Assisted suicide Archives - Page 6 of 11 - Protection of Conscience Project Library

Aid-in-dying laws and the physician’s duty to inform

Mara Buchbinder

Abstract
On 19 July 2016, three medical organisations filed a federal lawsuit against representatives from several Vermont agencies over the Patient Choice and Control at End of Life Act. The law is similar to aid-in-dying (AID) laws in four other US states, but the lawsuit hinges on a distinctive aspect of Vermont’s law pertaining to patients’ rights to information. The lawsuit raises questions about whether, and under what circumstances, there is an ethical obligation to inform terminally ill patients about AID as an end-of-life option. Much of the literature on clinical communication about AID addresses how physicians should respond to patient requests for assisted dying, but neglects the question of how physicians should approach patients who may not know enough about AID to request it. In this article, I examine the possibility of an affirmative duty to inform terminally ill patients about AID in light of ethical concerns about professional responsibilities to patients and the maintenance of the patient–provider relationship. I suggest that we should not take for granted that communication about AID ought to be patient-initiated, and that there may be circumstances in which physicians have good reasons to introduce the topic themselves. By identifying ethical considerations that ought to inform such discussions, I aim to set an agenda for future bioethical research that adopts a broader perspective on clinical communication about AID.

Buchbinder M. Aid-in-dying laws and the physician’s duty to inform. J Med Ethics. 2016;43(10):1-4.

Conscientious Objection and Medical Assistance in Dying (MAID) in Canada: Difficult Questions – Insufficient Answers

PG Brindley, JP Kerrie

Canadian Journal of General Internal Medicine

Abstract
“Conscientious objection” typically implies refusal to participate in an action based on strongly held ethical beliefs. It is historically associated with refusing to fight on the grounds of personal conscience or religion.2 Like other military allusions such as collateral damage or life in the trenches, its usage has spread into wider societal use. Conscientious objection is now used in regards to opposing euthanasia in Canada. Euthanasia, in turn, is now referred to by the less emotive term, Medical Assistance in Dying (MAID). Most medical practitioners and hospitals that object do so in part because of their disagreement or discomfort with the act of killing. As such, the analogy is not wholly unjustified. What is less clear is how this construct, and this terminology, will ultimately affect patients, practitioners, administrators and politicians.

Brindley PG, Kerrie JP. Conscientious Objection and Medical Assistance in Dying (MAID) in Canada: Difficult Questions – Insufficient Answers. Canadian Journal of General Internal Medicine. 2016;11(4):7-10.

Euthanizing People Who Are ‘Tired of Life’ in Belgium

Raphael Cohen-Almagor, David Albert Jones, Chris Gastmans, Calum Mackellar

Euthanasia and Assisted Suicide: Lessons from Belgium

Abstract
In Belgium and in The Netherlands, a debate is developing about people who express a desire to end their lives although they do not suffer from an incurable, life-threatening disease. In 2000, a court in Haarlem in The Netherlands considered the case of 86-year-old Edward Brongersma who had expressed his wish to die to his general practitioner, Dr Philip Sutorius, claiming that death had ‘forgotten’ him, his friends and relatives were dead, and he experienced ‘a pointless and empty existence’. After repeated requests, Dr Sutorius euthanized his insisting patient and was then put on trial. The public prosecution recognized that Dr Sutorius fulfilled all the legal criteria but one: ‘hopeless and unbearable suffering.’ Therefore, the patient’s request should have been refused. The court did not discipline Dr Sutorius, saying that the patient was obsessed with his ‘physical decline’ and ‘hopeless existence’ and therefore was suffering ‘hopelessly and unbearably’. A spokesman for the Royal Dutch Medical Association reacted to the court judgment by saying that the definition of ‘unbearable suffering’ had been stretched too far and that ‘what is new is that it goes beyond physical or psychiatric illness to include social decline’. The then Justice Minister Benk Korthals said that being ‘tired of life’ is not sufficient reason for euthanasia. Since then, the debate as to whether physicians should comply with euthanasia requests of people who are ‘tired of life’ has been widened and many people in Belgium and in The Netherlands are calling for the law to be expanded in order to include similar patients. The methodology of this research is based on a critical review of the literature supplemented by communications with leading scholars and practitioners. First, concerns are raised about euthanizing people who say that they are ‘tired of life’. Some suggestions designed to improve the situation are offered. The Belgian legislators and medical establishment are invited to reflect and ponder so as to prevent potential abuse.

