Emotional and Psychological Effects of Physician-Assisted Suicide and Euthanasia On Participating Physicians

Kenneth R Stevens

The Linacre Quarterly
The Linacre Quarterly

Extract
Conclusion

Physician participation in assisted suicide or euthanasia can have a profound harmful effect on the involved physicians. Doctors must take responsibility for causing the patient’s death. There is a huge burden on conscience, tangled emotions and a large psychological toll on the participating physicians. Many physicians describe feelings of isolation. Published evidence indicates that some patients and others are pressuring and intimidating doctors to assist in suicides. Some doctors feel they have no choice but to be involved in assisted suicides. Oregon physicians are decreasingly present at the time of the assisted suicide. There is also great potential for physicians to be affected by countertransference issues in dealing with end-of-Iife care, and assisted suicide and euthanasia..


Stevens KR. Emotional and Psychological Effects of Physician-Assisted Suicide and Euthanasia On Participating Physicians. The Linacre Quarterly. 2006;73(3).

On the impermissibility of euthanasia in Catholic healthcare organizations

Ana S Iltis

Christian Bioethics
Christian Bioethics

Abstract
Roman Catholic healthcare institutions in the United States face a number of threats to the integrity of their missions, including the increasing religious and moral pluralism of society and the financial crisis many organizations face. These organizations in the United States often have fought fervently to avoid being obligated to provide interventions they deem intrinsically immoral, such as abortion. Such institutions no doubt have made numerous accommodations and changes in how they operate in response to the growing pluralism of our society, but they have resisted crossing certain lines and providing particular interventions deemed objectively wrong. Catholic hospitals in Belgium have responded differently to pluralism. In response to a growing diversity of moral views and to the Belgian Act of Euthanasia of 2002, Catholic hospitals in Belgium now engage in euthanasia. This essay examines a defense that has been offered of this practice of euthanasia in Catholic hospitals and argues that it is misguided.


Iltis AS. On the impermissibility of euthanasia in Catholic healthcare organizations. Christ Bioet. 2006;12(3):281-290.

Assisted Suicide & Euthanasia: a Proposal for Restructuring the Criminal Code of Canada

Eike-Henner Kluge

Humanist Perspectives
Humanist Perspectives

Extract
There are other flaws with Bill C-407, but this is not the place to present them in detail. However, there is one serious flaw that is appropriately considered in this forum, and that is the fact that the Bill is a partial measure at best. It deals only with assisted suicide, not euthanasia. It would not help those who, although competent, could not perform the final act themselves because they are disabled. . . .As well, the Bill ignores those who have never been competent and never will be. Their rights would still be less than those of other persons: they would be condemned to suffer when a competent person would not. An appropriately crafted suicide and euthanasia Bill would change that situation.


Kluge E-H. Assisted Suicide & Euthanasia: a Proposal for Restructuring the Criminal Code of Canada. Humanist Perspectives Online Supplement. 2005;38(4):1-5

(Correspondence) The Celestial Fire of Conscience

Oswaldo Castro, Frederic A Lombardo, Victor R Gordeuk

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

Extract
Real medical care and services always respect human
life. No one should be forced to collaborate in abortion (even when it is achieved through the prevention of implantation), lethal research on embryos, euthanasia, or assisted suicide.


Castro O, Lombardo FA, Gordeuk VR. (Correspondence) The Celestial Fire of Conscience. N Engl J Med. 2005 Sep 22;353(12):1301.

(Editorial) The sacred and the secular: the life and death of Terri Schiavo

CMAJ

Canadian Medical Association Journal, CMAJ
Canadian Medical Association Journal

Extract
. . . In medical and legal opinion, Terri Schiavo’s cognizance of her self and her life ended in 1990, when she suffered a cardiac arrhythmia and massive cerebral cortical encephalopathy that left her in a persistent vegetative state. Her facial expressions, along with a seemingly “normal” sleep–wake cycle, constituted but one dimension of the cruelty of this condition. . .

. . .More than one commentator has viewed the “right- to-life” fight to prolong Schiavo’s pitiable existence as an anti-abortion campaign “by other means.” . . .

. . . there seems little doubt that, in North America, ideology and religion have begun to seriously distort the type of consensus-building that is the proper business of democratic politics . . .

Where do physicians find themselves in such debates? Medicine is a secular and scientific profession that, for all that, must still contend with the sacred matters of birth, life and death. In practice, physicians must set aside their own beliefs in deference to the moral autonomy of each patient — or else transfer that patient’s care to someone who can meet this secular ethic. . .

. . .The emotionalism and rancour that swirled around the Schiavo case underscores a wider societal duty borne by the medical and scientific community. This is to remain alert to political and legislative tendencies that impose imprecise moral generalizations on the majority, at the expense of reason, scientific understanding and, not infrequently, compassion.


CMAJ. (Editorial) The sacred and the secular: the life and death of Terri Schiavo. Can. Med. Assoc. J.. 2005 Apr 26;172(9):1151.

