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1

Gielen, Joris, Stef van den Branden, and Bert Broeckaert. "Religion and Nurses' Attitudes To Euthanasia and Physician Assisted Suicide." Nursing Ethics 16, no. 3 (May 2009): 303–18. http://dx.doi.org/10.1177/0969733009102692.

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In this review of empirical studies we aimed to assess the influence of religion and world view on nurses' attitudes towards euthanasia and physician assisted suicide. We searched PubMed for articles published before August 2008 using combinations of search terms. Most identified studies showed a clear relationship between religion or world view and nurses' attitudes towards euthanasia or physician assisted suicide. Differences in attitude were found to be influenced by religious or ideological affiliation, observance of religious practices, religious doctrines, and personal importance attributed to religion or world view. Nevertheless, a coherent comparative interpretation of the results of the identified studies was difficult. We concluded that no study has so far exhaustively investigated the relationship between religion or world view and nurses' attitudes towards euthanasia or physician assisted suicide and that further research is required.
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2

Cohen, Cynthia B. "Christian Perspectives on Assisted Suicide and Euthanasia: The Anglican Tradition." Journal of Law, Medicine & Ethics 24, no. 4 (1996): 369–79. http://dx.doi.org/10.1111/j.1748-720x.1996.tb01881.x.

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We have always had the ability to commit suicide or request euthanasia in times of serious illness. Yet these acts have been prohibited by the Christian tradition from early times. Some Christians, as they see relatives and friends kept alive too long and in poor condition through the use of current medical powers, however, are beginning to question that tradition. Are assisted suicide and euthanasia compassionate Christian responses to those in pain and suffering who face death? Or are they ways of isolating and abandoning them, of fleeing from Christian compassion, rather than expressing it?The Committee on Medical Ethics of the Episcopal Diocese of Washington recently issued a report addressing assisted suicide and euthanasia. These matters cry out for religious contributions and perspectives, the Committee believes. The group recognizes that religious voices should not determine public policy, but believes they should be heard as we develop a social consensus about assisted suicide and euthanasia.
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Delaney, James J. "The Doctor–Patient Relationship: Does Christianity Make a Difference?" Christian bioethics: Non-Ecumenical Studies in Medical Morality 27, no. 1 (March 13, 2021): 1–13. http://dx.doi.org/10.1093/cb/cbaa018.

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Abstract The nature of the doctor–patient relationship is central to the practice of medicine and thus to bioethics. The American Medical Association (in AMA principles of medical ethics, available at: https://www.ama-assn.org/delivering-care/ethics/patient-physician-relationships, 2016) states, “The practice of medicine, and its embodiment in the clinical encounter between a patient and a physician, is fundamentally a moral activity that arises from the imperative to care for patients and to alleviate suffering.” In this issue of Christian Bioethics, leading scholars consider what relevance (if any) Christianity brings to the relationship between physician and patient: does Christianity make a difference? The contributors consider this question from several different perspectives: the proper model of medicine, the role that the Christian moral tradition can play in medicine in a secular pluralistic society, how a Christian understanding of virtue can inform practices such as perinatal hospice and physician-assisted suicide, and whether or not appeals to Christian values can (or should) ground a physician’s right to conscientious objection.
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Clements, Ben. "An Assessment of Long-Term and Contemporary Attitudes towards ‘Sanctity of Life’ Issues amongst Roman Catholics in Britain." Journal of Religion in Europe 7, no. 3-4 (December 4, 2014): 269–300. http://dx.doi.org/10.1163/18748929-00704005.

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The Roman Catholic Church has long-standing and steadfast positions on ‘sanctity of life’ issues. This article examines the views of Catholics in Britain on two of these issues: assisted suicide and abortion. It looks at whether Catholics still retain distinctive views on these issues compared to wider society and then examines which socio-demographic and religious factors underpin their attitudes. Catholics tend to be more likely than the general population to oppose assisted suicide and abortion in particular circumstances and to view them as less morally justifiable. Amongst Catholics, socially-conservative views on these issues are associated with various socio-demographic factors and both believing and behaving aspects of religiosity.
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Madadin, Mohammed, Houria S. Al Sahwan, Khadijah K. Altarouti, Sarraa A. Altarouti, Zahra S. Al Eswaikt, and Ritesh G. Menezes. "The Islamic perspective on physician-assisted suicide and euthanasia." Medicine, Science and the Law 60, no. 4 (July 5, 2020): 278–86. http://dx.doi.org/10.1177/0025802420934241.

