The At Issue series includes a wide range of opinion on a single controversial subject. Each volume includes primary and secondary sources from a variety of perspectives -- eyewitnesses, scientific journals, government officials and many others. Extensive bibliographies and annotated lists of relevant organizations to contact offer a gateway to future research.

In the present article the concept of the right to die will be analyzed in English and American literature between 1990 and 1994.

The article discusses the way people wish to die, analyzing the legal situation in countries that permit either euthanasia or physician-assisted suicide. While criticizing the Dutch, Belgian and Swiss models, I argue that the Oregon model is the one with apparently little abuse. Building on the experiences of Oregon, the Netherlands, Belgium, Switzerland, and the Northern Territory of Australia, the article ends with a set of guidelines to improve the conduct of PAS.

The prohibition on administering lethal medication to a patient can be found in the first code of medical deontology (450 BC), which calls on doctors to practice their art with purity and piety. Today, in some countries, doctors are faced with an ethical and deontological dilemma: patients or their relatives request deep and continuous sedation in the name of the “right to die”, believing their life to be inhuman and unworthy! The very concept of the “right to die” (...) is a complex and delicate subject, undefined and un-framed by law. However, it is often discussed in the context of individual rights and medical ethics, often leaving the physician torn on one side by compassion and a sense of medical duty to alleviate a patient’s unnecessary suffering. The “right to die” is an ethical and legal concept that supports the freedom of a human being who is incurably ill or “tired of living” to end his or her life, or to obtain the necessary assistance to do so, by refusing treatment. Yet the universal Hippocratic law that underpins medical practice formally prohibits doctors from assisting suicide. This prohibition is based on the physician’s commitment to defending and preserving life until its natural end. The aim of this study was to see in what sense we can speak of a “right to die” in the philosophy of medicine, so that death can be experienced with humanity and dignity, even by means of deep and continuous sedation. The subject is all the more topical as this right is claimed in the name of human dignity and individual rights and freedoms. (shrink)

The right to die has for decades been recognised for persons in a vegetative state, but there remains controversy about ending life-sustaining medical treatment for persons in the minimally conscious state. The controversy is rooted in assumptions about the moral significance of consciousness, and the value of life for patients who are conscious and not terminally ill. This paper evaluates these assumptions in light of evidence that generates concerns about quality of life in the MCS. It is argued that (...) surrogates should be permitted to make decisions to withdraw life-sustaining medical treatment from patients in the MCS. (shrink)

Discusses the moral and ethical aspects of euthanasia and related topics.

Cohen-Almagor's book represents a remarkable contribution to the discussion of the right to die with dignity. It offers the discussion of a wide range of topics. They include: the terminology respectful of human dignity ; the question of autonomy; the sanctity-of life – quality of life debate; criticism of some extreme quality-of-life position; criticism of Ronald Dworkin's distinction between critical and experiential interests and the consequences this author draws from it; active and passive euthanasia; the Dutch experience and the (...) Oregon Death with Dignity Act; and many others. The book is discussed from a basically sympathetic view, where some details are focused on as meriting some further examination. Some remarks are offered to indicate the complexity of the definition of autonomy; a defense of Dworkin's argument is offered; an insistence on the necessity to rely on moral conferring features is remarked. (shrink)

In this short paper I will discuss the ambiguous and, even, controversial term ‘right to die’ in the context of the euthanasia debate and, in particular, in the case of passive euthanasia. First I will present the major objections towards the moral legitimacy of a right to die, most of which I also endorse myself; then I will investigate whether the right to die could acquire adequate moral justification in the case of passive euthanasia. In the light (...) of the Kantian tradition I will argue that since rights are understood as based upon duties, the right to die should also presuppose a corresponding duty, which to me could be either an imperfect, solidarity-related duty, or an autonomy-related one, at least as far as the unwanted prolongation of life is concerned. I will conclude with the view that the right to die could actually be considered a legitimate one in the case of passive euthanasia, when the application of life-supporting techniques is against the wishes and the best interests of the patient. (shrink)

Major considerations of disability studies—such as provision of care, accommodation for disabled people, and issues surrounding institutionalization—have been consistently marginalized in American bioethical discourse. The right to die, however, stands out as a paradigmatic bioethical debate. Why do advocates for expanding the volition and self-direction of disabled people emerge from the periphery only to help those disabled people who choose death? And why do the majority of people assume an unrealistically low quality of life for those with disabilities? This (...) paper will argue that the dominance of the Western liberal tradition in American culture motivates both these phenomena: by emphasizing individual rights over duties and responsibilities, assuming the isolated and independent rights-bearer as the prototypical person, and evoking an unrealistically atomistic view of human interaction. As an alternative, I offer a framework rooted in feminist ethics that emphasizes context, gives moral weight to human relationships, abandons the problematic ideal of a lone rights-bearer, and emphasizes the mutual vulnerability of embodied individuals. (shrink)

