Ethics in cancer care

2019 ◽  
pp. 159-172
Keyword(s):  
Assisted Suicide ◽  
Ethical Issues ◽  
Ethical Principles ◽  
Assisted Dying ◽  
Physician Assisted Suicide ◽  
The United Kingdom ◽  
Drug Treatments ◽  
Potential Benefits ◽  
The Uk ◽  
The Right

The biomedical ethical principles of autonomy, beneficence, non-maleficence, and justice are well established, though they have been challenged by feminist and nursing ethics. Decision-making in practice requires a balance of not only ethical principles, but also legal and professional frameworks, alongside patient and family wishes. Cancer clinical trials raise ethical issues around the balance between risk and potential benefits to patients, and they may need support making the right decision about whether to participate. The rising cost of cancer drug treatments has raised difficult questions about which drugs should be authorized for use within the United Kingdom (UK)'s National Health Service. End-of-life care raises particularly challenging ethical issues. Mental capacity or competence is defined in law in the UK, and treatment decisions may be made on behalf of patients if they are assessed and found to lack capacity. However, patients and families are encouraged to make advance statements and decisions about treatment in the event of losing capacity. Decisions on whether to give, withdraw, or withhold treatment, artificial hydration and nutrition, and cardiopulmonary resuscitation (CPR) are sensitive, and should be based on assessment, consultation with family, and consideration of ethical, legal, and professional principles. Euthanasia and physician-assisted suicide (assisted dying) are highly contentious issues internationally and illegal in most countries. Some countries allow them under certain circumstances. In response to a patient asking about assisted dying, the nurse should listen to their concerns, be prepared to talk about the process of dying, and support them to establish their priorities.

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.

Empirical research in the debate on physician-assisted suicide and voluntary euthanasia

2007 ◽  
Vol 2 (3) ◽  
pp. 129-132
Author(s):  
Stephen W Smith
Keyword(s):  
Empirical Data ◽  
Assisted Suicide ◽  
Terminally Ill ◽  
Sufficient Evidence ◽  
Voluntary Euthanasia ◽  
Assisted Dying ◽  
Physician Assisted Suicide ◽  
Select Committee ◽  
End Of Life Decisions ◽  
The Uk

This article explores the use of empirical data when considering whether to legalize physician-assisted suicide (PAS) and voluntary euthanasia. In particular, it focuses on the evidence available to the Select Committee for the Assisted Dying for the Terminally Ill Bill on whether or not covert euthanasia is taking place in the UK under the current prohibition of PAS and voluntary euthanasia. The article shows that there is an insufficient evidentiary basis to make any claims about the extent of covert euthanasia within the UK, although there is sufficient evidence to conclude that instances of covert euthanasia do happen. The article also calls for more research to be conducted in order to determine the rate of covert euthanasia in order to inform debate about the legalization of end-of-life decisions such as PAS and voluntary euthanasia.

Physician-Assisted Suicide and Voluntary Euthanasia: is it time the UK law caught up?

1999 ◽  
Vol 6 (2) ◽  
pp. 107-117
Author(s):  
Pauline Griffiths
Keyword(s):  
Assisted Suicide ◽  
Personal Autonomy ◽  
Voluntary Euthanasia ◽  
Physician Assisted Suicide ◽  
Alternative Treatments ◽  
Vulnerable People ◽  
Pain And Suffering ◽  
Open Discussion ◽  
The Uk ◽  
The Right

People who wish to end their lives when they consider that they cannot endure further pain and suffering cannot legally obtain help to produce a peaceful death. The reality of practice seems to be that, covertly, physician-assisted suicide and voluntary euthanasia do take place. The value of personal autonomy in issues of consent has been clarified in the courts in that a competent adult person has the right to refuse or choose alternative treatments even if death will be the outcome. This issue needs open discussion and regulation in order to protect those vulnerable people in our society.

