Assisted Suicide,Euthanasia, and Suicide Prevention: The Implications of the Dutch Experience

What impact would legalization of assisted suicide and euthanasia have on our ability to treat suicidal patients and to prevent suicide? Information from a study of the Dutch experience illustrates how legal sanction promotes a culture that transforms suicide into assisted suicide and euthanasia and encourages patients and doctors to see choosing death as a preferred way of dealing with serious or terminal illness. The extension of the right to euthanasia to those who are not physically ill further complicates the problem. So too does the tendency of doctors in such a culture to begin to feel that they can make decisions about ending the life of competent terminally ill patients without consulting the patient. “Normalizing” suicide as a medical option lays the groundwork for a society that turns euthanasia into a “cure” for suicidal depression.     

On euthanasia: blindspots in the argument from mercy

In the euthanasia debate, the argument from mercy holds that if someone is in unbearable pain and is hopelessly ill or injured, then mercy dictates that inflicting death may be morally justified. One common way of setting the stage for the argument from mercy is to draw parallels between human and animal suffering, and to suggest that insofar as we are prepared to relieve an animal's suffering by putting it out of its misery we should likewise be prepared to offer the same relief to human beings.
In this paper, I will argue that the use of parallels between human and animal suffering in the argument from mercy relies upon truncated views of how the concept of a human being enters our moral thought and responsiveness. In particular, the focus on the nature and extent of the empirical similarities between human beings and animals obscures the significance for our moral lives of the kind of human fellowship which is not reducible to the shared possession of empirical capacities.
I will suggest that although a critical examination of the blindspots in these arguments does not license the conclusion that euthanasia for mercy's sake is never morally permissible, it does limit the power of arguments such as those provided by Rachels and Singer to justify it. I will further suggest that examination of these blindspots helps to deepen our understanding of what is at stake in the question of euthanasia in ways that tend otherwise to remain obscured.     

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.     

A suicidal adolescent's sleeping beauty syndrome: cessation orientations toward dying, sleep, and drugs

In a study of hospitalized suicidal youth, the account of a sixteen-year-old girl, diagnosed as schizophrenic, is analyzed to gain insight into a family's role in the suicidal career of an adolescent preoccupied with death and dying, sleep, and drugs; the interplay of her construction of reality with her risk-taking, self-injurious way of life; and her perceived problems of living and need for help. Her cessation orientations revealed a kind of Sleeping Beauty syndrome with fantasies on sleep, drugs, and death, including a death of the mind from overdosing. Such qualitative research on suicidal careers may increase our understanding of the at-risk adolescent population and assist in the development of a policy for identifying and meeting needs and following up on clues for prevention and early intervention.     

A Reply to Cholbi's 'Suicide Intervention and Non-Ideal Kantian Theory'

abstract    In his 'Suicide Intervention and Non-Ideal Kantian Theory' (2002), Michael J. Cholbi argues that nihilism and hopelessness are often motivating factors behind suicide, contrary to Immanuel Kant's prescribed motive of self-love. In light of this, Cholbi argues that certain paternalistic modes of intervention may not only be effective in preventing suicide, but are ultimately consistent with Kantian morality. This paper addresses certain perceived shortcomings in Cholbi's account of Kantian suicide intervention. Once the psychological complexities of the suicidal person are brought to bear, the suicidal person is found in many cases to be irrational at the time of her death. Because of this, rationalistic intervention strategies may prove ineffective, despite their being consistent with Kantian morality, and despite instances of suicide being non-ideal circumstances. Cholbi assumes throughout his article that suicidal human beings remain Kantian moral agents. However, because rationality represents a crucial criterion for Kantian moral agency, and because certain human beings who commit suicide are not rational, such human beings are not Kantian moral agents. Because Cholbi's intervention strategies are not applicable to (or effective towards) irrational suicidal people, his account is found incomplete.     

Activity,Passivity, and Normative Avowal

The idea that agents can be active with respect to some of their actions, and passive with respect to others, is a widely held assumption within moral philosophy. But exactly how to characterize these notions is controversial. I argue that an agent is active just in case (A) her action is one whose motive she can truly avow as reason‐giving, or (B) her action is one whose motive she can disavow, provided her disavowal effects appropriate modifications in her future motives. This view maintains a link between activity, reason‐responsiveness, and answerability, while avoiding commitments to an implausible theory of motivation.     

