From Reciprocity to Autonomy in Physician-Assisted Death: An Ethical Analysis of the Dutch Supreme Court Ruling in the Albert Heringa Case

Florijn, Barend W.

doi:10.1080/15265161.2020.1863510

Cited by 12 publications

(5 citation statements)

References 19 publications

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“…These reasons support the legalization of EAS, but may lead to considerable debate, especially regarding EAS for healthy older people, despite their autonomous decision-making. In turn, this debate may create barriers to the legalization of EAS practices [28,[30][31][32].…”

Section: Discussionmentioning

confidence: 99%

Attitudes toward the Legalization of Euthanasia or Physician-Assisted Suicide in South Korea: A Cross-Sectional Survey

Yun

Sim

Choi

et al. 2022

IJERPH

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This study aimed to investigate the general South Korean public attitudes toward the legalization of euthanasia or physician-assisted suicide (EAS) and examine the reasons underpinning these attitudes. From March–June 2021, we conducted a cross-sectional survey of a representative national sample of 1000 South Koreans aged 19 years or older. Three in four participants (76.4%) expressed positive attitudes toward the legalization of EAS. Participants who agreed with this legalization reported “meaninglessness of the rest of life” and “right to a good death” as their main reasons. Participants who disagreed with the legalization of EAS reported “respect for life”, “violation of the right to self-determination”, “risk of abuse or overuse”, and “violation of human rights” as theirs. In the multivariate logistic regression analyses, participants with poor physical status (adjusted odds ratio [aOR]: 1.41, 95%; confidence interval [CI]: 1.02–1.93) or comorbidity (aOR: 1.84, 95%; CI: 1.19–2.83) showed positive attitudes toward the legalization of EAS. In summary, most of the general South Korean population regards the legalization of EAS positively, especially participants with poor physical status or comorbidity.

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Section: Discussionmentioning

confidence: 99%

Attitudes toward the Legalization of Euthanasia or Physician-Assisted Suicide in South Korea: A Cross-Sectional Survey

Yun

Sim

Choi

et al. 2022

IJERPH

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“…Persons who do not fulfil this requirement, such as those 'tired of life', are therefore not eligible for assisted dying under the Dutch law. 13 There is, thus, an element of indirect paternalism present in assisted dying laws that require irremediable suffering. 17 The requirement aims to ensure that assisted dying is not available to persons for whom this would not be an objective benefit, 18 even if they make an autonomous request.…”

Section: Original Researchmentioning

confidence: 99%

“…There, providing assisted dying is only justified when a physician’s duty to preserve life conflicts with her duty to relieve suffering, which allows the physician to invoke force majeure . The patient’s suffering must be unbearable without prospect of improvement and without reasonable alternatives to relieve suffering 13 14…”

Section: The ‘Irremediable Suffering’ Requirementmentioning

confidence: 99%

“…The physician must also make an objective judgment of whether the person’s suffering is irremediable, that is, whether there are other viable options available to treat the patient’s medical condition. Persons who do not fulfil this requirement, such as those ‘tired of life’, are therefore not eligible for assisted dying under the Dutch law 13…”

Section: The ‘Irremediable Suffering’ Requirementmentioning

confidence: 99%

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An autonomy-based approach to assisted suicide: a way to avoid the expressivist objection against assisted dying laws

Braun

2022

J Med Ethics

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In several jurisdictions, irremediable suffering from a medical condition is a legal requirement for access to assisted dying. According to the expressivist objection, allowing assisted dying for a specific group of persons, such as those with irremediable medical conditions, expresses the judgment that their lives are not worth living. While the expressivist objection has often been used to argue that assisted dying should not be legalised, I show that there is an alternative solution available to its proponents. An autonomy-based approach to assisted suicide regards the provision of assisted suicide (but not euthanasia) as justified when it is autonomously requested by a person, irrespective of whether this is in her best interests. Such an approach has been put forward by a recent judgment of the German Federal Constitutional Court, which understands assisted suicide as an expression of the person’s right to a self-determined death. It does not allow for beneficence-based restrictions regarding the person’s suffering or medical diagnosis and therefore avoids the expressivist objection. I argue that on an autonomy-based approach, assisted suicide should not be understood as a medical procedure but rather as the person’s autonomous action.

