Physician-Assisted Suicide and Euthanasia: Theological and Ethical Responses

Euthanasia and rational suicide were acceptable practices in some quarters in antiquity. These practices all but disappeared as Hippocratic, Jewish, Christian, and Muslim beliefs took hold in Europe and the Near East. By the late nineteenth century, however, a political movement to legalize euthanasia and physician-assisted suicide (PAS) began in Europe and the United States. Initially, the path to legalization was filled with obstacles, especially in the United States. In the last few decades, however, several Western nations have legalized euthanasia, and several US jurisdictions have now legalized PAS, giving state sanction to these once forbidden practices. With increasing social and political pressure to accept PAS, Christians need to understand how to think about this issue from an explicitly Christian perspective. Independent of the question of legalization, there are significant theological and ethical questions. This special issue aims to address those concerns, including: how does the practice of PAS or euthanasia impact our attitudes toward death, and what does it mean to “die well?” Should physicians, as healers, be involved in assisting patients who wish to bring about their own death? Are these methods significantly distinguished from other ethically justified practices in end-of-life care that also lead to a person’s death? Can Christians, both as patients and practitioners, justify the use of these methods to relieve suffering in this manner as compatible with the faith? Although these questions are not new to the debate, it is increasingly important that these controversies are addressed as the practice of PAS is popularized.

Finitude, choice and the right to die: age and the completed life

This paper explores the concept of the completed life outlined in recent writing in the Netherlands on euthanasia and assisted suicide and its implications for ageing studies. Central to this theme is the basic right of people to self-determine the length of their later life, linked with the subsidiary right to assistance in achieving such self-determination. Although the notion of weariness with life has a long history, the recent advocacy of a self-limited life seems shaped by the new social movements presaged upon individual rights together with what might be called a distinctly third-age habitus, giving centre stage to autonomy over the nature and extent of a desired later life, including choice over the manner and timing of a person's ending. In exploring this concept, consideration is given to the notion of a ‘right to die’, ‘rational suicide’ and the inclusion of death as a lifestyle choice. While reservations are noted over the unequivocal good attached to such self-determination, including the limits to freedom imposed by the duty to avoid hurt to society, the article concludes by seeing the notion of a completed life as a challenge to traditional ideas about later life.

Looking at the facts about suicide

SUMMARYMost human actions, including suicide, are motivated by variable mixes of rational and irrational factors. Notwithstanding debates about rational suicide, the vast majority of people who die by suicide suffer deeply beforehand. Those who present to mental health services in suicidal crises do so in search of treatment, care and support. It is a privilege to try to provide it.

The Coming of Age of Old Age

Chapter 12 takes stock of the book’s central arguments and findings about the life stage relativity of values; midlife bias; human dignity; age group justice principles of capability sufficiency, relational equality, and reparations; narrative identity values of integrity, fairness, and prudence; geriatric and pediatric bioethics; ageism; fair subject selection; age-based rationing of life-saving medical care; mandatory retirement; duties to the dying, newly dead, and long gone; rational suicide; meeting the need for long-term care through family caregiving, migrant caregivers, and robotic caregivers (carebots); designing AI and sociable robots for older adults; duties to future people; and the prospects for future population aging. To remain relevant in aged societies, moral philosophers must tackle these concerns, end midlife bias, and contribute an account of the moral life that makes sense to people at each stage of life.

The Dying, the Newly Dead, and the Long Gone

Chapter 10 takes a careful look at duties to the dying, the newly dead, and the long gone. Care of the dying and newly dead are urgent matters for aged societies, because older people die at higher rates than other age group. The chapter unpacks the slogan “Death with dignity” and asks what duties to respect the dignity of people near the end of life is required. It examines debates over physician-assisted death and rational suicide for healthy older people. It evaluates definitions of death, noting global variation, and proposes duties owed to the newly dead and long gone. Key concepts, such as narrative identity, help flesh out the idea of a “good death.” Borrowing from ethics and archeology literature, Chapter 10 introduces a systematic way to think about duties to the long gone, including human fossils with archeological significance and ancestors in native burial grounds.

Rational and irrational suicide in Plato and modern psychiatry

SUMMARYSuicide is a complex issue that is sparking increasingly more debate in contemporary society. There is need for an open discussion on the concept of rational suicide, specifically in relation to psychiatric disorders, so as to resolve the conflict between the duty of care of psychiatrists and the autonomy of patients. To be able to conduct such a discussion in an objective manner, we must first be made aware of the potential prejudices that we harbour on the topic of suicide as a result of our societal and historical background. A historical and philosophical approach to the topic, through careful examination of the topic of suicide in the texts of Plato, helps create such an awareness.

Rational Suicide in Late Life: A Systematic Review of the Literature

Background and Objectives: The complex concept of rational suicide, defined as a well-thought-out decision to die by an individual who is mentally competent, is even more controversial in the case of older adults. Materials and Methods: With the aim of better understanding the concept of rational suicide in older adults, we performed a systematic review of the literature, searching PubMed and Scopus databases and eventually including 23 published studies. Results: The main related topics emerging from the papers were: depression, self-determination, mental competence; physicians’ and population’s perspectives; approach to rational suicide; ageism; slippery slope. Conclusions: Despite contrasting positions and inconsistencies of the studies, the need to carefully investigate and address the expression of suicidal thoughts in older adults, as well as behaviours suggesting “silent” suicidal attitudes, clearly emerges, even in those situations where there is no diagnosable mental disorder. While premature conclusions about the “rationality” of patients’ decision to die should be avoided, the possibility of rational suicide cannot be precluded.

Suicide Prevention

Suicide is a major public health and mental health challenge and claims as many as one million lives worldwide each year. It is also an individual tragedy with devastating consequences for family members, friends, and others who have been bereaved. Attempted suicide and suicidal behaviour are even more common. In recent years there has been an enormous amount of research and a growing realization that suicide can be prevented. There are approaches that we can use at societal and individual levels which will potentially save lives. This book provides a comprehensive but concise overview of the field of suicide prevention. It places suicide in a historical context before highlighting its complexity and possible causes. It goes on to discuss public health strategies and policy as well as psychological and pharmacological approaches to treatment and prevention. It also includes guidance for assessing people who present to services with suicidal thoughts or behaviours, along with a number of case vignettes. Suicide bereavement and technology-based approaches to intervention are discussed, and frequently asked questions on topics as diverse as enquiring about suicidal thoughts, rational suicide, and suicide terrorism are answered. This text is practical in its focus but strongly evidence-based and will be relevant to all those with an interest in preventing suicide.