The 'Right' to Die: The Case for and against Voluntary Passive Euthanasia

The capacity to sustain human biological life by biomedical technology and improved life support systems has reawakened debate on the 'right' to die and euthanasia. How can the medical and allied health professions resolve the dilemma between a basic respect for human life and the changed conditions of biomedical technology? Drawing upon the philosophic, religious, and medical traditions of the West, this paper explores and weighs the arguments for and against voluntary passive euthanasia. It is concluded that infants and children, minors, senile, psychotic, mentally retarded, and irrecoverably brain damaged persons should not be considered candidates for euthanasia because they are not competent to judge. Involuntary and active euthanasia are condemned as outside the religious and medical traditions of the West. This leaves a small group of candidates for euthanasia who are mentally competent and fully informed of their chances for prolongation of life. Consideration should also be given to the family of the dying person.     

“Good Manner of Dying” as a Normative Concept: “Autocide,”“Granny Dumping” and Discussions on Euthanasia/Death with Dignity in Japan

The purpose of this paper is to clarify the two characteristics of the way the issue of euthanasia/death with dignity has been discussed in Japan, compared with the situation in Europe and the USA. The two characteristics are: (i) that the concept of “euthanasia” is sharply distinguished from that of “death with dignity” in Japan in that the former only refers to the killing of a patient by administration of a lethal drug while the latter refers to letting a patient die by withholding or withdrawing life‐prolonging medical treatments; and (ii) that the view that it is sinful to commit suicide is not as common in Japan as it is in the West. In order to clarify these characteristics, I examine the nature of suicide and murder in relation to the issue of euthanasia and death with dignity while briefly reviewing the history of the debates in Japan in order to see how the characteristic understanding of “death with dignity” has generated. I also clarify, by giving examples, the structure of those narratives with regards to the “good manner of dying,” which excludes from society the elderly and people with incurable diseases and ones with motor and intellectual disabilities. In the end, I describe how biopolitics functions in the current Japanese situation.     

The final step: the issue of euthanasia of people with mental disabilities in Denmark

A number of Danish studies on the history of mental disability have been published in recent years, yet little attention has been devoted to the issue of euthanasia. It has been assumed that the Danes generally opposed radical German ideas about euthanasia of people with disabilities, especially after 1945. This article, however, will contend that a breeding ground for euthanasia was created during the early twentieth century and that many Danes were influenced by Nazi propaganda in the 1940s. Debates about euthanasia of people with mental disabilities continued way up to the 1970s. In fact, discussions about euthanasia or ‘mercy killing’ (medlidenhedsdrab) had their heyday in the years after World War II. Actual cases of ‘mercy killing’ of mentally disabled children appeared in this period. This article will argue that knowledge about the past is important in light of current debates in Europe about similar issues.     

The principle of double-effect in a clinical context

Whereas indirect euthanasia is a common clinical practice, active euthanasia remains forbidden in most countries. The reason for this differentiation is usually seen in the principle of double-effect (PDE). PDE states that there is a morally relevant difference between the intended consequences of an action and merely foreseen, unintended side-effects. This article discloses the fundamental assumptions presenting the basis for this application of the PDE and examines whether these assumptions are compatible with the PDE. It is shown that neither a liberal nor a utilitarian point of view makes the utilization of the PDE possible. In accordance with philosophical tradition, only within the doctrine of the sanctity of life does the PDE seem to be applicable. By analysing the premises of this doctrine, and comparing them with those of the PDE, the inconsistency of this idea is demonstrated. It is suggested that the role of the PDE in the current discussion on euthanasia is largely exaggerated. Electronic Publication     

Public attitudes toward life and death

Opinion trends in this country indicate sharp divisions in public sentiment over a number of life-taking actions. While legal abortion and capital punishment clearly head a list, a number of other issues have gained national attention in recent years. The present paper explores the structure of belief systems giving rise to normative conflicts of this kind. Of particular interest is the notion of a "pro-life" or other generic life orientation (e.g., the alleged "right-to-die" orientation of those who favor "mercy killings" in the case of terminally ill patients) as a possible explanation for public attitudes toward specific issues such as suicide and euthanasia. The present analysis assesses the empirical claims associated with such a model. The results offer qualified support for the existence of generic value orientations as revealed by public attitudes toward legal abortion, suicide, euthanasia, and capital punishment.     

Public Attitudes Toward Life and Death

Opinion trends in this country indicate sharp divisions in publicsentiment over a number of life-taking actions. While legalabortion and capital punishment clearly head the list, a numberof other issues have gained national attention in recent years.The present paper explores the structure of belief systems givingrise to normative conflicts of this kind. Of particular interestis the notion of a "pro-life" or other generic life orientation(e.g., the alleged "right-to-die" orientation of those who favor"mercy killings" in the case of terminally ill patients) asa possible explanation for public attitudes toward specificissues such as suicide and euthanasia. The present analysisassesses the empirical claims associated with such a model.The results offer qualified support for the existence of genericvalue orientations as revealed by public attitudes toward legalabortion, suicide, euthanasia, and capital punishment.     

