19. Medical Assistance in Dying

2019 ◽  
pp. 615-665
Author(s):  
G. T. Laurie ◽  
S. H. E. Harmon ◽  
E. S. Dove
Keyword(s):  
Medical Treatment ◽  
Assisted Suicide ◽  
Double Effect ◽  
Legal Aspects ◽  
Assisted Dying ◽  
Physician Assisted Suicide ◽  
Medical Assistance ◽  
Philosophical Concept ◽  
Medical Assistance In Dying ◽  
The Relationship

This chapter discusses ethical and legal aspects of euthanasia and assisted dying. It first examines the non-voluntary termination of life, covering the relationship between medical treatment and assistance in dying as a matter of failure to treat, and the philosophical concept of ‘double effect’. The chapter then discusses activity and passivity in assisted dying; dying as an expression of patient autonomy; suicide and assisted suicide; physician-assisted suicide; and assisted dying in practice.

scholarly journals Er det at blive gammel tilstrækkelig årsag til dødshjælp?

2020 ◽  
pp. 235-247
Author(s):  
Søren Holm
Keyword(s):  
Mental Illness ◽  
Elderly People ◽  
Assisted Suicide ◽  
The Elderly ◽  
Assisted Dying ◽  
Physician Assisted Suicide ◽  
Wish To Die ◽  
The Right ◽  
The Relationship ◽  
Vulnerable Elderly

A proposal put forth in the Dutch Parliament suggests that anyone over the age of 75 should have a legally guaranteed right to physician-assisted suicide if they wish to die, unless the wish is the result of a mental illness. This chapter discusses three questions about the relationship between age and entitlement to assisted dying: 1) are there good reasons to introduce a purely age-determined criterion for a right to assisted dying; 2) would such an age criterion lead to problematic discrimination against the elderly, or alternatively to discrimination against people who are too young to meet the criterion; and 3) what is the relationship between an age criterion and a postulated duty to choose assisted dying in specific situations. The discussion of these three issues shows that there are no good reasons for introducing an age criterion for the right to die, that an age criterion is potentially discriminatory to both the elderly and the young, and that introducing an age criterion could lead to problematic pressure against vulnerable elderly people.

An Advance Request: The Accessibility of Medical Assistance in Dying (MAID) for Patients Who Loose Decision-Making Capacity

2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Natasha Harris
Keyword(s):  
Decision Making ◽  
Assisted Suicide ◽  
Physician Assisted Suicide ◽  
Medical Assistance ◽  
Waiting Period ◽  
Medical Assistance In Dying ◽  
Decision Making Capacity

Since the legalization of Medical Assistance in Dying (MAID) in Canada in 2016, there have been discussions regarding the extension of this service to patients who lose decision-making capacity but have made a prior advance request for physician-assisted suicide. Both caregivers and physicians have shown some support for allowing patients to make advance requests for MAID. The proposed changes to the legislation would remove the mandatory 10 day waiting period and include a waiver of final consent for those who loose decision-making capacity following their MAID request.

To die, to sleep, perchance to dream? A response to DeMichelis, Shaul and Rapoport

2019 ◽  
Vol 45 (12) ◽  
pp. 832-834 ◽  
Author(s):  
Joel L Gamble ◽  
Nathan K Gamble ◽  
Michal Pruski
Keyword(s):  
Palliative Care ◽  
Medical Ethics ◽  
End Of Life ◽  
Assisted Suicide ◽  
Palliative Sedation ◽  
Physician Assisted Suicide ◽  
Medical Assistance ◽  
End Of Life Decisions ◽  
Medical Assistance In Dying ◽  
Life Decisions

In developing their policy on paediatric medical assistance in dying (MAID), DeMichelis, Shaul and Rapoport decide to treat euthanasia and physician-assisted suicide as ethically and practically equivalent to other end-of-life interventions, particularly palliative sedation and withdrawal of care (WOC). We highlight several flaws in the authors’ reasoning. Their argument depends on too cursory a dismissal of intention, which remains fundamental to medical ethics and law. Furthermore, they have not fairly presented the ethical analyses justifying other end-of-life decisions, analyses and decisions that were generally accepted long before MAID was legal or considered ethical. Forgetting or misunderstanding the analyses would naturally lead one to think MAID and other end-of-life decisions are morally equivalent. Yet as we recall these well-developed analyses, it becomes clear that approving of some forms of sedation and WOC does not commit one to MAID. Paediatric patients and their families can rationally and coherently reject MAID while choosing palliative care and WOC. Finally, the authors do not substantiate their claim that MAID is like palliative care in that it alleviates suffering. It is thus unreasonable to use this supposition as a warrant for their proposed policy.

scholarly journals The Doctor–Patient Relationship: Does Christianity Make a Difference?

