Abstract Contemporary bioethics generally stipulates that public moral deliberation must avoid allowing religious beliefs to influence or justify health policy and law. Secular premises and arguments are assumed to maintain the neutral, common ground required for moral deliberation in the public square of a pluralistic society. However, a careful examination of non-theistic arguments used to justify euthanasia (regarding contested notions of human dignity, individual autonomy, and death as annihilation) reveals a dependence on metaethical and metaphysical beliefs that are not universally accepted in a pluralistic society. Such beliefs function in non-theistic arguments in the same way that foundational beliefs justify moral convictions in religious frameworks of belief. This parallel is apparent when religious belief is defined broadly (a la John Reeder) as ‘the search for the good in light of the limits and possibilities of the real.’ Seen through this interpretive lens, frameworks comprising Secular foundational commitments function, in ethically relevant respects, like the guiding beliefs found in the comprehensive frameworks of traditional religions. When conscientious practice in healthcare is reconsidered in light of this foundational similarity between the religious and the secular, it is clear that those who object to the foundational beliefs underpinning Secular arguments for euthanasia should not be required to provide, participate in, or refer patients for euthanasia (or other ethically controversial practices similarly dependent on contested frameworks of belief) in pluralistic societies that prize moral freedom as a primary human good.
Ramona Coelho, Trudo Lemmens, K. Sonu Gaind, John Maher
Extract MAiD deaths have increased dramatically year after year in the short time since Canada’s legalization in 2016. MAiD cases in Canada involve almost exclusively euthanasia, with death being administered by the health care provider via lethal injection. Within three years of its introduction in 2016, the death rate by MAiD had risen to 2% of all deaths. By 2020, the rate had increased to 2.5% of all deaths, and by 2021, it was 3.3% of all Canadian deaths, with some provinces approaching 5%. These figures largely represent the escalating death rates even before the government expanded MAiD to those living with disabilities in 2021 . . . In coming years, death rates are thus likely to increase even more substantially as euthanasia and assisted suicide for those not dying but living with disabilities will be more widely provided, as well as once further expansion occurs in March 2023, to those living with sole mental health disorders.
Extract Military medicine is described as the ethical issue of dual loyalty, and how it relates to those health care personnel who are both officers in the military and are medical officers such as doctors and nurses. . . Notably, I wear two hats − one to my country as an officer and one to my patients as their doctor. This clinical role may bring conflict between professional duties to a patient and obligations − expressed or implied, real or perceived, to the interest of a third party such as an employer, an insurer or the state − that can violate patient’s rights. Dual loyalty, in this case, is simultaneous for obligations expressed or implied to a patient and a third party such as the military.
Nnenaya Agochukwu-Mmonu, Asa Radix, A Mark Fendrick
Extract The development of validated patient-centered outcome measures with direct input from the TGNB community is a necessary and critical component of the CED model. Without standardization, findings are frequently not generalizable, and the policy discourse is guided less by rigorous, often inconsistent measures. For example, the studies examining the mental health benefit for patients undergoing gender-affirming surgeries include measures that lack standardization, evaluate different interventions (ie, surgeries are rarely done with concurrent hormone administration), include dissimilar patient populations, and use different study designs. Given this heterogenity, wide variation in reported outcomes is not unexpected; although many studies demonstrate benefit, others report that patients have unrealistic expectations or experience decision regret, including rare reports of reversal surgery.
Abstract Conscientious objection (CO) in medicine is where a healthcare professional (HCP) firmly opposes, with an expression of reasoned disapproval, a legally available procedure or treatment that is proscribed by one’s conscience. While there remains controversy regarding whether conscientious objection should be a part of medicine, even among those who support CO state that if the HCP does not provide the requested service such as abortion, physician assisted suicide, etc., there is an obligation on the part of the objecting HCP to refer to someone who will provide it. However, referral makes the referring HCP complicit in the act the referrer believes to be immoral since the referrer has a duty to know that the HCP who will accept the patient is not only able to do the procedure but is competent in its performance as well. The referrer thus facilitates the process. Since one has a moral obligation to limit complicity with immoral actions when it cannot be avoided, the alternative is to allow the patient to transfer care to another when the patient has made the autonomous decision to reject the advice of the HCP.
Extract Doctors’ views on assisted dying are split, and most doctors’ organisations take no position on the issue; a few—including the BMA—oppose legalisation. Their stance matters: lawmakers and judges regularly seek, and listen to, their views. The BMJ has called for the professions’ representatives to take a position of neutrality—neither in support nor opposition—on the grounds that doctors should not obstruct a decision that is for society and parliament to make.