Understanding the justifiability scale in international surveys: an exploratory study

ABSTRACT

The justifiability scale (JS) is widely used to measure individual and country differences in moral attitudes. However, the validity of the instrument has been barely assessed. The current study addressed the concurrent and content validity of four popular JS items (justifiability of homosexuality, suicide, prostitution, and euthanasia). A sample of 493 Russians completed both JS and the four validated multi-item scales. Results demonstrated that multi-item scales measuring suicide, prostitution, and euthanasia attitudes explained less than half of the variance of the corresponding JS items. The JS underestimated the justifiability of homosexuality, prostitution and suicide, and overestimated the justifiability of euthanasia. The JS homosexuality item appeared to be a precise measure of attitudes towards male but less so female homosexuality. The concurrent validity of the four items was associated with item non-differentiation. We conclude that JS items should be used either after accounting for their bias, or as indicators of more abstract latent constructs.     

Euthanasia and assisted suicide

Americans' moral acceptance of doctor-assisted suicide and euthanasia is on the rise, as is their belief that the practices should be legal.     

Religion and Trends in Euthanasia Attitudes among U.S. Adults, 1977–2004

Though many studies address the role of religion in predicting social attitudes over time, none has examined this relationship specifically for euthanasia. Using a large, nationally representative data source, this study seeks to address this void. Our findings indicate that considerable differences exist among religious denominations regarding the legalization of euthanasia. Specifically, we note a liberalizing trend for all included denominations. We also demonstrate substantial differences in the rates of liberalization, particularly in comparison to conservative Protestants. We conclude with an assessment of our findings relative to previous studies on religion and public opinion.

Moral principles shaping public policy on euthanasia

People's fear of enduring a prolonged, costly dying while attached to life-sustaining machines has prompted support for the legalization of active euthanasia. Four major principles--sanctity of life, prohibition against killing, autonomy, and the common good--have a bearing on the debate.     

Bildung und der Dinfluss von Argumenten auf das Moralische Urteil

According to Kohlberg our moral judgment develops in an irreversible sequence of 6 stages. Starting on a level where moral problems are perceived from an egocentric point of view until an increasingly broader and more integrated perspective replaces the initially more restricted one. By using a vignette design on the background of this theory euthanasia was selected as an example to investigate to what extent arguments can morally justify a decision. In order to judge which arguments are adequate and which are less adequate cognitive competence is required. A central task of the education system is to increase this competence. Therefore it is assumed that the impact of different arguments depends above all on the level of education. All in all, the empirical analyses reported in this article do not confirm these hypotheses. In methodological respect the analyses go beyond earlier research since a recently developed multi level procedure is used. This allows an estimate of the intra-individual answer behavior of respondents and inter-individual differences between respondents simultaneously.     

A GAME THEORETIC ANALYSIS OF VOLUNTARY EUTHANASIA AND PHYSICIAN ASSISTED SUICIDE

In countries/states where voluntary euthanasia (VE) or physician-assisted suicide (PAS) is legal, the patient's decision about whether to request VE or PAS heavily relies on the information others provide. We use the tools of microeconomic theory to study how communication between the patient, his family and his physician influences the patient's decision. We argue that families have considerable power over the patient and that the amount of information that is transmitted from physician to patient might be severely diminished as a result of legalizing VE or PAS. We discuss our main results in the context of the ongoing normative debate over the legalization of VE and PAS. (JEL D8, I12)     

Behavioral economics of death and dying decisions: Both rational and irrational approaches

A decision to accept death and forego life-extending medical procedures can be both rational and irrational. This article reviews perspectives on death from the viewpoint of behavioral economics, which relies on psychology as the basis of decision-making in this regard. According to behavioral economics, both the benefits of living and the costs of death should be emphasized so that a person who is thinking about suicide reconsiders that option and, hopefully, changes his or her mind and tries to safeguard life and avoid life-threatening risks. One way to make dying decisions more rational is to write out a living will or advance directives to help doctors understand a patients’ intentions with regard to decisions about dying should they become unable to articulate that intention at some later, critical, life-or-death situation. Living wills and advance directives can therefore reduce the chances of mercy killing or euthanasia, especially in the context of a developing country, especially when life-extending technologies are limited.     

