The killing of severely disabled newborns: the spectre behind the legalisation of physician-assisted suicide and euthanasia

Arguments made by those in favour of the legalisation of physician-assisted suicide (PAS) and euthanasia often rely upon the idea of the quality of life. This idea states that an individual's life is not valuable as an intrinsic good, but is only good based upon the things which it allows us to do. It thus allows the argument that it is morally permissible to kill individuals whose lives have fallen below an acceptable 'quality of life.' However, this concept may require that one accept the killing of individuals who have not expressly request to be killed such as severely disabled newborns. This paper will examine the issue of whether those who utilise a quality of life approach to justify the legalisation of PAS and euthanasia must logically accept the policy of killing severely disabled newborn children. First, there will be an examination of the concept of quality of life and its importance in the arguments for the legalisation of PAS or euthanasia. This paper will then consider how notions of personhood interact with the concept of quality of life in order to create the problem faced by those who favour the legalisation of PAS or euthanasia. Finally, this paper will consider how the notion of autonomy may be used as a way to avoid this difficulty created by the quality of life approach.     

Assisted suicide bordering on active euthanasia

A 44-year-old woman was almost completely paralysed after a severe brainstem haemorrhage. Even after several years of efforts at rehabilitation, she remained completely dependent on the help of others. However, a special device enabled her to administer (after careful preparation) liquids through the PEG catheter despite her poorly coordinated movements. Four years after the stroke, the woman joined a right-to-die society with the wish to bring her life to an end. A doctor working with this organisation prescribed her a lethal dose of pentobarbital. In the presence of her husband and her companion from the organisation, the woman administered herself the lethal substance by means of the device. On the basis of the fact that she herself had switched the device on this death was classed as (assisted) suicide.     

Elderly suicide and attempted suicide: one syndrome

In this study we explore whether elderly suicide victims who had a previous history of attempted suicide differ from those with no similar history. A group of the elderly, who ended their lives with fatal self-harm (FSH) and had a history of deliberate self-harm (DSH) was compared to a matching group of the elderly who also ended their lives with FSH, but who were not known to have had any history of DSH. The comparison was in respect of epidemiological, social, psychological characteristics, service input and methods of suicide. The elderly, with a history of DSH, were more likely to have been known to the mental health services than the elderly who did not have such a history (P<.05). The two groups used similar methods in their final FSH act. The elderly victims of FSH with or without a previous history of DSH share the same characteristics. The two groups appear to be part of one syndrome. Deliberate self-harm in the elderly should be taken seriously as an unsuccessful suicide rather than a manipulative act or a cry for help and attention.     

African ethics and voluntary euthanasia

This paper outlines the relationship between euthanasia and its ethical norms and practices in a part of West Africa. The various sub-types of euthanasia are described in detail, parallel with the role of African ethical theories in determining their relevance. The author discusses the implications of this approach relative to the social and economic state of African communities.     

Terminal sedation: between pain relief, withholding treatment and euthanasia

In the last five to ten years there has been increasing debate on terminal sedation, a medical practice that is difficult to place between other decisions at the end of life, like alleviating pain, withholding treatment, and (in jurisdictions where this is allowed) euthanasia or physician-assisted suicide. Terminal sedation is the administration of sedative drugs with the aim to reduce the consciousness of a terminal patient in order to relieve distress. It is frequently accompanied by the withdrawal (or withholding) of life-sustaining interventions, such as hydration and nutrition. It is typically a measure of the last resort, to be considered in situations where all other measures to reduce pain and suffering have failed. While similar to palliative measures as far as the sedation itself is concerned, withholding of hydration and nutrition brings terminal sedation into the realm of non treatment decisions. At the same time, to the extent that the combination of these two measures may shorten the patient's life, the practice may be easily associated with euthanasia. It is no surprise therefore, that terminal sedation has been called (and has been disqualified as) 'slow euthanasia' or 'backdoor euthanasia'. This paper addresses the question how terminal sedation may be looked upon from a legal point of view. Is it indeed a disguised form of euthanasia, or should it be considered as a practice in its own right? In the latter case, what does it imply in legal terms, and under which conditions and safeguards could it be legally justified? To answer these questions, I will look first at the different clinical realities that may be brought under the heading 'terminal sedation'. Then I will deal with its two components--sedation on the one hand, and withholding artificial feeding on the other--in a legal perspective. The paper ends with conclusions on terminal sedation as a whole.     

Latest legal and social developments in the euthanasia debate: bad moral consciences and political unrest

Several events that took place during recent years, such as the French Act on the rights of patients and the end of life, the Terri Schiavo case and Lord Joffe's proposal for an Assisted Dying Bill in the United Kingdom, have triggered the debate on euthanasia more than ever. It is therefore opportune to revisit basic notions related thereto and to make a comparative analysis of the legal regime of euthanasia in several countries in Europe and elsewhere, as well as to try to see how the public awareness of the problem has of late developed. There seems to be a clear trend in many legal systems towards an increasing respect for the patient's right to self-determination. However, we are still looking at a complex social game, where legal and medical terminology are manipulated and euphemisms are invented in order to accommodate bad moral consciences and avoid political unrest.     

Dying with dignity: developments in the field of euthanasia in The Netherlands

The development of the debate on euthanasia in The Netherlands, the role of the courts and proposals for legislation are discussed. In foreign newspapers and other publications an erroneous picture of the Dutch situation on euthanasia is sometimes given. In Parliament two proposals for legislation are pending. The parliamentary debate is expected to be reopened in 1989.     

自杀意念与企图评估的研究进展

自杀意念（suicidal ideation）是指想死的意愿或不想活的一系列想法。自杀企图（attempted suicide）指有想死的愿望并有行动计划。自杀者多见于年轻人，给社会带来极大危害，这一现象目前已引起国内外的高度关注。及时发现影响自杀意念和自杀企图的相关因素，是有效预防自杀发生的关键。最近研究证实，绝大多数自杀者行动前常存在与近期压力或应激冲动有关的事件，情绪低落、酒精和药物滥用、寻求帮助的动机等，即自杀前有一定的征兆和活动计划。