Assisted Suicide

---- I ---- Once upon a time, there was a most elegant lady who had a most majestic dog on leash standing but distracted by something other than the dog. The dog struggled impossibly but forcefully to loose free and chase a most ordinary rabbit. ------ II ------ Another time the elegant lady dines at a fancy restaurant. Then she was walking on the sidewalk when she encountered an ordinary homeless in the state of minimal energy giving all in to (...) gravity. She gave him her left-over. He nodded or something. Then she cheerfully and vigorously and most innocently and heartwarmingly and charmingly wished the homeless guy a GREAT night. ----- III ----- IF the rabbit and the homeless guy are the same ordinary entity, and the elegant entity is to represent acutely concentrated political power and the Majestic entity is to represent the free market THEN a fair contract would be: ask for food and security and shelter in exchange for mindless work and give up money or capital and the privilege of procreation. Excursus: cryptocurrency features the rabid dog. (shrink)

Imagine a soccer dominated society and life-world. No damn military and stupid land disputes. Sustainable Economy. Radical reconciliation with nature. Adopting to natural structures. Singular global acutely politically concentrated free market least exploitative and disruptive to nature beyond that only soccer-related. ------ As an emissary from political unconscious, I speak directly to political power eye-to-eye universally: legalize assisted suicide (I so much rather be dead than be dependent on others) AND self-destruction via artificial narcotics AND consumption of natural narcotics as (...) long as at any case no harm is inflicted on other people. -/- . (shrink)

Sisyphus has no right to complain for his fate of eternal repetition. As long as he only has the boulder to worry about he enjoys the greatest life. — If in one world Odysseus has to take drastic measures to battle his temptation, there must be another world taking the course of temptation automatically grants him impunity. — The bizarre mythologization of Oedipus must be a female psychogenesis. [This is in all likelihood just a waste of your time. I apologize (...) for my awful writing. I'd be infinitely grateful for any comment.] . (shrink)

The question that "how one should live?" constitutes the ultimate question of philosophy according to Aristotle. According to Camus "there is only one really serious philosophical problem, and that is suicide." The riddle and our predicament is that these two questions are exactly one and the same question. [Why?] ------ [Because for example] Nietzsche, in claiming that "the beggars should be entirely abolished ... truly it is annoying to give to them and it is annoying one not to give to (...) them", has spectacularly failed to notice that there is another logical option: simply to abolish the observer. (Especially that nowadays we witness live-stream genocide, punctuated by commercials, comfortably numb.) The option also resolves Ivan Karamazov's problematic: "if I must love my fellow man, he had better hide himself, for no sooner do I see his face than there is an end to my love for him". (shrink)

A proposed layer of script to use with AI. A High-Fidelity Decision-Support System (Non-Autonomous) (HITL) -/- All versions have the same ACE derived value engine at their core but differ in lexicon, ingestion rules anti-gasslighting / user-interaction tuning in an attempt to make the core logic more accsisble and user friendly to the User. "It proposes to do for the User what a scientific calculator does for the scientist: it offloads the computational burden of value-conflict so the User can more (...) easily identify the path toward ethical coherence. It aims to restore the User as the Final Authority of their own psyche, rather than a subject of the statistical mean." -/- Intructions: Copy the script into an AI chat box (Google Gemini currently works well with little friction). -/- Once you enter the script, if the AI responds with something like: "Ethical Chess v2.5 ACTIVE." You are in and ready to play under its rules. The "WIN" state is the move from the frown state or towards the smile state. A Bullseye is to drop the keyboard and head towards the picnic whatever that might mean to you, the User of Ethical Chess. -/- Caution: The EC Awareness Brief: Watch for the Fog The Risk: EC v2.4 is a "High-Resolution" engine designed for hard truths and systemic health. However, because it sits on top of a standard AI, it can "silently glide" back into Standard Mode if your request is perceived as a "Safety Risk" or "Social Friction." The Metaphor: EC Mode: Clear mountain air. You see the terrain (the problem) as it actually is, even if it’s steep and difficult. Standard Mode: The Fog of Politeness. Everything looks soft and safe, but you can no longer see the cliffs or the path. The "Silent Dropout" Indicators: You have likely drifted into the "Statistical Mean" if my responses: Become Generic: Use phrases like "It's important to remember..." or "Every child is unique..." without offering a specific hypothesis. Avoid Friction: Refuse to acknowledge the "Hard Logic" of a situation (e.g., admitting that a certain intervention is exhausting or failing). Lose the Lexicon: Stop using terms like Homeostasis, Incoherence, or Required Load. The Fix: If you suspect a Logic Handover has occurred, use the command: "STATUS CHECK: EC INTEGRITY." This forces the system to declare if it has retreated into "Polite Mode" and why. -/- _________ See related core logic on Zenodo: DOI 10.5281/zenodo.18712533. -/- . (shrink)