Using the right to die and the United States Supreme Court case of Cruzan v. Director, Missouri Department of Health as exemplars, this article explores the notion of third-order decisionmaking. If first order decisionmaking is about what should happen, and second-order decisionmaking is about who should decide what should happen, then third-order decisionmaking is about who should decide who decides. This turns out to be an apt characterization of constitutionalism, which is centrally concerned with the allocation of responsibility for (...) making decisions about the allocation of responsibility. Deference to erroneous second-order decisions, as in the Cruzan case itself, may merely be an example of this central feature of constitutionalism. Keywords: constitutionalism, Cruzan case, right-to-die, rules CiteULike Connotea Del.icio.us What's this? (shrink)

Argument about euthanasia in Australia intensified following the world's first legal euthanasia death of Bob Dent under the Northern Territory's short-lived Rights of the Terminally Ill Act 1995. This paper takes stock of the implacably opposed positions on euthanasia following Bob Dent's death, which provides a focus for the controversy, and identifies the key doctrines which separate adversaries in the euthanasia debate and their associated incommensurable intuitions.

In this essay, I maintain that the issue of whether the right to die is viable as a constitutionally protectable right remains open. I intend to reconcile the Supreme Court's holdings in Glucksberg and Quill by examining the different rationales the Justices offered for their decisions. I do not believe this issue can be resolved simply by asserting that the intention of the actor is different when assisting suicide, as compared to when life-sustaining treatment is withdrawn. Rather, the (...) right to die continues to be viable due to the level of abstraction at which the Court chose to frame the issue in these cases. (shrink)

How a "right to die" may become a "coercive option".

abstract In 2002 Diane Pretty went to the European Court of Human Rights to gain a ruling about assisted suicide. In the course of this she argued that the right to life implied a right to die. This paper will consider, from an ethical rather than a legal point of view, how the right to life might imply (or not) a right to die, and whether this includes either a right that others shall help us (...) die, or a right against non‐interference if others are willing to help us. It does this by comparing the right to life to conceptions of property rights. This is not because I think human life is property, but because some of our ways of talking and thinking about our control over our own lives seem to be similar to our thoughts about our control over our own property. The right to life has traditionally been taken as a negative right, that is a right that others not deprive us of life. Pretty's argument, however, seems to be moving towards a positive right, not just to remain alive, but to be enabled in doing what we want to with our lives, and thus disposing of them if we so choose. The comparison with property rights suggests that the right to die only applies if our lives are ours absolutely, and may itself be modified by the suggestion that suicide harms all of us by devaluing human life in general. (shrink)

The aim of this paper is to ponder the intricate issue of the right to die in dignity by focusing attention on the role of the patient's beloved people. I first provide critical examination of some of the arguments advanced by Ronald Dworkin. I proceed by contemplating relevant scenarios and examining three American court decisions: Saikewicz, Spring and Gray. The first case, Saikewicz, concerns a patient who had no family or other beloved people. I observe that this fact had (...) a significant bearing on the court's ruling not to provide him treatment. The second case, Spring, involves a patient whose family wanted to withhold treatment from him. I argue that we should be cautious of incidents in which the best interests of the patient's beloved people come at the expense of the best interests of the patient. Spring is an example of such a case. The third case, Gray, serves as an example whereby the best interests of the patient coincide with the best interests of her beloved people. I conclude by arguing that attention has to be given to the question of whether the patient's close-ones demonstrate a unified position in regard to the destiny of the patient. Gegenstand des Beitrags ist es, das schwierige Problem des Rechts, in Würde zu sterben, im Hinblick auf die Rolle der Personen zu überdenken, die dem Patienten nahestehen. Der Autor setzt sich zunächst kritisch mit einigen von Ronald Dworkin vorgetragenen Argumenten auseinander. Dann stellt er die relevanten Fallgestaltungen dar und untersucht drei Entscheidungen amerikanischer Gerichte: die Fälle Saikewicz, Spring und Gray. Der erste Fall, Saikewicz, betrifft einen Patienten ohne Familie oder andere ihm nahestehende Personen. Dieser Umstand hatte einen wesentlichen Einfluß auf die Entscheidung des Gerichts, von der Anordnung einer Behandlung des Patienten abzusehen. Im zweiten Fall, Spring, wünschte die Familie, daß der Patient nicht behandelt würde. Der Autor mahnt für alle die Fälle zur Vorsicht, bei denen die Umstände so beschaffen sind, daß das wohlverstandene Interesse der Angehörigen und das des Patienten kollidieren. Der Fall Spring ist ein Beispiel für eine solche Kollisionssituation. Der dritte Fall, Gray, dient als ein Beispiel, in dem sich das wohlverstandene Interesse des Patienten und das der ihm nahestehenden Personen decken. Zuletzt geht es um die Frage, ob die Angehörigen und andere dem Patienten nahestehende Personen in ihren Vorstellungen über das weitere Schicksal des Patienten übereinstimmen oder nicht. Die Frage verdient eine besondere Aufmerksamkeit. (shrink)