Peter Singer and Non-Voluntary 'Euthanasia': tripping down the slippery slope

ABSTRACT This article discusses the nature of euthanasia, and the way in which redevelopment of the concept of euthanasia in some influential recent philosophical writing has led to morally less discriminating killing/letting die/not saving being misdescribed as euthanasia. Peter Singer's defence of non-voluntary 'euthanasia'of defective infants in his influential book Practical Ethics is critically evaluated. We argue that Singer's pseudo-euthanasia arguments in Practical Ethics are unsatisfactory as approaches to determining the legitimacy of killing, and that these arguments present a total utilitarian improvement policy—not a case for non-voluntary euthanasia.     

Morality in flux: medical ethics dilemmas in the People's Republic of China.

The bioethical dilemmas receiving the most attention in China now relate to the two ends of life: birth and death. On one end are issues relating to reproductive technology, especially birth control and family planning; at the other end is euthanasia...More research and discussion among people from various fields is needed. Progress will be made one step at a time, and I recommend that we proceed now to win acceptance of brain death criteria; to make clear the distinctions between passive and active euthanasia,...to encourage the use of living wills; and to protect the interests of newborns who are not terminally ill, including those with mild defects. In the changing context of modernization, in which different and even incompatible value systems must coexist, it is best for us to approach the ethical dilemmas facing us with mutual respect and understanding.     

Der Fall Ludwig Tessnow (1872–1939)

The journeyman carpenter Ludwig Tessnow was sentenced to death for four murders by the Greifswald jury court in 1902. The death sentence was upheld during the retrial in 1906 but was later commuted to life imprisonment. According to the unanimous opinion of psychiatric experts Tessnow committed the crimes while in a state of mental incompetence caused by epileptic twilight states. The court, however, ignored this mitigating circumstance in its decision-making process. Seen from a historical perspective, the case is of forensic psychiatric interest because this criminal trial clearly shows the conflicts in competence which arose in the nineteenth century between judges and medical experts when mental competence had to be assessed. It also allows some insight into how mentally ill offenders were dealt with at the beginning of the twentieth century when the influence of public opinion was (and still is) a noteworthy element of prejudgement which was additionally consolidated by the established system of jury courts. The Tessnow case reveals by way of example the usual practice of official consignment of mentally disordered offenders to hospitals at the end of the nineteenth century until the Nazi era. New particulars of the Tessnow findings adequately verified that Tessnow had not been executed in the Greifswald prison as mistakenly believed. It could be proved that Ludwig Tessnow was admitted to the LandesheilanstaltStralsund (state mental hospital in Stralsund) where he became a victim of the Nazi euthanasia program.     

安乐死是何种权利?——关于安乐死的法伦理学解读

安乐死是能为人们带来人格利益的道德权利。我们没有合理的理由对其做出限制 ,但它却很难成为一种法定的权利。主要的阻碍是立法的客观条件不具备 ,以及法律天生的对人性的忧虑。这意味着 ,安乐死作为一种应有的权利要转化为法定权利 ,尽管不是没有可能 ,但要有十分的耐心和谨慎。     

Sedation before ventilator withdrawal: can it be justified by double effect and called "allowing a patient to die"

...Recognizing that sedation and ventilator withdrawal have a causal impact on a patient's death does not open the door to active euthanasia but helps resist it by showing clearly where the debate centers. The heart of the euthanasia issue is not whether providers play a causal role in patients' deaths. They obviously often do when they withdraw burdensome or futile treatment or provide comfort, and these actions can be morally justified in appropriate circumstances. The key point is whether we can morally justify physicians playing two stronger causal roles: providing drugs and information for suicide and doing something in order to kill their patients. Before we can agree with those ethicists who argue that one can justify assisted suicide and active euthanasia despite the moral tradition that has shunned these causal roles, they must clearly show that the human good -- the good of the professions and of society at large, as well as the good of patients -- will be better served by physicians assisting in suicide and giving lethal injections....     

Life insurance, living benefits, and physician-assisted death

One of the most significant concerns about the legalization of physician-assisted death in the United States relates to the possibility that a chronically or terminally ill person would choose to end her or his life for financial reasons. Because we believe that the life insurance industry is uniquely poised to help minimize any such incentive, we submit that it has a moral obligation to do so. In particular, we propose that the industry encourage greater flexibility in the payout of policy benefits in the event an insured should be diagnosed with a terminal illness or suffer from intractable pain.     

