Abstract Introduction and Background: Euthanasia has expanded significantly around the world over the past years. The debate concerning euthanasia has focused on the legalization, complex issues faced by the medical team, and perspective on assisted dying. Euthanasia known as assisted suicide is a deliberate medical procedure of intentionally withholding treatment or withdrawing life-support measures to end the life of a suffering patient. Purpose Statement: To define euthanasia and its background as well as discuss the psychological and moral effects that surround the subject. Literature Review: Five articles were selected. Quantitative and exploratory qualitative studies were obtained from existing literature, collection of data and statistics from relevant publications, peer-reviewed analysis, and original research papers with a focus on psychological and moral effects on participating, healthcare professionals. Findings: Participation in euthanasia can have significant emotional and psychological impacts on participating healthcare professionals which can lead to long-term personal and professional effects. Some are unsupportive of this practice while some were supportive of it. Conclusion: Despite the importance of this topic to medical practice, there are limited studies on addressing the psychological and moral impacts of euthanasia on participating healthcare professionals. Future research needs to explore how health professionals are negatively emotionally affected by their involvement in assisted suicide

In the medical context, it is an accepted (yet controversial) fact that doctors may sometimes legitimately hasten death when providing palliative care to dying patients. Or even, in relation to treatment decisions leading to withdrawal or omission, some doctors may choose death over life for certain patients and yet we seldom hear of doctors in the dock for intentional killing. Where complicity in suicide is concerned, it seems that the compassionate lay person has little reason to be fearful of criminal reprisal. The question, however, of whether a person suspected of complicity in suicide, or a doctor suspected of intentionally causing the death of a patient, will be greeted by sympathy or condemnation is a legal minefield. A range of diverse legal, moral and circumstantial factors will determine firstly, whether one is prosecuted and secondly, whether one will be subject to juridical disapproval and possible incarceration. This thesis sets out to explore whether continued obfuscation, together with turning a blind eye to possible breaches of the law, is the best approach to the moral dilemma over what should be permitted in assisted dying and end-of-life law. This is not a rhetorical question with a trite answer. Such obfuscation may be viewed as having certain advantages. This thesis explores the legal and ethical issues in the context of recent developments, societal concerns and international influences in order to examine whether the current legal position in respect of homicide and complicity in suicide is tenable. The analysis invites the conclusion that whilst some legal change is both desirable and necessary, any legal reform should seek to facilitate a cautious compromise that reflects the legitimate concerns of those opposed to legal change.

In 2015, the Supreme Court of Canada ruled in the Carter decision that the prohibitions against physician-assisted dying, as outlined in section 241(b) of the Criminal Code of Canada, were unconstitutional as they violated an individual’s s.7 rights as outlined in the Canadian Charter of Rights and Freedoms. Though the jurisprudence of this landmark decision and subsequent amendments to Canadian law are interesting in and of themselves, what is particularly interesting about Carter is the framework within which physician-assisted dying is conceptualized. The Court shifts from a religiously informed framework for conceptualizing assisted suicide to a non-religious conceptualization of physician-assisted dying. Given that there remains much to be explored about nonreligion, this thesis asks: how is ‘nonreligion’ constructed by law in relation to physician-assisted dying in Canada? Since the Carter decision is not explicitly about religion or nonreligion the analysis in this thesis maps how the concepts life, death, and morality are reconceptualized. The analysis reveals that nonreligion is a phenomenon that is absent of the transcendent and is instead given positive content through a focus on autonomy. The conceptualization of nonreligion as presented in this thesis contributes to the literature that emphasizes that nonreligion is both positive and meaningful and not simply deficit terminology.

The contemporary juridico-political and bioethical debate over physician assisted dying has emerged as one of the most divisive of the late 20th and early 21st centuries. Commonly strained through Western conceptions of individual rights and near ubiquitous calls for the respect an abstractly defined human dignity, popular discourse on assisted dying tends to promote universal understandings of both human beings as well as ethical, legal, moral action. This thesis, however, holds these debates in abeyance preferring rather to explore the ways in which the possibility of an assisted death creates a more meaningful dying space for many Canadian advocates. And though I cannot answer for everyone, for many of the 24 individuals I spent months interviewing, “hanging out” with and generally following around to various meetings/training sessions, the assisted death is not some nihilistic response to the suffering of our materially bounded/feeling bodies, but a contemporary recurrence of a deeply spiritual, relational and artful dying.

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.