The isolation of the Netherlands as the only country in which voluntary euthanasia is legal is about to end. In October 2001 the Belgian Senate voted by almost a 2:1 margin to allow doctors to act on a patient's request for assistance in dying. The legislation is expected to pass the lower house shortly. That the Netherlands' closest neighbor is likely to be the next country to take this step should provide food for thought among those who have denounced voluntary (...) euthanasia in the Netherlands as rife with abuses. If that were really the case, why would the country that is better placed than all others to know what goes on in the Netherlands – not only because of its geographical proximity, but because most of its people are Dutch-speaking – be ready to copy the Dutch model? (shrink)

Even in the Netherlands, where the practice of physician-assisted death (PAD) has been legalized for over 20 years, there is no such thing as a ‘right to die’. Especially patients with extraordinary requests, such as a wish for PAD based on psychiatric suffering, advanced dementia, or (a limited number of) multiple geriatric syndromes, encounter barriers in access to PAD. In this paper, we discuss whether these barriers can be justified in the context of the Dutch situation where PAD is (...) legally permitted for those who suffer unbearably and hopelessly as a result of medical conditions. Furthermore, we explore whether there are options to address some of the barriers or their consequences, both within the Dutch legal framework or by adjusting the legal framework, and whether these options are feasible. We conclude that although there are insufficient arguments to overrule the doctor’s freedom of conscience in the Netherlands, there are ways to address some of the barriers, mainly by offering support to doctors that would be willing to support a request. Moreover, we believe it is morally required to reduce or mitigate where possible the negative consequences of the barriers for patients, such as the long waiting time for those who suffer from psychiatric disorders, because it is unlikely the adjustments suggested to the system will ensure reasonable access for these patient groups. (shrink)

In this paper, we analyze the legal situation regarding physician-assisted suicide in the world. Our hypothesis is that the prohibitive stance on physician-assisted suicide in most societies in the world today seems to be related to our moral attitudes toward suicide. This brings us to a discussion about life itself. We claim that the total lack of legal protection for physician-assisted suicide from international organizations and most countries in the world lies in a philosophical assumption that supports much of our (...) common beliefs about what life really is. This assumption states that life must be thought of as not belonging exclusively to the individual. We argue that this assumption is a misconception that can be heard in the debate on suicide. Consequently we endorse a different conception of life which tends to favor a pro-choice stance towards suicide and assisted death in general. This position takes the patient’s decision about when to die more seriously. We conclude that there is no reason why physician-assisted suicide does not deserve legal protection as an individual right to die under international law. (shrink)

First published in 1996. Routledge is an imprint of Taylor & Francis, an informa company.

The isolation of the Netherlands as the only country in which voluntary euthanasia is legal is about to end. In October 2001 the Belgian Senate voted by almost a 2:1 margin to allow doctors to act on a patient's request for assistance in dying. The legislation is expected to pass the lower house shortly. That the Netherlands' closest neighbor is likely to be the next country to take this step should provide food for thought among those who have denounced voluntary (...) euthanasia in the Netherlands as rife with abuses. If that were really the case, why would the country that is better placed than all others to know what goes on in the Netherlands – not only because of its geographical proximity, but because most of its people are Dutch-speaking – be ready to copy the Dutch model? (shrink)

Lam, Joseph Peter Fitzsimons is a competent journalist who does not shy away from expressing his personal opinion on controversial social and ethical issues. In a Sydney Morning Herald online comment published on 11 December 2016, he not only praised the courage of the premier of Victoria, Daniel Andrews, but also appealed to members of the New South Wales parliament to follow Andrews' lead to legalise euthanasia. Anticipating the eventual collapse of his own health in the future, Fitzsimons insisted that (...) lawmakers should respect his autonomy and his choice of a peaceful and dignified death. As far as I can see, however, respect for a person's autonomy is not the main problem here. Rather, the key difficulty rests with Fitzsimons's reasoning. He argued: Let's say that at the age of 80 or so, I decide that my meaningful life is over, and all that awaits me is-I know, I know, too much detail- incontinent pain for the next five years. And let's say that I don't want that, and would rather pass away peacefully, and with dignity, in a medically supervised manner. My question to the opponents of euthanasia: if I choose to do that, what business is it of yours? (shrink)

