Our research explores the application of Large Language Models for enhancing legal advice through AI-driven conversational agents, focusing on the analysis and interpretation of user-generated content from a prominent online legal community. By leveraging BERTopic for topic modeling and GPT-3.5 for labeling of user intents, we constructed a dataset that served as the foundation for fine-tuning the Mistral 7B language model. This process involved Supervised Fine Tuning and Direct Preference Optimization, culminating in the creation of a Domain Specific (...) Language Model for legal expertise. This model was then employed to guide GPT-3.5 responses, ensuring domain-specific relevance and contextual appropriateness. The evaluation of these responses was conducted using GPT-4, supplemented by human assessment, to gauge the quality of the models' outputs. We leverage an innovative end-to-end pipeline, building upon the framework proposed by Wang et al. (Empower large language model to perform better on industrial domain-specific question answering, 2023. arXiv:2305.11541), specifically adapted for the legal domain. This pipeline provides a foundational framework for developing sophisticated and scalable user-facing chatbots, presenting an alternative to the more common retrieval augmented generation techniques. Our contributions include providing datasets for further research on Legal Question Answering systems and advancements in human alignment of responses from chatbots. This research advances the technical frontier in AI-driven legal assistance and opens new avenues for enhancing the accessibility and quality of legal support through conversational AI technologies. (shrink)

In this Second Edition of her best-selling ethics paperback text, renowned paralegal educator Therese Cannon clearly addresses pertinent case law, rules changes, and other developments involving this important area of the law. Organized in 10 concise chapters, Ethics and Professional Responsibility for Legal Assistants, Second Edition, covers key concepts, including unauthorized practice of law; confidentiality; conflicts of interest; fees; trends in legal malpractice; discovery abuse and other advocacy issues; pro bono work; and more. to help your students (...) grasp the material, the pedagogy features: chapter reviews discussion questions cases for further analysis helpful appendices, including the Model Guidelines, standards, and codes for ABA, NALA, and NFPA. Ideal for use in your next ethics class, this flexible paperback can also easily be used to add an ethics component to your Introduction to Law course, student internship program, or other courses in your curriculum. This superb book is also accompanied by a valuable Instructor's Guide, which provides answers to every discussion question in the text and the specific page numbers to find answers to all review questions. It also contains sample syllabi and references to additional source materials to help you adapt this book to your course. (shrink)

The U.S. military is developing augmented reality (AR) capabilities for use on the battlefield as a means of achieving greater situational awareness. The superimposition of digital data—designed to expand surveillance, enhance geospatial understanding, and facilitate target identification—onto a live view of the battlefield has important implications for virtuous conduct in war: Can the soldier exercise practical wisdom while integrated into a system of militarized legibility? Adopting a virtue ethics perspective, I argue that AR disrupts the soldier’s immersion in the scene (...) such that he is blinded to features beyond those identified in advance by the military’s system of cybernetic judgment. I turn to Michael Walzer’s classic account of the “naked soldier” dilemma to illustrate how AR capabilities radically shrink the bounds within which the soldier can cultivate the capacity for right conduct. By transforming the ambiguous ethical matter of killing an enemy combatant into the straightforward application of a rule, AR hollows out the soldier’s potential for virtuous action. The “smart battlefield” leaves no space for deliberative judgments that transcend the technical and legal determinations already written into the soldier’s view of the scene. (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)

The rapid advancement of artificial (computer) intelligence systems (CIS) has generated a means whereby assistive bionic prosthetics can become both more effective and practical for the patients who rely upon the use of such machines in their daily lives. However, de lege lata remains relatively unspoken as to the legal status of patients whose devices contain self-learning CIS that can interface directly with the peripheral nervous system. As a means to reconcile for this lack of legal foresight, this (...) article approaches the topic of CIS-nervous system interaction and the impacts it may have on the legal definition of “persons” under the law. While other literature of this nature centres upon notions of transhumanism or self-enhancement, the approach herein approached is designed to focus solely upon the legal nature of independent CIS actions when operating alongside human subjects. To this end, it is hoped that further discussion on the topic can be garnered outside of transhumanist discourse to expedite legal consideration for how these emerging relationships ought to be received by law-generating bodies internationally. (shrink)