Developments in the practice of physician-assisted dying: perceptions of physicians who had experience with complex cases

2016 ◽  
Vol 44 (5) ◽  
pp. 292-296 ◽  
Author(s):  
Marianne C Snijdewind ◽  
Donald G van Tol ◽  
Bregje D Onwuteaka-Philipsen ◽  
Dick L Willems
Keyword(s):  
The Netherlands ◽  
Assisted Suicide ◽  
Secondary Analysis ◽  
Public Debate ◽  
Complex Case ◽  
Assisted Dying ◽  
Physician Assisted Suicide ◽  
Physician Assisted Dying ◽  
The Right ◽  
The Way

BackgroundSince the enactment of the euthanasia law in the Netherlands, there has been a lively public debate on assisted dying that may influence the way patients talk about euthanasia and physician-assisted suicide (EAS) with their physicians and the way physicians experience the practice of EAS.AimTo show what developments physicians see in practice and how they perceive the influence of the public debate on the practice of EAS.MethodsWe conducted a secondary analysis of in-depth interviews with 28 Dutch physicians who had experience with a complex case of EAS. Respondents were recruited both by the network of physicians working for SCEN (Support and Consultation for Euthanasia in the Netherlands) as well as via a national questionnaire, wherein participating physicians could indicate their willingness to be interviewed.ResultsThree themes came up in analysing the interviews. First, the interviewed physicians experienced a change in what (family of) patients would expect from them: from a role as an involved caregiver to being the mere performer of EAS. Second, interviewees said that requests for EAS based on non-medical reasons came up more frequently and wondered if EAS was the right solution for these requests. Last, respondents had the impression that the standards of EAS are shifting and that the boundaries of the EAS regulation were stretched.ConclusionsThe perceived developments could make physicians less willing to consider a request for EAS. Our results also raise questions about the role of physicians and of EAS in society.

Terminal Sedation: Palliative Care for Intractable Pain, Post Glucksberg and Quill

2003 ◽  
Vol 29 (1) ◽  
pp. 45-76
Author(s):  
Rob McStay
Keyword(s):  
Palliative Care ◽  
Supreme Court ◽  
Assisted Suicide ◽  
Life Support ◽  
Intractable Pain ◽  
Terminal Sedation ◽  
Physician Assisted Suicide ◽  
The Right ◽  
Artificial Life Support ◽  
Unconscious State

In 1997, the U.S. Supreme Court tacitly endorsed terminal sedation as an alternative to physician-assisted suicide, thus intensifying a debate in the legal and medical communities as to the propriety of terminal sedation and setting the stage for a new battleground in the “right to die” controversy. Terminal sedation is the induction of an unconscious state to relieve otherwise intractable distress, and is frequently accompanied by the withdrawal of any life-sustaining intervention, such as hydration and nutrition. This practice is a clinical option of “last resort” when less aggressive palliative care measures have failed. Terminal sedation has also been described as “the compromise in the furor over physician-assisted suicide.”Medical literature suggests that terminal sedation was a palliative care option long before the Supreme Court considered the constitutional implications of physician-assisted suicide. Terminal sedation has been used for three related but distinct purposes: (1) to relieve physical pain; (2) to produce an unconscious state before the withdrawal of artificial life support; and (3) to relieve non-physical suffering.

scholarly journals Euthanasia and suicide: a medical and social discourse

2021 ◽  
Vol 25 (1) ◽  
pp. 107-112
Author(s):  
V. N. Ostapenko ◽  
I. V. Lantukh ◽  
A. P. Lantukh
Keyword(s):  
Quality Of Life ◽  
Assisted Suicide ◽  
Human Life ◽  
Modern Science ◽  
Physician Assisted Suicide ◽  
Adequate Quality ◽  
The Subject ◽  
Strong Explosion ◽  
The Right

