups oppose it. Hindus, in general, express both supporting and opposing views on euthanasia, whereas, Christians and Muslims have hardened their opposition against it. The Supreme Court judgment and the Report of the Law Commission pave the way for the development of new policies pertaining to passive euthanasia by the central government of India. Once such legislation is passed, passive euthanasia may, and probably will, have an enormous impact on the cultural, political, public and medical spheres of India in the near future. (shrink)

Our goal in this article is to explicate the way, and the extent to which, euthanasia can be voluntary from both the perspective of the patient and the perspective of the health care providers involved in the patient’s care. More significantly, we aim to challenge the way in which those engaged in ongoing philosophical debates regarding the morality of euthanasia draw distinctions between voluntary, involuntary, and nonvoluntary euthanasia on the grounds that drawing the distinctions in the (...) traditional manner (1) fails to reflect what is important from the patient’s perspective and (2) fails to reflect the significance of health care providers’ interests, including their autonomy and integrity. (shrink)

Background: Nurses’ voices remain unheard in most debates about euthanasia, although their crucial role in the euthanasia process is widely acknowledged. Moreover, in Canadian euthanasia law, nurses have a more active role, which further highlights the need for knowledge about nurses’ attitudes towards their role in the euthanasia process. Research questions: What are Finnish nurses’ attitudes towards their potential role in the euthanasia process? Which characteristics are associated with those attitudes? Research design: Cross-sectional web-based survey. (...) Participants and research context: 1003 nurses, recruited via social media and the members’ bulletin of the Finnish Nurses Association. Ethical considerations: Ethical approval was obtained from the Committee on Research Ethics of the university to which the first author was affiliated. Findings: The great majority (85.2%) of nurses felt that their perspective should be considered in decision-making related to euthanasia. Furthermore, most of the participants (74.7%) reported willingness to participate in the euthanasia process if it were legal, and 88.6% agreed that a nurse should be present when euthanasia is performed if the patient wishes so. Furthermore, over half agreed that some of the preparatory tasks were part of their job description. However, a minority (32.9%) agreed with a possible obligation to participate based on their profession. Nurses’ age, religiosity and educational level influenced their attitudes in the current results. Discussion: Despite the strong agreement on decision-making concerning euthanasia and participation in the euthanasia process, obligation to participate based on the profession was rejected by most participants. Nurses regarded themselves as consultants in the decision-making process, which may indicate their unwillingness to share the responsibility for the decision itself. Conclusion: Specific safety mechanisms should be considered to protect nurses who refuse to be involved in the euthanasia process due to harm that involuntary participation might cause. (shrink)

In this Critical Notice of Emily Jackson and John Keown’s Debating Euthanasia , the respective lines of argument put forward by each contributor are set out and the key debating points identified. Particular consideration is given to the points each contributor makes concerning the sanctity of human life and whether slippery slopes leading from voluntary medically assisted dying to non-voluntary euthanasia would be established if voluntary medically assisted dying were to be legalised. Finally, consideration is given to the (...) positions adopted by the contributors in relation to the legalisation of voluntary medically assisted dying. (shrink)

In the debate surrounding the morality and legality of the practices of physician-assisted death and euthanasia, a common logical argument regularly employed against these practices is the “slippery slope argument.” One formulation of this argument claims that acceptance of physician-assisted death will eventually lead down a “slippery slope” into acceptance of active euthanasia, including its voluntary, non-voluntary, and/or involuntary forms, through psychological and social processes that warp a society’s values and moral perspective of a practice over an (...) extended period of time. This formulation is known as the psychological slippery slope argument. This paper analyzes the psychological slippery slope argument as it is applied to the practice of physician-assisted death, and utilizing recent empirical evidence from various nations around the world that practice physician-assisted death and/or euthanasia, the paper argues that employing the psychological slippery slope argument against physician-assisted death is logically fallacious, this kind of slippery slope is unfounded in practice, and thus the psychological slippery slope argument is insufficient on its own to justify continued legal prohibition of physician-assisted death. (shrink)