Background: Debates over legalisation of physician-assisted suicide or euthanasia often warn of a “slippery slope”, predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period.Methods: The data from Oregon comprised all annual and cumulative Department of Human Services reports 1998–2006 and three independent studies; the data from the Netherlands comprised all (...) four government-commissioned nationwide studies of end-of-life decision making and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought.Results: Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured , people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups.Conclusions: Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges. (shrink)

Medical assistance in dying has received considerable attention from many in the field of bioethics. Philosophers, theologians, lawyers, and clinicians of all sorts have engaged with many challenging aspects of this issue. Public debate, public policy, and the law have been enhanced by the varied disciplinary analyses. With the legalization of MAiD in Canada, some attention is now being turned to issues that have historically been overshadowed by the debate about whether to permit MAiD. One such issue is voluntary stopping (...) eating and drinking as an alternative to MAiD. In this paper, I will apply a legal lens to the issue. An understanding of whether VSED is legal provides a foundation for ethical reflection on whether it ought to be permitted. Is it permitted for those who prefer VSED to MAiD? Is it permitted for those who do not qualify for MAiD under our current legislation – for those who do not have a grievous and irremediable medical condition, for mature minors, for individuals whose sole underlying medical condition is a mental disorder and who do not otherwise meet the eligibility criteria, and for individuals who have lost capacity but had completed an advance directive? (shrink)

In the United States, judicialrulings that unrealistically addressed the complexityof cases and demonstrated limited understanding ofprinciples, helped to create a legal quagmire whichlegislatures had to confront. Moreover, thelegislative response was often slow and inadequate interms of both the scope and clarity of the laws. However, since the 1970s, progress has been made onmany fronts, particularly in regard to advancedirectives dealing with end-of-life decisions. Thedebate over physician-assisted suicide has spawned arepetition of moral and legal arguments. Thoseagainst legalization have failed (...) to make a realisticappraisal of the dilemmas facing patients and theirfamilies in an age of technological medicine deliveredin the context of the marketplace. The underlyingproblem is a system in dire need of reform that willno longer treat health care as a commodity of themarketplace and provide universal health care. Terminal care as an integral part of health care willsubstantially benefit from such reforms because amajor obstacle to comprehensive palliative care is thecondition of the present system. (shrink)

L’assistance médicale à mourir (AMM) a reçu beaucoup d’attention de la part de nombreux acteurs dans le domaine de la bioéthique. Des philosophes, des théologiens, des avocats et des cliniciens de toutes sortes ont abordé de nombreux aspects difficiles de cette question. Le débat public, la politique publique et la loi ont été renforcés par des analyses disciplinaires variées. Avec la légalisation du AMM au Canada, on s’intéresse maintenant à des questions qui ont toujours été éclipsées par le débat sur (...) l’autorisation de l’AMM. Un de ces problèmes est l’arrêt volontaire de manger et boire (AVMB) comme une alternative à l’AMM. Dans cet article, je vais appliquer une perspective légale à la question. Une compréhension des aspects légaux de l’AVMB permet d'établir les fondements d'une réflexion éthique au sujet de son autorisation. Est-il permis pour ceux qui préfèrent l’AVMB à l’AMM? Est-il permis pour ceux qui ne sont pas admissibles à l’AMM en vertu de notre législation actuelle – pour ceux qui n’ont pas de maladie grave et irrémédiable, pour les mineurs matures, pour les personnes dont la seule condition médicale sous-jacente est un trouble mental et qui ne rencontrent pas les critères d’admissibilité, et pour les personnes ayant perdu leur capacité, mais ayant rempli une directive préalable? (shrink)

