Assignment (MPhil)--University of Stellenbosch, 2000. / ENGLISH ABSTRACT: This study was undertaken to evaluate whether a mentally competent mature human being, who is suffering an intolerable, irremediable existence resulting from an incurable agonising or devastating paralysing disease; has a moral, personal and civic right to end that life or have it ended by requesting assistance in meeting death in a humane, compassionate and dignified manner. ~ The righteousness of such assistance can only be gauged if it follows the repeated and voluntary request of someone who is presently not suffering from any psychiatric disorder, is presently mentally competent or had made such a written or verbal witnessed advance directive while mentally competent to do so. ~ This study will not deal with assistance in dying either active or passive which is performed on severely mentally and physically handicapped new-born babies with scant prospect of survival; nor with euthanasia for the relief of malignant or paralysing disease in those with life-long [anoxic, congenital, inflammatory or traumatic] mental incompetencies who have never had decision-making capacity. ~ This study will not address issues of aid-in-dying for mentally incompetent persons suffering from senile dementia, Alzheimer's disease, or permanent vegetative states due to brain pathology following anoxic, circulatory, infective, malignant or traumatic events, who have not made advance directives and who had never stated preferences concerning assisted euthanasia. The aim of this study is to outline the moral case advanced by those in favour of legalising Voluntary Assisted Euthanasia [VAE] also called Assisted Euthanasia [AE] and to develop ethically sound and practical proposals for policy and actions contributing towards the resolution of the moral dilemma faced daily by doctors when asked by mentally competent patients suffering from irremediable malignant or paralysing diseases or the agonising symptoms of end-stage Acquired Immune Deficiency Syndrome (AIDS) for assistance to end their lives. }ii> This study will cover and discuss the more important objections of those opposed to the legalising of assisted suicide for mentally-competent terminal patients who are irremediably suffering in their bodies or from dehumanising incurable endstage paralysing diseases and are near to an inevitable death. }ii> The insights of philosophers, theologians, physicians and sociologists on the subject of suicide and aid-in-dying, have been researched in the extensive literature that exists (both in print and in cyberspace) on these subjects and are presented with the study. }ii> The study tries to show that a competent adult in certain grim circumstances should have an inalienable human right, if not a constitutional one, to request assisted euthanasia or aid-in-dying or assistance in ending their lives. }ii> Such assistance must be subject to peer review, after careful assessment by a multidisciplinary team in the healing [both physical and spiritual] professions This paper will try to determine whether the actionalisation of voluntary assisted suicide or assisted euthanasia is murder or an act of compassion and empathy performed out of respect for a fellow human being's autonomy and in deference to their right to self-determination and self-realisation. ~ The relevance of this situation is that aid-in-dying is becoming one of the major, moral, religious, philosophical and bio-medical dilemmas at this time. ~ The author's position is that it is neither just nor ethical to prevent a mentallycompetent human being, who is tormented by agonising, incurable terminal physical or irremediable paralysing disease, from deciding to chose to die when he/she can no longer bear the torment and asking for professional assistance to effect this. This relief should be given not only to those who are able to make an enduring, informed contemporaneous decision, but also to those who [when they still had decision-making capacity] had previously made a considered informed advance directive about the use of ordinary and extraordinary medical methods of sustaining a life that had become merely an existence. / AFRIKAANSE OPSOMMING: Die studie is onderneem om te evalueer of 'n bevoegde, volwasse mens wat 'n onverduurbare en ongeneesbare bestaan het a.g.v. 