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End of life
Published in Gary Chan Kok Yew, Health Law and Medical Ethics in Singapore, 2020
It is useful from the outset to differentiate the forms of euthanasia. The most controversial is voluntary euthanasia which takes place upon the patient’s request and the physician executes the final act. Where the final act is executed by the patient with the assistance of a physician, it is known as physician-assisted suicide. In some cases, the patient may not be physically capable of executing the final act due to disability. Non-voluntary euthanasia occurs when the patient does not have the capacity to request or consent to euthanasia or did not express his wish when he had capacity. Involuntary euthanasia is performed on a person who has expressed that he does not want to die or he is not asked for his decision. Most people would frown on involuntary euthanasia. There is also a distinction between euthanasia that is described as active (based on a positive act) or passive (an omission such as withdrawing life support).
The Redefinition Issue
Published in David Lamb, Organ Transplants and Ethics, 2020
In one of many pro-euthanasia reports disseminated by the British media the example of voluntary euthanasia, as practised in Holland, was cited in an article published in the Observer Magazine as being ‘already years ahead of any country in Europe’ (Skipworth, 1989:22). The author’s belief would appear to be that Holland, where estimates of the annual figure of those who are killed by their physicians vary from 5,000 to 20,000, is somehow more progressive than other countries. This, of course, is a matter of opinion. But where opinion merges with an ill-informed approach to the concept of death then the prospect of serious ethical abuse looms large. This can be seen when the writer of that same article extolling the virtues of Dutch euthanasia refers to the limitations of laws which restrict the practice to voluntary euthanasia. Skipworth cites the case ‘of a brain-dead woman who has been kept alive artificially for the past 14 years following an anaesthetist’s mistake during a Caesarian operation. Because she had not asked for euthanasia, she cannot receive it’ (ibid:22). With such arguments criteria for death are expressed in self-contradictory terms and then muddled with criteria for non-voluntary euthanasia, the morality of which is simply assumed without recourse to reason or justifications.
End of life
Published in Yann Joly, Bartha Maria Knoppers, Routledge Handbook of Medical Law and Ethics, 2014
The third group of treatment decisions at the end of life addresses the use of lethal medication. Voluntary euthanasia is defined in the Netherlands, Belgium and Luxembourg – three countries where euthanasia is legalised – as the intentional termination of a patient’s life by someone other than the patient, at the patient’s request. Assisted suicide is ‘intentionally assisting a person, at this person’s request, to terminate his or her life’ (Broeckaert and the Flemish Palliative Care Federation 2009: 34–5). Non-voluntary euthanasia involves someone intentionally terminating the life of a patient, but not at the patient’s request.
The ongoing discussion on termination of life on request. A review from a German/European perspective
Published in International Journal of Psychiatry in Clinical Practice, 2021
The main features of the extreme position of the Australian philosopher Peter Singer may also have influenced discussions on euthanasia. About 10 to 20 years ago, Singer’s views received some interest worldwide; however, in Germany his ideas were mainly criticised, particularly in the media. He describes his philosophy of ‘practical ethics’ (which is also the title of one of his books; Singer 2011) as ‘utilitarian’ and bases his arguments on a certain hierarchy of value among living beings. In his philosophy, he not only supports ‘voluntary euthanasia’ but even justifies ‘non-voluntary euthanasia’ in cases in which ‘a human being is not capable of understanding the choice between life and death’. He considers in particular severely disabled infants, accident victims and senile people with severe mental disabilities to be candidates for ‘non-voluntary euthanasia’. Fortunately, Singer's extreme and shocking position found hardly any followers in Germany, although sometimes it is supported indirectly in a watered-down form in certain, usually cautious statements, which are often described as a pragmatic philosophy of daily life. For example, the public discussion in the media about the dementia of the famous university professor for philology, Walter Jens, included questions about whether a person with dementia can still participate in life at all and whether that person still has any personal dignity. This attitude can go all the way to the conviction, which is even presented by well-known (often philosophically and sometimes even theologically shaped) personalities or intellectuals, that in the case of serious dementia termination of life on request could be the effective or indicated remedy. Thus, another famous university professor, the professor of theology and close friend of Walter Jens, Hans Küng, made a kind of pact with Walter Jens that they would request death by euthanasia if either of them developed dementia (Jens and Küng 1995). This was years before Walter Jens was affected by dementia. The perspective of euthanasia in case of dementia is probably primarily a reaction to the severe intellectual deficits and the extreme need for care in the late stages of the disease; however, it does not attach enough importance to the personal dignity that still exists, despite all the person’s deficits, and completely contradicts what I, like most physicians who care for people with dementia and their relatives, experience in my daily work. Time and again, we are impressed by patients’ and caregivers’ positive attitude to life ‘despite everything’ and the extraordinary care given to people with dementia. In this context, it is interesting that ultimately Walter Jens did not request death by euthanasia and actually expressed great fear about it.