Moral Madness

One clear reason why human agents often act badly is because they are insufficiently attentive to moral considerations and concerns, or tempted to ignore these in pursuit of more immediate satisfactions. In so far as madness, insanity or mental instability may be regarded as undermining moral agency, it might also be supposed that such madness attaches more to the non‐moral than the moral reasons or motives of agents. Still, the well‐known quote from Chesterton at the start of this paper may give pause to conventional thought on this matter. With reference to the ideas of Plato and Freud, as well as attention to literary and cinematic “case studies,” this paper argues that moral reasons and motives – of an apparently Chestertonian kind – may be a prime source of morally “insane” conduct.     

悟践疗法与中国心理治疗本土化

中国心理学家在心理治疗本土化方面进行了许多尝试,其中开本土化之先河的是悟践疗法.从悟践疗法的发展可以了解在不同社会历史背景下中国心理治疗本土化的早期特征.悟践疗法的人性主义理论是中国心理治疗本土化的理论产物,强调人性是由生物性、心理性和社会性三方面融合的全方位、全息的整体.悟践疗法的认知与行为的有机结合是中国心理治疗本土化的实践特色.理论和实践证明:悟践疗法具有承前启后、与时俱进的历史和现实意义.     

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.     

Reactions Toward Mental, Physical, and Substance-Abuse Disorders

In this study, participants read 3 separate vignettes describing a hypothetical sibling with each of the following disorders: substance abuse, schizophrenia, and a physical illness. As hypothesized, and consistent with attribution theory, the hypothetical patient with a substance-abuse disorder was perceived as having the most control over his or her illness and the associated symptoms, and the patient described as having a physical illness was perceived as having the least control over his or her illness. Also in support of attribution theory, the hypothetical patient described as having a substance-abuse disorder elicited the most negative emotional reactions from participants, and the patient described as having a physical illness elicited the least negative emotional reactions. Again in support of attribution theory and study hypotheses, participants reported the most willingness to help a physically ill hypothetical sibling.     

Euthanasia in psychiatry can never be justified. A reply to Wijsbek

In a recent article, Henri Wijsbek discusses the 1991 Chabot “psychiatric euthanasia” case in the Netherlands, and argues that Chabot was justified in helping his patient to die. Dutch legislation at the time permitted physician assisted suicide when the patient’s condition is severe, hopeless, and unbearable. The Dutch Supreme Court agreed with Chabot that the patient met these criteria because of her justified depression, even though she was somatically healthy. Wijsbek argues that in this case, the patient’s integrity had been undermined by recent events, and that this is the basis for taking her request seriously; it was unreasonable to expect that she could start again. In this paper, I do not challenge the Dutch euthanasia criteria in the case of somatic illness, but I argue that both Chabot and Wijsbek are wrong because we can never be sufficiently confident in cases of severe exogenous depression to assist the patient in her irreversible act. This is partly because of the essential difference between somatic and mental illness, and because of the possibility of therapy and other help. In addition, I argue that Wijsbek’s concept of integrity cannot do the work that he expects of it. Finally, I consider a 2011 position paper from the Royal Dutch Medical Association on euthanasia, and the implications it might have for Chabot-style cases in the future.     

Death in Our Life

This paper examines a central aspect of the relations between duration and quality of life by considering the moral right to voluntary euthanasia, and some aspects of the moral case for a legal right to euthanasia. Would widespread acceptance of a right to voluntary euthanasia lead to widespread changes in attitudes to life and death? Many of its advocates deny that, seeing it as a narrow right enabling people to avoid ending their life in great pain or total dependence, or a vegetative state. I argue that the right cannot cogently be conceived as a narrow right, confined to very limited circumstances. It is based on the value of having the normative power to choose the time and manner of one's death. Its recognition will be accompanied by far reaching changes in culture and attitudes, and these changes will enrich people's life by enabling them to integrate their death as part of their lives.     

The relationships among clinical depression, suicide, and other actions that may hasten death

Clinical depression and other psychological disorders have been associated with suicidal ideation, attempts, and deaths. Because of the link between suicide and mental illness, whenever discussion of "assisted suicide" arises, the possibility that major depression is affecting the decision arises. This article examines the literature on clinical depression as it relates to suicide, "assisted suicide," and other decisions that will hasten death (i.e. withholding and withdrawing treatment, terminal sedation, and voluntarily stopping eating and drinking). Ethical and legal considerations when working with individuals who are considering taking an action that would hasten death are also briefly reviewed. The article ends with practice and policy recommendations.