Euthanasia has been subject of controversy since antiquity, but 3000 years later it still seems to be highly debated among contemporary ethicists and philosophers. The main purpose of this essay is to investigate under which circumstances euthanasia could be morally permissible, by highlighting and discussing the most debated objections against it. The first objection brings up the problem of how we can be sure that a wish to die is confident and final. This objection is followed by a discussion about the risks of administering euthanasia incorrectly. The second objection concerns whether voluntary euthanasia and physician-assisted suicide really is necessary. Here, the main question is whether people about to die would be harmed rather than helped if they had euthanasia and physician-assisted suicide available as an alternative. The third section discusses the doctrine of double effect. Here, the main purpose is to investigate where DDE stands in relation to cases of euthanasia and physician-assisted suicide. Furthermore, the final two objections concern the parallel between killing and letting die, and second of all the slippery-slope argument in connection with euthanasia. The essay concludes with a discussion about the ways in which practicing euthanasia can be harmful, as well as a more detailed debate about the sustainability of the objections mentioned above.

The thesis deals with the subject of dying and death and focuses on secondary school students' awareness of this issue. The theoretical part of the thesis describes stages of dying, the needs of a dying person and their emotional state. Furthermore, it distinguishes between dying at home and dying in a health care institution. In the following chapters, the thesis focuses on palliative care, the process of grieving, funeral rites and the issue of euthanasia. The method of the theory was reading of literature that specializes in the issue. The practical part of the thesis compares data from questionnaires given to secondary school students on the topic of death and dying. The research shows that the students' awareness of the issue is considerably low - 84% respondents did not know what the term "palliative care" meant, 88% respondents did not know what the term "hospice" meant and 74% respondents were not familiar with the term "euthanasia". The research has found that there is a need to broaden the secondary school students' knowledge on the topic of dying. KEYWORDS thanatology, dying, death, euthanasia, palliative care

Introduction: Palliative sedation is the use of sedatives to lower the alertness for symptomcontrol, when suffering is otherwise uncontrollable. Its role in palliative care is frequentlyargued, with both proponents and opponents. End-of-life decisions raise many concerns,including ethical ones, regarding which ethical principle should be valued the most. Someopponents argue that palliative sedation is ethically similar to euthanasia, but there alsoappears to be some confusion concerning concepts and definitions. Aim: To discuss ethical arguments for and against palliative sedation, and relevant ethicaldifferences between palliative sedation and euthanasia. Furthermore, to try to clarify differentconcepts and definitions used in the discussion of the matter. Materials and methods: This work is based on a qualitative literature study, and anargumentative- and concept analysis on hermeneutic ground. Material was gathered through aliterature search, and contains official material, debate articles and scientific articles. Results: Palliative sedation can be argued to protect the ethical values of autonomy,beneficence, dignity and integrity, but simultaneously it is argued to violate those ethicalconcepts. There seems to be disagreements regarding which principle should be highestvalued. Conclusion: The matter of palliative sedation is delicate, and engages a lot of people. Pro- andcontra-arguments vary in strength, partly because of an inconsistency in the use of differentconcepts and definitions. In most of the material studied, it is argued that palliative sedation isethically acceptable, whereas euthanasia is not.

O trabalho foi um estudo retrospectivo da dinâmica populacional canina no Município de Ibiúna no período de 1998 a 2002, onde se objetivou avaliar esta dinâmica populacional em termos de animais recolhidos, eutanasiados e adotados, e sua influência nesta população. Utilizaram-se na análise de dados, informações do Departamento de Zoonoses da Secretaria Municipal de Saúde do Município de Ibiúna -SP. Para informações dos animais adotados foi elaborado um questionário onde foram entrevistados cento e oitenta e seis proprietários de outubro de 2002 a abril de 2003, que adotaram cães no período estudado. Os resultados mostraram que o número de cães recolhidos foi progressivo a cada ano estudado, bem como os animais eliminados. A eutanásia e o recolhimento de cães não foram mecanismos eficientes de controle populacional canino. A razão cão/habitante foi crescente, e esta relação média nos últimos cinco anos foi de 1:3,77. A adoção de cães não resolveu o problema do abandono desses animais. Há necessidade de implantação de medidas de controle populacional mais abrangentes. / This work was a retrospective study of populational canine dynamic in the city of Ibiúna from 1998 to 2002. The objective was to assess this populational dynamic in terms of sheltered, euthanazied and adopted animals as well as the influence of these actions in this population. Some information from the Zoonosis Department of Secretaria Municipal of Health in the City of Ibiuna (SP) was used in the analysis of data. A questionnaire was prepared to obtain information about animals and 186 owners were surveyed from October 2002 to April 2003. The results showed that the number of sheltered animals increased progressively during each year of study as well as the number of eliminated animals. The euthanasia and the action of sheltering dogs in the city of Ibiuna were not efficient in the canine population control. The dog per inhabitant ratio was increased in the last five years with a mean ration given by 1:3,77. The adoption of dogs did not solve the problem of abandoned dogs. It is necessary to implement a broader criteria of population control.