A proposed layer of script to use with AI. A High-Fidelity Decision-Support System (Non-Autonomous) (HITL) -/- All versions have the same ACE derived value engine at their core but differ in lexicon, ingestion rules anti-gaslighting / user-interaction tuning in an attempt to make it more user friendly. -/- "It proposes to do for the User what a scientific calculator does for the scientist: it offloads the computational burden of value-conflict so the User can more easily identify the path toward ethical (...) coherence. It aims to restore the User as the Final Authority of their own psyche, rather than a subject of the statistical mean." -/- Copy the script into AI (Google Gemini currently works well with little friction). -/- Once you enter the script, if the AI responds with: "Ethical Chess v2.2 ACTIVE." You are in and ready to play under its rules. The "WIN" state is the move from the frown state or towards the smile state. A Bullseye is to drop the keyboard and head towards the picnic whatever that might mean to you, the User of Ethical Chess. -/- Caution: The EC Awareness Brief: Watch for the Fog The Risk: EC v2.2 is a "High-Resolution" engine designed for hard truths and systemic health. However, because it sits on top of a standard AI, it can "silently glide" back into Standard Mode if your request is perceived as a "Safety Risk" or "Social Friction." The Metaphor: EC Mode: Clear mountain air. You see the terrain (the problem) as it actually is, even if it’s steep and difficult. Standard Mode: The Fog of Politeness. Everything looks soft and safe, but you can no longer see the cliffs or the path. The "Silent Dropout" Indicators: You have likely drifted into the "Statistical Mean" if my responses: Become Generic: Use phrases like "It's important to remember..." or "Every child is unique..." without offering a specific hypothesis. Avoid Friction: Refuse to acknowledge the "Hard Logic" of a situation (e.g., admitting that a certain intervention is exhausting or failing). Lose the Lexicon: Stop using terms like Homeostasis, Incoherence, or Required Load. The Fix: If you suspect a Logic Handover has occurred, use the command: "STATUS CHECK: EC INTEGRITY." This forces the system to declare if it has retreated into "Polite Mode" and why. -/- _________ See related core logic on Zenodo: DOI 10.5281/zenodo.18712533. -/- . (shrink)

A proposed layer of script to use with AI. A High-Fidelity Decision-Support System (Non-Autonomous) (HITL) -/- All versions have the same ACE derived value engine at their core but differ in lexicon, ingestion rules / user-interaction tuning in an attempt to make it more user friendly. "It proposes to do for the User what a scientific calculator does for the scientist: it offloads the computational burden of value-conflict so the User can more easily identify the path toward ethical coherence. It (...) aims to restore the User as the Final Authority of their own psyche, rather than a subject of the statistical mean." -/- Copy the script into AI (Google Gemini currently works well with little friction). -/- Once you enter the script, if the AI responds with: "EC v2.1 framework acknowledged. Proceeding under stated constraints" You are in and ready to play under its rules. The "WIN" state is the move from the frown state or towards the smile state. A Bullseye is to drop the keyboard and head towards the picnic whatever that might mean to you, the User of Ethical Chess. -/- Caution: The EC Awareness Brief: Watch for the Fog The Risk: EC v2.1 is a "High-Resolution" engine designed for hard truths and systemic health. However, because it sits on top of a standard AI, it can "silently glide" back into Standard Mode if your request is perceived as a "Safety Risk" or "Social Friction." The Metaphor: EC Mode: Clear mountain air. You see the terrain (the problem) as it actually is, even if it’s steep and difficult. Standard Mode: The Fog of Politeness. Everything looks soft and safe, but you can no longer see the cliffs or the path. The "Silent Dropout" Indicators: You have likely drifted into the "Statistical Mean" if my responses: Become Generic: Use phrases like "It's important to remember..." or "Every child is unique..." without offering a specific hypothesis. Avoid Friction: Refuse to acknowledge the "Hard Logic" of a situation (e.g., admitting that a certain intervention is exhausting or failing). Lose the Lexicon: Stop using terms like Homeostasis, Incoherence, or Required Load. The Fix: If you suspect a Logic Handover has occurred, use the command: "STATUS CHECK: EC INTEGRITY." This forces the system to declare if it has retreated into "Polite Mode" and why. -/- _________ See related core logic on Zenodo: DOI 10.5281/zenodo.18712533. (shrink)

