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May 2014 EACME Newsletter
Contents
Guest editorial J. Hewitt
Dealing with Requests for Physician Assisted Suicide of Psychiatric Patients in the Netherlands. Development of a Training Module E. Ettema, A. Ruissen and G. Widdershoven
Conference Report: Ethics and evidence in end-of-life decision making A. Lindblad
Assisted dying in Turkey Ö. Yücel
Euthanasia and the Law in the UK A. Smith
End of Life Issues in Neo-Natal Care in Turkey T. Ozdogan
The Attitude of the International Institutions towards Euthanasia in Europe D. Fieldsend
Assistance au suicide en Suisse. Les elements principaux J. Martin
Perspectives on Assisted Suicide in the UK: The Dichotomy between Physical and Psychological Suffering J. Hewitt
Transnational issues of Assisted Dying Ch. Rehmann- Sutter
Physician Assisted Suicide: The present situation in Germany – The evolution of a pragmatic and evidence-based approach M. Wulf M. Stratling
Deadline Next Newsletter + EACME Conference 2014
Editorial
Perspectives on Assisted Dying in Europe
Death may be seen as the greatest of harms or conversely, as a release from greater harms of suffering and indignity. The way in which we view death will of course influence our beliefs about the moral rightness or wrongness of assisted dying. It is perhaps one of the most important ethical debates of the 21st Century, and one which has provoked the general public, health care clinicians and ethicists alike to examine the traditional role of medicine in reversing the trajectory towards death, to a one which instead concerns itself with responding to the expressed desires of people with regard to the end of suffering, even where those desires include death.
There appears to be a growth in permissive views towards assisted dying in many countries in Europe. It is possible to posit a number of reasons for a growth in libertarian views towards a right to die. Many Western countries have seen a change towards a secularisation of values, an increased emphasis on self-determination and a decrease in absolute faith in medical paternalism. Technological advances in medicine have meant that people are now living longer, but not necessarily healthier or happier lives. The availability of a wider range of treatments and life-sustaining technologies has given rise to medical dilemmas in terms of withholding and withdrawing treatment, which did not exist to cause concern for the predecessors of contemporary medicine. Our increased ability to keep people alive in circumstances of extreme debility or advanced disease has in itself contributed to our obligation to discuss when life may not be the best option or in the person’s best interests.
There are however equally plausible arguments that caution us to examine the potential dangers of judging some lives as not being worth living. Coercion to die can never be acceptable, but what counts as coercion may be more subtle and difficult to legislate against. Those who oppose assisted dying warn of the potential for the most vulnerable in our societies to feel that their burden of care is too great and therefore, where an option to die is available, such people may feel obligated to do so. Slippery slope arguments have also been posited, whereby the temptation to de-prioritise certain groups due to scant resources may give rise to active euthanizing of those whose care is most costly.
In this Newsletter, we seek to examine some of these views as reflected in the cultural norms of different countries in Europe. The totality of Europe is by no means represented here, but each brief article provides a fascinating glimpse into many of the key elements of the assisted dying debate. Assisted suicide, passive and active euthanasia are discussed. Important issues of cogent legislation, protection of the vulnerable and the limits of medical autonomy are explored across the life-span in relation to neonates, competent and incompetent adults, persons with mental illness and the elderly. The policies of each country both challenge and inform legal statutes in other cultures. The topic of transnational dying creates particular challenges for all of us, in terms of the increased burden this places upon countries who are willing to assist non-nationals to die, and the obligations of countries who do not allow assisted suicide but whose citizens are served by such a system.
Perhaps what is most compelling in the perspectives set out in this Newsletter is the general commonality of endorsement of supporting a right to die in certain circumstances of extreme suffering. Importantly however, opposing arguments are also set out, which remind us of the weight of the issue at hand and the significance of providing assistance to an end which can never be reversed.
It has been a great privilege for me to have been involved in this Special Issue on assisted dying and it is with much gratitude that I thank all the contributors for providing such important insights and valuable debate.
Best Wishes
Jeanette Hewitt
Department of Philosophy, History & Law
School of Health Science SWANSEA
South Wales SA2 8PP
UNITED KINGDOM
Download the full May 2014 EACME Newsletter
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