[Utilitarism, Nazism, and Euthanasia] The article is an answer to Prof. Munzarová who criticised my defence of physician-assisted suicide. The article points to shortcomings in the reply of prof. Munzarová which flow from the author’s underestimation of normative theory. Among these shortcomings are the ignoring of the arguments of her opponent; her calling into question the moral credit of the proponents of the competing theory (utilitarianism) rather than a critical analysis; unclear theoretical principles (a switching between paternalism and autonomy, (...) the presentation of the “principle of double-effect” as the standpoint of common sense); an unconvincing version of the “argument of the slippery slope” (ignoring the diametrical differences between the contemporary demand of some patients for assisted death and the Nazi programme of involuntary euthanasia). (shrink)

Apologists for physician-assisted suicide maintain that democracy's commitment to life, liberty, and the pursuit of happiness entitles any rational adult to decide when to end one's life. Yet the procedure nullifies freedom and the right to life, and is thus anti-democratic. Both on the practical and theoretical levels, assisted suicide leads to involuntary euthanasia. On the theoretical level, the distinction between voluntary and involuntary euthanasia is clear, but on the practical level it becomes blurry. Both pre-Nazi (...) Germany and contemporary Holland offer ample evidence for the slippery slope that leads from voluntary to involuntary euthanasia. While advocates of assisted suicide regard the transition to the involuntary as an "abuse," that transition is, however, necessarily implied, and hence justified by assisted suicide. For the putative "right" to kill oneself implies that one has rights of disposal over one's life. But what is in principle disposable may be disposed of by others. Any argument for voluntary euthanasia implies the justification of involuntary eutharuisia. Therefore, physician-assisted suicide nullifies the right to life and with it the democratic charter. (shrink)

Rights are not redundant elements of a plausible utilitarian theory and the right to life is an inseparable companion of the rights to nourishment and to medical care. The deeper reason for this thesis is the interdependence of values concerning vitality. In this perspective it is inconsistent to say that the (normal) newborn is unable to have a right to life, but has a right to be fed. The hidden premise of Singer’s rebuttal of involuntary euthanasia is a (...) theory of rights as vetoes against imposed benefits. Without openly subscribing to such a theory there is no answer to ‘logical slippery slope’ arguments and no protection against dangerous ‘quality of life’ considerations as a basis of decisions over life and death. (shrink)

Background The justification for Nazi programs involving involuntary euthanasia, forced sterilisation, eugenics and human experimentation were strongly influenced by views about human dignity. The historical development of these views should be examined today because discussions of human worth and value are integral to medical ethics and bioethics. We should learn lessons from how human dignity came to be so distorted to avoid repetition of similar distortions. Discussion Social Darwinism was foremost amongst the philosophies impacting views of human dignity (...) in the decades leading up to Nazi power in Germany. Charles Darwin's evolutionary theory was quickly applied to human beings and social structure. The term 'survival of the fittest' was coined and seen to be applicable to humans. Belief in the inherent dignity of all humans was rejected by social Darwinists. Influential authors of the day proclaimed that an individual's worth and value were to be determined functionally and materialistically. The popularity of such views ideologically prepared German doctors and nurses to accept Nazi social policies promoting survival of only the fittest humans. A historical survey reveals five general presuppositions that strongly impacted medical ethics in the Nazi era. These same five beliefs are being promoted in different ways in contemporary bioethical discourse. Ethical controversies surrounding human embryos revolve around determinations of their moral status. Economic pressures force individuals and societies to examine whether some people's lives are no longer worth living. Human dignity is again being seen as a relative trait found in certain humans, not something inherent. These views strongly impact what is taken to be acceptable within medical ethics. Summary Five beliefs central to social Darwinism will be examined in light of their influence on current discussions in medical ethics and bioethics. Acceptance of these during the Nazi era proved destructive to many humans. Their widespread acceptance today would similarly lead to much human death and suffering. A different ethic in needed which views human dignity as inherent to all human individuals. (shrink)

This chapter contains sections titled: Introduction Definition of Disability Causes of Intellectual Impairment Evolving Terminology for Intellectual Impairment The Bell Curve and IQ: Levels of Intellectual Disability Cognitive Developmental Thresholds Intellectual Disability and the Brain: Fluid and Crystallized Intelligence Neuroplasticity in Brain Development Developmental Perspective on Intellectual Disability: Cognitive Developmental Thresholds Moral Development Implications of Recognizing Personhood and Autonomy Participation in Research Summary References.