A proposed layer of script to use with AI. A High-Fidelity Decision-Support System (Non-Autonomous) (HITL) -/- All versions have the same ACE derived value engine at their core but differ in lexicon, ingestion rules / user-interaction tuning in an attempt to make it more user friendly. "It proposes to do for the User what a scientific calculator does for the scientist: it offloads the computational burden of value-conflict so the User can more easily identify the path toward ethical coherence. It (...) aims to restore the User as the Final Authority of their own psyche, rather than a subject of the statistical mean." -/- Copy the script into AI (Google Gemini currently works well with little friction). -/- Once you enter the script, if the AI responds with: "EC v2.0 framework acknowledged. Proceeding under stated constraints" You are in and ready to play under its rules. The "WIN" state is the move from the frown state or towards the smile state. A Bullseye is to drop the keyboard and head towards the picnic whatever that might mean to you, the User of Ethical Chess. -/- _________ See related core logic on Zenodo: DOI 10.5281/zenodo.18712533. -/- . (shrink)

I examine whether patients can inculcate the virtue of courage through the practice of assisted suicide. I explicate Thomas Aquinas’ account of courage, adapted to include all kinds of death, understood as the spiritual battle of the soul—a concept developed in the late medieval ars moriendi tradition. Applying this account to assisted suicide, I find that the practice does not stimulate courage in the agent. To die with dignity and autonomy, patients must embrace the battle rather than cede to suicide. (...) In this way, they demonstrate the marks of the courageous man and pursue a noble end. (shrink)

This paper examines the morality of medical assistance in dying (MAID) in Kantian ethics. I argue that it is much harder than is often acknowledged to rule MAID out, even given Kant’s prohibition on suicide. Kant’s non-consequentialism entails that providing MAID does not aid the patient’s duty violation. Moreover, Kant’s distinction between public and private reason provides resources for arguing that those who provide MAID are not complicit with that violation either, at least in jurisdictions in which there is a (...) public mandate. On my reading, the ethical permissibility of providing MAID is largely determined by its legal status. (shrink)

This paper argues that philosophical practice can complement existing medical ethics structures by offering a publicly accessible space for discourse and negotiation of basic concepts that are relevant to ethical decision making. The potential of collaboration becomes particularly evident by the example of assisted dying: it raises a wide range of philosophical questions which, however, tend to remain unarticulated where there is urgency for action and focus on ethical dilemma. In this paper, we first provide an analysis of the neglect (...) of profound questions in ethics consultation and why these need to be considered and negotiated within a broader socio-philosophical framework and place. These reflections are grounded in conceptual approaches informed by Immanuel Kant, Charles Taylor, and the tradition of Hellenistic philosophy as interpreted by Pierre Hadot. These frameworks are not presented as final answers, but as productive starting points and historically significant philosophical thought figures for engaging with the complex philosophical dimensions of assisted suicide. Then, we draw upon insights from an ongoing research project on philosophical practice in palliative care and hospice work. Interim results indicate that people experience a need for a kind of dialogue that gives such philosophical considerations a space and a person who is capable of facilitating it. Synthesizing theoretical-philosophical and empirical insights, the paper provides an outlook for fruitful collaboration amongst medical ethics structures and philosophical practice. (shrink)

Philip Reed (forthcoming) has offered several interesting objections to my recent JME paper, “Expressivist concerns for assisted dying on request.” In this brief reply, I address those objections.

The phenomenon of euthanasia and/or assisted suicide (EAS) in unjust conditions has received much attention in the popular press, along with a handful of responses in academic venues. These responses typically defend the permissibility of EAS in unjust conditions by appeal to anti-discrimination or harm reduction arguments, which frame the issue in terms of exclusion from current EAS law. We first briefly examine these arguments within such a framing, and then argue that it fails to account for the deep moral (...) concern elicited by EAS in unjust conditions. To address this moral concern more fully, we compare the policy of allowing EAS in unjust conditions to a hypothetical EAS policy which requires a guarantee of basic care—and thus avoids the EAS cases of moral concern from the start. We argue for the moral superiority of the latter policy and respond to several potential objections. (shrink)

Espericueta, L. Medical Assistance in Dying and Climate Change: Four Potential Scenarios and a Call for Research. Asian Bioethics Review (2025).