Last November, soon after Colorado became the latest state to authorize physician-assisted suicide, National Public Radio's The Diane Rehm Show devoted a segment to legalization of “physician assistance in dying,” a label that refers to both physician-assisted suicide and voluntary active euthanasia. Although the segment initially focused on PAD in the context of terminal illness in general, it wasn't long before PAD's potential application to dementia patients came up. A caller said that her mother had Alzheimer's disease and was being (...) cared for at great expense. Suspecting that she will suffer the same fate, the caller reported that she had included in her will “my specific request that if I should be diagnosed, and it is legal to do so, I would like to opt out of a life and many years of suffering.” A few countries, such as the Netherlands and Belgium, already allow PAD for dementia in certain circumstances. It wouldn't be surprising to see a U.S. legalization effort in the coming years. (shrink)

Law 49/2018, of August 14, created the Portuguese legal regime of the assisted decision-making (capacity), thus eliminating the legal institutes of interdiction and disqualification, provided for in the Civil Code (CC). The aim of this legal regime was to embed a new vision of disability based on a model of rights, that grants people with disabilities an independent and autonomous life and reflects the acceptance of the International Convention on the Rights of Persons with Disabilities (CRPD) guidelines. (...) This paper intends to discuss the ‘new’ Portuguese legal system regarding the legal capacity of persons with disabilities and its role in valuing the expression of the real will of people with disabilities. (shrink)

Bioethics, Volume 36, Issue 4, Page 381-387, May 2022.

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)

In June 2015, the Supreme Court of Canada struck down the Criminal Code's prohibition on assisted death. Just over a year later, the federal government crafted legislation to entrench medical assistance in dying (MAiD), the term used in Canada in place of physician‐assisted death. Notably, Canada became the first country to allow nurse practitioners to act as assessors and providers, a result of a strong lobby by the Canadian Nurses Association. However, a legislated approach to assisted death has proven challenging (...) in a number of areas. Although it facilitates a degree of accountability, precision and accessibility, it has also resulted in particular challenges negotiating the diverse perspectives of such a morally contentious act. One of these challenges is the tendency to conflate what is legal and what is moral in a modern liberal constitutionalism that places supreme value on autonomy and choice. Such a conflation tends to render invisible the legal and moral/ethical considerations necessary for nurses and nurse practitioners to remain ethical actors. In this paper, we introduce this conflation and then discuss the process of lawmaking in Canada, including the legalization of MAiD and the contributions of nursing to that legalization. We then engage in a hypothetical dialogue about the legal and moral/ethical implications of MAiD for nursing in Canada. We conclude with an appeal for morally sustainable workspaces that, when implementing MAiD, appropriately balance patient choices and nurses’ moral well‐being. (shrink)

Assisting suicide is legal in Switzerland if it is offered without selfish motive to a person with decision-making capacity. Although the ‘Swiss model’ for suicide assistance has been extensively described in the literature, the formally and informally protected liberties and claims of assistors and recipients of suicide assistance in Switzerland are incompletely captured in the literature. In this article, we describe the package of rights involved in the ‘Swiss model’ using the framework of Hohfeldian rights as modified by Wenar. (...) After outlining this framework, we dissect the rights involved in suicide assistance in Switzerland, and compare it with the situation in England and Germany. Based on this approach, we conclude that in Switzerland, claim rights exist for those requesting suicide assistance, and for those who are considering providing such assistance, even though no entitlements exist toward suicide assistance. We then describe the implementation of the ‘Swiss model’ and difficulties arising within it. Clarifying these issues is important to understand the Swiss situation, to evaluate what features of it may or may not be worth correcting or emulating, and to understand how it can impact requests for suicide assistance in other countries due to ‘suicide tourism’. It is also important to understand exactly what sets Switzerland apart from other countries with different legislations regarding suicide assistance. (shrink)

Embryo litigation -- Access to ART treatment : insurance and discrimination -- General professional liability litigation -- Paternity and donor insemination -- Maternity and egg donation -- Traditional and gestational surrogacy arrangements -- Posthumous reproduction : access and parentage -- Same-sex parentage and ART -- Genetics (PGD) and ART -- ART-related embryonic stem cell legal developments -- ART-related adoption litigation -- ART-related fetal litigation and abortion-related litigation.