Daniel Callahan has argued that economic and social benefits would result from a policy of withholding medical treatments which prolong life in persons over a certain age. He claims 'the real goal of medicine' is to conquer death and prolong life with the use of technology, regardless of the age and quality of life of the patient, and this has been responsible for the escalation of health care expenditure. Callahan's proposal is based on economic rationalism but there is little evidence (...) to suggest that substantial economic savings could be achieved. Moreover, his argument raises serious moral objections. A policy of withholding treatments from members of a social group involves elements of compulsion and discrimination, both of which would intrude on the doctor-patient relationship, undermine the autonomy of elderly patients, and invoke the slippery slope towards involuntary forms of euthanasia. Life-death decisions should be based on more than the one criterion of age, and take account of more relevant factors such as the patient's usual state of well-being, her/his expressed wishes, informed consent and the type of illness. Any move to the implementation and enforcement of the policy Callahan recommends would be rejected by health professionals and the public. (shrink)

Some people in Japan are still comfortable with the paternalistic role of doctors, but others wish that their own decisions would receive a greater amount of respect. A total of 747 students of universities and colleges and 114 parents of these students participated in a questionnaire survey. Most of the participants thought that autonomy should be respected in situations involving death with dignity and euthanasia, whereas it should not be respected in attempted suicide and involuntary admission of individuals (...) with mental illness. A cluster analysis revealed that the participants could be divided into the following groups: aid in dying advocates, complete libertarians, protectors of the mentally ill, complete paternalists, and questionables. The assertion of independence score of the Scale for Independent and Interdependent Construal of the Self showed a significant difference among the 5 clusters. These findings suggest that the traditional paternalistic relationship between doctor and patient is undergoing a gradual transformation in Japan. (shrink)

Under what conditions is it morally permissible to commit suicide, to assist in someone’s suicide, or to kill another person with his/her consent? Under what conditions is it morally permissible to use force to prevent such acts? I shall defend a libertarian answer to these questions. On this view, autonomous agents initially fully own themselves in the same sense that one can fully own an inanimate object such as a car. Just as full owners of cars are morally permitted, under (...) a broad range of conditions, to destroy their cars or have someone else do so, autonomous agents who fully own themselves are permitted, under a broad range of conditions, to terminate their lives or to have someone else do so. Furthermore, under these conditions, other agents are not permitted to use force to prevent a full self-owner’s consensual death. I shall focus on consensual killing (i.e., with the killed person’s consent) of autonomous agents. This includes suicide, assisting with suicide, voluntary euthanasia, and even cases where a non-sick person requests that another kill her. I shall not address cases of killing that are involuntary (against the will of the person killed) or non-voluntary (where the being killed is not autonomous; e.g., killing animals, children, and incapacitated adults). These are important issues, but they cannot be addressed here. (shrink)

This textbook in Medical Ethics covers most of the standard issues. Each chapter begins with detailed comments by the editors, followed by the best available articles on each topic covered.