2021 ◽  
Vol 27 (1) ◽  
pp. 1-13
Author(s):  
James J Delaney
Keyword(s):  
Assisted Suicide ◽  
Clinical Encounter ◽  
Patient Relationship ◽  
Physician Assisted Suicide ◽  
Doctor Patient Relationship ◽  
Moral Tradition ◽  
Practice Of Medicine ◽  
Christian Understanding ◽  
The Relationship ◽  
Perinatal Hospice

Abstract The nature of the doctor–patient relationship is central to the practice of medicine and thus to bioethics. The American Medical Association (in AMA principles of medical ethics, available at: https://www.ama-assn.org/delivering-care/ethics/patient-physician-relationships, 2016) states, “The practice of medicine, and its embodiment in the clinical encounter between a patient and a physician, is fundamentally a moral activity that arises from the imperative to care for patients and to alleviate suffering.” In this issue of Christian Bioethics, leading scholars consider what relevance (if any) Christianity brings to the relationship between physician and patient: does Christianity make a difference? The contributors consider this question from several different perspectives: the proper model of medicine, the role that the Christian moral tradition can play in medicine in a secular pluralistic society, how a Christian understanding of virtue can inform practices such as perinatal hospice and physician-assisted suicide, and whether or not appeals to Christian values can (or should) ground a physician’s right to conscientious objection.

Some Choice: Law, Medicine, and the Market (1998) by George J. Annas. New York, N.Y.: Oxford University Press, 1998. 320 pp. $29.95

2000 ◽  
Vol 9 (2) ◽  
pp. 288-291
Author(s):  
Norman L. Cantor
Keyword(s):  
New York ◽  
New England ◽  
Assisted Suicide ◽  
Healthcare Providers ◽  
Legal Aspects ◽  
Physician Assisted Suicide ◽  
Critical Function ◽  
Presidential Candidates ◽  
Medical Experiments ◽  
Cigarette Advertising

George Annas serves a critical function as an incisive commentator on the interactions between law and medicine and law and public health. Along with Alex Capron, Dena Davis, Rebecca Dresser, and Larry Gostin—to pinpoint a few—Professor Annas analyses legal aspects of a spectrum of medicolegal issues both in a forum and in a manner that makes them accessible and understandable to a broad community of healthcare providers. His latest book, Some Choice, continues that valuable tradition. The bulk of the volume (17 out of 22 chapters) is drawn from essays originally published as the “Legal Issues in Medicine” feature of the New England Journal of Medicine. The topics include such staples of patients' rights debate as the boundaries of informed consent, authorization of medical experiments, and physician-assisted suicide. A treat is the inclusion of less frequently covered issues, such as access to health information concerning presidential candidates and constitutional bounds of limits on cigarette advertising.

Physician-Assisted Suicide: Where to Draw the Line?

2000 ◽  
Vol 9 (3) ◽  
pp. 407-410 ◽  
Author(s):  
ERNLÉ W.D. YOUNG
Keyword(s):  
Public Policy ◽  
Assisted Suicide ◽  
Assisted Dying ◽  
Physician Assisted Suicide ◽  
Assisted Death ◽  
Policy Issues ◽  
Moral Distinction ◽  
Physician Assisted Dying ◽  
Hippocratic Tradition

In brief compass, I will touch on three of the central ethical and public policy issues that divide those who are opposed to physician-assisted dying from those who are supportive of this practice. These are: (1) the moral distinction (if any) between actively hastening death and passively allowing to die; (2) how to interpret the Hippocratic tradition in medicine with respect to physician-assisted death; and (3) whether physician-assisted suicide can be effectively regulated. I shall summarize the arguments pro and con with respect to each issue, and also indicate my own position.