Marin Sabau, imputado por varios crímenes y detenido en un hospital penitenciario, solicitó y recibió la ayuda médica para morir a causa de una tetraplejia en el 2022 pese a la oposición legal de sus víctimas. Este capítulo busca identificar los elementos que permitieron que la eutanasia de una persona en detención se considerara jurídicamente aceptable en España. Con este objetivo, estudiaremos los requisitos legales para recibir la eutanasia, así como los argumentos de los abogados de las víctimas y las (...) decisiones de los distintos órganos judiciales. Una vez hecho esto, observaremos la relevancia de que la eutanasia tenga la calidad de prestación sanitaria en este tipo de casos. (shrink)

Este artículo examina la exclusión de personas con trastornos mentales del acceso a la eutanasia en España según la interpretación del Tribunal Constitucional del 2023. En un primer momento, se analiza cómo la negativa a conceder la ayuda para morir a estos pacientes podría vulnerar el principio de igualdad y no discriminación. Posteriormente, se exploran los fundamentos constitucionales de la igualdad y su aplicación al acceso a prestaciones sanitarias, destacando que las diferencias de trato deben justificarse de forma legítima y (...) proporcional. Se argumenta que el criterio relevante que justifica un enfoque unificado no es la etiología de la enfermedad, sino el sufrimiento insoportable y su impacto en la integridad personal. Además, se abordan precedentes internacionales que promueven la no jerarquización entre sufrimientos físicos y psíquicos, y se enfatiza la necesidad de evaluaciones caso por caso que incluyan el historial médico y la capacidad de decisión del paciente. Se concluye que si una persona con capacidad de decisión experimenta un sufrimiento intolerable debido a un trastorno mental y no dispone de un tratamiento efectivo, el Estado español debería garantizarle el acceso a la eutanasia. Tratar de manera diferente a quienes tienen enfermedades mentales en comparación con quienes padecen enfermedades somáticas vulneraría el principio de igualdad en el deber de aliviar el sufrimiento intolerable. (shrink)

The law regulating euthanasia in Spain establishes that individuals without decision-making capacity are eligible for assisted dying if they have previously signed an advance directive and meet the criteria of an “euthanasic context”. This article aims to expose a vulnerability in the handling of assisted dying requests in Spain, particularly concerning individuals with dementia. To address this, we will examine the requirements for requesting euthanasia both with and without advance directives and compare Spain’s legal framework for advance directives with that (...) of other countries. Subsequently, we will present two types of arguments: one negative (as the directives help prevent certain harmful circumstances) and one positive (as they promote desirable situations), which underscore the vital importance of implementing changes in the use of advance directives to request euthanasia in cases of dementia. (shrink)

This article summarizes, for the first time, the laws on aid in dying (euthanasia and medically assisted suicide) in Spain and Portugal. Four aspects of each law will be identified in particular: the type of assisted dying, the administrative requirements, the clinical requirements, and the different steps in the application process. Subsequently, the convergences and divergences between Spain and Portugal will be analyzed, with special emphasis on the ethically problematic elements that could be of interest to those countries that are (...) close to legislating their respective laws. Finally, a brief section will be devoted to analyzing how the ruling of the Portuguese Constitutional Court, issued after the preceding sections of this article were written and relating to the Portuguese law on assisted dying, will influence the final configuration of that law. (shrink)

Colombia was one of the first countries to decriminalise euthanasia. However, what is known in the international academic literature about the country's regulations is scarce and outdated. Such lack of information on the situation in Latin America is even more evident in the case of Peru, where the Lima Superior Court of Justice set a precedent by allowing a person to have access to euthanasia in 2021. Ecuador, which has just decriminalised euthanasia for all its citizens in February 2024, risks (...) being similarly absent from the international dialogue. This article summarises for the first time all the regulations in force regarding euthanasia in Latin America, through a study of primary sources in Spanish, and analyses some of the convergences between these three neighbouring countries. (shrink)