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Physician-assisted suicide (PAS) and euthanasia can be debated from ethical and legal perspectives, and there are a variety of views regarding their acceptability and usefulness. Religion is considered an important factor in determining attitudes towards such practices. This narrative review aims to provide an overview of the Islamic perspective on PAS and euthanasia and explore the Islamic approach in addressing the related issues. The PubMed database was searched to retrieve relevant articles, then the references listed in the selected articles were checked for additional relevant publications. Additionally, religious books (Quran and hadith) and legal codes of selected countries were also consulted from appropriate websites. The Islamic code of law discusses many issues regarding life and death, as it considers any act of taking one’s life to be forbidden. Islam sanctifies life and depicts it as a gift from God ( Allah). It consistently emphasises the importance of preserving life and well-being. Therefore Muslims, the followers of Islam, have no right to end their life. All Islamic doctrines consider PAS and euthanasia to be forbidden. However, if the patient has an imminently fatal illness, withholding or withdrawing a futile medical treatment is considered permissible. From a legal perspective, Islamic countries have not legalised PAS and euthanasia. Such practices are therefore considered suicides when patients consent to the procedure, and homicides when physicians execute the procedure.
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Nemţoi, Gabriela. "The Right to Life versus the Right to Die." Logos Universality Mentality Education Novelty: Law 8, no. 1 (December 10, 2020): 01–15. http://dx.doi.org/10.18662/lumenlaw/8.1/31.

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Considered a current topical the euthanasia, or under other names such as medically assisted suicide, or death with dignity, is a procedure that ensures the death of people suffering from incurable diseases and who over time are subject to degrading suffering. Recognition of a right to death is considered to be a delicate matter, susceptible to a multidisciplinary approach, with social, legal, moral, religious aspects. Although euthanasia or medically assisted suicide is legalized in many countries, it practically calls into question the extent to which the protection of the right to life must be exercised. Paradoxically, the very right to life - an essential principle, constituting the indispensable condition for exercising the other guaranteed rights, does not enjoy the establishment of well-defined borders. This paper is a summary of this phenomenon, which is growing, motivated mainly by the care and protection that must be given to the individual, regardless of his condition.
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7

Kelleher †, Michael J., Derek Chambers, Paul Corcoran, Helen S. Keeley, and Eileen Williamson. "Euthanasia and Related Practices Worldwide." Crisis 19, no. 3 (May 1998): 109–15. http://dx.doi.org/10.1027/0227-5910.19.3.109.

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The present paper examines the occurrence of matters relating to the ending of life, including active euthanasia, which is, technically speaking, illegal worldwide. Interest in this most controversial area is drawn from many varied sources, from legal and medical practitioners to religious and moral ethicists. In some countries, public interest has been mobilized into organizations that attempt to influence legislation relating to euthanasia. Despite the obvious international importance of euthanasia, very little is known about the extent of its practice, whether passive or active, voluntary or involuntary. This examination is based on questionnaires completed by 49 national representatives of the International Association for Suicide Prevention (IASP), dealing with legal and religious aspects of euthanasia and physician-assisted suicide, as well as suicide. A dichotomy between the law and medical practices relating to the end of life was uncovered by the results of the survey. In 12 of the 49 countries active euthanasia is said to occur while a general acceptance of passive euthanasia was reported to be widespread. Clearly, definition is crucial in making the distinction between active and passive euthanasia; otherwise, the entire concept may become distorted, and legal acceptance may become more widespread with the effect of broadening the category of individuals to whom euthanasia becomes an available option. The “slippery slope” argument is briefly considered.
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8

Giese, Constanze. "German Nurses, Euthanasia and Terminal Care: a Personal Perspective." Nursing Ethics 16, no. 2 (March 2009): 231–37. http://dx.doi.org/10.1177/0969733008100368.