Annotation. The problem of suicide and euthanasia has been particularly updated with the spread of the COVID-19 pandemic, which caused a strong explosion of suicide, because medicine was not ready for it, and the man was too weak in front of its pressure. The article considers the issue of euthanasia and suicide based on philosophical messages from the position of a doctor, which today goes beyond medicine and medical ethics and becomes one of the important aspects of society. Medicine has achieved success in the continuation of human life, but it is unable to ensure the quality of life of those who are forced to continue it. In these circumstances, the admission of suicide or euthanasia pursues the refusal of the subject to achieve an adequate quality of life; an end to suffering for those who find their lives unacceptable. The reasoning that banned suicide: no one should harm or destroy the basic virtues of human nature; deliberate suicide is an attempt to harm a person or destroy human life; no one should kill himself. The criterion may be that suicide should not take place when it is committed at the request of the subject when he devalues his own life. According to supporters of euthanasia, in the conditions of the progress of modern science, many come to the erroneous opinion that medicine can have total control over human life and death. But people have the right to determine the end of their lives while using the achievements of medicine, as well as the right to demand an extension of life with the help of the same medicine. They believe that in the era of a civilized state, the right to die with medical help should be as natural as the right to receive medical care. At the same time, the patient cannot demand death as a solution to the problem, even if all means of relieving him from suffering have been exhausted. In defense of his claims, he turns to the principle of beneficence. The task of medicine is to alleviate the suffering of the patient. But if physician-assisted suicide and active euthanasia become part of health care, theoretical and practical medicine will be deprived of advances in palliative and supportive therapies. Lack of adequate palliative care is a medical, ethical, psychological, and social problem that needs to be addressed before resorting to such radical methods as legalizing euthanasia.

scholarly journals From Warnock to the Stem Cell Bank—Evaluating the UK's Regulatory Measures for Stem Cell Research

2005 ◽  
Vol 2 (1) ◽  
pp. 1-14 ◽  
Author(s):  
Richard Twine
Keyword(s):  
Stem Cell ◽  
Stem Cell Research ◽  
Ethical Issues ◽  
Cell Bank ◽  
The United Kingdom ◽  
Institutional Learning ◽  
Regulatory Measures ◽  
United Kingdom Government ◽  
The Uk ◽  
Made In

AbstractThe United Kingdom government regards its regulations for stem cell research as some of the most rigorous in the world. This paper chronologically outlines the important stages in the evolution of these regulatory measures over the past twenty years, including the Warnock Report, the Human Fertilisation and Embryology Act 1990, the subsequent series of reports and consultations, and the establishment of the UK stem cell bank. Attending both to the discursive framing of stem cell research and the ethical issues faced, an assessment is made in terms of the appropriateness, adequacy and effectiveness of the UK's regulatory measures. Although institutional learning is detected in areas such as improving public engagement, the UK regulatory process has been open to the accusation of a scientific community regulating itself. This paper recommends that in order to avoid any possible complacency further improvements in public inclusiveness and interdisciplinary representation on regulatory committees should be sought.

Szasz, suicide, and medical ethics

Thomas Szasz ◽  
2019 ◽  
pp. 55-64
Author(s):  
George J. Annas
Keyword(s):  
Mental Illness ◽  
Informed Consent ◽  
Suicide Prevention ◽  
Assisted Suicide ◽  
Physician Assisted Suicide ◽  
The Subject ◽  
The Right ◽  
Suicidal Patients ◽  
Commit Suicide

Szasz objected to the medicalization of suicide, the legalization of suicide prevention, and especially the coercive role of psychiatry in this realm. He declared that, by medicalizing suicide, we banish the subject from discussion. What is meant by acceptable and unacceptable “suicide”? Who has a right to commit suicide? How does suicide implicate freedom? Does it reflect abortion jurisprudence? How do psychiatrists become suicide’s gatekeepers? Current phenomena (e.g., new physician-assisted suicide legislation) illuminate these and other issues (e.g., euthanasia, informed consent, informed refusal, the “right to die,”), all suggesting how Szasz would react to each. Suicide is legal, but is almost always considered a result of mental illness. Courts approve psychiatrists who want to commit “suicidal” patients involuntarily. Granting physicians prospective legal immunity for prescribing lethal drugs is, at best, a strange and tangential reaction to our inability to discuss suicide (and dying) rationally. Szasz got it right.

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.

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