Cohen-Almagor R, Jones DA, Gastmans C, Mackellar C. Euthanizing People Who Are ‘Tired of Life’ in Belgium. In: Jones DA, Gastmans C, MacKellar C, editors. Euthanasia and Assisted Suicide: Lessons from Belgium. 2017;188-201. Available from: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3052105

Assisted Dying Bill for England and Wales

Raphael Cohen-Almagor

Euthanasia and Assisted Suicide: Global Views on Choosing to End Life

Abstract
This paper is aimed to suggest an improved set of guidelines for physician-assisted suicide. Thus it is very practical, based on 25 years of research in eight countries and it does not expand on the underpinning theoretical basis for the guidelines. I have been an advocate of physician-assisted suicide and explained the reasoning elsewhere, primarily in The Right to Die with Dignity and Euthanasia in the Netherlands. I support the idea that patients should be able to decide the time of their death with the help and support of the medical profession. People have human dignity. At the end of their lives, the medical profession should respect their wishes and help them to the best of their abilities. By ‘dignity’ it is meant worthiness, merit. The Oxford English Dictionary defines it as “the state or quality of being worthy of honour or respect”. Kant explained that human beings are end in themselves and that for something to be an end in itself, “it doesn’t have mere relative value (a price) but has intrinsic value (i.e. dignity)”. He further elucidated that autonomy is the basis for the dignity of human nature and of every rational nature. Kant calls dignity an unconditional and incomparable worth that admits of no equivalent. All rational creatures have it, by virtue of their reason, and dignity constrains the ways in which we can legitimately interact. In a similar fashion, Dworkin asserted that individuals have a right to dignity because they are human. I argue that dignity is both objective and subjective concept. It is socially constructed and made up of values and feelings that one feels about oneself, about one’s self-worth and respect. It is further argued that legislation of physician-assisted suicide is a matter of moral necessity and political expediency.

Cohen-Almagor R. Assisted Dying Bill for England and Wales. In: Cholbia M editors. Euthanasia and Assisted Suicide: Global Views on Choosing to End Life. 2017;29-44.

Doctors Have no Right to Refuse Medical Assistance in Dying, Abortion or Contraception

Julian Savulescu, Udo Schuklenk

Abstract
In an article in this journal, Christopher Cowley argues that we have ‘misunderstood the special nature of medicine, and have misunderstood the motivations of the conscientious objectors’. We have not. It is Cowley who has misunderstood the role of personal values in the profession of medicine. We argue that there should be better protections for patients from doctors’ personal values and there should be more severe restrictions on the right to conscientious objection, particularly in relation to assisted dying. We argue that eligible patients could be guaranteed access to medical services that are subject to conscientious objections by: (1) removing a right to conscientious objection; (2) selecting candidates into relevant medical specialities or general practice who do not have objections; (3) demonopolizing the provision of these services away from the medical profession.

Savulescu J, Schuklenk U. (2016) Doctors Have no Right to Refuse Medical Assistance in Dying, Abortion or Contraception. Bioethics. doi:10.1111/bioe.12288

Beneficent Voluntary Active Euthanasia: A Challenge to Professionals Caring for Terminally Ill Patients

Ann-Marie Begley

Abstract
Euthanasia has once again become headline news in the UK, with the announcement by Dr Michael Irwin, a former medical director of the United Nations, that he has helped at least 50 people to die, including two between February and July 1997. He has been quoted as saying that his ‘conscience is clear’ and that the time has come to confront the issue of euthanasia.

For the purposes of this article, the term ‘beneficent voluntary active euthanasia’ (BVAE) will be used: beneficent from the prima facie principle of beneficence, to do good, and voluntary to indicate that this must be carried out at the request of a competent client. This implies adherence to another prima facie principle, that of respect for autonomy. Active implies that something is done or given with the intention of hastening death. The word euthanasia itself simply means ‘good death’.

This article examines the moral positions of two nurses and one junior doctor towards the subject of BVAE and an attempt is made to represent the main conflicting moral positions. The central arguments against BVAE and counterarguments are presented. The conclusion reached is that consenting adults should not be prevented from availing themselves of BVAE if another consenting adult (a medical doctor) is available and capable of carrying out their wishes. This being the case, it is suggested that BVAE should be available as an option in hospices and in the community.

The aims of this article are: to generate debate among professionals; to present a three-way discussion that might be useful as a focus for educational purposes, particularly at undergraduate level; to challenge professionals to confront the issue of euthanasia; and to plead the case of those who request assistance in exercising autonomy by gaining control over their own deaths.