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The nursing profession in Germany is facing a public debate on legal and ethical questions concerning euthanasia on request and physician-assisted suicide. However, it seems questionable if the profession itself, individual nurses or the professional associations are prepared to be involved in such a public debate. To understand this hesitation, the present situation is considered in the light of the tradition and history of professional care in Germany. Obedience to medical as well as to religious authorities was long part of nurses' professional identity, but is no longer relevant. The lack of reflection and discussion on how to take a balanced view of ethical and political questions concerning nursing, and the role and responsibility of nurses in end-of-life decisions and situations of caring for dying people are discussed using the situation of nurses in the Netherlands as a comparison.
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Russell, Cathriona. "Care, Coercion and Dignity at the End of Life." Studies in Christian Ethics 32, no. 1 (October 25, 2018): 36–45. http://dx.doi.org/10.1177/0953946818807463.

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End-of-life debates in medical ethics often centre around several interrelated issues: improving care, avoiding coercion, and recognising the dignity and rights of the terminally ill. Care ethics advocates relational autonomy and non-abandonment. These commitments, however, face system pressures—economic, social and legal—that can be coercive. This article takes up two related aspects in this domain of ethics. Firstly, that competence and communication are core clinical ethics principles that can sidestep the overplayed dichotomies in end-of-life care. And secondly, it questions the assumption that advance directives are universally benevolent—comparing the provisions of the Council of Europe’s 1999 recommendations on protection of human rights and dignity of the dying within the framework of the Irish context. The article also registers the unintended impacts of changing legal frameworks in relation to euthanasia and assisted suicide in Europe, including recent proposals in the Netherlands. A focus on human dignity can provide a theologically and philosophically shared normative orientation that argues for present directives rather than only advance directives, and a presumption in favour of ‘living up to death’. Dignity approaches not only grant rights but secure them by supporting ongoing initiatives that honour, rather than erode, the ‘longevity dividend’.
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10

Chakraborty, Rajshekhar, Areej R. El-Jawahri, Mark R. Litzow, Karen L. Syrjala, Aric D. Parnes, and Shahrukh K. Hashmi. "A systematic review of religious beliefs about major end-of-life issues in the five major world religions." Palliative and Supportive Care 15, no. 5 (January 19, 2017): 609–22. http://dx.doi.org/10.1017/s1478951516001061.

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ABSTRACTObjective:The objective of this study was to examine the religious/spiritual beliefs of followers of the five major world religions about frequently encountered medical situations at the end of life (EoL).Method:This was a systematic review of observational studies on the religious aspects of commonly encountered EoL situations. The databases used for retrieving studies were: Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. Observational studies, including surveys from healthcare providers or the general population, and case studies were included for review. Articles written from a purely theoretical or philosophical perspective were excluded.Results:Our search strategy generated 968 references, 40 of which were included for review, while 5 studies were added from reference lists. Whenever possible, we organized the results into five categories that would be clinically meaningful for palliative care practices at the EoL: advanced directives, euthanasia and physician-assisted suicide, physical requirements (artificial nutrition, hydration, and pain management), autopsy practices, and other EoL religious considerations. A wide degree of heterogeneity was observed within religions, depending on the country of origin, level of education, and degree of intrinsic religiosity.Significance of results:Our review describes the religious practices pertaining to major EoL issues and explains the variations in EoL decision making by clinicians and patients based on their religious teachings and beliefs. Prospective studies with validated tools for religiosity should be performed in the future to assess the impact of religion on EoL care.
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11

Alves, Anne-Sophie. "Steps Towards Legalization of Euthanasia in Portugal." Bioethica 8, no. 2 (November 7, 2022): 85–96. http://dx.doi.org/10.12681/bioeth.31783.

