Attitudes Toward Euthanasia and Justifying Reasons Of Elderly Israelis and Their Family Members

Abstract

The purpose of the current study was to reach an interpretive understanding of the reasons underlying favorable and unfavorable attitudes of Israeli elderly adults and their family members toward euthanasia. The informants were 47 individuals representing 19 families who were asked for their attitudes toward four case studies that represented withholding and withdrawing treatment, active euthanasia, and physician-assisted death. Results of the grounded theory analysis revealed that most of the participants favored withholding life-sustaining treatment and that almost half of them thought active euthanasia and physician-assisted suicide were morally acceptable as long as the decision was made by the individual patient himself or herself (voluntary). The reasons that justified their attitude positions were named according to six dimensions: promoting life, promoting death, self-control, dele-gators, allowing to die, and one-way street. The analysis further examined similar reasons that were provided as justifications for attitudes by two or more family members. These family reason dimensions were labeled according to their similarities to various ethical perspectives, including character ethics, natural laws, liberal individualism, communitarianism, beneficence, and casuistry. The research highlighted the importance of self-control as a core concern of individuals and family members when addressing the moral issues surrounding euthanasia.     

Assisted Suicide,Suffering and the Meaning of a Life

The ethical problems surrounding voluntary assisted suicide remain formidable, and are unlikely to be resolved in pluralist societies. An examination of historical attitudes to suicide suggests that modernity has inherited a formidable complex of religious and moral attitudes to suicide, whether assisted or not. Advocates usually invoke the ending of intolerable suffering as one justification for euthanasia of this kind. This does not provide an adequate justification by itself, because there are (at least theoretically) methods which would relieve suffering without causing the physical death of the suffering person. Carried to extremes, these methods would finish the life worth living, but leave a being which was technically alive. Such acts, however, would provide no moral escape, since they would create beings without meaning. Arguments seeking to justify ending the lives of others need some grounding in concepts of the meaning of a life. The euthanasia discourse therefore needs to take at least some account of the meaning we construct for our lives and the lives of others.     

Active Versus Passive Euthanasia: An Attributional Analysis1

The present study investigates the way in which observers judged physicians who engaged in various acts of euthanasia. These acts varied over two dimensions: voluntary versus nonvoluntary (on the patient's part) and active versus passive (on the physician's part). Vignettes about a patient who was severely burned in an apartment fire were read by 632 subjects (199 men and 433 women). The vignettes varied the physician's actions and whether the patient requested to die or not. After reading one vignette, participants responded to a 19-item questionnaire to assess the moral evaluation, responsibility, and professional conduct of the physician. The results indicated no significant differences in the perception of the physician involved in voluntary or nonvoluntary euthanasia. The physician was perceived more negatively, held more responsible, and perceived as acting outside the standards of the medical profession in situations of active euthanasia in contrast to passive euthanasia. The data also suggested that the temporal relationship of the physician's behavior to the patient's death affected the perception of the physician's responsibility and professional conduct.     

Beliefs in and About God and Attitudes Toward Voluntary Euthanasia

I use data from the General Social Survey to evaluate several hypotheses regarding how beliefs in and about God predict attitudes toward voluntary euthanasia. I find that certainty in the belief in God significantly predicts negative attitudes toward voluntary euthanasia. I also find that belief in a caring God and in a God that is the primary source of moral rules significantly predicts negative attitudes toward voluntary euthanasia. I also find that respondents’ beliefs about the how close they are to God and how close they want to be with God predict negative attitudes toward voluntary euthanasia. These associations hold even after controlling for religious affiliation, religious attendance, views of the Bible, and sociodemographic factors. The findings indicate that to understand individuals’ attitudes about voluntary euthanasia, one must pay attention to their beliefs in and about God.     

Traditional God Images and Attitudes Towards Voluntary Euthanasia

I use data from the General Social Survey (N = 8905) to evaluate whether imagining God in traditional ways is associated with attitudes towards voluntary euthanasia. Bivariate analysis reveals that individuals who imagine God as a father, a master, and a king have negative attitudes towards voluntary euthanasia. The associations between imagining God as a father and as a master and attitudes towards voluntary euthanasia hold after controlling for religious affiliation, frequency of religious attendance, views of the Bible, and other sociodemographic characteristics that predict attitudes towards voluntary euthanasia; however, the association between imagining God as a king do not. I also find that while there is no association between imagining God as a judge on voluntary euthanasia attitudes at the bivariate level, there is a significant and positive association with having favorable voluntary euthanasia attitudes in the full model, revealing a suppression effect. These findings highlight the importance of evaluating if different, distinct beliefs about the same religious object have differential associations with social attitudes and behaviors.     