This essay has examined Paul's Epistle to the Philippians to examine how his letter, in the context of his time, may contribute to the discussion of the modern day, regarding assisted suicide in palliative care. This has mainly been done through a hermeneutical study of Philippians, specifically 1:21-1:27, 2:5-11 and 3:17-21. Additionally this study has utilised historical-critical methods to contextualise Paul's rhetoric and focusing on the idea of de-intoducring of the biblical text from the subsequent theological tradition and anachronisms. This essay has primarily been informed by Arthur J. Droge's article about the subject of suicide in Philippians (Mori Lucrum: Paul and the Ancient Theories of Suicide 1988), Linda Joelsson's book about Paul and the idea of death in the hermeneutical of psychology (Paul and Death - A Question of Psychological Coping 2017) and Karin B. Neutel & Peter-Ben Smits article about the likely conditions of his arrest while writing Philippians and the trauma of prison factors into the text (Paul, Imprisonment and Crisis 2021). The second chapter briefly examined the development of the theology of suicide since the time of St. Augustine and subsecuenty different modern day attitudes toward assisted suicide. The third chapter examined the occurrence and frequency of suicides in the Hebrew Bible and found a lack of moral condemnation of those who took their own lives. Thereafter the essay investigates the attitudes towards death and suicide in the jewish tradition, the Roman empire and finally the early christians. The fourth chapter examined the background of Philippians and the conditions of the imprisonmentand thereafter performed a exegetical investigation into the issue suicide in relation to the ideas of death and suicide of his time. The study showed that Paul expresses what can likely be interpretedas suicidal language in Philippians, but that Paul clearly rejects the idea in favor of performing hisapostolic duty. The essay concludes with a broader discussion on the idea of the challenges of interpretation, a comparison of Paul and the augustinian tradition in relation to suicde and the change in perception of the idea of the holiness of life in favour of personal autonomy. The answer to the main question of the study is that Paul's perspective in Philippians, may be valuable as a troubled and sympathetic christian role-model, a person who, when faced with the prospect of suicide, chooses life. Not because suicde is extraordinarily sinful, but does so for the sake of his chrisitan calling of living for his community. This seems to be a more contemporary and fruitful rhetoric, than the condemning tone of classic augustinian theology in the matter of assisted suicide.

Bakgrund: Dödshjälp och assisterat döende är tillåtna i flera länder men inte i andra. Sverige är ett av de länder där både eutanasi och assisterat döende är förbjudna. Ämnet är relevant i den offentliga debatten och som sjuksköterska i vården av allvarligt sjuka döende patienter har många blivit tillfrågade om att hjälpa till för att undvika smärtan genom att avsluta livet med en överdos. Patientens autonomi måste tillvaratas men sjuksköterskan får inte vara till hjälp med eutanasi och assisterad död. Hur reagerar sjuksköterskor på problemet och hur hanteras detta? I Sverige får sjukvårdspersonal, till skillnad från privatpersoner, inte hjälpa någon att begå självmord. När det inte finns någon möjlighet till botemedel bör vården koncentrera sig på att göra sista tiden i livet så symptomfri och bra som möjligt. Syfte: Syftet är att beskriva sjuksköterskors erfarenheter av att bemöta frågor om eutanasi/ assisterat självmord från patienter vid livets slut i palliativ vård. Metod: Studien har genomförts med kvalitativ induktiv ansats. Sjuksköterskor med erfarenhet av palliativ vård mellan 40 och 60 år intervjuades. Det användes förutbestämda öppna frågor och följdfrågor för att fördjupa det sagda. Kvalitativ innehållsanalys enligt Graneheim och Lundman (2004) användes för att få fram ett resultat.Resultat: Flera av informanterna i studien har upplevt en känsla av trygghet i att lagen förbjuder dem att förkorta livet för någon patient och att de kan erbjuda palliativ sedering för att lindra lidandet. Studien visar att sjuksköterskorna har en god beredskap när patienterna frågar om att få hjälp att dö. Studien visar också att sjuksköterskan har en viktig roll för ta reda på om vården kan vidta några andra åtgärder för att lindra lidandet. Slutsats: Sjuksköterskan har en god beredskap när patienterna frågar om att få hjälp att dö. Stödet kommer från kollegorna och lagen som ännu inte ger tillåtelse till eutanasi eller assisterat självmord. Studien visar också att sjuksköterskan har en viktig roll att undersöka vad som får patienten att uttrycka en dödsönskan och ta reda på om vården kan göra annat för att lindra lidandet som oftast upplevs outhärdligt och som är orsaken till frågan. / Background: Sweden is one of the countries where both euthanasia and assisted dying are prohibited. The topic is relevant in the public debate and as a nurse in the care of seriously ill dying patients, many have been asked to help avoid pain by ending life with an overdose. How do nurses react to the problem and how is this handled? In Sweden, healthcare professionals, unlike private individuals, are not allowed to help anyone to commit suicide. When there is no possibility of a cure, health care should concentrate on making the last time in life as symptom free and good as possible. Aim: The aim is to describe nurses’ experiences of responding to questions about euthanasia / assisted suicide from patients at the end of life in palliative care. Method: The study was conducted with a qualitative inductive approach. Nurses with experience in palliative care between the ages of 40 and 60 and with work experience between 2- 40 years were interviewed. Predefined open-ended questions were used and follow-up questions were asked to deepen what was said. Qualitative content analysis according to Graneheim and Lundman (2004) was used to obtain the result. Results: Several of the informants in the study have experienced a sense of security in the fact that the law prohibits them from shortening the life of any patient and that they can offer palliative sedation to alleviate the suffering. The study shows that nurses are well prepared when patients ask for help to die. The study also shows that the nurse has an important role to play in finding out if the health care can take any other measures to alleviate the suffering. Conclusion: The nurse is well prepared when patients ask for help to die. The support comes from colleagues and the law that does not yet give permission for euthanasia or assisted dying. The study also shows that the nurse has an important role to investigate in what makes the patient express a wish to die and find out whether the care can do something else to alleviate the suffering that is often experienced as unbearable and the cause of the question.