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In a world where everyone has their own beliefs and opinions, sometimes being extremely polarized, the subject of Euthanasia raises a lot of uncertainties and questions. It is way more than just a medical ethical problem, legal, religious, political, and philosophical arguments are brought into the discussion. As societies evolve, the way this topic is viewed changes, for this reason the number of countries which have legalized euthanasia or assisted suicide is growing. Despite of the different perspectives, either side of this debate has the same concern: the respect for the principle of human dignity. Portuguese society has been considering this topic for a long time, the prospect of having a law that allows patients in a situation of permanent and unbearable suffering to end their lives was brought to parliament being approved for the first time in January 2021 and then declared unconstitutional by the Constitutional Court and vetoed by the President of The Republic in March 2021. Subsequently, after a change in the decree that clarified the initial doubts that led to its rejection, the document was again vetoed by President Marcelo in November 2021. More recently, in June 2022 a new version of the decriminalization of euthanasia was approved, the opinions are divided, and the country is awaiting a response from its President, who has already affirmed that everything is open. Therefore, it is relevant to understand the legal aspects related to this subject. For the purpose of this research, it is necessary to comprehend the Portuguese legal order and Portuguese thoughts and views leading to a possible future decriminalization.
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12

DONG, Ping, and Xiaoyan WANG. "道德生死觀下的臨終關懷辨析." International Journal of Chinese & Comparative Philosophy of Medicine 1, no. 1 (January 1, 1998): 107–20. http://dx.doi.org/10.24112/ijccpm.11326.

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LANGUAGE NOTE | Document text in Chinese; abstract also in English.戀生懼死是人之常情。對於一個瀕臨死亡的人來說,其最大的悲劇莫過於沉浸於對死亡的心理焦慮之中。因此,臨終關懷的重要價值指向應是最大限度地減輕瀕死者的心理痛苦。人生的態度與死亡的觀點息息相闕,瀕死者的悲哀正在於死亡焦慮中的生死困惑。道家文化倡導出生入死、道法自然、無為處世。它以低音悠揚但可震憾現代人心曲的生死吟唱,可以引導臨終者走出死亡焦慮的心理誤區,消解悲苦於無形。安樂死是臨終關懷的應有之意。道家生死論尚自然,法自然,主張人為要與自然之序相協調,不應違反自然而強做妄為。道家反對用過枉之舉去擾亂人的生死變化,認為在死亡來臨時,順其自然,享其“安樂”,尊嚴而歸是不失為善終的。因此,在道家生死觀下,“被動安樂死”(即放棄治療)實為良策,而各種形式的“主動安樂死”(包括醫助致死)均與道家生死論主旨相悖。In confronting death there are differences among people regarding their deep concerns. A survey shows that most Chinese Catholics are worried about what will happen to them after death, whereas most other Chinese are concerned about unfinished life plans, unfulfilled familial obligations, and so on. However, most Western and Chinese authors agree that a great number of terminally ill patients suffer from anxiety, sadness, and depression. And no one denies that unease, puzzle, solitude, and even anger are often experienced by many dying patients. Against this background, this essay argues that the mental sufferings of terminally ill patients can appropriately be healed by taking the Daoist perspective over life and death. Moreover, the essay demonstrates that the Daoist position sheds light on the debate around the issue of passive and active euthanasia.According to the Daoist, the Dao is the way of nature. Nature is a universal process of constant change, binding all things together into a vast and natural harmony. Humans should live freely, naturally, and spontaneously in accord with the Dao. From the Daoist perspective, life and death can be analogized as day and night. They constitute two complementary aspects of nature. Where there is life, there is death. Everything living dies, and death implies new life. In short, just as the ceaseless transformation of four seasons in nature, life and death constitute a balanced knot in the harmonious chain of constant natural changes. Therefore, humans should take death naturally, just as they take life naturally. Humans should not have unnatural worry or anxiety on death in their mind.As there are the natural rules of the Dao, one should follow these rules rather than create artificial human laws. For the Daoist, one artificial expectation for humans is to gain an eternal life without death (here the classical philosophical Daoism remarkably differs from the subsequent religious Daoism which pursues immortality). The other unnatural concerns include mental inseparability from the benefits, utilities, and complicated human relations offered in the living world. The Daoist believes that life and death should be identified as one process and that humans and nature should be taken as a unity.Concerning the issue of euthanasia, we believe that the Dao as following nature is consistent with the position of so-called passive euthanasia. Passive euthanasia allows the terminally ill patient naturally to accept death by foregoing aggressive medical procedures when such procedures cannot do more benefit than harm to the patient. Peaceably accepting death when it naturally comes is the human action performed in accord with the Dao. Launching extra human efforts against natural processes is against the Dao.However, the Daoist cannot advocate any type of active euthanasia or physician assisted suicide. On the one hand, the Daoist admires the man who does not use unnatural instruments to prolong the period of dying in the natural process of death. On the other hand, however, to take active means to kill the patient is to act against the Dao. Indeed, actively to kill the patient is on purpose to destroy the natural mechanism and process of human life. It is to intervene with the spontaneous way of nature in the worst sense. Therefore, the Daoist cannot consider it good to take human life with the help of medical tools.DOWNLOAD HISTORY | This article has been downloaded 44 times in Digital Commons before migrating into this platform.
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Velasco Sanz, Tamara Raquel, Ana María Cabrejas Casero, Yolanda Rodríguez González, José Antonio Barbado Albaladejo, Lydia Frances Mower Hanlon, and María Isabel Guerra Llamas. "Opinions of nurses regarding Euthanasia and Medically Assisted Suicide." Nursing Ethics, July 2, 2022, 096973302211099. http://dx.doi.org/10.1177/09697330221109940.