Ending Life, Morality, and Meaning

Opponents of voluntary euthanasia and physician-assisted suicide often maintain that the procedures ought not to be accepted because ending an innocent human life would both be morally wrong in itself and have unfortunate consequences. A gravely suffering patient can grant that ending his life would involve such harm but still insist that he would have reason to continue living only if there were something to him in his abstaining from ending his life. Though relatively rarely, the notion of meaning of life has figured in recent medical ethical debate on voluntary euthanasia and physician-assisted suicide. And in current philosophical discussion on meaning of life outside the medical ethical debate on voluntary euthanasia and physician-assisted suicide several authors have argued that being moral and having a meaningful existence are connected to each other. In this article, I assess whether his intentionally refraining from causing the harm related to voluntary euthanasia and physician-assisted suicide would involve something to such a patient in the sense that it would promote the meaningfulness of his life.     

THE RECOGNITION OF RIGHTS IN EVERYDAY LIFE

Gewirth has argued that rights are justified by their role in the “generic features” of action. Simply by virtue of being a purposive agent capable of voluntary action, one must accept the logic that all persons with such characteristics have certain moral rights. But the language of rights theories does not deal with the process by which rights are acknowledged. How do we go about recognizing those characteristics of human life that underlie the logic Gewirth claims is necessary? By what process do I recognize, for example, your “right” to be told the truth? Acknowledging someone else's right involves two elements: a recognition of the content of the right and a recognition of the binding power of the right which is experienced by the agent as a sense of obligation. Analyzing the process by which these two factors are recognized and examining the foundation for that process will clarify some of the assumptions utilized in rights theories.     

Euthanasia and the Slippery Slope

Although those with liberal attitudes towards voluntary euthanasia are often castigated as crude consequentialists who give overriding value to social utility, two common arguments against permitting active voluntary euthanasia even in the most desperate of cases, the slippery-slope argument and the argument that further research into terminal care and pain control will be discouraged, are entirely consequentialist, and to invoke them to justify withholding assistance in these desperate cases is to fail to respect patients as ends in themselves.     

Physician-assisted suicide reconsidered: dying as a Christian in a post-Christian age.

The traditional Christian focus concerning dying is on repentance, not dignity. The goal of a traditional Christian death is not a pleasing, final chapter to life, but union with God: holiness. The pursuit of holiness requires putting on Christ and accepting His cross. In contrast, post-traditional Christian and secular concerns with self-determination, control, dignity, and self-esteem make physician-assisted suicide and voluntary active euthanasia plausible moral choices. Such is not the case within the context of the traditional Christian experience of God, which throughout its 2000 years has sternly condemned suicide and assisted suicide. The wrongness of such actions cannot adequately be appreciated outside the experience of that Christian life. Traditional Christian appreciations of death involve an epistemology and metaphysics of values in discordance with those of secular morality. This difference in the appreciation of the meaning of dying and death, as well as in the appreciation of the moral significance of suicide, discloses a new battle in the culture wars separating traditional Christian morality from that of the surrounding society.     

The sanctity of life: The role of purity in attitudes towards abortion and euthanasia

Although abortion and euthanasia are highly contested issues at the heart of the culture war, the moral foundations underlying ideological differences on these issues are mostly unknown. Given that much of the extant debate is framed around the sanctity of life, we argued that the moral foundation of purity/sanctity—a core moral belief that emphasises adherence to the “natural order”—would mediate the negative relationship between conservatism and support for abortion and euthanasia. As hypothesised, results from a nation-wide random sample of adults in New Zealand (N = 3360) revealed that purity/sanctity mediated the relationship between conservatism and opposition to both policies. These results demonstrate that, rather than being motivated by a desire to reduce harm, conservative opposition to pro-choice and end-of-life decisions is (partly) based on the view that ending a life, even if it is one's own, violates God's natural design and, thus, stains one's spiritual purity.     

