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. 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" 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.

This thesis proposes a model for legalized Physician-Assisted Suicide [PAS] for adoption into Canadian legislation. The basis of this model is one which respects the individual freedom to make end-of-life decisions free from state interference. The research herein supports the provisions contained in Oregon legislation where PAS has been legalized on the basis that the Oregon model is consistent with the guarantees afforded under s.7 of the Charter of Rights and Freedoms. Oregon maintains strict regulatory barriers which protect against the threat of abuse which the Supreme Court reasoned in Rodriguez outweighed her s.7 rights to autonomy. This thesis will engage in the theories of Ronald Dworkin who supports the preservation of the sanctity of human life which Sopinka J. held prevailed over s. 7 violations in Rodriguez and seeks a model which respects individual freedom without compromising that sanctity or value of life.

Several longitudinal studies show that over time the American public has become more approving of euthanasia and suicide for terminally ill persons. Yet, these previous findings are limited because they derive from biased estimates of disaggregated hierarchical data. Using insights from life course sociological theory and recently developed cross-classified mixed effects logistic regression, I better account for this liberalization process by disentangling the age, period, and cohort effects that contribute to longitudinal changes in these attitudes. Findings indicate that while attitudes toward euthanasia and suicide have liberalized over time, they remained relatively stable over the past 10 years. Furthermore, this study finds significant age effects in which the probability of agreement to euthanasia and suicide steadily decreases throughout the life course. Contrary to previous research, this study finds that when controlling for age and period effects, there are no significant birth-cohort effects that contribute to longitudinal changes in these attitudes.

Assisted suicide in the perspective of the Czech criminal law and a comparison with the common law Abstract The strict prohibition on assisted suicide does not reach full acceptance among the members of the Czech society, regardless of their professional or non-professional background, similarly as it did not reach full acceptance in some of the common law countries, which consequently departed or are soon to depart from this regulatory conception. The objective of the two so far proposed Czech bills was identical, however, owing to the lack of clarity and detail, which certainly did not amount to the seriousness of the issue they aimed to regulate, none of them was successful. Hence, the legislative works were recommenced last year and resulted in the third bill, which claimed to be much more elaborative on the key issues and accordingly precise in the usage of language. Although the bill has not been introduced yet, the assumptions based not only on the territorial proximity are, that its prime source of inspiration resided mostly in the permissive regulatory attitude towards assisted suicide (or voluntary, active and intentional, euthanasia) as implemented in the European countries. However, notwithstanding the utter differences in the conception of the common law legal system, especially for such...

In 2016, Gray and Jones adapted the narrative policy framework (NPF) to a qualitative context. In this research, I build from their resulting Qualitative NPF (Q-NPF) method to analyze 300 randomly selected Canadian media articles published between 2007-2017 on the topic of Medical Assistance In Dying (MAID). I begin by explaining how the concrete procedures of MAID are distinct from other end-of-life practices, and introduce the terminology that will be used throughout this research. I then introduce historic and academic literature relevant to the form and content of the contemporary media narratives to be analyzed, especially drawing theoretically from Rose’s (2013) discussion of biomedical personhood discourses and Butler’s theory of unevenly distributed precarity. I then explain the methodology of qualitative narrative policy analysis (Q-NPF), and apply it to Canada’s MAID debate by dividing the policy positions into what I call the Freedom, Protection, and Fence-sitting narrative policy camps. The Freedom camp advocated for MAID legalization; the Protection camp advocated against MAID legalization; and the Fence-sitting camp avoided advocating either for or against baseline legalization of MAID, instead weighing in only on peripheral issues. I discuss the qualitative differences of narrative content specific to these three camps, highlighting the most prominent narrative trends (by frequency of publication) and discussing the ways in which these findings either accord with or contradict the expectations of the literature review. Finally, I update the reader on Canadian legislative developments since 2017 and identify how the data of 2007-2017 anticipated these developments, demonstrating the salience and predictive power of Q-NPF. I conclude by proposing new directions for potential investigation. / Graduate / 2022-12-13