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Background Safeguarding the right to die according to the principles of autonomy and freedom of each person has become more important in the last decade, therefore increasing regulation of Euthanasia and Medically Assisted Suicide (MAS). Aims To learn the opinions that the nurses of the autonomous region of Madrid have regarding Euthanasia and Medically Assisted Suicide. Research design Cross-sectional descriptive study. Participants and research context All registered nurses in Madrid. The study was done by means of a self-completed anonymous questionnaire. The variables studied were social-demographic, giving opinions about Euthanasia and MAS. Ethical considerations Each participant was assured maximum confidentiality and anonymity, ensuring the ethical principles set out in the Declaration of Helsinki, as well as in the Organic Law 3/2018, on Personal Data Protection and guarantee of digital rights. Findings A total of 489 nurses answered the questionnaire. In total, 75.7% of the nurses confirmed that Euthanasia should be regulated in Spain. 66.3% indicated that information on Euthanasia should be provided jointly by doctors and nurses, and 42.3% considered that it could be applied by both medical and nursing professionals. A total of 87.2% advocated the participation of nurses in health policy, influencing the drafting of the law. In the face of possible regulation, 35% would request Conscientious Objection, being closely related to their religious beliefs. Discussion Different authors point out that nurses’ perceptions and attitudes towards Euthanasia are conditioned by different factors, such as religion, gender, poor palliative care, legality and the patient's right to die. Conclusion Nurses are positioned in favour of the regulation and practice of Euthanasia and MAS, depending on their age, years of experience, training, model of care and especially religious beliefs.
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Pentaris, Panagiotis, and Lucy Jacobs. "UK Public’s Views and Perceptions About the Legalisation of Assisted Dying and Assisted Suicide." OMEGA - Journal of Death and Dying, August 3, 2020, 003022282094725. http://dx.doi.org/10.1177/0030222820947254.