'n ongeneesbare, folterende of vernietigende siekte, 'n morele, persoonlike of burgerlike reg het om daardie lewe te beeïndig of hulp te vra om dit te laat beeïndig, ten einde die dood op 'n menswaardige wyse tegemoet te gaan. ~ Die regverdigbaarheid van bogenoemde hulp kan slegs bepaal word as dit volg op die herhaalde en vrywillige versoeke van iemand wat nie, wanneer hy/sy dit versoek, ly aan 'n geestessiekte nie, wat bevoeg is of wat so 'n geskrewe of mondelinge versoek, met getuies, gemaak het terwyl die persoon kompetent was. ~ Die studie handel nie oor bystand-in-sterfte, aktief of passief, waar dit uitgevoer word op fisies of psigies ernstig gestremde pasgebore babas met 'n skrale kans op oorlewing nie; ook nie oor genadedood ter verligting van kwaadaardige of verlammende siekte in diegene met lewenslange [anoksiese, kongenitale, inflammatoriese of traumatiese] geestelike ongesteldhede, wat nog nooit besluitnemende kapasiteit gehad het nie. ~ Die studie ondersoek nie gevalle van bystand-met-sterfte waar inkompetente persone wat ly aan seniliteit, Alzheimer se siekte, of permanente vegetatiewe toestande a.g.v. brein patologie n.a.v. anoksiese, sirkulatoriese, infektiewe, kwaadaardige of traumatiese gebeure, nie direk gevra het vir genadedood of nooit die voorkeur vir geassisteerde genadedood uitgespreek het nie. Die doel van hierdie studie is om die morele saak van diegene ten gunste van die wettiging van Vrywillige Geassisteerde Genadedood, ook bekend as Geassisteerde Genadedood, te stel en om praktiese sowel as eties verantwoordbare voorstelle te maak vir beleid en optrede wat kan bydra tot die oplos van die morele dilemma wat dokters daagliks in die gesig staar wanneer hulle deur geestelik bevoegde pasiënte wat ly aan ongeneesbare, kwaadaardige of verlammende siektes, of die folterende simptome van die finale stadium van Verworwe Immuniteits Gebrek Sindroom [VIGS], gevra word vir bystand in die beeïndiging van hulle lewens. ~ Die studie sal die belangriker besware van diegene aanspreek wat teen die wettiging is van geassisteerde genadedood vir geestelik bevoegde terminale pasiënte wat ongeneesbaar ly of van dehumaniserende ongeneesbare finale stadium siektes en wat naby is aan 'n onafwendbare dood. ~ Die insigte van filosowe, teoloë, dokters en sosioloë oor bystand-met-sterfte en selfmoord, is nagevors in die wye literatuur beskikbaar is (beide in druk en kuberruimte) oor hierdie onderwerpe en word saam met die studie angebied. ~ Die studie probeer aantoon dat 'n bevoegde volwassene in sekere erge omstandighede 'n onvervreembare mensereg, indien nie 'n konstitusionele reg nie, behoort te hê om bystand tydens genadedood te versoek. ~ Sulke bystand moet onderworpe wees aan groepsevaluasie, na versigtige ondersoek deur 'n multi-dissiplinêre span in die gesondheidsprofessies [beide fisies en psigies]. Die studie sal probeer bepaal of die uitvoering van vrywillige geassisteerde selfmoord of geassisteerde genadedood moord is, of 'n aksie van empatie, uitgevoer uit respek vir 'n medemens se outonomie, sy/haar reg tot selfdeterminasie en self-realisasie. )lo- Die relevansie van hierdie situasie lê daarin dat bystand-met-sterfte besig is om een van die belangrikste morele, religieuse, filosofiese en biomediese dilemmas van ons tyd te word. )lo- Die outeur se posisie is dat dit nie regverdig of eties is om te verhoed dat 'n geestelik bevoegde mens, wat ly aan folterende, ongeneesbare terminale fisiese of ongeneesbare verlammende siekte, self kies om te sterf wanneer hy/sy nie meer die lyding kan verdra nie en vir professionele bystand vra om dit uit te voer. Die verligting behoort gegee te word, nie net aan diegene wat in staat is om 'n bindende en ingeligte besluit te maak nie, maar ook aan -diegene wat [toe hulle nog besluitnemende kapasitiet gehad het] vroeër 'n oorweegde, ingeligte vroegtydige versoek gemaak het aangaande die gebruik van gewone en buitengewone mediese metodes vir die verlenging van 'n lewe wat bloot 'n bestaan geword het.

