Euthanasia Archives - Page 6 of 13 - Protection of Conscience Project Library

Moral Disengagement-Mechanisms Propelling the Euthanasia/PAS Movement

Fabian Stahle

Abstract
The international movement that promotes the legalisation of euthanasia/physician-assisted suicide (PAS) is propelled by highly potent psychological mechanisms to overcome the resistance to its agenda. It is all about cognitive restructuring to justify inhumane actions. These are always in use when normal, well-socialised persons are coerced into accepting and participating in the killing of fellow human beings. Various scientific studies, pioneered by Albert Bandura, have shown that participators are able to endure their deeds by activating these powerful mechanisms of moral disengagement. However, those who make use of such mechanisms pay a high price. These mechanisms have a personality-changing power that dehumanizes the perpetrators. For the society that has allowed itself to be manipulated by such mechanisms for the purpose of systematizing “death on demand”, there are also serious consequences. These consequences can be described in terms of dehumanization and brutalization of that society as a whole.

Stahle F. Moral Disengagement-Mechanisms Propelling the Euthanasia/PAS Movement. J Ethics Ment Health. 2017;10 (1-15)

Medical Assistance in Dying — Implementing a Hospital-Based Program in Canada

Madeline Li, Sarah Watt, Marnie Escaf, Michael Gardam, Ann Heesters, Gerald O’Leary, and Gary Rodin

New England Journal of Medicine, NEJM — New England Journal of Medicine

Extract
After Canada legalized medical assistance in dying (MAiD), the University Health Network in Toronto implemented a hospital-based MAiD program. UHN offers a framework for assessing patients for and providing MAiD while respecting the rights of patients and staff.

Li M, Watt S, Escaf M, Gardam M, Heesters A, O’Leary G, M.B., Rodin G. Medical Assistance in Dying — Implementing a Hospital-Based Program in Canada. N Engl J Med 2017; 376:2082-2088 May 25, 2017 DOI: 10.1056/NEJMms1700606

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

Patient’s Autonomy, Physician’s Convictions and Euthanasia in Belgium

Raphael Cohen-Almagor

Abstract
The aim of this paper is to show the inherent contradiction in the Belgian euthanasia practice. While stressing patient’s autonomy, medical professionals exhibit paternalism in deciding the patient’s fate. First, background information is provided. Then the 2014 Belgian Society of Intensive Care Medicine Council Statement Paper will be considered. Concerns are voiced about euthanizing people who fail to find meaning in their lives, including those who underwent unsuccessful sex-change operation and blind people, euthanizing patients who did not give their consent, and euthanizing people with dementia. Finally, some suggestions designed to improve the situation are offered.

Cohen-Almagor R. Patient’s Autonomy, Physician’s Convictions and Euthanasia in Belgium. Annual Rev Law Ethics. 2016 Dec;24:343-356.

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

Why Are Religious Reasons Dismissed? Euthanasia, Basic Goods, and Gratuitous Evil

Stephen Napier

Abstract
Many proponents of euthanasia eschew appeals to religious premises as good reasons for thinking that human life has intrinsic worth. The reasons offered are that religious reasons do not meet some theory-neutral epistemic standard. My first argument is to show that pro-euthanasia arguments fail to meet those same standards. In order to avoid this incoherence, the rejection of religious reasons is a function of thinking that such reasons are simply false. Arguing against religious belief has typically fallen to the evidential argument from evil. My second argument is to show that the argument from evil must hold to a basic goods account of human life. Such an account is contrary to the view of human life held by most euthanasia proponents. So, euthanasia proponents who reject religious belief on the basis of an argument from evil must hold to a contradictory view of human worth. One cannot both be a euthanasia proponent and reject arguments against euthanasia (that are based in part on religious premises). I explore ways to resolve this tension, but none save pro-euthanasia arguments.

Napier S. Why Are Religious Reasons Dismissed? Euthanasia, Basic Goods, and Gratuitous Evil. Christ Bioeth (2016) 22 (3): 276-300 doi:10.1093/cb/cbw012

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