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Current debates about assisted dying and assisted suicide cover a series of medical, legal, moral, ethical and religious aspects. Yet, public views on the subject remain underexplored and, therefore, not always accounted for in the formation of public policy. This paper reports on empirical data from a cross-sectional study in the UK in 2019, which examines public views about the legalisation of assisted dying and assisted suicide, by means of a self-administered Qualtrics-based survey (self-devised vignettes). A combination of simple random and convenience sampling was used. Participants (n = 297) state their preference that both assisted dying and assisted suicide should be legalised in the UK (n = 70%), while doctors should be legally allowed to support such wishes of patients with an incurable and painful illness from which they will die (n = 62.22%). The paper concludes that public opinion needs to be further accounted for in policymaking and discourses regarding patient autonomy and dignity of care.
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Grove, Graham, Melanie Lovell, and Megan Best. "Perspectives of Major World Religions regarding Euthanasia and Assisted Suicide: A Comparative Analysis." Journal of Religion and Health, January 29, 2022. http://dx.doi.org/10.1007/s10943-022-01498-5.

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AbstractEuthanasia and physician-assisted suicide (EPAS) are important contemporary societal issues and religious faiths offer valuable insights into any discussion on this topic. This paper explores perspectives on EPAS of the four major world religions, Christianity, Islam, Hinduism and Buddhism, through analysis of their primary texts. A literature search of the American Theological Library Association database revealed 41 relevant secondary texts from which pertinent primary texts were extracted and exegeted. These texts demonstrate an opposition to EPAS based on themes common to all four religions: an external locus of morality and the personal hope for a better future after death that transcends current suffering. Given that these religions play a significant role in the lives of billions of adherents worldwide, it is important that lawmakers consider these views along with conscientious objection in jurisdictions where legal EPAS occurs. This will not only allow healthcare professionals and institutions opposed to EPAS to avoid engagement, but also provide options for members of the public who prefer an EPAS-free treatment environment.
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Evenblij, Kirsten, H. Roeline W. Pasman, Agnes van der Heide, Johannes J. M. van Delden, and Bregje D. Onwuteaka-Philipsen. "Public and physicians’ support for euthanasia in people suffering from psychiatric disorders: a cross-sectional survey study." BMC Medical Ethics 20, no. 1 (September 11, 2019). http://dx.doi.org/10.1186/s12910-019-0404-8.

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Abstract Background Although euthanasia and assisted suicide (EAS) in people with psychiatric disorders is relatively rare, the increasing incidence of EAS requests has given rise to public and political debate. This study aimed to explore support of the public and physicians for euthanasia and assisted suicide in people with psychiatric disorders and examine factors associated with acceptance and conceivability of performing EAS in these patients. Methods A survey was distributed amongst a random sample of Dutch 2641 citizens (response 75%) and 3000 physicians (response 52%). Acceptance and conceivability of performing EAS, demographics, health status and professional characteristics were measured. Multivariable logistic regression analyses were performed. Results Of the general public 53% were of the opinion that people with psychiatric disorders should be eligible for EAS, 15% was opposed to this, and 32% remained neutral. Higher educational level, Dutch ethnicity, and higher urbanization level were associated with higher acceptability of EAS whilst a religious life stance and good health were associated with lower acceptability. The percentage of physicians who considered performing EAS in people with psychiatric disorders conceivable ranged between 20% amongst medical specialists and 47% amongst general practitioners. Having received EAS requests from psychiatric patients before was associated with considering performing EAS conceivable. Being female, religious, medical specialist, or psychiatrist were associated with lower conceivability. The majority (> 65%) of the psychiatrists were of the opinion that it is possible to establish whether a psychiatric patient’s suffering is unbearable and without prospect and whether the request is well-considered. Conclusion The general public shows more support than opposition as to whether patients suffering from a psychiatric disorder should be eligible for EAS, even though one third of the respondents remained neutral. Physicians’ support depends on their specialization; 39% of psychiatrists considered performing EAS in psychiatric patients conceivable. The relatively low conceivability is possibly explained by psychiatric patients often not meeting the eligibility criteria.
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Glick, Shimon. "The Pitfalls of the Ethical Continuum and its Application to Medical Aid in Dying." Voices in Bioethics 7 (December 16, 2021). http://dx.doi.org/10.52214/vib.v7i.8945.