Thesis (MA)--Stellenbosch University, 2001. / ENGLISH ABSTRACT: Suicide is a truly philosophical problem. Judging whether life is or not worth living amounts to answering the fundamental question of philosophy. In Africa, suicide is not uncommon as evidenced by the Botswana experience. Suicide acts are the forefront of the daily existence even today. Suicide is felt in different areas of Botswana and while the study draws heavily on Africa especially Botswana, reference is also made to countries outside Africa. Hence, suicide in this thesis is not addressed in a restrictive manner. But its manifestation in essence is assessed in a general mode. This implies that the escalation of suicide is viewed from the sociological, psychological and philosophical implications. Although it is not easy to accept and live with suicide, people are beginning to accommodate it as an inevitable concept. However, the family and friends of a person who has committed suicide still feels ashamed, humiliated and sometimes guilty. The aim of this assignment is to analyse and evaluate the moral argument for and against suicide and to focus on the moral implications of committing suicide. While agreeing that individuals' autonomy are personal, the writer tries to suggest a way out of this self-destruction (suicide) which is just a means to an end and not an end in itself. The writer in the concluding chapter tries to explore the pros and cons of suicide, and comes up with the conclusion that the right to live should be given attention than the right to die, at least to preserve its generations which all creatures strive for. Areas of focus: • The concept of Suicide • The nature and incidence of Suicide. • Arguments in favour of Suicide • Arguments against Suicide • The Suicide I Euthanasia Debate / AFRIKAANSE OPSOMMING: Selfmoord is 'n ware filosofiese probleem. Om te oordeel of 'n lewe die moeite werd is om gelewe te word, vereis 'n antwoord op 'n fundamentele vraag van filosofie. In Afrika is selfmoord nie ongewoon nie, soos gesien in die geval van Botswana. Selfmoord kom baie algemeen daar voor. Selfmoord word aangetref in verskeie areas in Botswana, en, alhoewel die studie fokus op Afrika - en spesifiek Botswana, word daar ook verwys na lande buite Afrika. Maar die manifestasie daarvan word in essensie en in die algemeen aangespreek. Dit beteken dat die toename in selfmoord in terme van die verskynsel se sosiologiese, sielkundige en filosofiese implikasies aangespreek word. Alhoewel dit nie maklik is on selfmoord te aanvaar en mee saam te leef nie, begin mense dit aanvaar as 'n onvermydelike verskynsel. Maar die familie van 'n persoon wat selfmoord gepleeg het voel steeds skaam, verneder en soms skuldig. Die doel van hierdie werkstuk is om die argumente vir en teen selfmoord te analiseer, te evalueer, en om te fokus op die morele implikasies van selfmoord. Alhoewel die outeur saamstem dat individue outonoom is, word sterk teen die morele aanvaarbaarheid van selfmoord geargumenteer. In die gevolgtrekking ondersoek die outeur die voordele en nadele van selfmoord en eindig met die bevinding dat die reg tot lewe meer aandag behoort te kry as die sg. reg om te sterf. Areas waarop gefokus word: • Die konsep "selfmoord" as sodanig • Die aard van selfmoord en (hoe algemeen dit voorkom.) • Argumente ten gunste van selfmoord • Argumente teen selfmoord • Die selfmoord -genadedood debat

Den moderna sjukvårdens avancerade resurser räddar många liv, men kan också leda till ett utdraget och plågsamt döende. I ett fåtal länder i världen är eutanasi och läkarassisterat självmord ett val för den som drabbats av en obotlig sjukdom som leder till döden. Syftet med denna studie är att beskriva obotligt sjuka patienters uppfattningar om dödshjälp. En litteraturstudie genomfördes och relevanta sökord som motsvarade syftet användes vid artikelsökning. Vid bearbetning av data framkom tre olika kategorier med subkategorier som motsvarade de olika uppfattningarna. Resultatet visar att positiva uppfattningar till dödshjälp kan bero på patientens egna syn på värdighet, självbestämmande och hopp, medan negativa uppfattningar till dödshjälp kan bero på rädsla eller religion. Även kommunikation med vårdpersonal kan påverka patienters uppfattningar om dödshjälp. För att möta obotlig sjuka patienters behov den sista tiden i livet behövs det kunskap om alla sorters tankar patienten kan ha, detta gäller även tankar om dödshjälp. Vidare forskning inom området dödshjälp behövs för att möta alla utmaningar som det innebär när patienter önskar hjälp med att dö.