Background: After over 4 years since medical assistance in dying legalization in Canada, there is still much uncertainty about how this ruling has affected Canadian society. Objective: To describe the positive aspects of medical assistance in dying legalization from the perspectives of hospice palliative care providers engaging in medical assistance in dying. Design: In this qualitative descriptive study, we conducted an inductive thematic analysis of semi-structured interviews with hospice palliative care providers. Participants and setting: Multi-disciplinary hospice palliative care providers in (...) acute, community, residential, and hospice care in Vancouver and Toronto, Canada, who have engaged in end-of-life care planning with patients who have inquired about and/or requested medical assistance in dying. Ethical considerations: The research proposal was approved by University of British Columbia Research Ethics Board in Vancouver and University Health Network in Toronto. Participants were informed regarding the research goals, signed a written consent, and were assigned pseudonyms. Results: The 48 participants included hospice palliative care physicians (n = 22), nurses (n = 15), social workers (n = 7), and allied health providers (n = 4). The average interview length was 50 min. Positive aspects of medical assistance in dying legalization were identified at (1) the individual level: (a) a new end-of-life option, (b) patients’ last chance to express control over their lives, (c) patient and family comfort and relief, and (d) a unique learning experience for hospice palliative care providers; (2) the team level: (a) supportive collegial relationships, (b) broadened discussions about end-of-life and palliative care, and (c) team debriefs provide opportunities for education and support; and (3) the institutional level: (a) improved processes to facilitate the implementation logistics. Conclusion: While being involved in the medical assistance in dying process is complex and challenging, this study sheds light on the positive aspects of medical assistance in dying legalization from the hospice palliative care provider’s perspectives. Medical Assistance in Dying legalization has resulted in improved end-of-life conversations between hospice palliative care providers, patients, and their families. Improved communication leads to a better understanding of patients’ end-of-life care plans and bridges some of the existing gaps between hospice palliative care and medical assistance in dying. (shrink)

When an individual facing intractable pain is given an estimate of a few months to live, does hastening death become a viable and legitimate alternative for willing patients? Has the time come for physicians to do away with the traditional notion of healthcare as maintaining or improving physical and mental health, and instead accept their own limitations by facilitating death when requested? The Universities of Oxford and Cambridge held the 2013 Varsity Medical Debate on the motion “This House Would Legalise (...) Assisted Dying”. This article summarises the key arguments developed over the course of the debate. We will explore how assisted dying can affect both the patient and doctor; the nature of consent and limits of autonomy; the effects on society; the viability of a proposed model; and, perhaps most importantly, the potential need for the practice within our current medico-legal framework. (shrink)

Medical assistance in dying (MAiD) in Canada is a complex, novel interprofessional practice governed by stringent legal criteria. Often, patients need assistance navigating the system, and MAiD providers/assessors struggle with the administrative challenges of MAiD. Resultantly, the role of the MAiD care coordinator has emerged across the country as a novel practice dedicated to supporting access to MAiD and ensuring compliance with regulatory requirements. However, variability in the roles and responsibilities of MAiD care coordinators across Canada has highlighted the (...) need for accountability and standardization for this practice. This manuscript constitutes a first attempt to describe this emerging role, through discussion of proposed standards of practice, as well as roles and responsibilities, and ethical duties of this emergent professional practice. We detail the core commitments of MAiD care coordinators to patients, providers/assessors and institutions involved in the MAiD process. We address the core competencies that inform the unique skillset required by MAiD care coordinators to facilitate high-quality care, while highlighting the moral and ethical considerations embedded in this work. To illustrate the complexity of the MAiD care coordinator role, case examples involving ethical dilemmas encountered in practice are included. Finally, a code of ethics is proposed to serve as a guide for appropriate professional practice and conduct. This manuscript is intended to illustrate the importance of transparency and accountability for this new role that provides service to vulnerable patients and families; this is especially critical as the ethical complexity of MAiD is likely to increase with future changes in legislation opening MAiD access to new populations. (shrink)

