GOING GENTLY INTO THAT GOOD NIGHT: THE CONSTITUTIONALITY OF CONSENT IN CASES OF EUTHANASIA

Although consent is a justification ground in South African law, its applicability to cases of euthanasia has been the subject of controversy. It is submitted that relying on the distinction between omission and commission, or causation or intent will not prove useful in justifying mercy killing. In terms of the South African Constitution (and various human rights guaranteed therein), there may be compelling arguments for legalizing euthanasia. For instance, section 10 of the Constitution guarantees the right to dignity. A lack of control over your destiny essentially involves a loss of dignity. Further, the right to dignity and the qualified right to personal autonomy inform section 14: the right to privacy. This right holds that an individual can make certain fundamental private choices without state interference. Surely this would extend to how to end one’s life? This article advocates that a rights-based approach be used to inform the doctrine of consent. This would entail taking the victim’s shared responsibility into account thereby reducing the perpetrator’s fault.

Searching for meaning in chaos: Viktor Frankl's story

The existential psychiatrist Viktor Frankl (1905–1997) lived an extraordinary life. He witnessed and experienced acts of anti-Semitism, persecution, brutality, physical abuse, malnutrition, and emotional humiliation. Ironically, through these experiences, the loss of dignity and the loss of the lives of his wife, parents and brother, his philosophy of human nature, namely, that the search for meaning is the drive behind human behaviour, was moulded. Frankl formulated the basis of his existential approach to psychological practice before World War II (WWII). However, his experiences in the concentration camps confirmed his view that it is through a search for meaning and purpose in life that individuals can endure hardship and suffering. In a sense, Frank’s theory was tested in a dramatic way by the tragedies of his life. Following WWII, Frankl shaped modern psychological thinking by lecturing at more than 200 universities, authoring 40 books published in 50 languages and receiving 29 honorary doctorates. His ideas and experiences related to the search for meaning influenced theorists, practitioners, researchers, and lay people around the world. This study focuses specifically on the period between 1942 and 1945. The aim is to explore Frankl’s search for meaning within an unpredictable, life-threatening, and chaotic context through the lens of his concept of noö-dynamics.

Resilience of Military Metaphors

Military metaphors have been ubiquitous in medicine for centuries. This indicates that tropes of battle may be helpful to some persons in coping with illness. This chapter examines pathographies, that is, stories of illness written by patients, and the words that describe their experiences. A powerful example of a war correspondent and historian of battles of WWII illustrates how military language offers a sense of control and self-reliance for a person who values action and engagement. Thus, for some, figures of war and victory are especially resonant and may counter the loss of dignity and fear that accompany illness. However, this demands bravado, stoicism, and even denial. Further, the words may shift to heroism in the face of defeat as the illness worsens. This chapter notes the particular responsibilities of the physician caring for the “warrior” patient and the imperative for an adaptable and nuanced stance as the illness evolves.

Physician’s Code of Ethics: Education of Dignity

Education is a part of the educational process that forms a person’s ability to feel dignity in himself and in others. Such a skill is of particular importance to the healthcare professional, whose vocation requires sensitivity to the patient. In a state of disease, a person acutely experiences a “loss of dignity”. So, one of the tasks of a physician is to see the dignity of his patient, to recognize its regions that are injured, and to pay proper respect to the inviolable core of the dignity. The author of the article provides guidelines for such a distinction. She researches the types of dignity, identifies the most important of them, and demonstrates situations in medical practice in which this distinction is relevant. The author understands dignity as a multifaceted phenomenon which corresponds to the inviolable value of the human person, virtue, the status of a moral subject. Such multifacetedness is reflected in attempts to typologize dignity. The article presents the concepts of distinguishing types of dignity proposed by L. R. Kass (basic dignity of human being and full dignity of being human), V. Kniazevich (ontological and existential aspects), A. Rodziński (dignity of personality, personal dignity and dignity of the person), D. P. Sulmasy (attributed, inflorescent and intrinsic dignity). The disease, especially the serious one, is a test of dignity. The author, however, argues, that the basic layer of dignity remains inviolable even in states that do not correspond to the status of a rational being. It is claimed that the disease injures less significant layers of dignity. The physician’s vocation, therefore, is to recognize these injured aspects and to demonstrate to the patient the fact that his basic, intrinsic, ontological dignity cannot be lost under any circumstances. Educating future physicians to be able to distinguish between all aspects of dignity should be an important part of the educational process in medical schools.