Background: Active euthanasia is legal in Netherlands, Belgium and Luxembourg. In Switzerland, Estonia and the states of Wasington and Oregon in USA are only doctor-assisted euthanasia legal. When patient’s receive a diagnosis of a terminall illness studies shows that various kinds of suffering, pain, religion and feeling that you are dependent on relatives are factors which affect people's quality of life and attitude to euthanasia. Some patients want to end their life while others want to manage their lives. There are disagreements about whether euthanasia could be a option. Aim: To describe the attitude of patients with an incurable terminal illness has to euthanasia and what factors as affecting their attitude. The aim is also to describe the research group in the articles. Method: A descriptive design has been used in this litterature study. Twelve articles have been used, seven Qualitative and five Quantitative. Results: The results depends on various factors such as pain, religion, depression, physical function and suffering. These factors affected the patient’s attitudes towards euthanasia. The composition of the articles emerge that 680 patients were positive to euthanasia, 483 patients were against, and 34 patients had not answered the question. Conclusion: A positive attitude to euthanasia can be seen clearly in the research of the articles results. However, only one study came from Sweden and therefore the authors think that more research is needed to gain an understanding of patient’s attitude. There are concerns that euthanasia will be miss-used or abused when the patient’s have been asked about their attitudes. [1]Totalt 1197 svarande, 680 patienter för, 483 patienter emot, 34 svarande ej. / Bakgrund: I Nederländerna, Belgien och Luxemburg är det lagligt med aktiv dödshjälp. I länderna Schweiz, Estland och delstaterna Washington och Oregon i USA är det lagligt med läkar-assisterat självmord. När patienter får en diagnos med en dödlig sjukdom framkommer det i studier att vid olika typer av sjukdomar uppfattas lidande, smärta, religion samt att vara andra närstående till besvär som faktorer vilket påverkar personernas livskvalité och inställning till eutanasi. En del patienter vill avsluta sitt liv andra vill hantera sitt liv därför råder det delade meningar kring inställningen till eutanasi. Syfte: Syfte med denna studie var att beskriva vilken inställning patienter med obotligt dödliga sjukdomar har till eutanasi och vilka faktorer som påverkar deras inställning. Syftet var även att beskriva vilken undersöknings grupp de valda artiklarna hade. Metod: En deskriptiv design har används i denna litteraturstudie. Tolv artiklar har används, sju Kvalitativa och fem Kvantitativa. Huvudresultat: Resultatet är beroende av olika faktorer såsom, smärta, religion, depression, fysiska funktionen och lidandet. Dessa faktorer påverkade patienternas olika inställning till eutanasi. I sammansättningen av artiklarna framkom det 56,8% patienter var för eutanasi, 40,3% patienter var emot och 2,8 % patienter har inte svarat på frågan1. Slutsats: Stora skillnader kan ses till inställningen om eutanasi i sammanställningen av artiklarnas resultat. Dock framkommer endast en studie ifrån Sverige och därför anser författarna att mer forskning behövs för att få en förståelse för patienternas inställning. Även en risk för att eutanasi skall missbrukas uppkommer i studien när patienter skall besvara frågan om de är för eller emot.

Euthanasia represents one of the most controversial topics around the world. As I mentioned in the first chapter there is no worldwide consistency whether to accept the idea of legalization Active Voluntary Euthanasia ("AVE") or not. The goal of this diploma thesis is not to persuade anybody. In approximately 60 pages of the text I am providing readers with some essential information about euthanasia in the Czech Republic. I am also trying to compare the foreign legal regulation of euthanasia and assisted suicide but theoretical ideas as well. The first chapter is mainly trying to capture the reader's focus and setting the theme of my diploma thesis. The second chapter of my thesis is called ,,The Term Euthanasia". This chapter provides readers with several definitions of euthanasia and Physician Assisted Suicide ("PAS") as well as some historic data. The act of euthanasia has its origin in Greek. First word euthanasia is mentioned in old Greek literature. The term euthanasia is composed from two Greek words. Eu which means good or normal and Thanatos which means death. The word euthanasia can be literally translated as a "good death". It should be mentioned that during the centuries the meaning of euthanasia has changed. Today's understanding of euthanasia is ending ones life in order to relieve...