The international community has long been affected by the political, philosophical and ethical issues surrounding the practice of tyrannicide, defined as the targeted killing of a tyrant. However, there exists no specific international legal instrument that concerns the practice of tyrannicide, rendering the legitimacy of the practice ambiguous. This paper aims to investigate the issue of tyrannicide and offers a number of speculative arguments concerning its legal-philosophical status. It finds that there are essentially two arms of international (...) class='Hi'>legal jurisprudence that may regulate the practice of tyrannicide. The first is largely prohibitive and is based on the derived legal arguments against assassination involving the element ofperfidy, relevant extradition law, provisions in the Hague, Geneva and New York Conventions, and the prohibition on the use of force in the UN Charter. The second position, though far more radical and speculative, is more permissive regarding the moral legitimacy of tyrannicide. This position is based on arguments from the classical international theorists Gentili, Grotius and Vattel, contemporary human rights standards, the principle of humanitarian intervention, the duty to protect, and legal category of hostis hutnani generis. It is argued that though the vast majority of international legal principles are indicative ofthe illegality oftyrannicide, that the practice may nevertheless be philosophically legitimated under humanitarian principles. (shrink)

ABSTRACTIn this paper, I examine the arguments against physician assisted suicide . Many of these arguments are consequentialist. Consequentialist arguments rely on empirical claims about the future and thus their strength depends on how likely it is that the predictions will be realized. I discuss these predictions against the backdrop of Oregon's Death with Dignity Act and the practice of PAS in the Netherlands. I then turn to a specific consequentialist argument against PAS – Susan M. Wolf's feminist critique of (...) the practice. Finally, I examine the two most prominent deontological arguments against PAS. Ultimately, I conclude that no anti‐PAS argument has merit. Although I do not provide positive arguments for PAS, if none of the arguments against it are strong, we have no reason not to legalize it. (shrink)

In 2017, Victoria became the first state in Australia to pass legislation permitting voluntary assisted dying. Under this law, only those people who are near the end of their lives may access voluntary assisted dying, and because many of these people require nursing care to manage the progression of their illness or their symptoms, it will invariably have an impact on nursing practice. The Victorian law includes a series of procedural steps as safeguards to ensure that the law operates as (...) intended. To support people who choose voluntary assisted dying and to practice safely within boundaries of the law, nurses must be aware of these requirements and how they operate. However, there are often gaps in nurses’ legal knowledge. This was demonstrated in an article that aimed to inform nurses about the operation of Voluntary Assisted Dying Act 2017 (Vic) but contained several errors and misstatements of the law. Our article corrects these errors and discusses how the law is intended to be applied by revisiting the fictional case of Chloe – a woman with a terminal illness who is seeking voluntary assisted dying. As the Voluntary Assisted Dying Act 2017 (Vic) also protects nurses from liability if they act in accordance with its provisions, we conclude that sound knowledge and understanding of its operation support nurses to provide the safe, comprehensive and compassionate care their patients deserve at the end of life. (shrink)

This article explores at least two dominant critiques of assisted dying from a disability rights perspective. In spite of these critiques, I conclude that assisted dying ought to be permissible. I arrive at the conclusion that if we respect and value people with disabilities, we ought to permit assisted dying. I do so in the following manner. First, I examine recent changes in legislation that have occurred since the Royal Society of Canada Expert Panel on End-of-Life Decision-Making report, published in (...) this journal. I suggest that these changes are likely to only strengthen opposition to assisted dying from disability rights activists and people with disabilities. Second, I focus on respect for people with disabilities and in particular, respect for their autonomy and decision-making abilities. Third, I explore the opposition to assisted dying that focuses on risk and the vulnerability of people with disabilities. Here I suggest that this risk ought not to be of special concern. Ultimately, I conclude that upholding respect for the disabled requires the legalization of assisted dying, rather than the denial of access in a misguided effort to protect people with disabilities. (shrink)

This book provides a history of Nazi medical euthanasia programs, demonstrating that arguments in their favor were widely embraced by Western medicine before the Third Reich. Contributors find significant continuities between history and current physician-assisted suicide and euthanasia and urge caution about their legalization or implementation.

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.

