'The Patient as Victim and Vector' is jointly written by four authors at the University of Utah with expertise in bioethics health law, and both clinical practice and public health policy concerning infectious disease.

Involuntary psychiatric commitment for suicide prevention and physician aid-in-dying (PAD) in terminal illness combine to create a moral dilemma. If PAD in terminal illness is permissible, it should also be permissible for some who suffer from nonterminal psychiatric illness: suffering provides much of the justification for PAD, and the suffering in mental illness can be as severe as in physical illness. But involuntary psychiatric commitment to prevent suicide suggests that the suffering of persons with mental illness does not justify ending (...) their own lives, ruling out PAD. Since both practices have compelling underlying justifications, the most reasonable accommodation might seem to be to allow PAD for persons with mental illness whose suffering is severe enough to justify self-killing, but prohibit PAD for persons whose suffering is less severe. This compromise, however, would require the articulation of standards by which persons’ mental as well as physical suffering could be evaluated. Doing so would present a serious philosophical challenge. (shrink)

Margaret Pabst Battin has established a reputation as one of the top philosophers working in bioethics today. This work is a sequel to Battin's 1994 volume The Least Worst Death. The last ten years have seen fast-moving developments in end-of-life issues, from the legalization of physician-assisted suicide in Oregon and the Netherlands, to a furor over proposed restrictions of scheduled drugs used for causing death, and the development of "NuTech" methods of assistance in dying. Battin's new collection (...) covers a remarkably wide range of end-of-life topics, including suicide prevention, AIDS, suicide bombing, serpent-handling and other religious practices that pose a risk of death, genetic prognostication, suicide in old age, global justice and the "duty to die." It also examines suicide, physician-assisted suicide, and euthanasia in both American and international contexts. As with the earlier volume, these new essays are theoretically adroit but draw richly from historical sources, fictional techniques, and ample factual material. (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)

Daryl Pullman (2023), seeking to slow the slide down what he sees as the slippery slope of MAID, employs an epigraph from H.L. Mencken: “For every human problem there is a solution that is simple,...

Book reviewed in this article: Am I My Parents' Keeper? An Essay on Justice Between the Young and Old. By Norman Daniels.

If you developed Alzheimer disease, would you want to go all the way to the end of what might be a decade‐long course? Some would; some wouldn't. Options open to those who choose to die sooner are often inadequate. Do‐not‐resuscitate orders and advance directives depend on others' cooperation. Preemptive suicide may mean giving up years of life one would count as good. Do‐it‐yourself methods can fail. What we now ask of family and clinicians caring for persons with dementia, and of (...) patients given no better option than to go on with lives they may not want, is unacceptable. To explore how one might better control one's own dying and avoid burdening others with overwhelming care and morally painful choices, we propose a thought experiment: an advance directive implant that would enable persons with early dementia, while competent, to arrange their own deaths without the subsequent intervention of anyone else. (shrink)

In his carefully documented article, “From reciprocity to autonomy in physician-assisted death: an ethical analysis of the Dutch Supreme Court ruling in the Albert Heringa case,” Berand Florijn (20...

This compact and innovative book tackles one of the central issues in drug policy: the lack of a coherent conceptual structure for thinking about drugs. Drugs generally fall into one of seven categories: prescription, over the counter, alternative medicine, common-use drugs like alcohol, tobacco and caffeine; religious-use, sports enhancement; and of course illegal street drugs like cocaine and marijuana. Our thinking and policies varies wildly from one to the other, with inconsistencies that derive more from cultural and social values than (...) from medical or scientific facts. Penalties exist for steroid use, while herbal remedies or cold medication are legal. Native Americans may legally use peyote, but others may not. Penalties may vary for using different forms of the same drug, such as crack vs. powder cocaine. Herbal remedies are unregulated by the FDA; but medical marijuana is illegal in most states. Battin and her contributors lay a foundation for a wiser drug policy by promoting consistency and coherency in the discussion of drug issues and by encouraging a unique dialogue across disciplines. The contributors are an interdisciplinary group of scholars mostly based at the University of Utah, and include a pharmacologist, a psychiatrist, a toxicologist, a trial court judge, a law professor, an attorney, a diatary specialist, a physician, a health expert on substance abuse, and Battin herself who is a philosopher. They consider questions like the historical development of current policy and the rationales for it; scientific views on how drugs actually cause harm; how to define the key notions of harm and addiction; and ways in which drug policy can be made more consistent. They conclude with an examination of the implications of a consistent policy for various disciplines and society generally. The book is written accessibly with little need for expert knowledge, and will appeal to a diverse audience of philosophers, bioethicists, clinicians, policy makers, law enforcement, legal scholars and practitioners, social workers, and general readers, as well as to students in areas like pharmacy, medicine, law, nursing, sociology, social work, psychology, and bioethics. (shrink)

Is suicide wrong, profoundly morally wrong? Almost always wrong, but excusable in a few cases? Sometimes morally permissible? Imprudent, but not wrong? Is it sick, a matter of mental illness? Is it a private matter or a largely social one? Could it sometimes be right, or a "noble duty," or even a fundamental human right? Whether it is called "suicide" or not, what role may a person play in the end of his or her own life? This collection of primary (...) sources--the principal texts of ethical interest from major writers in western and nonwestern cultures, from the principal religious traditions, and from oral cultures where observer reports of traditional practices are available, spanning Europe, Asia, the Middle East, Africa, Oceania, the Arctic, and North and South America--facilitates exploration of many controversial practical issues: physician-assisted suicide or aid-in-dying; suicide in social or political protest; self-sacrifice and martyrdom; suicides of honor or loyalty; religious and ritual practices that lead to death, including sati or widow-burning, hara-kiri, and sallekhana, or fasting unto death; and suicide bombings, kamikaze missions, jihad, and other tactical and military suicides. This collection has no interest in taking sides in controversies about the ethics of suicide; rather, rather, it serves to expand the character of these debates, by showing them to be multi-dimensional, a complex and vital part of human ethical thought. (shrink)