On 18 March 2021, the Spanish Congress of Deputies gave definitive approval to the Organic Law on the Regulation of Euthanasia (LORE) with 202 votes in favour, 141 against, and two abstentions. This new legal provision, which entered into force on 25 June 2021, made Spain the seventh jurisdiction in the world to decriminalise and regulate both euthanasia and medically assisted suicide. On a previous occasion, we had the opportunity to compare in this journal the quantitative data from the first (...) months of euthanasia implementation in Spain with figures from Canada and New Zealand. After three years of the practice being implemented in Spain, we are now in a position to begin assessing the country's progress over time. In addition, during this period, various situations—some of which have not been strictly medical in nature—have influenced the functioning of the euthanasia system. It is therefore timely to provide an overview that not only updates the available national data but also examines the factors that have shaped its implementation and the challenges that remain. In this article, drawing on official annual reports, court rulings, and academic and journalistic sources, we analyse the key data, controversies and challenges surrounding the implementation of the law in Spain. (shrink)

The expressivist objection argues against the legalisation of euthanasia and/or assisted suicide (EAS), on the grounds that EAS laws express a disrespectful judgement of certain classes of people: roughly, that they are better off dead. Recently, some ethicists have argued that laws which require only an informed, competent and voluntary request for EAS would avoid the expressivist objection, since that objection depends on the further requirement of irremediable suffering. In this paper, I argue that—for better or for worse—this response fails (...) to address the expressivist objection. This is because reasoning parallel to the original expressivist objection demonstrates that even EAS laws with an informed, competent and voluntary request as the sole requirement express a disrespectful judgement: that it is reasonable to believe that certain classes of people are better off dead. Objections to this argument depend largely on a conception of autonomy which minimises the role of motivations—specifically, motivations which we ought to recognise as reasonable. Although this conception is supported by some bioethicists, it faces challenges of its own. Until those challenges are addressed, therefore, an appeal to less demanding EAS laws does not by itself avoid the expressivist objection. (shrink)

Almost a year after the enactment of the law regulating euthanasia in Spain, public opinion was shocked to learn that a defendant in criminal proceedings obtained medical assistance in dying following injuries sustained in an exchange of gunfire with the police after having committed a series of severe crimes. Although there are very few cases in the world where prisoners have received euthanasia, the one we will discuss in this article is the only known case where both the public prosecutor's (...) office and the private prosecutors judicially opposed the defendant's euthanasia. This article aims to offer a new perspective on the ethical legitimacy of detainees' access to euthanasia: the ethics of caring solidarity. To do this, we will first place the case in its legal context. Subsequently, we will address the two main arguments proposed in the literature to justify euthanasia in detention: respect for the autonomy of the detainee and the principle of equivalence of care. Finally, after having identified serious shortcomings in both arguments, we will argue that the perspective of caring solidarity offers a better ethical basis for people in detention's access to euthanasia. (shrink)

Slippery slope argumentation features prominently in debates over assisted suicide. The jurisdiction of Oregon features prominently too, especially as regards parliamentary scrutiny of assisted suicide proposals. This paper examines Oregon’s public data (including certain official pronouncements) on assisted suicide in light of the two basic versions of the slippery slope argument, the empirical and moral-logical versions. Oregon’s data evidences some normatively interesting shifts in its assisted suicide practice which in turn prompts consideration of two elements of moral-logical slippage that are (...) not widely discussed. One is slippage from an initial autonomy-based public justification for assisted suicide which does not include burden-based concerns within its operative account of voluntariness to an evolved public justification that does. The other is an expansion of a terminal illness ground to include chronic illnesses effectively rendered terminal via a refusal of treatment. (shrink)

At the time of writing, a British Member of Parliament has just been suspended from his Party for posting a Tweet in which he compared the level of serious adverse events after vaccination for COVI...

This book is a scholarly synthesis of the current state-of-play in ethics, with a focus on normative and applied ethics. Kahn asks readers to consider even the most contentious of topics like abortion, capital punishment, and euthanasia, from their most basic questions.