Une personne compétente peut-elle refuser des soins afin de rendre son décès naturel raisonnablement prévisible pour être admissible à l’aide médicale à mourir (AMM)? Prenons l’exemple d’un patient compétent atteint d’une paralysie du côté gauche à la suite d’un accident vasculaire cérébral droit qui ne devrait pas mourir avant de nombreuses années ; normalement, la cause de son décès ne serait pas prévisible. Cependant, il refuse de se retourner régulièrement, de sorte que son médecin peut prédire que des plaies de (...) pression se développeront, entraînant une infection pour laquelle il refusera le traitement et mourra par conséquent. Est-il maintenant admissible à l’AMM? Prenons l’exemple d’un patient compétent atteint d’une sténose spinale (affection non mortelle) qui refuse de manger (mais pas de boire pour ne pas perdre sa capacité à cause de la déshydratation). Par conséquent, son médecin peut prédire la mort par famine. Est-elle maintenant admissible à l’AMM? Pour répondre à ces questions, nous devons répondre à trois sous-questions : 1) les patients compétents ont-ils le droit de refuser des soins ; 2) les prestataires de soins de santé ont-ils l’obligation de respecter ces refus ; et 3) les décès résultant de refus de soins sont-ils naturels aux fins de déterminer si un patient est admissible à l’AMM? Si un patient compétent a le droit de refuser certains soins particuliers et que les prestataires de soins de santé ont l’obligation de respecter ce refus, et si le décès qui résulterait du refus de ces soins est naturel, alors ce refus de soins est une voie légale vers le AMM. Toutefois, si le patient compétent n’a pas le droit de refuser certains soins particuliers, ou si les prestataires de soins de santé n’ont pas l’obligation de respecter ce refus, ou si le décès qui résulterait du refus de ces soins n’est pas naturel, alors ce refus de soins ne constitue pas une voie légale vers le AMM. Dans cet article, nous explorons ce terrain juridique complexe avec les implications éthiques les plus profondes : l’accès à l’AMM. (shrink)

No laws or official guidelines govern medical assistance for dying in Japan. However, over the past several years, cases of assisted suicide or voluntary euthanasia, rarely disclosed until recently, have occurred in close succession. Inspired by these events, ethical, legal, and social debates on a patient’s right to die have arisen in Japan, as it has in many other countries. Several surveys of Japanese people’s attitudes towards voluntary assisted dying suggest that a certain number of Japanese prefer active euthanasia. (...) Against this background, it is important to discuss voluntary assisted dying cases in Japan and the Japanese views on them and to consider their implications. We review three recent Japanese voluntary assisted dying cases and discuss the various objections to voluntary assisted dying that have been published in response to these in various media outlets. Our counterarguments include the double suffering of people who are unable to give up their desire to die, individuality of death, variability of culture, problem of being an annoyance to (burden on) others, a slippery slope argument supporting voluntary assisted dying, and unfair claims about responsibility and excessive burden on people who are unable to give up their desire to die. We also point out the psychocultural and social problems in Japanese society that these objections reflect, and argue that voluntary assisted dying can be ethically acceptable under certain conditions. We conclude that Japanese society must change in order to enable those who sincerely wish to die to do so in a better way. (shrink)

In ‘Assisted Gestative Technologies,’ Romanis argues for the conceptual creation of a new genus of assisted reproductive technologies, in recognition of the unique ethical, legal and social implications assistive gestative technologies raise.1 She argues this taxonomic classification might allow for ethicolegal determinations regarding one AGT to be generalised to other instances of this technology. Romanis correctly identifies a lack of appropriate regulations for dealing with the rapidly developing field of assisted and artificial gestation, noting the current discussion of surrogacy (...) law reform in the UK offers an opportunity to redress this. However, when reading this article what strikes me most is not how AGTs, ARTs or assisted conception are defined, but rather what constitutes a technology. Surrogacy is introduced as assisted gestation, but uterine transplantation as being on the spectrum of AGTs. While both might use assisted conception, for example, in vitro fertilisation, it is unclear what part of uterus donation or transplantation is to be considered technological? This is not to say such processes do not involve technologies—of course they do—but we do not typically describe surgery itself as an instance of technology. This distinction is relevant if the purpose of establishing this genus of AGTs is to group morally relevant characteristics of technologies together or create paradigm cases for casuistical reasoning. Considering the above …. (shrink)

abstract Many have held that there is some kind of incompatibility between a commitment to good end-of-life care and the legalization of physician-assisted suicide. This opposition to physician-assisted suicide encompasses a cluster of different claims. In this essay I try to clarify some of the most important of these claims and show that they do not stand up well to conceptual and empirical scrutiny.