A Kantian Moral Duty for the Soon-to-be Demented to Commit Suicide

It has been argued that, on Kantian grounds, pedophiles, rapists and murderers are morally obligated to take their own lives prior to committing a violent action that will end their moral agency. That is, to avoid destroying the agent's moral life by performing a morally suicidal action, the agent, while he still is a moral agent, should end his body's life. Although the cases of dementia and the morally reprehensible are vastly different, this Kantian interpretation might be useful in the debate on the permissibility of suicide for those facing dementia's effects. If moral agents have a duty to act as moral agents, then those who will lose their moral identity as moral agents have an obligation to themselves to end their physical lives prior to losing their dignity as persons.     

Asymmetries in ethics

Ethical notions such as good and bad, are often treated as though they were ‘symmetric’ in the sense of having the same moral ‘weight’, one in a positive the other in a negative sense. I argue that they are in fact ‘asymmetric’ and that the negative members of such pairs of notions are more fundamental and definite, logically speaking, and operationally more important than the positive members. Detailed arguments are given to show this for some non‐moral notions, such as life and death, health and illness; some semi‐moral notions such as pleasure and pain; and finally for the moral notions of happiness, benevolence, right, and good and their negative counterparts. One of the intentions of the article is to show that a systematic view of such asymmetries may have consequences for one's view of the proper or desirable structure of a general theory of ethics: norms stating prohibitions and norms stating permissions will be seen to be, in a sense defined in the text, more fundamental and important than norms stating ('positive') obligations.     

Observations on the rejection of physician-assisted suicide: a Roman Catholic perspective.

Roman Catholic moral theology follows a centuries-old tradition of moral reflection. Contemporary Roman Catholic moral theory applies these traditional arguments to the realm of medical ethics, including the issues of active euthanasia and physician-assisted suicide. Unavoidable moral limits on licit medical intervention sometimes require that the moral duty to treat cede to the duty to cease treatment when measures become more harmful than beneficial to the patient. This does not reduce the need for the compassionate use of palliative care in response to suffering. However, it does mean that rather than being excessively committed to maintaining mere biological human life, or actively seeking death, that we learn a sober realism about the limits of human life. Catholic moral analysis examines an act objectively, both in its relation to the agent and as a material event in the world. This allows both the virtuous or vicious intentions of the agent and the effects of the action to be included in its moral evaluation. Thus, Catholic moral analysis is both quasi-deontological and quasi-consequentialist. Objectively, active euthanasia and physician-assisted suicide, as acts of deliberate killing, are seen as repugnant, in that they fail to incarnate a benign inner intention or to form an agent in virtue. Catholic moral theology is extremely skeptical that an act of intending death directly can be consonant with a sincere compassion for the dying, suffering person and views it as a direct negation of the precious gift of human life.     

Mental Illness,Natural Death,and Non-Voluntary Passive Euthanasia

When it is considered to be in their best interests, withholding and withdrawing life-supporting treatment from non-competent physically ill or injured patients – non-voluntary passive euthanasia, as it has been called – is generally accepted. A central reason in support of the procedures relates to the perceived manner of death they involve: in non-voluntary passive euthanasia death is seen to come about naturally. When a non-competent psychiatric patient attempts to kill herself, the mental health care providers treating her are obligated to try to stop her. Yet it has been suggested that death by suicide can be a part of the natural course of a severe mental illness. Accordingly, if the perceived naturalness of the deaths occurring in connection with non-voluntary passive euthanasia speaks for their moral permissibility, it could be taken that a similar reason can support the moral acceptability of the suicidal deaths of non-competent psychiatric patients. In this article, I consider whether the suicidal death of a non-competent psychiatric patient would necessarily be less natural than those of physically ill or injured patients who die as a result of non-voluntary passive euthanasia. I argue that it would not.     

Moral foundations and political attitudes: The moderating role of political sophistication

Political attitudes can be associated with moral concerns. This research investigated whether people's level of political sophistication moderates this association. Based on the Moral Foundations Theory, this article examined whether political sophistication moderates the extent to which reliance on moral foundations, as categories of moral concerns, predicts judgements about policy positions. With this aim, two studies examined four policy positions shown by previous research to be best predicted by the endorsement of Sanctity, that is, the category of moral concerns focused on the preservation of physical and spiritual purity. The results showed that reliance on Sanctity predicted political sophisticates' judgements, as opposed to those of unsophisticates, on policy positions dealing with equal rights for same‐sex and unmarried couples and with euthanasia. Political sophistication also interacted with Fairness endorsement, which includes moral concerns for equal treatment of everybody and reciprocity, in predicting judgements about equal rights for unmarried couples, and interacted with reliance on Authority, which includes moral concerns for obedience and respect for traditional authorities, in predicting opposition to stem cell research. Those findings suggest that, at least for these particular issues, endorsement of moral foundations can be associated with political attitudes more strongly among sophisticates than unsophisticates.     