Engaged neutrality is far from an abdication of responsibility. It honours the diversity in professionals’ opinion. We believe that it also enables organisations to facilitate and fully engage with much needed societal conversations about death and what it means to die well.
Neutral organisations can be closely involved in drafting laws and guidelines, which would be impossible if they opposed their existence. They can lobby for the interests of doctors who do not wish to participate, as well as of doctors who do. . .
Najat Tajaâte, Nathalie van Dijk, Elien Pragt, David Shaw,A. Kempener‑Deguelle, Wim de Jongh, Jan Bollen,Walther van Mook
Background: A patient who fulfils the due diligence requirements for euthanasia, and is medically suitable, is able to donate his organs after euthanasia in Belgium, the Netherlands and Canada. Since 2012, more than 70 patients have undergone this combined procedure in the Netherlands. Even though all patients who undergo euthanasia are suf‑ fering hopelessly and unbearably, some of these patients are nevertheless willing to help others in need of an organ.
Organ donation after euthanasia is a so‑called donation after circulatory death (DCD), Maastricht category III procedure, which takes place following cardiac arrest, comparable to donation after withdrawal of life sustaining therapy in critically ill patients. To minimize the period of organ ischemia, the patient is transported to the operating room immediately after the legally mandated no‑touch period of 5 min following circulatory arrest. This means that the organ donation procedure following euthanasia must take place in the hospital, which appears to be insurmountable to many patients who are willing to donate, since they already spent a lot of time in the hospital.
Case presentation: This article describes the procedure of organ donation after euthanasia starting at home (ODAEH) following anesthesia in a former health care professional suffering from multiple system atrophy. This case is unique for at least two reasons. He spent his last conscious hours surrounded by his family at home, after which he underwent general anaesthesia and was intubated, before being transported to the hospital for euthanasia and organ donation. In addition, the patient explicitly requested the euthanasia to be performed in the preparation room, next to the operating room, in order to limit the period of organ ischemia due to transport time from the intensive care unit to the operating room. The medical, legal and ethical considerations related to this illustrative case are subsequently discussed.
Conclusions: Organ donation after euthanasia is a pure act of altruism. This combined procedure can also be performed after the patient has been anesthetized at home and during transportation to the hospital.
Rapid Response: extract Jocelyn Downie and Udo Schuklenk conclude, first, that the Canadian experience denies the existence of a ‘slippery slope’ expanding medical termination from a limited to a broader medical constituency. Second, they argue a failure to provide social constituents of health and support is a significant factor in the increased requests for ‘medical aide in dying.’ (1) It is hard to credit their conclusions on either point. . . .
. . . As a Canadian long engaged in this debate–legal and social–as well as in the care of those with chronic conditions I thus find their arguments incomplete and their conclusions inaccurate. . .
Because of the difficulties in researching torturers, little is known about how they are recruited, trained, and authorized, and how they morally justify their actions. This study examines oral history testimonies from 14 former torturers in Saddam Hussein’s Iraq. Torturers volunteered for jobs in the security services, and attributed their choice of career to psychologically traumatic childhoods. Torturers were trained to think of their victims as subhuman and dangerous, and to cultivate mercilessness as a type of strength. They carried out torture under direct orders, and two were tortured themselves when they failed to obey. They justified their actions morally by diffusing responsibility, blaming victims, and using just-cause thinking. Overall, the findings show that there is no single path to becoming a torturer, as there is great variation even among torturers from a single country. Much more research is needed to fully understand how torturers think and work.
Extract The New Mexico Senate passed the Elizabeth Whitefield End-of-Life Options Act on March 15 by a vote of twentyfour to seventeen. That vote followed a February vote of thirty-nine to twenty-seven in the lower chamber. Now with the stroke of Governor Michelle Lujan Grisham’s pen, New Mexico has become the ninth state in the United States to enact a physician assisted suicide law. (The practice also is legal in Washington, DC.) The End-of-Life Options Act is incompatible with the moral teachings of Catholicism (along with several other religions). A provider who embraces the Catholic faith will be faced with the following ultimatum: You can either write a prescription for a lethal dose of a sedative or refer the patient to a physician who will then write it, or you can suffer the professional consequences of conscientiously objecting to both of those options. It is clear upon review of the End-of-Life Options Act that it fails to fully protect the conscience rights of providers. . .