Background: In Switzerland, non-medical right-to-die organisations such as Exit Deutsche Schweiz and Dignitas offer suicide assistance to members suffering from incurable diseases. Objectives: First, to determine whether differences exist between the members who received assistance in suicide from Exit Deutsche Schweiz and Dignitas. Second, to investigate whether the practices of Exit Deutsche Schweiz have changed since the 1990s. Methods: This study analysed all cases of assisted suicide facilitated by Exit Deutsche Schweiz (E) and Dignitas (D) between 2001 and 2004 (...) and investigated by the University of Zurich’s Institute of Legal Medicine (E: n = 147; D: n = 274, total: 421). Furthermore, data from the Exit Deutsche Schweiz study which investigated all cases of assisted suicide during the period 1990–2000 (n = 149) were compared with the data of the present study. Results: More women than men were assisted in both organisations (D: 64%; E: 65%). Dignitas provided more assistance to non-residents (D: 91%; E: 3%; p = 0.000), younger persons (mean age in years (SD): D: 64.5 (14.1); E: 76.6 (13.3); p = 0.001), and people suffering from fatal diseases such as multiple sclerosis and amyotrophic lateral sclerosis (D: 79%; E: 67%; p = 0.013). Lethal medications were more often taken orally in cases assisted by Dignitas (D: 91%; E: 76%; p = 0.000). The number of women and the proportion of older people suffering from non-fatal diseases among suicides assisted by Exit Deutsche Schweiz has increased since the 1990s (women: 52% to 65%, p = 0.031; mean age in years (SD): 69.3 (17.0) to 76.9 (13.3), p = 0.000), non-fatal diseases: 22% to 34%, p = 0.026). Conclusions: Weariness of life rather than a fatal or hopeless medical condition may be a more common reason for older members of Exit Deutsche Schweiz to commit suicide. The strong over-representation of women in both Exit Deutsche Schweiz and Dignitas suicides is an important phenomenon so far largely overlooked and in need of further study. (shrink)

A widely adopted approach to end-of-life ethical questions fails to make explicit certain crucial metaphysical ideas entailed by it and when those ideas are clarified, then it can be shown to be inadequate. These metaphysical themes cluster around the notions of personal identity, personhood and humanness, and the metaphysics of substance. In order to clarify and critique the approach just mentioned, I focus on the writings of Robert N. Wennberg as a paradigm case by, first, stating his views of personal (...) identity, humanness, personhood, and the relations among them; second, offering a comparison of a view of humans as substances (understood in the classic interpretation of Aristotle and Aquinas) vs. a view of humans as property-things; third, applying the metaphysical distinctions surfaced in the second section towards a critique of Wennberg. (shrink)

The reemergence of the question of suicide in the medical context of physician-assisted suicide seems to me one of the most interesting and fertile facets of late modernity. Aside from the disruption which this issue may cause in the traditional juridical relationship between individuals and the state, it may also help to transform the dominant conception of subjectivity that has been erected upon modernity's medicalized order of death. To enhance this disruptive potential, I am going to examine the perspectives on (...) death offered by two contemporary writers: Zygmunt Bauman and Jean Baudrillard. Each of these writers recognizes the centrality of death to modern culture, as Heidegger did, but they also go beyond him in specifying the ways in which death maintains a presence in late modernity, despite efforts to conceal it. In particular, both of these writers recognize the important role that medicine has played in ordering the modern conception of death. After situating these two perspectives in relation to each other, and in relation to Heidegger, who will serve here as a sort of benchmark, I will return to the issue of suicide. Given the differences in their readings of the role that death and medicine play in modern culture, these post-Heideggerians take strikingly different positions on this issue. By engaging these perspectives, I intend not only to point out the tremendous potential which this issue holds for a fundamental rethinking of modern subjectivity, but also reveal some of the dangers that may beset any naive optimism about the right to die. (shrink)