Medical ethics in Norway: Modern medicine — Traditional morality

In Norway, by tradition a Lutheran country, the puritan ethics of a “moral minority” has a strong influence on the development and manifestations of medical ethics. Those who exert this influence are found primarily among politicians, the clergy, and, last but certainly not least, among nurses and doctors. The focus of interest is not so much on problems of bioethical moral theory or the teaching of bioethics to students, but very much on attitudes and policies with regard to substantive issues traditionally regarded in Norway as burning bioethical issues, such as: medical research ethics, abortion, prenatal diagnosis, euthanasia, definitions of death, and reproductive technologies.     

The Moral Deliberations of 15 Clergy on Suicide and Assisted Death: A Qualitative Study

Given the relationship between moral objections to suicide, physician-assisted suicide (PAS), and euthanasia and religion, it is important to understand under what conditions clergy have moral objections to suicide, ending futile medical treatment, PAS, and euthanasia. This study used thematic analysis to explore the moral deliberations of 15 clergy and the right- and wrong-making properties of nine death and dying scenarios. Fifteen Catholic, Jewish, and Protestant clergy completed semi-structured interviews. Data analysis generated eight themes: sanctity of life, preservation of the natural course of life, pastoral care, support of the faith community, referral to professional services, end-of-life decision in community, consultation with medical professionals, and a shift to a hopeful narrative. Respondents consistently endorsed the priority of pastoral care, demonstrating a deep concern for the well-being of suffering congregants. In conclusion, respondents were consistent in the application of eight themes to end-of-life scenarios but differed in their approach to the removal of a feeding tube and being present for a PAS death. Every respondent objected to suicide.     

Desire for euthanasia or physician-assisted suicide in palliative cancer care.

OBJECTIVE: To investigate the attitudes of terminally ill individuals toward the legalization of euthanasia or physician-assisted suicide (PAS) and to identify those who would personally desire such a death. DESIGN: In the Canadian National Palliative Care Survey, semistructured interviews were administered to 379 patients who were receiving palliative care for cancer. Patients who expressed a desire for physician-hastened death were followed prospectively. MAIN OUTCOME MEASURES: Attitudes toward the legalization of euthanasia or PAS were determined, as was the personal interest in receiving a hastened death. Demographic and clinical characteristics were also recorded, including a 22-item structured interview of symptoms and concerns. RESULTS: There were 238 participants (62.8%) who believed that euthanasia and/or PAS should be legalized, and 151 (39.8%) who would consider making a future request for a physician-hastened death. However, only 22 (5.8%) reported that, if legally permissible, they would initiate such a request right away, in their current situations. This desire for hastened death was associated with lower religiosity (p=.010), reduced functional status (p=.024), a diagnosis of major depression (p<.001), and greater distress on 12 of 22 individual symptoms and concerns (p<.025). In follow-up interviews with 17 participants, 2 (11.8%) showed instability in their expressed desire. CONCLUSION: Among patients receiving palliative care for cancer, the desire to receive euthanasia or PAS is associated with religious beliefs; functional status; and physical, social, and psychological symptoms and concerns. Although this desire is sometimes transitory, once firmly established, it can be enduring.     

First Persons: On Richard Moran's Authority and Estrangement

Richard Moran's Authority and Estrangement offers a subtle and innovative account of self-knowledge that lifts the problem out of the narrow confines of epistemology and into the broader context of practical reasoning and moral psychology. Moran argues convincingly that fundamental self/other asymmetries are essential to our concept of persons. Moreover, the first- and the third-person points of view are systematically interconnected, so that the expression or avowal of one's attitudes constitutes a substantive form of self-knowledge. But while Moran's argument is wide-ranging and compelling, he relies throughout on an overly intellectualized conception of first-person attitudes as attitudes of reflection or deliberation. That conception is at once implausible and unnecessary to the main current of his argument, whose goal is to demonstrate that our self-conception as persons depends on both the distinctness and the interconnectedness of our first- and third-person perspectives on ourselves.