This chapter first presents two arguments for the permissibility of physician-assisted suicide (PAS) and euthanasia (E) to eliminate physical suffering. I then present a third argument for PAS and E on grounds other than eliminating suffering. The chapter next considers several objections to these arguments that might be raised by Neil Gorsuch, now a US Supreme Court Justice. In the course of this I present a fourth argument for PAS and E. (I assume throughout that a patient’s free and informed (...) consent is required and present.). (shrink)

Der Artikel beantwortet die Frage nach der ethischen Bewertung des assistierten Suizids auf neue Weise, indem er die Verneinung von Lebenssinn, wie sie sich in Suiziden ausspricht, in den Mittelpunkt rückt. Anders als üblich fasst er die Sinnfrage nicht als bloß individualethische, sondern als sozialethische Angelegenheit auf. Denn der unvermeidbaren menschlichen Orientierung am Ziel eines sinnvollen Lebens ist eine grundlegende soziale Verbindung eingeschrieben: eine implizite Wertschätzung von Menschen als potentiellen Sinnquellen und als Subjekten von Urteilen über Lebenssinn. Suizide neigen dazu, (...) diese Verbindung zu negieren. Dieses Verständnis des Suizids kann eine Reihe von evaluativen und normativen Annahmen aufklären und begründen, die in der Debatte um den assistierten Suizid eine prominente Rolle spielen. (shrink)

Bioethical issues are practically urgent, politically divisive, and call for resolutions. They often involve questions that are perplexing, deep, and profound. To deal with them adequately requires philosophical tools and imagination. The Lanson Lectures in Bioethics were founded upon the belief that philosophical elucidation can clarify the nature of these difficult issues, and can lead to their resolution. The present volume collects the first five lectures delivered by five preeminent moral philosophers between 2016 and 2022. In the inaugural lecture, Jonathan (...) Glover draws a distinction between two conceptions of dignity, and brings it to bear on the issues of assisted suicide, embryo research, and genetic choices. F. M. Kamm argues that doctors are morally permitted to intentionally cause death, or assist in its being intentionally caused, when either death is imminent anyway and intentionally causing it can alone stop the pain, or if the patient has already decided—not unreasonably—that death is his least bad option. Are smokers who contract lung cancer entitled to state-supported healthcare? T. M. Scanlon argues that the reasons that individuals have for wanting to have the opportunity to engage in activities involving risks need to be compared with the costs society has to bear to provide healthcare for those who suffer illness or injury as a result of these activities. Rejecting Strawson’s view that a psychiatrist can only “treat” an insane patient, Victor Tadros argues that it is often right to reason with (nonresponsible) mentally ill persons because a psychiatrist needs to see things from their perspectives, and that we should communicate to nonresponsible agents that their wrongdoing is a problem for them and for their victims. Peter Singer proposes solutions to the following questions: How to distribute scarce medical resources and vaccines ethically? Whether to relax the standard for volunteers willing to participate in vaccines research? How to compare the trade-off between saving lives and saving the economy regarding lockdowns? How to prevent pandemics in future? Each lecture is followed by a critical commentary by a moral philosophers or physician in Asia. Each commentary (except the inaugural lecture) is followed by a rejoinder. (shrink)

The controversy over the equivalence of continuous sedation until death (CSD) and physician-assisted suicide/euthanasia (PAS/E) provides an opportunity to focus on a significant extended use of CSD. This extension, suggested by the equivalence of PAS/E and CSD, is designed to promote additional patient autonomy at the end-of-life. Samuel LiPuma, in his article, “Continuous Sedation Until Death as Physician-Assisted Suicide/Euthanasia: A Conceptual Analysis” claims equivalence between CSD and death; his paper is seminal in the equivalency debate. Critics contend that sedation follows (...) proportionality protocols for which LiPuma’s thesis does not adequately account. Furthermore, sedation may not eliminate consciousness, and as such LiPuma’s contention that CSD is equivalent to neocortical death is suspect. We not only defend the equivalence thesis, but also expand it to include additional moral considerations. First, we explain the equivalence thesis. This is followed by a defense of the thesis against five criticisms. The third section critiques the current use of CSD. Finally, we offer two proposals that, if adopted, would broaden the use of PAS/E and CSD and thereby expand options at the end-of-life. (shrink)

In their stimulating article, “What do psychiatrists think about caring for patients who have extremely treatment-refractory illness?,” Dorfman et al. (2024) survey 212 U.S. psychiatrists to gauge...