IntroductionOver the last decades a positive shift in attitudes towards legalisation of assisted dying (AD) (AD including euthanasia (EUT) and physician-assisted suicide (PAS)) have occurred in western Europe. Physicians are generally more negative than the general public toward legalisation. Medical students’ attitudes, as future practitioners, are important to assess when addressing this ethically complex issue.AimThe aim was to explore the attitudes among medical students at Örebro university, Sweden regarding assisted dying and their stance on the legalisation of assisted dying and to evaluate if religious beliefs, current term of study, gender, and a shift of legal framing would affect medical students´ attitudes.MethodsA cross-sectional online-based anonymous survey containing eight different patient scenarios was distributed to all medical students enlisted at Örebro university Sweden (n=657). Association between demographics and positive attitudes towards AD was tested using logistic regression, and McNemar for difference of proportion in attitudes between various scenario framings.ResultsThirty five percent (n=229) of the medical students responded with completed questionnaires. Sixty percent of the respondents believed PAS for terminally ill patients should be legalized in Sweden. Shifting of legal framing resulted in statistically significant differences of position in all eight scenarios (p<0.05). Strong religious beliefs were associated with decreased likelihood for positive attitudes towards AD in scenario 1-6 (p<0.05).ConclusionsMost respondents in this study believed PAS should be legalised. Held attitudes toward AD were affected by religious beliefs and legal framework. Additional studies to further explore medical students´ attitudes are deemed necessary.

Introduktion: Trots mycket forskning inom cancer som genererar nya riktlinjer och behandlingsmetoder är ett cancerbesked ofta förknippat med döden. Om cancerns påverkan på kroppen är tillräckligt allvarlig kan inte längre behandling tillgås. Med det övergår individens vård till palliativ vård, vilket betyder symtomlindring, närståendestöd samt kommunikation för att nå en god och värdig död. Sjuksköterskor har rapporterat att de mottagit önskan om dödshjälp av cancerpatienter, i syfte att bestämma själv och avsluta lidandet.  Syfte: Syftet var att undersöka terminala cancerpatienters syn på en god och värdig död samt dödshjälp. Metod: En systematisk litteraturöversikt utfördes med innehåll från tolv kvalitativa originalartiklar. För att få fram artiklar användes PubMed. En tematisk analys användes för att sammanställa teman baserat på studiernas resultat.  Resultat: Deltagare för dödshjälp motiverade sin ståndpunkt med hänvisning till individens autonomi, samt såg det som en möjlighet att få slut på lidande. Deltagare mot dödshjälp ansåg att det var likvärdigt med självmord, risk för bruk i fel syfte, ej överensstämmer med individens tro och att det alltid fanns hopp och mening. Synen på en god död och värdig död delgavs av deltagarna till förberedelser och rätten att få bestämma själv, att finna nya perspektiv och uppnå acceptans för sitt tillstånd. För att nå en god och värdig död behövdes stöd från anhöriga och vårdpersonal. Det ansågs att sjuksköterskan behövde ha en tät dialog med patienten och involverade patienten i beslut för att tillgodose autonomin.  Slutsats: För att en god och värdig död ska tillgodoses krävs det att vårdpersonal tillsammans med anhöriga strävar efter att uppfylla autonomin hos cancerpatienter. / Introduction: Although cancer research has given new methods and treatment guidelines, a cancer diagnosis is still often associated with death. If the impact of the cancer is too major, treatment is no longer an option. With that the treatment transitions to palliative care, focusing on relief of symptoms, support for related and communication working towards a good death. Nurses have reported that they have received a request from cancer patients to obtain euthanasia or physician-assisted suicide (PAS).  Purpose: The purpose of this systematic literature review was to investigate the views of terminal cancer patients regarding a good death as well as euthanasia and PAS.  Method: A literature review has been constructed from twelve qualitative original articles. The search for articles were found using the database - PubMed. A thematic analysis was used to identify themes, based on the studies results.  Result: These generated three central themes; Support for euthanasia and PAS, Opposition towards euthanasia and PAS and lastly A good death with under themes. Participants who supported euthanasia and PAS motivated it with a person's right to decide and a possibility to end suffering. Participants opposed towards euthanasia and PAS viewed it as an act equal to suicide, and saw a risk of it being abused, some also believed euthanasia and PAS to go against their beliefs and that there always is hope and meaning. The participants' view of a good death was preparedness, the right to decide by themselves, finding new perspectives and acceptance for their condition. To reach a good death support from related and healthcare workers, as well as frequent dialogs with the nurse to involve the patient in decisions to cater to their autonomy was of great importance. Conclusion: To reach a good death the autonomy of cancer patients need to be respected by healthcare workers and relatives.

No description available.

