Covid-19 and our Duty to Die

When considering our own death, we normally weigh its impact on the people we love and care about, as well as worrying about the way in which our life might end, hoping that not too much suffering precedes it. However, such view, despite necessary, is a passive understanding of death, interpreted as something that merely happens to us, where we would have some control over timing if physician-assisted dying were legal in our countries. But what if our relation to death would not end there? What if special medical needs, such as the emergency situation resulting from the Covid-19 pandemic, could have a direct impact on us creating a moral duty to end our lives? That is the thesis that will be advocated for in this paper: a moral duty to die will arise in some people to save resources that will help others get through Covid-19. It is important to indicate that the duty to die is personally acknowledged and self-imposed, thus nobody can be coerced to carry it out; for autonomy would be lost and such action should be considered an instance of incitement to die, therefore being morally blameworthy.

A Smart Ethics is an Ethics Committed to Close-Listening

"A ‘smart’ bioethics is an ethics that is able to recognize and address the real-life and context-embedded moral concerns of the people it intends to serve, whether those people are patients, relatives, healthcare professionals, researchers or policy-makers. Therefore, close-listening to what those people have to say, should be at the start of each bioethics-undertaking. In this presentation, I will explore how narrative approaches taken from the humanities and social sciences could help bioethicists in the 21st century to attune to and examine both the stories of others and the stories we create ourselves in medicine and bioethics. I will discuss why this is an essential first step before we embark on the normative task of bioethics, and how it entails a scrutinization of epistemological and meta-ethical positions. Following, I will use my own research project –an empirical-ethical exploration of physician-assisted dying in Dutch general practice– as an example of how narrative approaches used in empirical research, training of researchers and normative evaluation may change one’s perspective on a highly contested bioethical issue. Last, I will discuss the question whether concepts such as narrative humility and epistemic (in)justice could and should receive more attention in bioethics-training and-research. "

“If Only I Could Start All over…” A Case Study of Spiritual Care Provision to a Patient with a Psychiatric Disorder Requesting Physician-Assisted Dying in The Netherlands

In a growing number of countries, legislation permits physicians—under strict conditions—to grant a request for physician-assisted dying (PAD). Legally allowing for the possibility of granting such a request is in accordance with central humanistic values such as respect for autonomy and self-determination. The Netherlands is one of few countries where severe suffering from a psychiatric illness qualifies as a ground for a request for PAD. Central in this article is a case description of spiritual care provision in the Netherlands by a humanist healthcare chaplain to a patient requesting PAD because of psychiatric suffering. We discuss what we may learn from the case description about how spiritual caregivers may support patients who express a wish to die, and about their contribution to the care for patients with a psychiatric disorder who request PAD.

A Lack of Respect in Bioethics

Samuel Kerstein points out that although respect is a commonly deployed concept in bioethics, requirements of respect usually amount to respect for autonomy, or for giving proper weight to the choices made by competent persons. Kerstein argues that increased emphasis on another sense of respect, respect for the worth of persons, will greatly enrich discussions in several areas of bioethics. He sketches a Kantian account of respect for persons’ worth, one that incorporates a prohibition on using them merely as means as well as a prescription to treat them as having unconditional, preeminent value. He then applies the account to questions regarding the morality of physician-assisted dying, the ethical distribution of scarce, life-saving medical resources, and morally appropriate reasons for having children.

Euthanasia in an Aging America: An Ethical Challenge for Mental Health Counselors

The average age of individuals in the United States and worldwide is steadily increasing, resulting in an increase in the number of older, terminally ill adults who may seek counseling for end-of-life decisions. Euthanasia is one such end-of-life option that is emerging in the United States. Physician-assisted dying, currently the only legal form of active euthanasia in eight states and the District of Columbia, is a relatively new and often misunderstood end-of-life option. Although arguments continue about this issue, the American Mental Health Counselors Association has developed ethical codes to guide mental health counselors working with terminally ill clients making end-of-life decisions. The core moral and ethical principles of autonomy, beneficence, nonmaleficence, justice, fidelity, and veracity provide guidance for helping terminally ill clients explore end-of-life options that could include physician-assisted dying when it is a legally viable option. Additional recommendations are made for increasing intellectual and emotional competence regarding euthanasia.

Arguments over Ends

In the United States, vast resources are put into end-of-life care and there is resistance to wider reliance on hospice, not to mention physician-assisted dying. How does dying get managed, and how do decisions about death get produced, within the logics that pervade contemporary healthcare? This chapter explores this question by considering how dispositions of humility and impulses toward autonomy operate both for dying persons and the caregivers attending to them in death. It argues that a relationally supported process of emotionally preparing for dying provides an experience through which we can learn about humility, autonomy, and other dispositions important for critical democratic citizenship: self-knowledge, self-determination, intellectual courage, generosity toward self and others, openness to uncertainty, and the will to persevere in our aspirations despite undeniable fragility.

What’s Wrong with (Some) Judges? Carter and the Invention of a Right to ‘Physician-Assisted Dying’

This chapter argues that, in addition to rights-fundamentalism, another problem lies in the ‘progressive’ zeal, which moves some judges to exploit the room for creativity granted by abstract concepts, in order to invent novel rights. This, too, is imprudent in having courts, rather than elected legislatures, decide ethical issues that are politically controversial. The argument develops through an examination of Carter v. Canada, the 2015 judgement of Canada’s Supreme Court, which decided that an absolute prohibition of ‘physician-assisted dying’ violated the Canadian Charter of Rights and Freedoms. The chapter concludes that Carter shows that charters that include unspecified rights generate several problems: they give judges no determinate guidance in deciding cases; they purport to exist before their limits have been set in relation to competing rights, whereas a right’s existence cannot be known until competing claims have been considered; and they afford judges vast room for the exercise of philosophical discretion, in which they lack professional expertise or authority. In addition, there are also problems with the views of the interpretation of rights: that judges have privileged insight into what ‘real rights’ are; and that they are not simply interpreters but developers of law, responsible for keeping it abreast of ‘progressive’ social mores. These views incline judges to overlook the natural myopia of their case-focused attention, the limitations of courts in achieving a comprehensive view of social facts, judges’ lack of accountability for the policy effects of their decisions, and their relative immunity from direct challenge by diverse viewpoints.