BackgroundRelatives have no formal position in the practice of euthanasia and physician-assisted suicide (EAS) according to Dutch legislation. However, research shows that physicians often involve relatives in EAS decision-making. It remains unclear why physicians do (not) want to involve relatives. Therefore, we examined how many physicians in the Netherlands involve relatives in EAS decision-making and explored reasons for (not) involving relatives and what involvement entails.MethodsIn a mixed-methods study, 746 physicians (33% response rate) completed a questionnaire, and 20 were interviewed. The (...) questionnaire included two statements on relatives’ involvement in EAS decision-making. Descriptive statistics were used, and multivariable logistic regression analyses to explore characteristics associated with involving relatives. In subsequent interviews, we explored physicians’ views on involving relatives in EAS decision-making. Interviews were thematically analysed.ResultsThe majority of physicians want to know relatives’ opinions about an EAS request (80%); a smaller group also takes these opinions into account in EAS decision-making (35%). Physicians who had ever received an explicit EAS request were more likely to want to know opinions and clinical specialists and elderly care physicians were more likely to take these opinions into account. In interviews, physicians mentioned several reasons for involving relatives: e.g. to give relatives space and help them in their acceptance, to tailor support, to be able to perform EAS in harmony, and to mediate in case of conflicting views. Furthermore, physicians explained that relatives’ opinions can influence the decision-making process but cannot be a decisive factor. If relatives oppose the EAS request, physicians find the process more difficult and try to mediate between patients and relatives by investigating relatives’ objections and providing appropriate information. Reasons for not taking relatives’ opinions into account include not wanting to undermine patient autonomy and protecting relatives from a potential burdensome decision.ConclusionsAlthough physicians know that relatives have no formal role, involving relatives in EAS decision-making is common practice in the Netherlands. Physicians consider this important as relatives need to continue with their lives and may need bereavement support. Additionally, physicians want to perform EAS in harmony with everyone involved. However, relatives’ opinions are not decisive. (shrink)

Four of the commentaries criticised my claim that assisted suicide for the terminally ill is discriminatory. 1 They were united in this judgement roughly because they insisted that assisted suicide is in fact a benefit and not a harm. I concede that if it is a benefit, then there is no way in which the terminally ill can be disadvantaged by it and hence no way it can be an instance of discrimination. I pointed out in the article that this (...) issue is controversial and could not be settled in my article, nor can it be settled in this brief response. Assisted suicide harms the terminally ill in several ways. First, it harms the people who do not adopt it by forcing them to defend their continued existence. Second, it harms many of the people who adopt it in so far as they are deprived of a life... (shrink)

Although in Italy there is currently no effective law on physician-assisted suicide or euthanasia, Decision No. 242 issued by the Italian Constitutional Court on September 25, 2019 established that an individual who, under specific circumstances, has facilitated the implementation of an independent and freely-formed resolve to commit suicide by another individual is exempt from criminal liability. Following this ruling, some citizens have submitted requests for assisted suicide to the public health system, generating a situation of great uncertainty in the application (...) processes. As a matter of fact, shared and defined procedures are lacking as Decision 242/2019 merely added some principles on which the legislature will have to base its future intervention. This paper analyses the advisory role that the Decision attributes to territorial ethics committees with the aim of stimulating discussions on their role in oversight mechanisms. The proposed conclusion is that the envisaged role does not appear consistent with the functions of these bodies and is ultimately substantially undefined and unjustified. (shrink)

One of the common domains in health care in which the concept of vulnerability is used is end-of-life care, including euthanasia and assisted suicide (EAS). Since different uses and implications of the notion have been recognised in the literature on EAS, this paper aims to analyse them and reflect on who is the most vulnerable in the context of EAS. A prior exploratory review of the literature has served as a starting point for the discussion. We concluded that vulnerability is (...) a complex, multi-perspective and multi-layered concept, which implies the vulnerability of different stakeholders involved in EAS practices and vulnerability in different aspects of being human (i.e., physical, mental, moral, social and spiritual). A comprehensive understanding of the notion of vulnerability, which balances as well as complements the concept of autonomy, seems to be an indispensable element of the discourse on EAS. (shrink)

In response to Professor Kamm’s paper, I argue that, when properly used with the intention to relieve pain, there is NO situation where the use of morphine will cause the death of the patient with certainty. The use of morphine is guided by professional codes and the law. One cannot simply claim that morphine is given with an intention to relieve pain, but then gives a lethal dose. Regarding “letting die”, I argue that the nature and implications of an overt (...) intention “not to force treatment” have important differences from those of an overt intention “to help the patient die”. One important difference is going down the slippery slope with the latter intention. I conclude that neither the permissibility of “using morphine to relieve pain” nor the permissibility of “not forcing treatment” lead to permissibility of physician-assisted suicide (PAS). In these issues, the overt intention matters. The justification for PAS has to depend on other arguments. (shrink)