Old age rational suicide

In the societal debate surrounding voluntary euthanasia or physician‐assisted suicide, there is a concern that older people will be left exposed to any legislation, subject to either faint suggestion or outright coercion from familial or professional carers. Whilst it is critical to take account of older people's potential vulnerability to any current or proposed assisted suicide legislation, there is a parallel strand of research exploring another relationship which older people can have with this debate: one of activism. Sociological research has shown that older people make up the “rank and file” of those active within the right‐to‐die movement. One of the stated motivations of some older people requesting hastened death has been that, in spite of an absence of life‐threatening disease, they feel “tired of life” or that they have lived a “completed life” and feel ready to die. The notion of suicide for reasons of longevity and being tired of life are becoming increasingly significant given the fact of global ageing. This article brings together empirical and theoretical research on the phenomenon of old age rational suicide in order to develop an underexplored area in both the sociology of death and the sociology of ageing.     

Highly religious young Catholics in Northern Ireland: Renewing the Catholic landscape?

This article explores findings from a 2022 survey of students associated with the Catholic Chaplaincy at Queen's University, Belfast. It is the first study to investigate the beliefs, practices, and experiences of highly religious young Catholics in Northern Ireland. It presents survey findings on beliefs, practices, and influences on faith; dynamics of increased religiosity; and views on Church teachings on same sex relationships, euthanasia, sexual relationships, and abortion. Women are more likely to disagree with Church teachings on these issues than men. The survey confirms the importance of family socialization but finds that a substantial minority experience religious change at university. Respondents prioritize renewal but disagree on how to prompt it: some advocate greater ‘openness’ to women, LGBTQ+, and others perceived as marginalized; and others feel ‘evangelization’ should be emphasized. ‘Post-secular Catholicism’ is used as a foundation for reflections on religious persistence among Northern Ireland's young Catholics, raising questions about their potential role in renewing Ireland's Catholic landscape in light of the synodal process underway in the Church.     

Ethics and Institutional Conflict of Interest: The Research Confidentiality Controversy at Simon Fraser University

This paper describes the lengthy controversy at Simon Fraser University (SFU) over academic freedom and the ethics and law of research confidentiality that began when the Vancouver Coroner subpoenaed criminology graduate student Russel Ogden to testify at an inquest. There were two parts to the controversy. The first concerned the SFU administration's failure to mount a legal defense of Ogden's undertaking to keep absolutely confidential the identities of participants in his study of assisted suicide and euthanasia of persons with AIDS. The second concerned the threat to academic freedom created by the administration's subsequent imposition of limited confidentiality on researchers according to its Law of the Land doctrine of research ethics. We examine these controversies and the institutional conflict of interest underlying them in light of the ethical principles for research with human subjects laid out in various disciplinary ethics codes and, after the fact, by the Tri-Council Policy Statement, the research ethics code created by Canada's three federal research-granting agencies.     

Definitions of Need: Can disabled people and care professionals agree?

This paper attempts to examine the ideological frames of reference that inform the definitions of need that are used by disabled and non-disabled people. The main aim of the research upon which this paper is based being to test the degree of congruence of the non-disableds view of need with that of disabled people. Central to this is an exploration of the differences that exist in the perception of disability held by disabled people and nondisabled people. It investigates this through the use of a staged vignette based around a fictitious character (Mr Arthur Angus) and his family. The paper seeks to explore the multidimensional contexts in which individuals operate based upon a deconstruction of the medical/social locus of control model.     

COMPENSATING WAGE DIFFERENTIALS FOR MANDATORY OVERTIME?

This paper examines the extent to which individuals who are employed by firms that require mandatory overtime receive a compensating wage differential for this "distasteful" working condition. While the empirical results indicate that the average worker does not receive a positive differential for this working condition, the results do indicate that unionized workers and (perhaps) newly hired workers receive a positive differential. The paper then develops a framework to determine if any observed compensating differential is, in fact, fully compensating. The application of this framework to the mandatory overtime issue reveals that the fully compensating differential would be relatively small. The methodology developed in this paper should prove useful in a variety of other contexts.     

Public space as 'context' in assistive information and communication technologies for people with cognitive impairment

This paper examines emergent issues of 'context' raised by the application of information and communication technologies for people with cognitive impairment. The issue of the development and application of cognitive prostheses for this group provides an opportunity to examine assumptions and issues emerging from this area pertaining to understandings of the term 'context' in these applications. In this sense the paper takes these assumptions and issues as a point of departure for the development of a 'problematic' that can contribute to the study of the experience of cognitive impairment. The paper specifically addresses recent concerns about the lack of knowledge of these experiences in public spaces such as shopping centres, given that this is a critical site for the civic participation of this group. We argue that this participation should be understood in terms of the 'meeting of two histories': the history of contemporary requirements governing participation in public space and the habitus of people with cognitive impairment with regard to this participation. The paper proposes that the salience of cognitive impairment in these spaces turns on what it means for individuals to inhabit them as complex 'Container Technologies' (Sofia) and underlines the importance of understanding their efforts to attain a sense of normality (Goffman) in these contexts. We propose that this approach can inform research contributing to the development of a 'pattern language', informing applications that make cognition a system property in networks that operate between humans, machines and their contexts.