Medico-legal issues at the end of life
Peter Hutton, Ravi Mahajan, Allan Kellehear in Death, Religion and Law, 2019
In some other jurisdictions, taking one’s own life when terminally ill or having intolerable suffering is permitted provided that the patient is in a sound mental state. The terminology of this area is difficult, but an accepted terminology based on the type of intervention would be as follows. Assisted dying is usually defined as a terminal prognosis of less than six months; the patient takes the prescribed lethal drugs. In the USA it is permitted in Oregon, Vermont, Montana and Washington.Assisted suicide is usually defined as intolerable suffering or an incurable condition without necessarily being terminally ill; the patient takes the prescribed lethal drugs. It is permitted in Switzerland.
The legal framework for palliative care in the United Kingdom and Ireland
John Lombard in Law, Palliative Care and Dying, 2018
There are considerable similarities in the provision of palliative care in Ireland and in England and Wales. The voluntary sector in Ireland has also been a driving force behind the development of palliative and specialist palliative care. Furthermore, the Irish legal framework for palliative care provision is similarly fragmented. There is little relevant legislation addressing aspects of palliative and end-of-life care. Assisted suicide is prohibited under section 2(2) of Criminal Law (Suicide) Act 1993. While section 14(1) of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2009 requires written operational policies and protocols to be put in place for end-of-life care in designated centres.98 Applicable case law is limited and has been referenced in Chapters 2 and 3.99 These cases have demonstrated the importance of protecting human rights, the possibility of treatment withdrawal, respect for advance decisions, and the prohibition on assisted suicide in Ireland. Moreover, Fleming v Ireland underlined the importance of clarity in the legal status of specialist palliative care practices. Beyond this, the legal framework is composed of professional guidelines and may be informed by the guidance of representative bodies and non-governmental organisations.
Palliative Care
Kathleen Benton, Renzo Pegoraro in Finding Dignity at the End of Life, 2020
Laws governing euthanasia in Western societies have largely been constructed along the traditional Judeo-Christian viewpoints and historically have not permitted either euthanasia or physician-assisted suicide. However, these laws have been changing in recent years (Broeckaert et al., 2009; Cohen, 2015; Curlin et al., 2008; Ganzini et al., 2000; Gastmans et al., 2006; Gill, 2000; Kaldjian et al., 2004). In the United States, although euthanasia is not legal anywhere, physician-assisted suicide is now legal by state law in nine locations (Colorado, Hawaii, Maine, New Jersey, Oregon, Vermont, and Washington, as well as the District of Columbia) and has been mandated by court ruling in two others (Montana and California) (Quill & Sussman, 2019). Internationally, physician-assisted suicide is legal in Switzerland, Albania, Germany, Japan, Canada, and the Australian state of Victoria (Curlin et al., 2008; Quill & Sussman, 2019). Active human euthanasia is legal in the Netherlands, Belgium, Colombia, Luxembourg, and Canada (Curlin et al., 2008; Quill & Sussman, 2019). The changing legal environment in the areas of euthanasia and physician-assisted suicide likely reflects changes in the both cultural and religious viewpoints on these subjects and will remain a subject of some controversy for Christians in the coming years.
Experiences and views of Dutch general practitioners regarding physician-assisted death for patients suffering from severe mental illness: a mixed methods approach
Published in Scandinavian Journal of Primary Health Care, 2021
Rosalie Pronk, Nieke P. Sindram, S. van de Vathorst, D. L. Willems
Various issues arise regarding PAD for psychiatric suffering: the ‘criteria of due care’ can be more difficult to interpret in case of psychiatric illness compared to somatic suffering. It can be harder to establish whether the patient’s death wish is part of the mental illness, or not [10,11]. The capacity of the patient to understand her situation and make decisions regarding her treatment may be impaired [12]. Patients who are depressed may, for example, hold the unjustified belief that chances of recovery are minimal [13]. The second criterion of the Dutch euthanasia act, stating ‘suffering must be unbearable and without prospect of improvement’, may also be difficult to apply. The diagnostic and prognostic uncertainties that come with mental illnesses could make it difficult to establish whether a patient has a reasonable chance to recover [11,13]. Another issue that is mentioned in the literature is the vulnerability of patients suffering from mental illnesses, and their need for protection [11,14,15]. A final concern regarding physician-assisted death in psychiatry relates to the concept of hope. It has been argued that discussing the option of assisted suicide with a patient suffering from a mental illness might provoke feelings of desperation and demoralization (a loss of hope) in the patient, which could lead to unjustified beliefs about the impossibility of recovery [16,17].
An Autonomy-Based Approach to Justifying Physician-Assisted Death: A Recent Judgment of the German Federal Constitutional Court
Published in The American Journal of Bioethics, 2022
Esther Braun, Jakov Gather, Matthé Scholten, Jochen Vollmann
Following intensive societal and parliamentary debates, the German parliament adopted a law criminalizing assisted suicide in 2015. The German Federal Constitutional Court stated in its 2020 judgment that the prohibition of assisted suicide is incompatible with the German constitution. The court declared that the general right of personality enshrined in the German constitution entails a right to a self-determined death, which includes the freedom to take one’s own life and seek assistance from third parties for this purpose. The judgment states that the right to a self-determined death is not limited to people suffering from serious or incurable illnesses or to certain stages of life. The central criterion that persons seeking assisted suicide must fulfill is that their wish must be based “on the free will of the affected person” (Bundesverfassungsgericht 2020, para. 232). A concrete legal framework regulating assisted suicide in Germany is still outstanding.
Meaningful Respect for the Autonomy of Persons with “Completed Life”: An Analysis in Light of Empirical Research
Published in The American Journal of Bioethics, 2022
M. L. Zomers, E. J. van Wijngaarden, J. J. M. van Delden, G. J. M. W. van Thiel
In much of the debate about legalization of assisted suicide for persons with “completed life,” this complexity has not been sufficiently acknowledged. Instead, a “completed life” experience has been presented as clear-cut, and the death wish as well-considered and stable. Based on this simplified view, it might seem a logical step to provide assisted suicide if a person with “completed life” asks for it. But what if this person is lonely yet dependent on other people, has financial problems, and is, therefore, deprived of adequate care and support? Or what if this person non-autonomously decides to end his or her life, i.e., the decision to end one’s life is not a well-considered, voluntary decision made in a mentally competent state? This could, for example, happen if one has mixed feelings about one’s death wish and longs for but has no access good conversations and information to find out what one truly wishes, what possible responses to the death wish could be, and how certain distress can be taken away or needs can be fulfilled to relieve the death wish in other ways than by ending one’s life. Besides, it may be questioned whether one can autonomously decide to end one’s life if one is led by pressure from non-rational bodily and emotional compulsions or if one suffers from mental health problems or decline.
Related Knowledge Centers
- Euthanasia
- Involuntary Euthanasia
- Voluntary Euthanasia
- Informed Consent
- Medical Prescription
- Terminal Illness
- Consent
- Legality of Euthanasia
- NON-Voluntary Euthanasia
- Right to Die