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A philosophical, existential, ethical, legal, and medical debate regarding the availability of Physician-Assisted Suicide (PAS), and the more current term, preferred by proponents, Physician Assisted Dying (PAD), has taken place over the last 2 years in the editorial pages of Palliative and Supportive Care (Breitbart, 2010a; Rich, 2011). Intelligent people of good will can disagree. On December 31, 2009, the Montana Supreme Court ruled that nothing in state law prevents patients from seeking physician-assisted suicide (PAS), thus paving the way for the procedure to take place legally in Montana, without any of the guidelines in place in states like Oregon and Washington where PAS is already legal. In my 2010 editorial (Breitbart, 2010a), on the events in Montana that made PAS permissible, I argued against PAS as an option for palliative care clinicians and physicians in general, from my 28 year perspective as a psychiatric palliative care clinician, and researcher (studying the causes of requests for PAS and interventions to ameliorate the suffering leading to requests for PAS). My argument was based on a variety of issues, including the fact that the communication of a request for PAS by a distressed patient with a terminal disease was extraordinarily complex and required an intensively sophisticated response that utilized an interdisciplinary care team, including mental health professional. I argued that the solution to suffering was the elimination of suffering not the elimination of the sufferer, perhaps by utilizing new interventions developed for despair at the end of life by researchers like Chochinov (2011) and Breitbart (2010b, 2012). I argued that the potential for abuses of legalizing PAS would adversely affect vulnerable populations in our society (e.g., the under-insured, the uninsured, the elderly, the disabled, those whose voices are under-represented in the health care system). I also ultimately
A philosophical, existential, ethical, legal, and medical debate regarding the availability of Physician-Assisted Suicide (PAS), and the more current term, preferred by proponents, Physician Assisted Dying (PAD), has taken place over the last 2 years in the editorial pages of Palliative and Supportive Care (Breitbart, 2010a; Rich, 2011). Intelligent people of good will can disagree. On December 31, 2009, the Montana Supreme Court ruled that nothing in state law prevents patients from seeking physician-assisted suicide (PAS), thus paving the way for the procedure to take place legally in Montana, without any of the guidelines in place in states like Oregon and Washington where PAS is already legal. In my 2010 editorial (Breitbart, 2010a), on the events in Montana that made PAS permissible, I argued against PAS as an option for palliative care clinicians and physicians in general, from my 28 year perspective as a psychiatric palliative care clinician, and researcher (studying the causes of requests for PAS and interventions to ameliorate the suffering leading to requests for PAS). My argument was based on a variety of issues, including the fact that the communication of a request for PAS by a distressed patient with a terminal disease was extraordinarily complex and required an intensively sophisticated response that utilized an interdisciplinary care team, including mental health professional. I argued that the solution to suffering was the elimination of suffering not the elimination of the sufferer, perhaps by utilizing new interventions developed for despair at the end of life by researchers like Chochinov (2011) and Breitbart (2010b, 2012). I argued that the potential for abuses of legalizing PAS would adversely affect vulnerable populations in our society (e.g., the under-insured, the uninsured, the elderly, the disabled, those whose voices are under-represented in the health care system). I also ultimately
Background Dignity is omnipresent in Western ethics, but it also provokes dissension and controversy. One of the most striking examples is the debate on medically assisted death, where dignity is invoked to support antagonistic positions. While some authors conclude that the concept is useless as an ethical reference, many others invite us to deepen our analysis from a multidimensional perspective, to enrich it and make it useful. This scoping study is intended to provide an overview of the different conceptions of dignity used in the assisted dying debate, to better grasp the multiple facets of the concept. Methods The Joanna Briggs Institute's JBI Manual for Evidence Synthesis guided the scoping review. Key words were based on the researchers' expertise and were used to identify relevant literature in French and English. Eleven databases covering the last six decades were consulted. Initially, 2,071 references were found in the databases. After excluding duplicates, screening titles, abstracts, and full texts, and after a specific literature search on the concept of relational dignity, 156 papers were found to match the identified inclusion criteria. Results The literature highlights the stark confrontation between two dominant conceptions of dignity: ontological and autonomist. However, a lesser-known conceptualization of dignity integrates these two perspectives, underlining the relational and social dimensions of dignity. As a result, dignity emerges as a dynamic, experiential, and dialogical concept, that modulates itself according to circumstances. This raises the possibility of breaking through the binary debate and questioning the current frameworks that define dignity. Conclusions This multidimensional conceptualization of dignity could lead to a more complete and nuanced understanding of the concept, as well as open richer normative horizons regarding the issue of medically assisted death. Supplementary Information The online version contains supplementary material available at 10.1186/s12910-024-01095-z.
The average age of individuals in the United States and worldwide is steadily increasing, resulting in an increase in the number of older, terminally ill adults who may seek counseling for end-of-life decisions. Euthanasia is one such end-of-life option that is emerging in the United States. Physician-assisted dying, currently the only legal form of active euthanasia in eight states and the District of Columbia, is a relatively new and often misunderstood end-of-life option. Although arguments continue about this issue, the American Mental Health Counselors Association has developed ethical codes to guide mental health counselors working with terminally ill clients making end-of-life decisions. The core moral and ethical principles of autonomy, beneficence, nonmaleficence, justice, fidelity, and veracity provide guidance for helping terminally ill clients explore end-of-life options that could include physician-assisted dying when it is a legally viable option. Additional recommendations are made for increasing intellectual and emotional competence regarding euthanasia.
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