Involuntary autobiographical memories (IAMs) and déjà vu are phenomena that occur spontaneously in daily life. IAMs are recollections of the personal past, whereas déjà vu is defined as an experience in which the person feels familiarity at the same time as knowing that the familiarity is false. We present and discuss the idea that both IAMs and déjà vu can be explained as natural phenomena resulting from memory processing and, importantly, are both based on the same memory retrieval processes. (...) Briefly, we hypothesise that both can be described as “involuntary” or spontaneous cognitions, where IAMs deliver content and déjà vu delivers only the feeling of retrieval. We map out the similarities and differences between the two, making a theoretical and neuroscientific account for their integration into models of memory retrieval and how the autobiographical memory literature can explain these quirks of daily life and unusual but meaningful phenomena. We explain the emergence of the déjà vu phenomenon by relating it to well-known mechanisms of autobiographical memory retrieval, concluding that IAMs and déjà vu lie on a continuum. (shrink)

High-level cognitions can enter consciousness through the activation of certain action sets and the presentation of external stimuli (“set-based entry,” for short). Set-based entry arises in a manner that is involuntary and systematic. In the Reflexive Imagery Task, for example, subjects are presented with visual objects and instructed to not think of the names of the objects. Involuntary subvocalizations arise on roughly 80% of the trials. We examined whether or not set-based entry can also occur in the case (...) of involuntary counting. Subjects in Experiment 1A were instructed to not count the number of objects presented in an array. Involuntary counting arose on a high proportion of the trials (a mean proportion of ∼0.90) for stimulus arrays having 2–5 objects, and such counting arose less frequently across trials when the array consisted of 6–10 objects (a mean proportion of ∼0.21). The data from Experiment 1B revealed that, when people choose to perform Set X, they also experience thoughts about an unselected Set (Set Y ). Subjects were trained on one set (e.g., to “color name”) and then, when presented with stimuli, were given the choice to perform the trained set or a novel set. Consistent with theories proposing that the conscious contents represent several potential action plans, subjects were equally likely to experience set-related imagery or set-unrelated imagery. Our findings regarding set-based entry are relevant to many subfields of psychology and neuroscience (e.g., the study of high-level mental processes, attention, imagery, and action control). (shrink)

Involuntary commitment links the healthcare, public health, and legislative systems to act as a “carceral health-service.” While masquerading as more humane and medicalized, such coercive modalities nevertheless further reinforce the systems, structures, practices, and policies of structural oppression and white supremacy. We argue that due to involuntary commitment’s inextricable connection to the carceral system, and a longer history of violent social control, this legal framework cannot and must not be held out as a viable alternative to the criminal (...) legal system responses to behavioral and mental health challenges. Instead, this article proposes true alternatives to incarceration that are centered on liberation that seeks to shrink the carceral system’s grasp on individuals’ and communities’ lives. In this, we draw inspiration from street-level praxis and action theory emanating from grassroots organizations and community organizers across the country under a Public Health Abolition framework. (shrink)

Assessing what counts as infertility has practical implications: access to (state-funded) fertility treatment is usually premised on meeting the criteria that constitute the chosen definition of infertility. In this paper, I argue that we should adopt the expression “involuntary childlessness” to discuss the normative dimensions of people’s inability to conceive. Once this conceptualization is adopted, it becomes clear that there exists a mismatch between those who experience involuntary childlessness and those that are currently able to access fertility treatment. (...) My concern in this article is explaining why such a mismatch deserves attention and what reasons can be advanced to justify addressing it. My case rests on a three-part argument: that there are good reasons to address the suffering associated with involuntary childlessness; that people would decide to insure against it; and that involuntary childlessness is characterized by a prima facie exceptional kind of desire. (shrink)

Mental time travel is the ability to mentally project oneself into one’s personal past or future, in terms of memories of past events or projections of possible future events. We investigated the frequency and valence of involuntary MTT in the context of high trait worry. High and low worriers recorded the frequency and valence of involuntary memories and future projections using a structured notebook and completed measures probing individual differences related to negative affectivity. Involuntary future projections were (...) as frequent as involuntary memories. We found a positivity bias for both past and future MTT, in that fewer negative events were reported than positive or neutral ones. This positivity bias was greater for future than for past events. Individual differences related to negative affectivity were positively associated with the proportion of negative events, indicating a reduced positivity bias in individuals with a general tendency to experience negative affect. (shrink)

