Euthanasia

I argue that Joseph Raz’s paper on euthanasia faces a problem of coherence with Joseph Raz’s paper addressing the question of “Why should I be moral?”.

Does each of us have the right to terminate our own existence if we so decide? Can we delegate this task to others? With what methods can we decide these questions? With Michele Carter, John Loughney, and Patrick Sullivan.

Is it possible to donate unpaired vital organs, foreseeing but not intending one’s own death? We argue that this is indeed psychologically possible, and thus far agree with Charles Camosy and Joseph Vukov in their recent paper on “double effect donation.” Where we disagree with these authors is that we see double-effect donation not as a morally praiseworthy act akin to mar- tyrdom but as a morally impermissible act that necessarily disrespects human bodily integrity. Respect for bodily integrity goes beyond (...) avoiding the aim to kill; not all side effects of deliberate bodily interventions can be outweighed by intended benefits for another even if the subject fully consents. It is not any necessary intention to kill or harm another or oneself that makes lethal donation/harvesting illicit but the more immediate intention to accept or perform surgery on an (innocent) person combined with the foresight of lethal harm and no health-related good for him or her. Double-effect donation falls foul of the first condition of double-effect reasoning in that the immediate act is wrong in itself. We argue further that the wider effects of such don- ation would be socially disastrous and corrupting of the medical profession: doctors should retain a sense of nonnegotiable respect for bodily integrity even when they intervene on willing subjects for the benefit of others. (shrink)

Continuous deep sedation at the end of life is a practice that has been the topic of considerable ethical debate, for example surrounding its perceived similarity or dissimilarity with physician-assisted dying...

In opposing the legalization of physician-assisted suicide and voluntary euthanasia, Peter Harrell '02 in his April 3 column claims that the example of the Netherlands — so far the only country in the world where both of these practices take place openly and without fear of prosecution — shows that this would be a dangerous course to follow. But none of the evidence that he offers allows him to draw this conclusion.

This paper approaches the question of whether death is bad through three argumentative axes. First, the symmetry argument: the nothingness before birth and the nothingness after death are essentially the same; to consider birth good while judging death as bad is logically inconsistent. Second, the argument from the origins of resistance: the fear of and resistance to death is learned through witnessing the deaths of others. What the living experience as the badness of death is not a judgment about death (...) itself, but a preemptive encounter with one's own finitude. Third, the echo- in-the-void argument: the act of blaming death has no effect on death itself and serves only to torment the living. Through comparison with Epicurus's deprivation argument, this paper clarifies how these arguments differ from existing accounts and proposes a shift from the metaphysical question of death's badness to the practical question of how the living orient themselves toward it. (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)

Background Euthanasia is a controversial practice in many countries. Since Spain’s Euthanasia Law came into effect on March 24, 2021, healthcare providers have faced a new challenge since they must inform patients, provide care, accompany them, and implement the law. It also represents a new stumbling block at universities, which must adapt to regulatory changes and educate future professionals accordingly. Little is known about the attitude of nursing students in Spain toward euthanasia since this law was implemented. Objective This study (...) aims to answer the following research questions: What is the attitude of nursing students toward euthanasia? What factors influence this attitude? Research design A cross-sectional study was conducted using an online questionnaire. Participants and research context The study population comprised all nursing students at a public university in Barcelona ( n = 444), Spain, during the 2022–2023 academic year. The validated Spanish version of the Euthanasia Attitude Scale was employed. A bivariate analysis was performed. Ethical considerations The university Ethics Committee (CEEAH 6247) approved this study. All participating students signed an informed consent form. Participation was voluntary, and data anonymity and confidentiality were guaranteed. Results Two hundred and forty-four nursing students responded to the questionnaire. The mean total score was 79.64. Participants with religious beliefs presented lower scores, indicating a more negative attitude toward euthanasia. Participants in their second, third, or fourth year of the nursing degree scored higher, demonstrating a more positive attitude. Conclusions The attitude of nursing students toward euthanasia was remarkably positive. Working on ethical content during the degree course and clinical practice are factors that help to develop a more positive attitude. In addition, nursing education should encourage professional aspects to prevail over religious beliefs in euthanasia situations. (shrink)

Part of the "What Do I Do Now: Palliative Care" series, Clinical and Ethical Dilemmas in Palliative and End-of-Life Care bridges the gap between the clear, logical, and harmonious clinical world of textbooks and the chaotic, turbulent, resource-constrained, and often unpredictable world of everyday practice. Each chapter begins with a case and is followed by a diagnosis, explanation of next steps, and rationale for decision-making by experts in the field, mimicking the kind of "curbside consult" that occurs between an experienced (...) clinician and someone new to the field. Tackling dilemmas related to patients, families, healthcare professionals, and the healthcare system, this book comprehensively helps readers learn to apply practical knowledge in challenging circumstances-and often with incomplete information-to achieve clinical competency. The volume is also a self-assessment tool that tests the reader's ability to answer the question, "What do I do now?". (shrink)

There is disagreement among physicians and medical ethicists on the precise goals of Hospice and Palliative Medicine (HPM). Some think that HPM’s goals should differ from those of other branches of medicine and aim primarily at lessening pain, discomfort, and confusion, while others think that HPM’s practices should aim, like all other branches of medicine, at promoting health. I take the latter position: using the ars moriendi to set a standard for what it means to die well, I argue that (...) if HPM’s practices were to aim at mitigating suffering with little regard to promoting health, some patients would die worse deaths than if HPM’s practices were to aim at health. According to the ars moriendi, flourishing at the end of one’s life requires that persons exercise their agency and pursue the goods most important to them. On this view, HPM’s practices should promote patients’ health to enable them to pursue these goods. (shrink)

I identify what appears to be a "glaring" inconsistency between what Joseph Raz says on euthanasia in a 2012 lecture and what he says on well-being within his most celebrated book, The Morality of Freedom. There also appears to be a subtler inconsistency between what he says and his endorsement of H.L.A. Hart’s opposition to a definitional project.

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

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)

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)

An advance request for medical assistance in dying (MAiD) (ARM) is a document that allows individuals to request euthanasia if they lose their decision-making capacity. Currently, it is available in all countries where MAiD is permitted for individuals suffering from a serious and incurable illness whose natural death is not reasonably foreseeable, except in Canada. In this country, various citizen and parliamentary initiatives are considering the inclusion of this document in national legislation. This article presents for the first time a (...) compilation of all ARM regulations worldwide. Analysis of the international framework suggests that the requirements for drafting an ARM could influence the effective implementation of patients' wishes. (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)

Media coverage of euthanasia influences public perception and the configuration of the bioethical debate. This study analyzes how the newspapers Sur and La Opinión de Málaga have addressed euthanasia since the enactment of Organic Law 3/2021 regulating euthanasia in Spain. The objective is to identify the main discursive narratives, their impact on public opinion, and the terminological precision in the use of concepts such as “right to die,” “assisted suicide,” and “dignified death,” among others. A qualitativeinterpretative methodology is used, complemented (...) by quantitative analysis of term frequency in articles published between March 2021 and December 2023. The results show that the newspaper Sur tends to humanize the debate and normalize euthanasia as an individual right; while the newspaper La Opinión de Málaga adopts a more legalistic and neutral approach. It is concluded that both media play a key role in the construction of public discourse on euthanasia, although they present differences in narrative emphasis and terminological precision, which underlines the need for a more rigorous use of language in the media’s treatment of bioethical issues. (shrink)