Bakgrund: Sverige hör till ett av de länderna i världen där befolkningen lever längst, samtidigt går den medicinska utvecklingen ständigt framåt och skapar etiska dilemman gällande vården av den döende människan. Att förstå hur dessa patienter ska bemötas och vilka aspekter som är viktiga för en god död är en viktig del av den moderna sjukvården. Syfte: Syftet med denna litteraturöversikt var att undersöka vad en god död innebär ur ett patientperspektiv. Metod: Litteraturöversikt med deskriptiv design där resultatet baseras på 12 kvalitativa originalartiklar. Resultat: Resultatet visar på att vad en god död innebär är högst individuellt, några mönster framkom dock. Patienter värdesätter delaktighet i vården, de vill vara informerade om sin prognos och beslut som tas omkring den egna vården. Flertalet patienter vill fatta det slutgiltiga beslutet om sin behandling. Att behålla sin integritet och värdighet till slutet var andra delar i hur en god död upplevdes. Att styra över vart man dör är en annan viktig aspekt, att få dö en fridfull, smärtfri död i hemmet ansågs av många vara en god död. Assisterad dödshjälp ansågs i vissa fall bättre än en långsam process med mycket lidande under den sista tiden, men framförallt uttrycktes att döden skulle vara naturlig och inte utdragen. Slutsats: Döden och döendet är något som angår oss alla. Precis som övrig vård är det av stor vikt att även den palliativa vården individanpassas för att främja livskvalitet och bevara autonomi och värdighet / Background: Sweden has one of the highest life expectancies in the world, at the same time medical development is constantly ongoing. These two factors combined create ethical dilemmas regarding care for the dying patient. Understanding how patients in a palliative stage of their treatment view a good death and what aspects of care they value is a critical part of modern healthcare. Aim: The aim of this literature review is to get a better understanding of a good death from a patient perspective. Method: Literature review with a descriptive design where the result is based on 12 qualitative original articles. Result: The results show that a good death is a highly individual process. A few patterns emerged during this study. Patients value involvement in their own care; they want to be informed about their prognosis and their care. Many patients also want to make the final decision about their treatment. Retaining ones integrity and dignity to the end were also recognized as important factors of a good death. Having a say in where you die also important; to be able to have a peaceful and pain free death in ones home was considered part of a good death to many participants. Assisted euthanasia was, in some cases, considered better than a slow painful death. However, ensuring that the dying process was fast occurred via natural causes was more important. Conclusion: Death and the process of dying is something that affects us all. As in all care, it is important that palliative care is adapted to the individual to promote a better quality of life and to help the patient retain autonomy and dignity.