Involuntary autobiographical memories are typically discussed in the context of negative memories such as trauma ‘flashbacks’. However, IAMs occur frequently in everyday life and are predominantly positive. In spite of this, surprisingly little is known about how such positive IAMs arise. The trauma film paradigm is often used to generate negative IAMs. Recently an equivalent positive film was developed inducing positive IAMs . The current study is the first to investigate which variables would best predict the frequency of positive (...) IAMs. Higher levels of positive mood change to the film were significantly associated with the number of positive IAMs recorded in the subsequent week. Results demonstrate the importance of positive emotional reaction at the time of an event for subsequent positive IAMs. (shrink)

Aphantasia is a condition that is often characterized as the impaired ability to create voluntary mental images. Aphantasia is assumed to selectively affect voluntary imagery mainly because even though aphantasics report being unable to visualize something at will, many report having visual dreams. We argue that this common characterization of aphantasia is incorrect. Studies on aphantasia are often not clear about whether they are assessing voluntary or involuntary imagery, but some studies show that several forms of involuntary imagery (...) are also affected in aphantasia (including imagery in dreams). We also raise problems for two attempts to show that involuntary images are preserved in aphantasia. In addition, we report the results of a study about afterimages in aphantasia, which suggest that these tend to be less intense in aphantasics than in controls. Involuntary imagery is often treated as a unitary kind that is either present or absent in aphantasia. We suggest that this approach is mistaken and that we should look at different types of involuntary imagery case by case. Doing so reveals no evidence of preserved involuntary imagery in aphantasia. We suggest that a broader characterization of aphantasia, as a deficit in forming mental imagery, whether voluntary or not, is more appropriate. Characterizing aphantasia as a volitional deficit is likely to lead researchers to give incorrect explanations for aphantasia, and to look for the wrong mechanisms underlying it. (shrink)

Richard Swinburne argues that belief is a necessary but not sufficient condition for faith, and he also argues that, while faith is voluntary, belief is involuntary. This essay is concerned with the tension arising from the involuntary aspect of faith, the Christian doctrine that human beings have an obligation to exercise faith, and the moral claim that people are only responsible for actions where they have the ability to do otherwise. Put more concisely, the problem concerns the coherence (...) of the following claims: (1) one cannot have faith, (2) one has an obligation to have faith, and (3) ought implies can. To solve this dilemma, I offer three solutions that I believe have the philosophical resources to demonstrate the consistency of these claims. Thus, I defend the claim that it is logically possible for a person to be culpable for an involuntary failure to have faith in God. (shrink)

Mental time travel is the ability to mentally project oneself backward in time to relive past experiences and forward in time to pre-live possible future experiences. Previous work has focused on MTT in its voluntary form. Here, we introduce the notion of involuntary MTT. We examined involuntary versus voluntary and past versus future MTT in a diary study. We found that involuntary future event representations—defined as representations of possible personal future events that come to mind with no (...) preceding search attempts—were as common as involuntary autobiographical memories and similar to them regarding cuing and subjective qualities. Future MTT involved more positive and idyllic representations than past MTT. MTT into the distant future/past involved more representations of cultural life script events than MTT into the immediate past/future. The findings are discussed in relation to cultural learning and MTT considered as a higher mental process. (shrink)

The main objective of this paper was to examine the involuntary nature of music-evoked autobiographical memories. For this purpose, young adults, older adults, and patients with a clinical diagnosis of probable Alzheimer’s disease were asked to remember autobiographical events in two conditions: after being exposed to their own chosen music, and in silence. Compared to memories evoked in silence, memories evoked in the “Music” condition were found to be more specific, accompanied by more emotional content and impact on mood, (...) and retrieved faster. In addition, these memories engaged less executive processes. Thus, with all these characteristics and the fact that they are activated by a perceptual cue , music-evoked autobiographic memories have all the features to be considered as involuntary memories. Our paper reveals several characteristics of music-evoked autobiographical memories in AD patients and offers a theoretical background for this phenomenon. (shrink)