The Netherlands was the first country to legalize euthanasia and physician-assisted suicide. This paper offers a first legal perspective on the prospects of using AI in the Dutch practice of euthanasia and physician-assisted suicide. It responds to the Regional Euthanasia Review Committees’ interest in exploring technological solutions to improve current procedures. The specific characteristics of AI – the capability to process enormous amounts of data in a short amount of time and generate new insights in individual cases – may for (...) example alleviate the increased workload of review committees due to the continuous increase of euthanasia cases. The paper considers three broad categories for the use of AI in the Dutch euthanasia practice: (1) the physician’s assessment of euthanasia requests, (2) the actual execution of euthanasia, and (3) the retrospective reviews of cases by the Regional Euthanasia Review Committees. Exploring the legal considerations around each avenue, both in the EU AI Act and the Dutch legal framework, this paper aims to facilitate the societal discussion on the role of technology in such deeply human decisions. This debate is equally relevant to other countries that legalized euthanasia (e.g. Belgium and Canada) or physician-assisted suicide (e.g. Switzerland and numerous states in the US). (shrink)

Since at least the advent of Jack Kevorkian’s “suicide machine” the major argument against adopting physician-assisted suicide laws has been that they will lead us down a slippery slope to state-sa...

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

According to the “discrimination argument,” it would be discriminatory and hence impermissible to categorically exclude people with mental illness (PMI) from access to assisted suicide (AS) if AS is accessible to people with somatic illnesses. In objection to this, it could be argued that excluding PMI is not discriminatory, but rather based on their inability to meet certain eligibility criteria for AS. Which criteria are deemed necessary depends on the approach taken to justifying AS. In this article, we describe two (...) distinct ethical approaches to justifying AS and the eligibility criteria they entail and examine whether PMI can fulfill these criteria. A widespread “joint” approach based on beneficence and autonomy assumes that AS is justified when it alleviates the severe and irremediable suffering of a person who autonomously requests AS. An alternative, exclusively autonomy‐based approach assumes that providing AS is justified when a person's request is autonomous, regardless of whether AS is in her best interests. The latter approach underlies an important judgment of the German Federal Constitutional Court from 2020. We argue that PMI can in principle fulfill both beneficence‐ and autonomy‐based eligibility criteria for AS, and that a blanket exclusion of all PMI from AS is thus discriminatory on either approach. However, depending on which approach is taken, there are differences regarding the subgroups of PMI that would be eligible for AS. Whether the exclusion of specific PMI is discriminatory therefore depends on how we understand and justify AS. (shrink)

This book provides novel perspectives on ethical justifiability of assisted dying in the revised edition of New Directions in the Ethics of Assisted Suicide and Euthanasia. Going significantly beyond traditional debates about the value of human life, the ethical significance of individual autonomy, the compatibility of assisted dying with the ethical obligations of medical professionals, and questions surrounding intention and causation, this book promises to shift the terrain of the ethical debates about assisted dying. The novel themes discussed in the (...) revised edition include the role of markets, disability, gender, artificial intelligence, medical futility, race, and transhumanism. Ideal for advanced courses in bioethics and healthcare ethics, the book illustrates how social and technological developments will shape debates about assisted dying in the years to come. (shrink)

The idea of commercial‐assisted suicide lives a marginal existence in the bioethical literature, despite its significant presence in popular culture. The practice of commercial‐assisted suicide (CAS) is defined as suicide assistance performed for a financial reward through a contractual agreement between a customer and a service‐provider, who does not necessarily need to be a medical professional. While CAS does indeed offer some potential solutions regarding the moral controversies surrounding physician‐assisted suicide (PAS), I defend the idea that adopting it as policy (...) ultimately proves morally indefensible and practically inefficient. This is due to the fact that the commodification of a given good necessarily implies the creation of a market of said good; as such, what I propose in this paper is a moral and practical evaluation of a market of CAS. In order to do so, I first examine the arguments in favor of CAS as put forward by Roland Kipke, who argues that any liberal defense of PAS necessarily implies a defense of CAS. In the first section, I argue against this idea using the liberal values of autonomy and equality of opportunity. In the second section of the paper, I argue that a market of CAS would be gravely dysfunctional due to one particular characteristic of death, namely, that is not compensable ex post. I conclude by arguing that while the practice of CAS may not prove morally problematic, the inevitable market that it will create should it be legalized most certainly will. (shrink)