Euthanasia was and still is one of the most controversial topics. It is a complex problem that involves religious, moral, medical and legal aspects. My thesis is focused on euthanasia in relation to the law. The aim of the thesis is to analyse the issue of euthanasia from the perspective of legislation in the Czech Republic. The thesis consists of five chapters. The first chapter contains introduction to the topic of euthanasia. The second chapter is devoted to the definition of term euthanasia. Euthanasia is a word of Greek origin ("eu"- good and "thanatos"- death). Its meaning is good, beautiful or merciful death. Nowadays the term is used in the sense of intentionally termination of life on request to relieve pain and suffering. This chapter also includes the definition of forms of euthanasia. The third chapter is focused on euthanasia in the sense of killing on request. In this meaning, euthanasia has never been explicitly regulated in the Czech Republic. But it does not mean that the issue of legislation of euthanasia is not actual. This chapter is subdivided into the three parts. The first part is about history of legislation of euthanasia. The second part is concentrated on legal classification of euthanasia according to the Czech Penal Code. The last part contains the ideas de lege ferenda....

The diploma thesis is focused on the society's view of the problems of legalization of euthanasia. The thesis is divided into two main parts, the theoretical and the empirical one. The theoretical part consists of the basic terms related to the given problems, further of historical development of euthanasia, countries where euthanasia is legalized, arguments of proponents and opponents of euthanasia and paliative care. The practical part follows after theoretical information and deals with analysis of data gained by a questionnaire research and interpretation of individual findings relating to respondents' general awareness of euthanasia and differences in the view of euthanasia between lay public and professionals. At the end of the thesis, the concrete recommendations in future discussions about euthanasia are proposed on the basis of gained information.

The aim of this Master's degree thesis is an overall assessment of the issue of euthanasia and a consideration of its possible legal regulation. In order to accomplish this aim it was necessary to carry out an analysis of foreign legislations of euthanasia. Furthermore, I have dealt in this thesis with the current status of euthanasia under the legal order of the Czech Republic with primary emphasis on criminal law. This thesis consists in total of four chapters. Chapter One deals with the most general matters of euthanasia, in particular with the matter of the term itself, usually determined forms and historical developments of attitudes towards euthanasia. Chapter Two compares foreign legislations of euthanasia and their impact on practice. Chapter Three clarifies the status of euthanasia in respect of the Czech legal order, in particular from the perspective of criminal law, in respect of recent legislative efforts for its legal regulation and considerations of possible future legal development. The last chapter deals with fundamental arguments of supporters and dissenters of euthanasia and provides its summarizing assessment. The conclusion, which I have reached while working on this thesis, is kind of a compromise. I suppose that legalization of euthanasia does not stand for a right direction,...

Master of Science / Department of Animal Sciences and Industry / Timothy G. Rozell / Malnourished piglets that suffer from periweaning failure to thrive syndrome (PFTS) may show no signs of respiratory or enteric diseases but may have decreased feed intake and become debilitated after weaning. Euthanasia is a necessary component of swine production as it is sometimes the only option to alleviate suffering of piglets that are born with congenital defects or suffer from PFTS. Fifty-eight nursery-aged piglets were utilized in two experiments to evaluate blood parameter differences between healthy and unthrifty piglets and to compare euthanasia methods. Piglets were categorized into two health groups: healthy or unthrifty. During selection, blood was collected for analysis of blood parameters. Piglets were euthanized 24-32 hours after initial blood sampling and a second sample was collected for comparison. After euthanasia, piglets were necropsied for evaluation of euthanasia on pulmonary lesions. No significant difference in number of pulmonary lesions was found between health groups (P = 0.88). Healthy piglets had higher concentrations of glucose, ionized calcium and sodium, and greater pCO₂ than unthrifty piglets (P ≤ 0.05). Unthrifty piglets showed higher concentrations of hemoglobin and hematocrit (P = 0.0002) than healthy piglets. Piglets were assigned to one of two euthanasia methods to compare electrophysiological and behavioral parameters of hypobaric hypoxia and carbon dioxide gas. Two piglets at a time were euthanized for each method. One animal in the pair was fitted with electrocardiogram and electroencephalogram monitoring devices during euthanasia. Behavioral parameters were also recorded. The average treatment times were 27.4 ± 6.7 minutes for HH and 13.8 ± 5.1 minutes for CO2. Piglets euthanized via CO2 reached an isoelectric state faster than piglets euthanized via HH (P = 0.009). Behavioral observations revealed gasping in 100% of CO2 euthanized piglets during the first five minutes of treatment and only 28.6% of HH euthanized piglets during the same period. During HH, 57.1% of piglets became ataxic in the first five minutes while 76.9% of CO2¬ piglets became ataxic during the same period. Results of this trial indicate that HH may be a lower stress alternative to CO₂ as it causes fewer incidences of aversive behaviors in early stages of treatment.

