M.A. (Philosophy) / Please refer to full text to view abstract

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

Euthanasia has emerged as one of the leading ethical and moral issues of our time. This practice has been debated ever since ancient times. Medical and religious organizations are the front runners of this debate. At present, people of all classes have joined in and euthanasia movements have increased. Arguments in favour of euthanasia focus on the principles of self-determination and autonomy. The opponents on the other hand stress the danger of abuse of the practice and benefits of palliative care. The objective of this study was to explore the attitudes of university students towards the practice of euthanasia. The sample comprised three-hundred and ninety-two students from the faculties of Theology (100), Human Sciences (96), Law (99) and Medicine (99). Convenience sampling method was used to select the sample. Four different scales were used to collect data. MANOVA was used to analyze data. The results of this study showed that age and gender were not associated with the students' attitudes towards euthanasia, experiences with regards to end-of-life situations, level of religious beliefs and beliefs in autonomy. The students' year of study was also not associated with their attitudes towards euthanasia, level of religious beliefs as well as beliefs in autonomy. However, the findings showed that senior students had more experiences with regards to end-of-life situations, followed by post graduate while first- year students had the least experiences. Faculty was found to be associated with attitudes towards euthanasia, experiences with end-of-life situations as well as level of religious beliefs. Theology followed by Medical students showed the most positive attitudes towards euthanasia. Human sciences had the least positive attitudes towards euthanasia. Theology students had more experiences with regard to end-of-life situations while Human sciences showed the least experiences. Theology students were the most religious of the groups while Human sciences were the least. Medical students had the highest autonomy more than Human sciences students. / Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2008.

This study was conducted using a qualitative descriptive approach. It was based on an analysis that was done to determine awareness and attitude of patients in end of life issues. The semi-structured interviews were conducted for data collection. A sample of ten patients, five inpatient and five outpatient, was purposively chosen. Permission was obtained from the hospital superintendent and heads of departments, and also consent from patients, for the study. Data was analyzed, using the NVIVO program, a computer software, for data coding, and a conceptual model for categorization. From the findings, the researcher concluded that poor communication causes lack of knowledge in patients, which in turn limits the capacity for decision making in patients. The researcher also noted that participants were not aware of their autonomy in decision-making. / Thesis (M.Cur.)-University of Natal, Durban, 2002.

M.Cur. / Modern technology has brought on the possibility to sustain life for an indefinit3e period, but does not give answers to the questions arising from such situations. In view of shrinking resources available for tertiary care, and the growing awareness of justice, indefinite continuation of life-support therapy has been subjected to scrutiny. Traditionally the treating physician made all decisions regarding therapy. In Western culture the public are more aware of their right to self-determination and participation in decision making with the autonomy to do so. The nurse's role also changed from "handmaiden" to an independent practitioner who takes part in decision making regarding her patient. Decisions regarding life-support therapy is sensitive and becomes more complicated the more people become involved. The following question can then be asked: What are all the factors in decision making concerning life-support therapy? The aim of this study is to identify the factors in decision making concerning life support, as the first step in defining the parameters in decision making. The design chosen to identify these factors is a qualitative, exploratory, contextual, phenomenological case-study design. one case study was done on a patient where the continuation of life support was questioned. All persons involved with the patient were included in the case study. Interviews were conducted, observations and field notes were made and patient records were explored to identify factors in decision making. A narrative was written to present this information. As these constituted the micro-level, a literature study was done to identify factors on the macro- and meso-levels. The results of the analysis are presented as a list of factors in decision making concerning life-support therapy.

Thesis (M.A.)--Stellenbosch University, 2001. / ENGLISH ABSTRACT: The purpose of this study was to determine the attitudes older adults (65 years and older) have towards euthanasia. The subjects of the study were people 65 years of age and older who reside in homes for the aged within the Cape Metropolis. An equal number of subjects from the African, Coloured and European communities were randomly selected. A biographical questionnaire as well as the Euthanasia Attitude Scale and the Purpose In Life Test, were administered. The influence of four variables were focused on, namely age, ethnicity, meaning in life and health. Pearson correlation coefficient analysis and one-way ANOV A analysis were used. Ethnicity, meaning in life and health were not found to have a significant correlation with euthanasia. Age was the only variable found to have a significant correlation with euthanasia. The findings were discussed and certain recommendations were made. / AFRIKAANSE OPSOMMING: Die doel van die studie was om vas te stel wat die houding van ouer volwassenes (65 jaar en ouer) is ten opsigte van genadedood. Die proefpersone was almalouer as 65 jaar en woonagtig in ouetehuise binne die Kaapse Metropool. 'n Gelyke aantal proefpersone van die Afrika, Kleurling en Europese gemeenskappe is willekeurig gekies. 'n Biografiese vraelys, asook die "Euthanasia Attitude Scale" en "Purpose In Life Test", is gebruik. Die invloed van vier veranderlikes, naamlik: ouderdom, kultuur, betekenis in die lewe en gesondheid, is ondersoek. Pearson korrelasionele koëffisiënt en een-rigting ANOV A ontledings is gebruik. Etnisiteit, betekenis in die lewe en gesondheid het nie beduidend met genadedood gekorreleer nie, ouderdom was die enigste veranderlike wat beduidend met genadedood gekorreleer het. Die bevindinge is bespreek en sekere aanbevelings is gemaak.