Bakgrund: Eutanasi är ett ämne som är väl omdebatterat i världen och betyder egentligen hjälp till en smärtfri död, men används idag som synonym till dödshjälp. Aktiv dödshjälp innebär att läkaren förskriver ett läkemedel med syfte att avsluta en patients liv. Läkarassisterat självmord innebär att patienten själv tar läkemedlet medan aktiv dödshjälp innebär att sjukvården hjälper till att avsluta patientens liv. Syfte: Syftet var att beskriva sjuksköterskors inställning till eutanasi och de faktorer som beskrivs ligga bakom dessa inställningar, samt att beskriva undersökningsgrupperna i de valda artiklarna. Metod: Författarna gjorde en deskriptiv litteraturstudie. Artiklar har sökts fram i sökmotorn PubMed med en femårsbegränsning. Totalt 11 artiklar bearbetades och sammanställdes i kategorier för att besvara frågeställningarna. Resultat: Resultatet visade att sjuksköterskors inställning till eutanasi är en komplex fråga som kan vara beroende av olika faktorer som vilket land de arbetar i och vilka patientgrupper de arbetar med. Majoriteten av deltagarna i studierna var kvinnor i olika åldrar med olika lång arbetslivserfarenhet som sjuksköterska. Resultatet i föreliggande litteraturstudie presenteras utifrån tre huvudrubriker med utgångspunkt i frågeställningarna; Sjuksköterskors inställning till eutanasi, Bidragande faktorer till sjuksköterskornas inställning till eutanasi, samt den metodologiska aspekten undersökningsgrupper. Slutsats: Föreliggande litteraturstudie visar att sjuksköterskors inställning till eutanasi kan vara högst individuell och beroende av många faktorer. Att man som sjuksköterska kan komma i kontakt med dessa frågor är ett faktum, oavsett var och med vilka patienter man arbetar. Med mer erfarenhet och kunskap om ämnet kan sjuksköterskan känna sig tryggare i bemötandet med den döende patienten och dennes anhöriga. / Background: Euthanasia is a well-discussed subject all around the world and means help to a painless death. Active euthanasia means that a doctor prescribes a drug intended to end a patients’ life. Physician-assisted suicide means that the patient takes the drug themselves, while active euthanasia involves medical help to end the patient’s life. Aim: The aim of this study was to describe nurses’ attitudes towards euthanasia and the factors described underlie these attitudes, as well as to describe the study groups in the included articles. Method: The authors conducted a descriptive literature review. The articles were found in the search engine PubMed with a five-year limit. A total of 11 articles were processed and summarized into categories to answer the research questions. Findings: The results showed that nurses' attitudes towards euthanasia is a complex issue which may be dependent on several factors such as which country they work in and which patient groups they work with. Most participants in the studies were women of different age and different experience as a nurse. The result of the present literature review form three main headings, based on the issues; nurses' attitudes towards euthanasia, contributing factors to the nurses' attitudes towards euthanasia, as well as the methodological aspect - study groups. Conclusion: The present literature review shows that nurses' attitudes towards euthanasia can be very individual and depend on many factors. It is a fact that nurses may come in contact with these issues, no matter where and with what kind of patients they work. With more experience and knowledge of the subject, the nurse may feel safer in facing the dying patients and their relatives.

Die assistierte Selbsttötung ist gegenwärtig ein kontrovers diskutiertes Thema in Deutschland und besonders für die Ärzteschaft eine Herausforderung. Da viele Aspekte gerade der ärztlichen Suizidhilfe noch völlig unklar sind, wird zunächst ein grundlegender Überblick über die Formen der Sterbehilfe gegeben. In einer Zusammenschau der Debatte und verschiedener exemplarisch ausgewählter Reaktionen wird klar, dass das ärztliche Ethos ein Kernpunkt der Debatte ist. Dabei fällt auf, dass die Vorstellungen zu diesem besonderen beruflichen Ethos stark divergieren. Aus diesem Grund stehen die detaillierte Betrachtung der ärztlichen Suizidhilfe im Kontext des ärztlichen Ethos und die Prüfung der Fragestellung, ob die ärztliche Suizidhilfe dem ärztlichen Ethos widerspricht im Zentrum weiterer Ausführungen. Schließlich wird aufgezeigt, dass die Ablehnung der ärztlichen Suizidassistenz im Namen des ärztlichen Ethos derzeit nicht haltbar ist.