Recently, Canada’s National Post described in detail the death by lethal injection of a 94-year-old man, living alone, who had multiple medical problems but was not terminally ill. His son helped find a physician willing to administer lethal medication soon after his father told him he “wasn’t planning on adding another digit” to his age. The physician who complied with the request is a leading advocate for assisted death in Canada, who reportedly has been responsible for more than 30 life-terminating (...) acts within the few months since the law was passed in June 2016. The son of the man who died by active euthanasia declared, “Dad got the death he wanted.” Should a legal option of... (shrink)

A large body of literature considers the ethico-legal and regulatory issues surrounding assisted conception. Surrogacy, however, within this body of literature is an odd-fit. It involves a unique demand of another person—a form of reproductive labour—that many other aspects of assisted conception, such as gamete donation do not involve. Surrogacy is a form of assisted gestation. The potential alternatives for individuals who want a genetically related child but who do not have the capacity to gestate are ever increasing: with (...) the advent of uterus transplantation, and the anticipated development of artificial placentas.In this paper, I highlight the pertinent conceptual differences between technologies assisting conception and those assisting gestation to demonstrate that distinct issues arise when assisted gestative technologies are used. I argue that there is utility in considering AGTs as a genus of technologies. These technologies perform the same function from the perspective of putative parents and might exist on a spectrum of alternatives when they become more available. Moreover, since many of the same or very similar ethical, social and legal issues are raised by surrogacy, UTx and ectogestation, analysis of these issues will be better contextualised by considering these technologies together. Many of the matters currently being highlighted for reform in the context of surrogacy will inevitably impact on how other forms of assisted gestation are governed. The conversation should be broadened; we should consider how far other emerging technologies might be accommodated in revised regulatory schemes. (shrink)

As more jurisdictions permit a medically assisted death (MAiD)—and none of the jurisdictions that introduced MAiD has seen any serious attempts at reversing it—the focus of debate has turned to the question of what is a morally defensible access threshold for MAiD. This permits us to rethink the moral reasons for the legalization or decriminalization of assisted dying. Unlike what is assumed in many legislative frameworks, unbearable suffering caused by terminal illness is not what oftentimes motivates decisionally capable people to (...) request MAiD. This matters when access thresholds are considered. The argument advanced in this essay is that because MAiD is less destructive to people’s relationships and less harmful than medically unsupervised suicide, access to medical assistance in dying should be open to anyone who is legally capacitated and who persistently requests such assistance. (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)

Patients in Quebec can legally obtain medical assistance in dying (MAID) if they are able to give informed consent, have a serious and incurable illness, are at the end of their lives and are in a situation of unbearable suffering. Since the Supreme Court of Canada’s 2015 Carter decision, access to MAID, under certain conditions, has become a constitutional right. Quebec physicians are now likely to receive requests for MAID from their patients. The Quebec and Canadian laws recognize a physician’s (...) right to conscientious objection, but this right is contested both in the medical ethics literature and in the public sphere. This paper presents the results of a qualitative study conducted with twenty Quebec physicians who did not integrate MAID into their medical practice, either because they were opposed to or deeply ambivalent about MAID. The interviews aimed to explore the reasons – religious and secular – for opposition to or ambivalence towards MAID. The secular reasons given by participants were grouped into four main categories: 1) the ends of medicine and professional identity, 2) the philosophy of palliative medicine and resource allocation in palliative care, 3) benevolent paternalism, the “good death”, and the interests of future selves, 4) the risk of a slippery slope and the protection of vulnerable people. (shrink)