Involuntary memory was identified by the pioneering memory researcher Hermann Ebbinghaus more than a century ago, but it was not until very recently that cognitive psychologists began to study this memory phenomenon. This book is the first to examine key topics and cutting-edge research in involuntary memory. Discusses topics such as involuntary memories in everyday life, across the life-span, and in the laboratory; the special ways in which involuntary memories sometimes manifest themselves and a number of (...) theoretical treatments of the topic. Presents innovative research that not only represents the starting point of the study of involuntary memory, but also places it in such broader topics as autobiographical memory, consciousness and memory, aging and memory, implicit and explicit memory, depression, and psychosis. (shrink)

Clinical cases of frontal lobe lesions have been significantly associated with acquired aggressive behaviour. Restoring neuronal and cognitive faculties of aggressive individuals through invasive brain intervention raises ethical questions in general. However, more questions have to be addressed in cases where individuals refuse surgical treatment. The ethical desirability and permissibility of using intrusive surgical brain interventions for involuntary or voluntary treatment of acquired aggressiveness is highly questionable. This article engages with the description of acquired aggressiveness in general, and presents (...) a rare clinical case to illustrate the difficulties of treating this population. To expand the debate further, this article explores the ethics related to invasive brain surgery in three parts: a) it examines coercive involuntary invasive brain surgery for the benefit of protecting others on individuals suffering from acquired aggressiveness who lack decision-making capacities to consent; b) it addresses voluntary psychosurgery on individuals suffering from acquired aggressiveness who are competent to consent; and, c) it questions whether acquired aggressive individuals, who are legally competent, have a duty to consent to invasive brain surgery, in order to maintain their autonomy by reducing or even eliminate their aggressive drives. Ensuring the safety and efficacy of surgical brain interventions could increase the ethical permissibility of voluntary treatment, but it would not necessarily entail ethical justification for proceeding with invasive brain surgery for treatment of intractable acquired aggressive behaviour. (shrink)

Although involuntary autobiographical memories (IAMs) and déjà vu have important shared characteristics, in this commentary, we focus on potential differences that may question the argument that two phenomena lie on a continuum. We propose that differences in their frequency and autonoetic consciousness could be explained by different types of cues and memory representations involved in experiencing IAMs and déjà vu.

Justifying involuntary psychiatric treatment on the basis of a judgment that a person lacks capacity is usually expressed in terms of a person’s ability to make a decision about his or her health and treatment. Typically, this relates to the ability to refuse treatment. Exactly what “capacity” means, however, and how one determines when another individual lacks capacity, or lacks sufficient capacity, in this context is particularly controversial, with the United Nations Committee on the Rights of Persons with Disabilities (...) insisting that involuntary treatment be abandoned altogether and capacity tests avoided.Capacity is a concept that has multiple meanings and applications across different disciplines and... (shrink)

BackgroundInvoluntary treatment is a key issue in healthcare ethics. In this study, ethical issues relating to involuntary psychiatric treatment are investigated through interviews with Swedish psychiatrists.MethodsIn-depth interviews were conducted with eight Swedish psychiatrists, focusing on their experiences of and views on compulsory treatment. In relation to this, issues about patient autonomy were also discussed. The interviews were analysed using a descriptive qualitative approach.ResultsThe answers focus on two main aspects of compulsory treatment. Firstly, deliberations about when and why it was (...) justifiable to make a decision on involuntary treatment in a specific case. Here the cons and pros of ordering compulsory treatment were discussed, with particular emphasis on the consequences of providing treatment vs. refraining from ordering treatment. Secondly, a number of issues relating to background factors affecting decisions for or against involuntary treatment were also discussed. These included issues about the Swedish Mental Care Act, healthcare organisation and the care environment.ConclusionsInvoluntary treatment was generally seen as an unwanted exception to standard care. The respondents’ judgments about involuntary treatment were typically in line with Swedish law on the subject. However, it was also argued that the law leaves room for individual judgments when making decisions about involuntary treatment. Much of the reasoning focused on the consequences of ordering involuntary treatment, where risk of harm to the therapeutic alliance was weighed against the assumed good consequences of ensuring that patients received needed treatment. Cases concerning suicidal patients and psychotic patients who did not realise their need for care were typically held as paradigmatic examples of justified involuntary care. However, there was an ambivalence regarding the issue of suicide as it was also argued that risk of suicide in itself might not be sufficient for justified involuntary care. It was moreover argued that organisational factors sometimes led to decisions about compulsory treatment that could have been avoided, given a more patient-oriented healthcare organisation. (shrink)