Application of Inherent Dignity to the Abolition with Support Model

This chapter argues that inherent dignity is more than an abstract concept and must be understood within its social and political context. It applies the concept of inherent dignity in the disability context and to the Abolition with Support model. I argue that dignity is relevant to mental health in two ways. First, it relates to the loss of dignity that persons with mental impairment may experience by reason of their impairment itself and secondly by the way in which persons with mental impairment have historically been treated by the mental health system and society more generally. I consider the meaning of autonomy and the tensions between the concepts of dignity and autonomy. I argue that the meaning of dignity is wider than the legal recognition of autonomy. On a balanced and holistic reading of the CRPD which gives effect to all human rights, dignity may at times be given priority over autonomy, which could provide a human rights justification for limited detention and psychiatric treatment, rather than the abolition of mental health law. Nonetheless, the loss of dignity that is caused by the mental health system must also be addressed and provides a strong basis for significant systemic and legal reform.

Dignity Therapy

Maintenance and promotion of patient and family dignity is a core tenet of palliative care and has significant implications for end-of-life experience, with loss of dignity associated with increased suffering and desire for death. This chapter provides an overview of empirical research on dignity at the end of life, including the model of dignity in the terminally ill, measures to assess dignity including the Patient Dignity Inventory and the Dignity Impact Scale, and dignity therapy, an intervention aimed at bolstering dignity, meaning-making, and generativity needs to improve the end-of-life experience for patients and families. These topics are discussed in the context of a proliferation of research in the last decade across a diversity of cultures, languages, and illness groups.

Can Suicide Preserve One’s Dignity? Kant and Kantians on the Moral Response to Cognitive Loss

Kantian defenders of suicide for the soon-to-be demented claim that killing oneself would protect rather than violate a person’s inherent worth. The loss of cognitive functions reduces someone to a lower moral status, so they believe that suicide is a way of preserving or preventing the loss of dignity. I argue that they misinterpret Kant’s examples and fail to appreciate the reasons behind his absolute prohibition on suicide. Although Kant says that one may have to sacrifice one’s life to fulfill a moral duty, suicide is not morally equivalent to self-sacrifice because it involves treating oneself merely as a means. Furthermore, people facing the onset of dementia would not protect their dignity by killing themselves while they are still rational and would not avoid a demeaning existence.

448 - Euthanasia and Dementia

Background:The practice of assisted dying is increasingly being discussed in a growing number of countries and is progressively regarded as a last-resort option for those suffering from severe and irreversible diseases. Recently, euthanasia in patients with psychiatric disorders and dementia has taken a prominent place in the public debate, since little is known about the prevalence and practice of euthanasia in these particular cases. Remaining a controversial subject, this study aims to describe the evolution and characteristics in reported euthanasia cases, focusing in dementia patients and the perspective from different countries regarding the nature of suffering, the voluntariness of the request and the role of the physician in the process.Methods:A non-systematic review was performed, searching Pubmed/MEDLINE and Google Scholar for articles using the keywords dementia, euthanasia and assisted dying. Resultant articles were cross-referenced for other relevant articles not identified in the initial search.Results:Physicians consider less likely to perform euthanasia in patients with dementia, compared to patients with a severe and life-limiting somatic illness such as cancer. Both physicians and members of the general public acknowledge difficulties in the assessment of the voluntariness of the request and the extent of suffering of patients with advanced dementia, considering that communication is compromised. While euthanasia on the grounds of unbearable suffering caused by dementia remains a comparatively limited practice, its prevalence has risen and is related to loss of dignity or the knowledge that the lasting memory of their loved ones will be of the decomposed version of oneself.Conclusions:It is likely that the number of euthanasia requests from patients suffering from dementia and/or accumulation of health problems related to old age will continue to grow. The question of how policy makers and care providers should respond to these requests is, therefore, highly relevant, as welll as the development of practice guidelines, if medical staff is to respond adequately to these delicate requests.

Deployment of whistleblowing as an accountability mechanism to curb corruption and fraud in a developing democracy

PurposeThis paper investigates the challenges and opportunities for the deployment of whistleblowing as an accountability mechanism to curb corruption and fraud in a developing country. Nigeria is the institutional setting for the study.Design/methodology/approachAdopting an institutional theory perspective and a survey protocol of urban residents in the country, the study presents evidence on the whistleblowing program introduced in 2016. Nigeria’s whistleblowing initiative targets all types of corruption, including corporate fraud.FindingsThis study finds that, even in the context of a developing country, whistleblowing is supported as an accountability mechanism, but the intervention lacks awareness, presents a high risk to whistleblowers and regulators, including the risk of physical elimination, and is fraught with institutional and operational challenges. In effect, awareness of whistleblowing laws, operational challenges and an institutional environment conducive to venality undermine the efficacy of whistleblowing in Nigeria.Originality/valueThe study presents a model of challenges and opportunities for whistleblowing in a developing democracy. The authors argue that the existence of a weak and complex institutional environment and the failure of program institutionalization explain those challenges and opportunities. The authors also argue that a culturally anchored and institutionalized whistleblowing program encourages positive civic behavior by incentivizing citizens to act as custodians of their resources, and it gives voice to the voiceless who have endured decades of severe hardship and loss of dignity due to corruption.