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Photo by Hannah Busing on Unsplash INTRODUCTION Religion has long provided guidance that has led to standards reflected in some aspects of medical practices and traditions. The recent bioethical literature addresses numerous new problems posed by advancing medical technology and demonstrates an erosion of standards rooted in religion and long widely accepted as almost axiomatic. In the deep soul-searching that pervades the publications on bioethics, several disturbing and dangerous trends neglect some basic lessons of philosophy, logic, and history. The bioethics discourse on medical aid in dying emphasizes similarity over previously recognized important distinguishing features. For example, it overplays a likeness between assistance in dying and the withdrawal of life-saving technology. In many bioethics’ topics, arguments based on a logical continuum are used to question the lines demarcating important moral differences. l. The Line Between Ethical and Not: Logic Based on Continuum Careful case selection, often either end of a continuum, allows the tearing down or ridiculing of many rules and codes across most professions and fields of interest. This situation holds true for traffic laws as well as medical ethics guidelines. It is relatively simple for those who desire to attack a particular viewpoint by selecting a case that makes that position seem untenable. In the ethics realm, good and bad medicine exist at opposite ends of an ethical continuum, with many practices lying in between. For example, much of medical ethics exists between the Nazi criminal physicians and the most sainted nurse or physician. A gradual progression occurred over less than two decades from a utilitarian position that supported limited euthanasia for those with certain mental illnesses to genocide. German society embraced a utilitarian ethic in which the value of human life no longer was intrinsic but instrumental.[1] Many morally significant points on a continuum were then ignored as the misguided utilitarian policy rampantly continued. A point in the continuum to distinguish between ethically justifiable and that which is not can be difficult to identify compared to the two extremes. This continuum is not unique to ethics but can be applied to almost any other aspect of human life and endeavor. Between a severely ill schizophrenic person and a superbly well-adjusted individual, there is a continuum of mental and psychological function. The existence of a continuum should not paralyze thinking and prevent us from drawing lines and identifying moral differences based on objective criteria as well as moral philosophy. Yet, by focusing on a continuum, many bioethicists use logic to disregard dividing lines between an "ethical" and an "unethical" act. Unfortunately, sometimes bioethicists draw revolutionary conclusions that would change the scope of medical practices which is accepted as ethical. There are many examples of similar shifts on the continuum. Many authors argue for the ethical permissibility of abortion by pointing out that the human fetus is no different in various characteristics, one arguing it is as like an ape or chick as it is like a person,[2] and does not achieve unique human and individual characteristics until well into the first year of life.[3] While human fetuses arguably do not have certain distinctive qualities of personhood, most people shy away from the logical next conclusion: permitting infanticide. For example, Joshua Lederberg condemns infanticide, in the face of biological illogic, because of our emotional commitment to infants, to me, a relatively weak explanation. Sir Francis Crick suggests we might consider birth at two days of life in order to decide whether an infant is a "suitable" member of society.[4] Giublini and Minerva suggest that infanticide should be permissible since late pregnancy abortions are permissible, arguing there is no significant difference between a fetus just before birth and an infant just after birth.[5] Clearly the continuum approach would allow for subjective arguments in favor of later infanticide at other points many days post-birth. Years ago, with a cynical tone, I mentioned infanticide as a further step on the continuum beyond abortion, and I was rightly shouted down as being deliberately provocative to assert the logic would ever stretch so far. While it is not an accepted mainstream position, the movement in academic settings from widespread condemnation to limited possible acceptance of infanticide has taken place in an incredibly short time. Public opinion and medical opinion in these areas have shifted dramatically in a short time. In another area, from a biological and chemical point of view, there is a continuum from man down to a single carbon atom. Yet, it would not seem logical to ignore the emotional differences, the meaning of personhood, or the moral distinction between killing an insect and killing a person. ll. A False Continuum: Medical Aid in Dying I assert that there has been an erosion of ethical guidelines in recent years attributable to using continuums to camouflage important distinctions. James Rachels’ work on active and passive euthanasia, which contends that the two are ethically identical, exemplifies that logic.