Physician assisted suicide (PAS) has been a legalized presence in the United States since Oregon first passed the Death with Dignity Act in 1994. Now PAS is legalized in six states and it is realistic that nurses may encounter PAS during their career. This project explores pre-licensure nursing student attitudes toward PAS. A mixed method design incorporating descriptive correlation and thematic analysis of an open-ended question was used. Surveys were sent to 550 nursing students enrolled in the UCF nursing program asking participants to complete the 34-question survey. This survey included a 12 item “Domino scale” on student nursing opinions toward physician-assisted suicide, and a 23-item demographic scale. Complete, usable results were obtained from 231 participants. Demographic data revealed that the typical participant was between 18 and 25 years of age (80%), female (82%), single (87%), white (69%), in their first two semesters of the nursing program (60%), and unemployed (56%). The total scores for the Domino scale indicated a mean of 40. Regression analyses found that participant experience of someone having asked for help with PAS, and participant religiosity were significant predictors (F = 9.82, p = .0019; and F= 160.36, p < .0001) respectively of nursing student opinions on PAS as measured by the Domino scale. Qualitative analysis produced the following themes related to participant opinion on the nurse’s role in PAS: ways nurses can help with PAS, nurses should not be involved with PAS, clarification and delineation of the PAS process, the preservation of autonomy, the need for more education and inaccurate assumptions of PAS. This study showed that nursing students are moderately in support of PAS and willing to provide care to patients who are terminally ill regardless of a his or her personal decisions regarding PAS. Participants also comment that they desire additional education. Suggestions for further education, practice enhancements, research and policy development are discussed.

Bakgrund: Dödshjälp är endast lagligt i ett fåtal länder och stater i världen, men det förekommer att patienter förmedlar en önskan om dödshjälp till vårdpersonal, även i andra länder. Läkare beskriver bördan med att hantera förfrågningar om dödshjälp och försöker undvika dessa genom att behandla patienters fysiska samt psykiska behov. Anhöriga till individer som dött genom dödshjälp, menade att den döende individens livskvalitet förbättrades i slutet av deras liv relaterat till beslutet gällande dödshjälp. Syfte: Att beskriva sjuksköterskors attityder till, samt erfarenheter kring dödshjälp. Metod: En litteraturöversikt, i enlighet med Friberg genomfördes. Systematisk sökning har utförts i databaserna CINAHL Complete och PubMed. Resultatet av översikten baseras på 13 originalartiklar.  Resultat: Sjuksköterskors attityder varierar oavsett om de arbetar i länder där dödshjälp är lagligt eller inte. Tendenser tyder på att sjuksköterskor är mer positivt inställda till eutanasi än läkarassisterat självmord. De underliggande aspekter som påverkar sjuksköterskors attityder grundas på deras personliga värderingar utifrån professionell kunskap, erfarenheter och religiösa övertygelser. Sjuksköterskor kan rättfärdiga sina handlingar genom så kallad dubbel-effekt, där goda handlingar utförs trots att det kan leda till negativa konsekvenser. Palliativ vård fungerar som preventiv strategi, vilket tidvis minskar antalet förfrågningar om dödshjälp. Diskussion: Resultaten är diskuterade utifrån Beauchamp och Childress etiska principer, samt vårdande utifrån deras tolkning av vårdande etik. Det uppstår konflikter mellan sjuksköterskors personliga värderingar, yrkesprofessionella kunskap, lagar och de etiska principerna i vårdandet av döende individer med obotliga sjukdomar.

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