Begley A-M. Beneficent Voluntary Active Euthanasia: A Challenge to Professionals Caring for Terminally Ill Patients. Nurs Ethics. 1998;5(4):294-306.

Medical Assistance in Dying in Canada: An Ethical Analysis of Conscientious and Religious Objections

Timothy Christie, John Sloan, Dylan Dahlgren, Fred Koning

Abstract
Background: The Supreme Court of Canada (SCC) has ruled that the federal government is required to remove the provisions of the Criminal Code of Canada that prohibit medical assistance in dying (MAID). The SCC has stipulated that individual physicians will not be required to provide MAID should they have a religious or conscientious objection. Therefore, the pending legislative response will have to balance the rights of the patients with the rights of physicians, other health care professionals, and objecting institutions.

Objective: The objective of this paper is to critically assess, within the Canadian context, the moral probity of individual or institutional objections to MAID that are for either religious or conscientious reasons.

Methods: Deontological ethics and the Doctrine of Double Effect.

Results: The religious or conscientious objector has conflicting duties, i.e., a duty to respect the “right to life” (section 7 of the Charter) and a duty to respect the tenets of his or her religious or conscientious beliefs (protected by section 2 of the Charter).

Conclusion: The discussion of religious or conscientious objections to MAID has not explicitly considered the competing duties of the conscientious objector. It has focussed on the fact that a conscientious objection exists and has ignored the normative question of whether the duty to respect one’s conscience or religion supersedes the duty to respect the patient’s right to life.

Christie T, Sloan J, Dahlgren D, Koning F. Medical Assistance in Dying in Canada: An Ethical Analysis of Conscientious and Religious Objections. Bioethique Online. 2016 Aug 17;5(14):1-9.

Medical Assistance in Dying in Canada: An Ethical Analysis of Conscientious and Religious Objections

Dylan Dahlgren, Fred Koning, John Sloan, Timothy Christie

Abstract
Background: The Supreme Court of Canada (SCC) has ruled that the federal government is required to remove the provisions of the Criminal Code of Canada that prohibit medical assistance in dying (MAID). The SCC has stipulated that individual physicians will not be required to provide MAID should they have a religious or conscientious objection. Therefore, the pending legislative response will have to balance the rights of the patients with the rights of physicians, other health care professionals, and objecting institutions.

Methods: Deontological ethics and the Doctrine of Double Effect.

Christie T, Sloan J, Dahlgren D, Konging F. Medical Assistance in Dying in Canada: An Ethical Analysis of Conscientious and Religious Objections. BioéthiqueOnLine, 2016, 5/14

The Limits of Conscientious and Religious Objection to Physician-Assisted Dying after the Supreme Court’s Decision in Carter v. Canada

Amir Attaran

Extract
[The Supreme Court of Canada decision to legalize euthanasia and assisted suicide “is in abeyance until June 2016.”]. . . Trouble is, not many physicians seem willing to assist. . . . overall, it is clear that a majority of Canadian doctors polled refuse to participate in physician assisted dying.

. . . This article argues that whether doctors do or do not have the right to refuse to treat patients on conscientious or religious grounds is neither a difficult nor a novel legal issue. Patients and doctors have clashed on this issue before, and when they have, tribunals and courts have overwhelmingly sided with the patients over the doctors. . .

Attaran A. The Limits of Conscientious and Religious Objectionto Physician-Assisted Dying after the Supreme Court’s Decision in Carter v. Canada. Health Law Can. 2016 Feb;36(3):86-98.

Emerging assault on freedom of conscience

Stephen J. Genuis

Extract
Discussion on physician autonomy at the 2014 and 2015 Canadian Medical Association (CMA) annual meetings highlighted an emerging issue of enormous importance: the contentious matter of freedom of conscience (FOC) within clinical practice. In 2014, a motion was passed by delegates to CMA’s General Council,and affirmed by the Board of Directors, supporting the right of all physicians, within the bounds of existing legislation, to follow their conscience with regard to providing medical aid in dying. The overwhelming sentiment among those in attendance was that physicians should retain the right to choose when it comes to matters of conscience related to end-of-life intervention. Support for doctors refusing to engage in care that clashes with their beliefs was reaffirmed in 2015. However, a registrar from a provincial college of physicians and surgeons is reported to have a differing perspective, stating “Patient rights trump our rights. Patient needs trump our needs.

Genuis SJ. Emerging assault on freedom of conscience. Canadian Family Physician April 2016 vol. 62 no. 4 293-296.