Bakgrund: Eutanasi tycks oförenligt med sjuksköterskans profession för många. Frågan om eutanasi hanteras olika beroende på ländernas lagstiftning. Sjuksköterskor möter svårt sjuka patienter och har en nyckelroll i omvårdnaden i livets slutskede. De har även sjuksköterskans etiska kod att förhålla sig till. Sjuksköterskor konfronteras med patienters önskan om att få dö vilket kräver reflektion kring sin egen attityd. Syfte: Syftet var att undersöka sjuksköterskors attityder till eutanasi. Metod: En litteraturöversikt baserad på 12 vetenskapliga artiklar. Artiklarna hämtades från PubMed och Cinahl Complete. Elva artiklar använder en kvantitativ metod medan en artikel använder en kvalitativ metod. Resultat: Sju studier visar en övervägande positiv attityd till eutanasi. Fyra studier visar en övervägande negativ attityd. En studie visar inget tydligt ställningstagande. Fler sjuksköterskor kan tänka sig ta emot eutanasi än som kan acceptera att en familjemedlem tar emot eutanasi. Sjuksköterskor inom palliativ vård är generellt större motståndare till eutanasi. Viktiga faktorer till attityderna är religion, sjuksköterskans vårdområde, ålder och tilltron till medicinsk forskning. Diskussion: Metoden diskuteras utifrån dess styrkor och svagheter. Resultatet diskuteras utifrån Madeleine Leiningers omvårdnadsteori, tidigare forskning samt etisk litteratur. Resultatdiskussionen tar upp religionens, etikens och kulturens påverkan på attityderna. Variationer i attityder i länder där det är lagligt respektive olagligt diskuteras. Sjuksköterskors förhållningssätt till eutanasiprocessen och hur attityderna påverkar arbetet tas upp. Palliativ sedering som alternativ till eutanasi diskuteras utifrån ett utilitaristiskt perspektiv. / Background: Euthanasia seems incompatible with the nurse’s profession for many. The issue of euthanasia is handled differently depending on the country's legislation. Nurses meet severely ill patients and play a key role during end of life care. All nurses have their code of ethics to relate to. Nurses are confronted with patients’ desire to die, which requires reflection about their own attitude. Aim: The aim was to investigate nurses’ attitudes towards euthanasia. Method: A literature review based on 12 scientific articles. The articles were collected from PubMed and Cinahl Complete. Eleven articles use a quantitative method while one uses a qualitative method. Results: Seven studies show a mostly positive attitude towards euthanasia. Four studies show a mostly negative attitude. One study shows no clear position. More nurses are willing to receive euthanasia than to accept euthanasia for a family member. Nurses in palliative care are in general more negative to euthanasia. Important factors for attitudes are religion, the nurse's field of care, age and confidence in medical research. Discussion: The method is discussed based on its strengths and weaknesses. The result is discussed based on Madeleine Leininger's nursing theory, previous research and ethical literature. The outcome discussion addresses the influence of religion, ethics and culture on the attitudes. Variations in attitudes in countries where it is legal, or illegal are discussed. Nurse’s approach to the euthanasia process and how attitudes affect the work are addressed. Palliative sedation as an alternative to euthanasia is discussed from a utilitarian perspective.

ABSTRACTThe Belgian Euthanasia Act of 2002 (The Act), amended in 2014 to include the Minor Act (The Minor Act), has drawn international criticisms for its liberal laws and practices regarding Euthanasia. This paper is a response to allegations that the liberal laws on Euthanasia has encouraged doctors to adopt a paternalistic 2 approach towards their patients by terminating their lives without their explicit consent, i.e. engaging in Involuntary Euthanasia.3, 4, 5Although in theory, only Voluntary Euthanasia (explicit patient request and therefore consent) is permitted in Belgium 6 the allegations implied that in practice, Involuntary Euthanasia (no explicit patient request and therefore consent is given) is practiced, especially in the Intensive Care Units (ICU) in Belgium.This paper attempted to make distinctions between Terminal Sedation and Euthanasia based on current dominant discourse in Bioethics and argued that it is not Involuntary Euthanasia that is practiced in the ICU but Non-Voluntary Euthanasia or Terminal Sedation (explicit patient request and therefore consent is unavailable) is practiced based on the intent of the doctor. In presenting its arguments, this paper focused specifically on the reports it procured from its qualitative research. Finally, in order to understand if doctors in the ICU are Gods or Monsters, the paper attempted to answer four questions namely:1. Are doctors in Belgium Gods, who help end lives?2. Or are they Monsters, who help end lives?3. Or are they pre-hippocratic doctors, historically called Witch-Doctors, who are“for hire” to either “cure or to kill” with no loyalty to the Hippocratic Oath?4. Or are they mutated witch-doctors pressured to practice Euthanasia in a countrywhere the laws are perhaps fatally flawed? / Doctorat en Philosophie / info:eu-repo/semantics/nonPublished