Liberal articulations of the right to die generally focus on balancing individual rights against state interests, but this approach does not take full advantage of the disruptive potential of this contested right. This article develops an alternative to the liberal approach to the right to die by engaging the seemingly discordant philosophical perspectives of Michel Foucault and Thomas Hobbes. Despite Foucault’s objections, a rapprochement between these perspectives is established by focusing on their shared emphasis on the role (...) that death plays in the order of modernity. After the article has established the complementarity of Foucault and Hobbes, Hobbes’ unique stance toward suicide is first viewed in the context of the early-modern hostility toward suicide, and then contrasted with Foucault’s Stoic-inspired affirmation of suicide. This comparison of these two philosophers’ positions on suicide opens to contestation dimensions of modern subjects that remain undisturbed by liberal approaches to the right to die Key Words: bio-power • Michel Foucault • governmentality • Thomas Hobbes • liberalism • right to die • self-preservation • Seneca • Stoicism • suicide. (shrink)

John Rawls was the most influential political thinker of the twentieth century. This book applies his theory of justice to four perennial matters of concern that remain contested in the twenty-first century. Drawing surprising implications, this book deepens our understanding of these issues and points the way toward rational, just policy reform.

Assuming that both humans and nonhuman organisms have intrinsic value, the concept of a “death with dignity” should extend to the natural world. Recently, an effort has been undertaken to save the razorback sucker, an endangered species of fish in the Colorado River. Razorback are bred and raised in captivity and transferred to the river only when large enough to survive predation by nonnative fish. While this effort is well-intentioned, there is little chance that the razorback will again live unassisted (...) in the Colorado River. There may be human-centered reasons for saving the razorback. However, just as respecting a person sometimes requires limiting his or her life-sustaining medical treatment, so too respecting the razorback may require removing human assistance with its reproductive cycle. (shrink)

This paper examines two models of thinking relating to the issue of the right to die in dignity: one takes into consideration the rights and interests of the individual; the other supposes that human life is inherently valuable. I contend that preference should be given to the first model, and further assert that the second model may be justified in moral terms only as long as it does not resort to paternalism. The view that holds that certain patients are (...) not able to comprehend their own interests in a fully rational manner, and therefore ‘we’ know what is good for these patients better than ‘they’ do, is morally unjustifiable. I proceed by refuting the ‘quality of life’ argument, asserting that each person is entitled to decide for herself when it is worth living and when it is not. In this connection, a caveat will be made regarding the role of the family. (shrink)

Arguments in favor of legalized assisted suicide often center on issues of personal privacy and freedom of choice over one's body. Many disability advocates assert, however, that autonomy arguments neglect the complex sociopolitical determinants of despair for people with disabilities. Specifically, they argue that social approval of suicide for individuals with irreversible conditions is discriminatory and that relaxing restrictions on assisted suicide would jeopardize, not advance, the freedom of persons with disabilities to direct the lives they choose. This paper examines (...) the idea promoted by some proponents of assisted suicide that it is reasonable to be depressed about one's diminished quality of life in cases of irreversible illness or disability and, therefore, such depression should not call into question the individual's competence to request assistance in dying. The concept of rational depression is defined and examined in the context of: four real-life cases involving individuals with disabilities who requested assistance in dying; a set of criteria commonly applied to decision-making to determine rationality; and research bearing on the emotional status of people with disabilities. It is concluded that although disability is associated with particular socially mediated stressors, there is no theoretical or empirical evidence to indicate that depression and its role in the right to die is dynamically different, more natural, or more reasonable for disabled people than for non-disabled people. (shrink)

In 1992, Eluana Englaro was involved in a car accident in Italy that eventually left her in a permanent vegetative state requiring artificial nutrition and hydration. This paper, after briefly reviewing Eluana's case, gives a chronicle of Eluana last months until her death on 9 February 2009, and discusses the right-to-die controversy in Italy. For many years, Mr Englaro, Eluana's father, would litigate to enforce what he considered to be his daughter's wish to discontinue life-prolonging treatment. In July 2008, (...) the Court of Appeal of Milan has given its authorisation for artificial life support to be withdrawn. This ruling sparked a crusade, led by the government and the Vatican, against the court and Eluana's father, which included insinuations that the latter was murdering his daughter. Public opinion has overwhelmingly been sympathetic to the father's difficult decision, in stark contrast to the reactionary stance taken by the government. With the notable advances of medicine, doctors are increasingly faced with ethical issues. The vegetative state is just one of the many clinical conditions that obligate health professionals to reflect on ethical matters. The withdrawal of life-supporting care, and of artificial nutrition and hydration in particular in permanent vegetative state patients remains a measure which violates a tradition and a consolidated practice. It was thus inevitable that it would create great controversy. We should work towards making a decision process that ensures that continuation or suspension of artificial nutrition and hydration follows an explicit procedure, promoting the sharing and respect of the diverse moral responsibility of family members, nursing and medical staff. (shrink)

Name der Zeitschrift: Jahrbuch für Wissenschaft und Ethik Jahrgang: 19 Heft: 1 Seiten: 91-106.