[6] He illustrates this thesis, using a continuum to compare different scenarios with like consequences as morally equivalent, by comparing the deliberate drowning of a child with a deliberate failure to rescue a drowning child when easily able to do so. The author's comparison proposes that since much of the medical profession has already made peace with withholding treatment in order to hasten death, consistency inexorably demands that we permit active euthanasia as well.[7] When permission for active euthanasia was first introduced, it was limited exclusively to patients suffering severely from an intractable, incurable, and irreversible disease. These guidelines have been continuously eroded. There is now a substantial serious consideration for permitting active euthanasia of healthy elderly individuals who feel that they have completed their lives and are "tired of living."[8] There are many moral and factual differences along the ethical continuum. In human life, there is a difference between a live baby and a fetus, between a viable fetus and one that is not, between a fetus and a zygote, and between a zygote and a sperm cell. Similarly, there is a difference between pulling a trigger to kill someone and not interfering in preventing his death, which is reprehensible though both may be. There is a difference between not resuscitating an 80-year-old man with cancer when his heart stops and injecting him with a fatal dose of potassium chloride. I argue that an overt act of taking life repels civilized human beings is to be commended and encouraged as the reverence for human life or even for just a moment of human life is one of the great contributions of our civilization. CONCLUSION As an orthodox Jew, I feel that divinely inspired guidelines that have stood the test of centuries shape my beliefs, and such guidelines contradict medical aid in dying. I cannot speak to the viewpoint of those who do not access religion in defining their moral stance, nor do I implicate them in the current bioethics' trends, as I am not aware of the personal role of religion in the lives of most such authors. While many nonreligious people have a firm philosophical grounding and oppose medical aid in dying, I suggest that in the absence of any religious or other absolute standards, developing logically defensible ethical guidelines may be challenging. At the least, religion may play a role in defining the points on the continuums that are ethically meaningful and refuting the trending beliefs that if the endpoint is the same, allowing different methods of arriving at that end are somehow ethically equal. The continuum of ways death may result does not negate analysis of whether death is brought about in ways that recognize the importance of life. The German philosopher Hans Jonas said, "It is a question whether without restoring the category of the sacred, the category most thoroughly destroyed by the scientific enlightenment, we can have an ethics able to cope with the extreme powers that we possess today and constantly increase and are compelled to use."[9] While countries vary on the role of religion in policy, with many emphasizing freedoms of religion, a recent position paper released by a group of Jewish, Christian, and Moslem leaders (the three Abrahamic religions) suggested the need for agreement on the unique sanctity of human life.[10] I would recommend that such a document serve as an example of consensus on critical foundational bioethical guidelines for democratic secular societies. - [1] Alexander L (1949) Medical science under dictatorship. New England Journal of Medicine, 241, p39-47 DOI10.1056/NEJM194907142410201 [2] Lederberg J. (1967) A geneticist looks at contraception and abortion, Annals of Internal Medicine 67, sup 2, 25-27. https:/doi.org/10.7326/0003-4819-67-3-25 [3] Ibid. [4] Editorial, Sociology: Logic of biology. Nature 220, 429 (1968) https://www.nature.com/articles/220429b0 [5] Giublini A Minerva F (2013) After-birth abortion: why should the baby live. J Med Ethics 39, 261- [6] Rachels J (1975) Active and passive euthanasia. New England Journal of Medicine 292, 78-80 [7] Ibid. [8] Cohen-Almagor R Euthanizing people who are "tired of life". in Euthanasia and Assisted Suicide-Lessons from Belgium. Ch 11 of Euthanasia and Assisted Suicide, Cambridge University Press pp173-187. 2017 and DOI; https://doi.org/10.1017/9781108182799.012 [9] Hans Jonas, Technology and Responsibility: Reflections on the New Tasks of Ethics, 1972, found as Chapter IX, Philosophical Essays, 1980. https://inters.org/jonas-technology-responsability [10] A position paper of the Abrahamic Monotheistic religions on matters concerning the end-of-life. Vatican Press 28 October 2019 https://press.vatican.va/content/salastampa/en/bollettino/pubblico/2019/10/28/191028f.html
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