Medical assistance in dying (MAiD) was legalized in Canada in 2016. Canadians’ opinions on the service are nuanced, particularly as the legislation changes over time. In this paper, we outline findings from our review of representations of MAiD in Canadian news media texts since its legalization. These stories reflect the concerns, priorities, and experiences of key stakeholders and function pedagogically, shaping public opinion about MAiD. We discuss this review of Canadian news media on MAiD, provide examples of four key themes (...) we identified (vulnerability, autonomy, dignity, and human rights), and discuss their implications for health policy and equity. Though key stakeholders share the values of autonomy, dignity, and human rights, they appeal to them in diverse ways, sometimes with conflicting policy demands. These representations offer a useful gauge of how views about MAiD continue to shift alongside changes in federal legislation. These stories can influence related policies, respond to the powerful voices that shape MAiD legislation, and have the potential to change national conversations. Our analysis adds to the existing body of scholarship on MAiD by examining post-Bill C-7 news media, identifying related health equity issues and tensions, and discussing potential impacts of MAiD’s representations in news media. (shrink)

The practice of medically assisted dying has long been contentious, and the question of what to call it has become increasingly contentious as well. Particularly among U.S. proponents of legalizing the practice, there has been a growing push away from calling it “physician‐assisted suicide,” with assertions that medically assisted dying is fundamentally different from suicide. Digging deeper into this claim about difference leads to an examination of the difference between two kinds of suffering—suffering from physical conditions and suffering from psychological (...) conditions—and therefore leads also toward an examination of whether requests for medical assistance in dying by those suffering from psychological conditions and those suffering from physical conditions should be painted with the same brush. In this article, I aim both to illuminate some of the considerations that ought to be included in discussions related to medically assisted dying and to shed light on what the indirect effects of such discussions can be. I consider some of the reasons commonly given for holding that suicide and medically assisted dying differ fundamentally and then whether the conclusion that medically assisted dying should not be called “suicide” follows from the premises. I ask what else might justify the conclusion that the two acts ought to be called by different names, and I examine possible justifications for accepting this premise, as well as what justifications might exist for emphasizing how the acts are alike. Finally, I argue that we should be cautious before concluding that medically assisted dying should not be called “suicide.” We need more evidence either that the two acts are fundamentally different or that emphasizing differences between them is not likely to do more harm than good. (shrink)

BackgroundSurveys on attitudes towards assisted dying play an important role in informing public debate, policy and legislation. Unfortunately, surveys are often designed with insufficient attention to framing effects; that is, effects on the respondents’ stated attitudes caused by question wording and context. The purpose of this study was to demonstrate and measure such framing effects. MethodsSurvey experiment in which an eight-question survey on attitudes towards assisted dying was distributed to Norwegian citizens through a web-based panel. Two variations of question wording (...) as well as two variations of question order were employed. Respondents were randomized to receive one of four questionnaire versions. ResultsThree thousand and fifty responses were received. There were moderate to large question wording and question order effects. A majority of Norwegian citizens favour the legalization of assisted dying for patients with terminal or chronic disease. ConclusionsStakeholders in the assisted dying debate need to acknowledge potential framing effects, and accordingly should interpret survey results with caution. The same holds for researchers who conduct attitude surveys in the field of bioethics. (shrink)

Ever since medical assistance in dying (MAID) became legal in Canada in 2016, controversy has enveloped the refusal by many faith‐based institutions to allow this service on their premises. In a recent article in this journal, Philip and Joshua Shadd have proposed ‘changing the conversation’ on this issue, reframing it as an exercise not of conscience but of an institutional right of self‐governance. This reframing, they claim, will serve to show how health‐care institutions may be justified in refusing to (...) provide MAID on moral or religious grounds. I argue that it will not make it easier to justify institutional refusal, and is likely to make it harder. (shrink)

Along with the rapid growth that the field of assisted reproduction has experienced over the last few years, numerous ethical issues have arisen and need to be discussed thoroughly. One of them is the limitation of access to assisted reproduction techniques. Because no one should be discriminated against, it is essential to substantiate every single refusal of access carefully. The criterion of welfare of the child is used most frequently. In this paper, we propose a thought experiment aiming at contributing (...) to the discussion by demonstrating that this criterion, even in its strictest form, can easily allow access to assisted reproduction for legal persons as well. (shrink)