To accept a notion of rational suicide, as many contemporary bioethicists now urge, first makes possible certain kinds of manipulation into suicide which do not occur in suicide-impermissive societies. This paper describes the two principal mechanisms by which an individual can be manipulated into choosing to kill himself or herself, though that individual would not have done so otherwise, and identifies circumstantial and ideological changes in contemporary society which may be associated with such manipulation now and in the future. However, (...) the author holds that this prospect is not grounds for rejecting the notion of rational suicide;it must be accepted on other moral grounds, but with a clear view of the risks it will bring. (shrink)

This chapter contains sections titled: Bioethics as “Dilemma‐motivated” The Expanding Universe of Bioethics Issues Institutional Settings of Bioethics Bioethics and Moral Reasoning Bioethics as Minimally Conventional Bioethics as Interdisciplinary The Core Theoretical Problems of Bioethics Attacks on Bioethics Can Bioethics Provide Answers? The Scope of Bioethics: From Western to Global The Future of Bioethics The Social Role of Bioethics “Uncontested Core” of Bioethics Acknowledgments.

In the last several years, philosophical enthusiasm for applied professional ethics has spread from medicine to law, education, government, engineering, business, and to other professional and semiprofessional fields. Each involves an institutional structure within which professional practitioners provide specific services to those who seek them, and within which practitioner behavior in providing these services is regulated by both formal and informal institutional codes and conventions. Recent work in applied ethics has forced reinspection of these codes and conventions and of the (...) moral features of the professional practices they govern—from client confidentiality to the exchange of fees—and has revealed characteristic dilemmas and conflicts which are endemic to these areas of professional activity. Indeed, in some cases—for instance, in the de-paternalization of medicine—the inquiries of applied professional ethicists have begun to produce quite striking changes in professional practice itself. (shrink)

Addressing key issues arising from the nature of death, 'Death, Dying and the Ending of Life' examines important topics relating to bioethics, philosophy and literature.

While a national health care system may be greeted with enthusiasm on many grounds, it poses substantial moral problems – not the least of which would be the clash between the ‘standardization’ of care for the sake of efficiency and the needs of individual patients. Such problems are best seen in the treatment of dying patients. Keywords: best buy, cost-saving, dying, efficiency, practice guidelines, Rilke, standards of practice, two tier CiteULike Connotea Del.icio.us What's this?

Where assistance in suicide is readily available to those dying of AIDS, as in the west coast gay communities of the United States and in the Netherlands, we must examine the different roles of physicians and friends (including lovers, spouses, family members, religious advisors, members of support groups, and intimate others) in helping a person with AIDS decide about and carry out suicide. This paper makes a central assumption: that where assistance in suicide is available, it is the moral obligation (...) of others to protect and enhance as much as possible the rationality of that choice. Four components are identified in a rational choice about suicide in AIDS – whether it is a choice for or against suicide. Phrased as questions a person with AIDS might ask him- or herself, they are: (1) "Is suicide an option I want to consider?" (2) "Shall I hold out for the chance of a cure?" (3) "How shall I time my suicide?" (4) "What weight shall I give to the welfare and interests of others?" Although physicians often make assertions relevant to (1), they are appropriately involved only in (3); and although friends or intimate partners often provide the patient with anecdotal information relevant to (3), they should be involved primarily in (1). In short, both physicians and friends often intervene in the wrong parts of choices made by a person with AIDS about suicide. Keywords: AIDS, assisted suicide, euthanasia, rationality, role of friends and physicians, timing CiteULike Connotea Del.icio.us What's this? (shrink)

Despite its virtues, lay decision-making in medicine shares with professional decision-making a disturbing common feature, reflected both in formal policies prohibiting high-risk research and in informal policies favoring treatment decisions made when a crisis or change of status occurs, often late in a downhill course. By discouraging patient decision-making but requiring dedication to the patient's interests by those who make decisions on the patient's behalf, such practices tend to preclude altruistic choice on the part of the patient. This eclipse is (...) to be regretted not just because widescale altruism has the capacity to provide important social goods and correct injustices in distribution, but for intrinsic reasons as well. It is argued that preserving the possibility of altruism obliges patients – and future patients – to make decisions about dying and other medical matters in advance, thus avoiding that displacement of decision-making onto lay and professional second parties which results in altruism's eclipse. Keywords: altruism, medical decision-making, patient's interest, self-interest, autonomy, death and dying decisions, refusal of treatment, prolongation of life, allowing to die, high-risk research CiteULike Connotea Del.icio.us What's this? (shrink)

This chapter contains sections titled: The Malthusian Warning “Population Control” and its Critics “Leveling Off”: The Demographic Transition The Ethics of Population Programs Optimal Population Size: Fewer with More, or More with Less? A Thought‐Experiment About a Solution to the Population Problem References.

Volume 19, Issue 10, October 2019, Page W14-W17.