Without Conscience

Elie Wiesel

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

Extract
Inspired by Nazi ideology and implemented by its apostles, eugenics and euthanasia in the late 1930s and early 1940s served no social necessity and had no scientific justification. Like a poison, they ultimately contaminated all intellectual activity in Germany. But the doctors were the precursors. How can we explain their betrayal? What made them forget or eclipse the Hippocratic Oath? What gagged their conscience? What happened to their humanity?


Wiesel E. Without Conscience. N Engl J Med.. 2005 Apr 14;352(15):1511-1513.

The Killing of Psychiatric Patients in Nazi-Germany between 1939-1945

Michael Von Cranach

Israeli Journal of Psychiatry and Related Sciences
Israeli Journal of Psychiatry and Related Sciences

Abstract
Between 1939 and 1945, 180,000 psychiatric patients were killed in Nazi Germany. This paper opens with a brief discussion of the reasons for addressing this issue today; it is followed by the details of the so-called euthanasia program that entailed killing of patients by gas in special hospitals in the years 1939-1941, and in psychiatric hospitals in the years 1942-1945. In this latter period, patients were killed with lethal injections and through the introduction of a starvation diet. The fate of the Jewish patients and forced laborers, as well as the experiments conducted on the patients, are mentioned. Finally, some thoughts are presented to answer the question of why this could have happened. To me, the giving up of individual responsibility in an authoritarian system leads to the loss of the individual conscience and soul, including those of a psychiatrist.


Cranach MV. The Killing of Psychiatric Patients in Nazi-Germany between 1939-1945. Israeli J Psych & Related Sciences. 2003;40(1):8-18

A presentation by the same title with a similar abstract was presented at a meeting of the Israel Psychiatric Association, Jerusalem, 6th of December 2001.

Physician-Assisted Suicide and Euthanasia: German Protestantism, Conscience, and the Limits of Purely Ethical Reflection

Peter Bartmann

Christian Bioethics
Christian Bioethics

Abstract
In this essay I shall describe and analyse the current debate on physician assisted suicide in contemporary German Protestant church and theology. It will be shown that the Protestant (mainly Lutheran) Church in Germany together with her Roman Catholic sister church has a specific and influential position in the public discussion: The two churches counting the majority of the population in Germany among their members tend to ‘‘organize” a social and political consensus on end-of-life questions. This cooperation is until now very successful: Speaking with one voice on end-of-life questions, the two churches function as the guardians of a moral consensus which is appreciated even by many non-believers. . .I shall argue that it will be necessary to go beyond this actual controversy to the works of Gerhard Ebeling and Karl Barth for a clear and instructive account of conscience and a theological analysis of the concepts of life and suicide. On the basis of their considerations, a conscience-related approach to physician assisted suicide is developed.


Bartmann P. Physician-Assisted Suicide and Euthanasia: German Protestantism, Conscience, and the Limits of Purely Ethical Reflection. Christ Bioet. 2003;9(3):203-225.

Christian churches and euthanasia in the Low Countries: background, argumentation and commentary

Jans Jans

Ethical Perspectives
Ethical Perspectives

Extract
In this article, I will first describe the argumentative way in which the major Christian churches in the Netherlands and Belgium have dealt with what they considered the challenge of the demand to legalize euthanasia in their respective countries. Given the important differences between the courses of events in both countries, the part on the interventions in the Netherlands will be considerably longer than the one on Belgium. No doubt, the most important reason for this difference is the fact that the public discussion on euthanasia together with efforts to change the penal law prohibiting it, took shape in the Netherlands already from 1968 on. Next to this, the fact that the major Christian churches in the Netherlands were not in agreement on the proper approach also contributes to a more differentiated picture. In the third part of this article, I will present some comments and a moral theological evaluation of the core of the argumentation forwarded by the Christian churches.


Jans Jans. Christian churches and euthanasia in the Low Countries: background, argumentation and commentary. Ethical Perspect 2002;9(2-3) 119-33.

Palliative Care and Euthanasia: Belgian and Dutch Perspectives

Bert Broeckaert, Rien Janssens

Ethical Perspectives
Ethical Perspectives

Extract
In the first part of this article the input of palliative care organisations in the Dutch euthanasia debate is described and explained by situating it in its broader context. First opinions on euthanasia of a variety of palliative care organisations are described. Secondly the Dutch debate on palliative care and euthanasia is analysed and evaluated. In a second part of this article a brief introduction to Belgian palliative care is given. This introduction is followed by an overview of the way organised palliative care has been active in the Belgian euthanasia debate. Attention too is given to the Belgian discussion on palliative sedation, sedation being presented by some as the palliative alternative to euthanasia but seen by others as nothing but euthanasia in disguise


Broeckaert B, Janssens R. Palliative Care and Euthanasia: Belgian and Dutch Perspectives. Ethical Perspectives 9(2-3); 2002 Feb 01, 156-175