This thesis argues that the topic of active voluntary euthanasia (AVE) has been significantly neglected in existing political studies research, despite the fact that AVE reform raises fundamental questions about the scope and application of political authority. While this is predominantly a politics thesis in its focus, the thesis also draws when necessary on the broader scholarly literature on AVE, including literature fields such as ethics, as well as on broader public debate and the views of politicians. The thesis also examines, and engages with, the views of relevant traditional and contemporary political theorists including John Stuart Mill, Jeremy Bentham, and Amitai Etzioni. Whilst it will be acknowledged that liberal and utilitarian principles have helped shape and inform the AVE reform debate, and have useful contributions to offer, it is maintained that neither of these approaches provide a suitably comprehensive guide to policy. The thesis argues that communitarianism’s emphasis upon the communal good provides an indispensable counterbalance to potential problems that can arise with some other approaches, including excessive individualism and the uncertainties of moral subjectivism. More particularly, it is suggested that without an ongoing commitment to the principles of self restraint and ‘other regarding’ beneficence, legalised euthanasia could pose a serious threat to the welfare of vulnerable citizens. This is a point of view that is also expressed by many religious critics of AVE and it is argued that pro-choice advocates have relied unduly upon the separation of Church and State principle to deflect a legitimate criticism. Although it is conceded that a commitment to secular liberal–democratic principles is at odds with a legislative prohibition against the popularly endorsed option of last resort (beneficent) AVE it is, nevertheless, maintained that the concerns of these and other critics should not be ignored. Indeed, an examination of various case studies highlights the importance of ensuring a balance between individual autonomy and adequate legislative safeguards. Case studies examined include John Ashcroft’s controlled substances intervention in Oregon, US Congressional action to preserve the life of persistent vegetative state patient Terri Schiavo and Australian anti-suicide / active euthanasia legislation, particularly the Northern Territory’s Rights of the Terminally Ill Act. The conclusion of the thesis not only pulls together the key arguments regarding AVE but also highlights the insights which the AVE debate can provide for understanding broader issues in political theory and practice, particularly in regard to the rights of the individual and the responsibility of the state to legislate for the collective good. / Thesis (Ph.D.) -- University of Adelaide, School of History and Politics, 2008

M.Cur. / The purpose of this study is to establish guidelines for the utilization of narratives in popular literature in nursing education in order to facilitate reflective thinking with nursing students. The purpose of nursing education is to equip the prospective nursing practitioner to be able to function independently and effectively in a multicultural, technological and scientific nursing practice where caring is important. Quality nursing care demands critical analytical thinking (cognitive skills) and moral values (affective skills) of the nursing practitioner. This study investigates firstly the "what" of reflective thinking and concludes that reflection accommodates both thinking skills and values that should be facilitated at the prospective nursing practitioner. The facilitation of reflective thinking is demanding as it is a complex cognitive and affective thinking skill. The research focuses secondly on the way in which the narrative in popular literature can be applied to facilitate reflective thinking in nursing education. According to the constructivist learning approach meaningful learning and reflective thinking occur when coupled to previous knowledge and experience. The nursing student as adult learner has at his/her disposal certain advance knowledge and previous experience. Narratives and popular literature form part of the adult learner's advance knowledge and previous experience. The research design is a philosophical inquiry in which the following research strategies are used namely philosophical analysis as well as qualitative, exploratory, descriptive and contextual strategies. In order to meet the purpose of the research, four goals were set and which were executed in four phases. At first the term reflective thinking was subjected to the process of concept analysis in order to clarify it's specific meaning (connotations and denotations). A theoretical definition of reflective thinking was formulated for the study from the connotations whereas denotations were used as the basis of learning outcomes for the Programme of Euthanasia as an Ethical Issue in Nursing Education (the Programme).

M.Cur. (Psychiatric nursing) / Withdrawal of life-support treatment is a well-known concept which has been studied often, especially from a medical point of view. The life-world of families involved in decision making concerning withdrawal of life-support of a family member is, however, an unknown field. This leads to the reaction and behavior of families to this traumatic process often begin mistakenly described by professionals as "difficult" , "passive" or "incapable of decision making". The patient and his/her family have, to a large extent, the right of self-determination and the right to take part in decision making. In the intensive care unit it often happens, according to Burger (1996:1-175), that the patient is not able to participate actively in the decision making process because of his/her illness and/or medication. The family then steps forward as decision maker and as the patient's "mouthpiece". The situation arises where the family, who must make the decision about withdrawal of life support treatment, are exposed to utterly moral conflict. Burger (1996:163) found that a family that experiences such trauma is not capable of focusing and assimilating knowledge. Members of the family have a great need for support and the intensive care nurse cannot provide that support for different reasons. One of the reasons being limited time and the other not being able to build therapeutic relationships. Because of the above mentioned, the overall objective of this study is to analyse the phenomenon of families who are involved in decision making concerning withdrawal of life-support treatment of a family member. Guidelines have been formulated according to the analysis of this phenomenon for the psychiatric nurse specialist to mobilise resources for the family to promote, maintain and restore their mental health as integral part of health. The research model of Botes (1989:1-283) is used in this study. The study is undertaken from the Judeo-Christian perspective of Nursing for the Whole Person Theory (Oral Roberts University, Anna Vaughn School of Nursing, 1990:136-142). A phenomenon analysis was undertaken in two phases. During the first phase, secondary analysis of primary data was done on the family used in Burger (1996:1-175) and was followed up by phenomenological interviews with families in the same circumstances and according to the same criteria that Burger (1996:1-175) used in her study. Data were analysed in collaboration with an independent coder. The family used for member checking in this study was also used in data control. A literature control was conducted as part of data control. On the ground of the repetitive themes from the secondary analysis and phenomenological interviews with the family involved in member checking, guidelines were formulated in phase two, based on all the data obtained from phase one, for psychiatric nursing specialists to mobilise resources for families in this situation. The proposed guidelines leave the door open for follow-up research where a model for assistance can be formulated for psychiatric nursing specialists to assist these families, since intensive care personnel are either too involved in the process, or do not always know how to build therapeutic relationships and usually also do not have enough time to attend to the patient's family.