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“…Third, does the study by van den Berg et al underscore societal harm in the Netherlands in which access to EAS invokes the possibility that a right becomes an obligation? Again, not true. The Dutch Euthanasia Act formulates due care requirements for physicians and does not delineate patients’ rights . According to the due care requirements, the patient’s request should not only be voluntary, but also well considered.…”

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confidence: 99%

Narrative Ethics in Response to Unbearable Suffering—the Dutch Slippery Slope Is Nonexistent

Florijn

Kaptein

2021

JAMA Intern Med

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To the Editor This letter is in reference to the recently published Editorial by Meier. 1 Meier argues that the study by van den Berg et al 2 demonstrates that euthanasia or physician-assisted suicide (EAS) is a "quick, easy, and inexpensive" 1(p160) intervention offered in response to unbearable suffering attributable to multiple geriatric syndromes. Furthermore, absence of regulatory constraints to contain physician-assisted death may underscore real societal harms in the Netherlands.First, do physicians in the Netherlands follow "only vague" criteria before administering EAS? 1 Not true. In fact, the provision of EAS in the Netherlands is a violation of the criminal code. On performing EAS, physicians invoke force majeure, a legal concept based on an emergency situation instigated by a conflict of duties. This moral conflict consists of a physician's duty to protect life and a physician's duty to relieve suffering. Physicians are not punishable for invoking force majeure and when EAS is performed in accord with the statutory due care criteria laid down in article 2 of the Euthanasia Act. 3 As such, physicians' assessment of unbearable suffering ensures due care in carrying out EAS.Second, does permissive access to EAS and its expansion to older people with multiple geriatric syndromes reduce the responsibility to advocate for the continued life of the patient? 1 Not true. Physician and patient together decide when there is in all reasonableness no other solution to alleviate the patient's suffering other than to end the patient's life. This presupposes a vital patient-physician relationship centered around a practice of narrative ethics that respects people's story of suffering (often unbearable suffering rooted in a medical condition, but for older persons also due to social isolation and loneliness) to improve people's informed decision. 4 Third, does the study by van den Berg et al 2 underscore societal harm in the Netherlands in which access to EAS invokes the possibility that a right becomes an obligation? 1 Again, not true. The Dutch Euthanasia Act formulates due care requirements for physicians and does not delineate patients' rights. 5 According to the due care requirements, the patient's request should not only be voluntary, but also well considered. This again pinpoints narrative ethics that enable patients' clear insight into illness to make careful assessment of their story based on sufficient information provided by the physician.In conclusion, Meier's slippery slope argument is modest in the practical counsel it offers. Instead of pinpointing societal harm in the Netherlands, one could acknowledge that even though various moral principles can conflict in the moral life, decision-making in morality and public policy progresses with reasoning through difficult cases. 3 Therefore, the debate in the Netherlands, centered around how physicians should respond to unbearable suffering, is not societal harm but a narrative ethics approach that demonstrates "society's ability to surround its citizens...

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From Reciprocity to Autonomy in Physician-Assisted Death: An Ethical Analysis of the Dutch Supreme Court Ruling in the Albert Heringa Case

Cited by 12 publications

References 19 publications

Attitudes toward the Legalization of Euthanasia or Physician-Assisted Suicide in South Korea: A Cross-Sectional Survey

Attitudes toward the Legalization of Euthanasia or Physician-Assisted Suicide in South Korea: A Cross-Sectional Survey

An autonomy-based approach to assisted suicide: a way to avoid the expressivist objection against assisted dying laws

Narrative Ethics in Response to Unbearable Suffering—the Dutch Slippery Slope Is Nonexistent

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