scholarly journals En kritisk granskning av Oregonmodellen

2020 ◽  
pp. 275-290
Author(s):  
Anne-Berit Ekström ◽  
Mikaela Luthman
Keyword(s):  
Assisted Suicide ◽  
Nordic Countries ◽  
Suitable Model ◽  
Assisted Dying ◽  
Physician Assisted Suicide ◽  
Last Stage ◽  
Safe Model

The so-called Oregon model has been described as a more attractive and safer alternative for assisted dying than the controversial euthanasia laws in the Benelux countries. Many advocates of assisted dying believe that the Oregon model, which implies physician-assisted suicide, is better adapted to Swedish (Nordic) conditions. In order to be able to offer assisted dying according to the Oregon model, seven criteria must be met. In this chapter, we will analyse the criteria and examine whether the practices of the Oregon model meet them. Is it a safe model to help severely ill people from suffering during their very last stage of life? To what extent can the model guarantee security and justice for those involved? Finally, we want to investigate whether it can be a suitable model for the Nordic countries.

scholarly journals How does Medical Assistance in Dying affect end-of-life care planning discussions? Experiences of Canadian multidisciplinary palliative care providers

2021 ◽  
Vol 15 ◽  
pp. 263235242110459
Author(s):  
Anita Ho ◽  
Joshua S. Norman ◽  
Soodabeh Joolaee ◽  
Kristie Serota ◽  
Louise Twells ◽  
...  
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Assisted Dying ◽  
Life Care ◽  
Care Providers ◽  
Specialist Palliative Care ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Qualitative Thematic Analysis

Background: More than a dozen countries have now legalized some form of assisted dying, and additional jurisdictions are considering similar legislations or expanding eligibility criteria. Despite the persistent controversies about the relationship between medicine, palliative care, and assisted dying, many people are interested in assisted dying. Understanding how end-of-life care discussions between patients and specialist palliative care providers may be affected by such legislation can inform end-of-life care delivery in the evolving socio-cultural and legal environment. Aim: To explore how the Canadian Medical Assistance in Dying legislation affects end-of-life care discussions between patients and multidisciplinary specialist palliative care providers. Design: Qualitative thematic analysis of semi-structured interviews. Participants: Forty-eight specialist palliative care providers from Vancouver (n = 26) and Toronto ( n = 22) were interviewed in person or by phone. Participants included physicians ( n = 22), nurses ( n = 15), social workers ( n = 7), and allied health professionals ( n = 4). Results: Qualitative thematic analysis identified five notable considerations associated with Medical Assistance in Dying affecting end-of-life care discussions: (1) concerns over having proactive conversations about the desire to hasten death, (2) uncertainties regarding wish-to-die statements, (3) conversation complexities around procedural matters, (4) shifting discussions about suffering and quality of life, and (5) the need and challenges of promoting open-ended discussions. Conclusion: Medical Assistance in Dying challenges end-of-life care discussions and requires education and support for all concerned to enable compassionate health professional communication. It remains essential to address psychosocial and existential suffering in medicine, but also to provide timely palliative care to ensure suffering is addressed before it is deemed irremediable. Hence, clarification is required regarding assisted dying as an intervention of last resort. Furthermore, professional and institutional guidance needs to better support palliative care providers in maintaining their holistic standard of care.

Is Death Taboo for Older Chinese Immigrants?

2020 ◽  
pp. 003022282092788 ◽  
Author(s):  
Weiguo Zhang
Keyword(s):  
Focus Groups ◽  
Medical Treatment ◽  
End Of Life Care ◽  
Chinese Immigrants ◽  
Chinese Immigrant ◽  
Life Care ◽  
Medical Assistance ◽  
Medical Assistance In Dying ◽  
Greater Toronto Area ◽  
Older Chinese

Much of the scholarly literature sees death as a taboo topic for Chinese. To test this assumption, this study held seven focus groups in the Greater Toronto Area in 2017. It found that the majority of the older Chinese immigrant participants talked about death freely using either the word death or a euphemism. They talked about various issues including medical treatment and end-of-life care, medical assistance in dying, death preparation, and so on. A small number did not talk about death, but it seemed their reluctance was related to anxiety or discomfort or simply reflected a choice of words. The study concludes death as taboo could be a myth, at least for older Chinese immigrants.

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