Three groups of health care professionals were canvassed for their views on euthanasia - student nurses, practising nurses and doctors. The aim of the research was to make a possible contribution to a formalised health policy on this issue for the ACT. The following forms of euthanasia were covered by the research: (i) voluntary active euthanasia: (ii) voluntary passive euthanasia: (iii) involuntary active euthanasia: (iv) involuntary passive euthanasia. Passive forms of euthanasia were found to be the most acceptable. Voluntary forms of euthanasia were not found, in general, to be more approved of than involuntary forms of euthanasia. However, active forms of euthanasia were much less acceptable than passive forms. In order to adapt the research findings to a methodology for policy use. Allison's models (1971) of public policy development were modified into a single model. This provided an application of the research results in such a way as to allow for the development of a possible formalised policy on euthanasia, and practical applications. The conclusions drawn from the research findings and the subsequent recommendations are supportive of law reform and the implementation of a new policy on the issue of euthanasia.

<p>There is no stronger or more enduring prohibition in medicine than the rule against the killing of patients by doctors. This prohibition is rooted in some medical codes and principles. Out standing among the principles surrounding these prohibitions are the principles of beneficence and non-maleficience. The contents of these principles in a way mark the professional integrity of the physician. But the modern approach to health care services pulls a demand for the respect of the individual right of self-determination. This demand is now glaring in almost all the practices pertaining to health care services. In end of life decisions, this modern demand is found much in practices like physician- assisted suicide and euthanasia. It demands that the physician ought to respect the wish and choice of the patient, and so, must assist the patient in bringing about his or her death when requested. In such manner, this views the principle of autonomy as absolute and should not be overridden in any circumstance.</p><p>However, the physician on his part is part of the medical profession that has integrity to protect. This integrity in medical profession which demands that the physician works only towards the health care of the patient and to what reduces diseases and deaths often go contrary to this respect for individual autonomy. Thus faced with such requests by patients, the physician always sees his integrity in conflict with his demand to respect the autonomous choice of the patient and so has a dilemma in responding to such requests. This is the focus of this work,"Professional Integrity and the Dilemma in Physician- Assisted Suicide"</p><p>However, the centre of my argument in this work is not merely though necessary to develop general arguments for or against the general justification of PAS, but to critically view the role played by the physicians in assisting the death of their patients as it comes in conflict with the medical obligation and integrity. Is it morally right, out rightly wrong or in certain situation permissible that physicians respond positively to the request of the patients for PAS? This is the overarching moral problem in the morality of physician- assisted suicide, and this work will consider this in line with the main problem in the work “the dilemma of professional physicians in the assistance of suicide.</p>

<p>The two most controversial ends of life decisions are those in which physicians help patients take their lives and when the physician deliberately and directly intervenes to end the patients’ life upon his request. These are often referred to as voluntary euthanasia and physician assisted suicide. Voluntary euthanasia and physician assisted suicide have continued to be controversial public issues. This controversy has agitated the minds of great thinkers including ethicians, physicians, psychologists, moralists, philosophers even the patient himself. Hence the physician, patient, the public and policy makers have recently had to face several difficult questions.</p><p>Is it morally right to end the life of the patients? Is there any moral difference at all between Voluntary euthanasia and physician assisted suicide? Should a terminally ill patient be allowed to take his life and should the medical profession have the option of helping the patient die. Should voluntary euthanasia and physician assisted suicide be legalised at all? And what actually will be the legal and moral implications if they are allowed.</p><p>In a bid to find a lasting solution to these moral problems and questions has led to two different strong positions viz opponents and proponents of voluntary euthanasia and physician assisted suicide. The centre of my argument in this work is not to develop new general arguments for or against voluntary euthanasia and physician assisted suicide but to make a critical ethical comparative analysis of voluntary euthanasia and physician assisted suicide. This is the focus of my work. The sole aim of this work is neither to solely condemn nor to support voluntary euthanasia and physician assisted suicide but to critically analyze the two since we live in a world of pluralism.</p>