As diretivas antecipadas de vontade para o fim da vida são documentos que expressam os desejos da pessoa relacionados aos procedimentos que podem ser aplicados a ela em uma situação de assistência médica no fim da vida. Nesse sentido, as diretivas são úteis para informar as equipes de assistência médica a respeito dos tipos específicos de tratamento que o paciente permite, ou não permite, quando não estiver apto a manifestar suas vontades em uma hipotética situação futura de incapacidade. Este tipo de documento foi elaborado nos Estados Unidos na década de 1970, e foi introduzido no ordenamento ético brasileiro pela Resolução 1995/2012 do Conselho Federal de Medicina. O objetivo desta dissertação é estudar essa norma ética sob o enfoque do direito penal, uma vez que as diretivas antecipadas de vontade para o fim da vida possuem uma íntima relação com a ortotanásia e a eutanásia, que são passíveis de sanção penal no Brasil. Assim, é fundamental analisar as diretivas antecipadas utilizando as ferramentas da doutrina penal, e princípios como os da dignidade humana e razoabilidade. O objetivo é pesquisar as qualidades, imperfeições e limites das diretivas antecipadas sob o ordenamento jurídico nacional, e também compreender as bases legais das diretivas antecipadas, que são os institutos da autonomia e do consentimento. Concluímos que, ainda que as diretivas antecipadas de vontade sejam uma norma ética bem-vinda, demandam algumas melhorias e refinamentos, que poderiam ser representados pelos planejamentos antecipados de tratamentos, um tipo de documento direcionado aos valores de vida das pessoas. Além disso, uma mudança de paradigma relacionada à eutanásia, particularmente a eutanásia passiva e a ortotanásia, no sentido de descriminalizá-las, seria importante para que as diretivas antecipadas tenham eficácia no Brasil. / Advance directives for dying patients are documents which express personal desires related to procedures that may be applied to people in a situation of medical assistance in the end of life. In this sense, they are useful to make health assistance teams know about what kind of specific treatment the patients permit, or do not permit, when they are not able to communicate their wishes in a hypothetical and future situation of disability. This kind of document was created in the United States in the seventies, and entered Brazilian ethical law by Resolution 1995/2012 of the Federal Council of Medicine. The aim of this dissertation is to study this ethical rule by means of the criminal law, because advance directives have a close relation to euthanasia and ortothanasia, which are prone to criminal sanction in Brazil. Therefore, it is paramount to analyze the advance directives using the doctrinal tools of criminal law and principles like human dignity and reasonability. The goal is surveying the qualities, inadequacies and limits of advance directives under Brazilian law, and also to understand the legal basis of the advance directives, which are the institutes of autonomy and consent. We concluded that, although advance directives for dying patients are a welcome ethical law, it demands some improvement and refinement, which could be represented by the advance care planning, a kind of document that is focused on the life values of people. Furthermore, a change of paradigm related to euthanasia, particularly passive euthanasia and ortothanasia, in the direction of making them apart of criminalization, would be vital to promote the adequate efficacy of the advance directives in Brazil.