The involuntary admission or treatment of a mentally ill individual is highly controversial, as it may be argued that such intervention infringes on individual autonomy and the right to choose a particular treatment. However, this argument must be balanced with the need to provide immediate healthcare services to a vulnerable person who cannot or will not make a choice in his or her own best interests at a particular time. A study carried out in Gauteng Province, South Africa, highlighted (...) the fact that the annual rate of involuntary admissions increased by almost double from 2007 to 2008. This could indicate that healthcare providers are not treating patients without their consent only when this is absolutely necessary. Alternatively, it could indicate that healthcare professionals are more aware of the provisions of the Mental Health Care Act and relevant national policy guidelines. Or it could suggest that more patients are presenting with mental illnesses or disorders that require their involuntary admission. It remains for strategies to be developed that change negative perceptions and inequities for individuals with mental illness. Above all, the strategies should be underpinned by inalienable respect for mentally ill individuals – a concept that was blatantly disregarded in the Life Esidimeni case. In this article, we highlight the functions of mental health review boards and their accountability where involuntary admissions are concerned, while emphasising the protections for mentally ill persons as a vulnerable population group, as set out in the SA Constitution. (shrink)

Background: Dementia care at home often involves decisions in which the caregiver must weigh safety concerns with respect for autonomy. These dilemmas can lead to situations where caregivers provide care against the will of persons living with dementia, referred to as involuntary treatment. To prevent this, insight is needed into how family caregivers of persons living with dementia deal with care situations that can lead to involuntary treatment. Objective: To identify and describe family caregivers’ experiences regarding care decisions (...) for situations that can lead to involuntary treatment use in persons living with dementia at home. Research design: A qualitative descriptive interview design. Data were analysed using the Qualitative Analysis Guide of Leuven. Participants and research context: A total of 10 family caregivers providing care for 13 persons living with dementia participated in in-depth semi-structured interviews. Participants were recruited by registered nurses via purposive sampling. Ethical consideration: The study protocol was approved by the Ethics Committee of the University Hospitals Leuven and the Medical Ethical Test Committee Zuyderland. Findings: Family caregivers experience the decision-making process concerning care dilemmas that can lead to involuntary treatment as complicated, stressful and exhausting. Although they consider safety and autonomy as important values, they struggle with finding the right balance between them. Due to the progressive and unpredictable nature of dementia, they are constantly seeking solutions while they adapt to new situations. Family caregivers feel responsible and experience social pressure for the safety of persons living with dementia. They may be blamed if something adverse happens to the persons living with dementia, which increases an already stressful situation. Their experience is influenced by characteristics of the care triad (persons living with dementia, professional and family caregivers) such as practical and emotional support, knowledge, and previous experiences. Discussion and conclusion: To prevent involuntary treatment, professionals need to proactively inform family caregivers, and they need to support each other in dealing with complex care situations. (shrink)

Workers with involuntary clients influence the behaviour of their clients. One of the methods by which workers influence their clients relates to the way they model, encourage or reinforce their comments and behaviours. Practitioners may be aware or unaware of this process and of the extent to which it can impact on clients. This paper describes the process of modelling and reinforcement and discusses some of the ethical issues it raises. It suggests some guidelines by which the process may (...) be undertaken in an ethical manner and recommends the use of the ethics of care and concept of human dignity as additional theoretical resources to assist in working with this client group. (shrink)

The target article claims that involuntary autobiographical memories and déjà vu are based on the same retrieval processes, although they result in different phenomenological states. Here we argue that the differential engagement of attention at various stages of memory may be one of the determinants of when common retrieval processes give rise to such different experiences.