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.

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.

Under the Nazi regime in Germany (1933-1945) a calculated killing of chronic “mentally ill” patients took place that was part of a large biopolitical program using well-established, contemporary scientific standards on the understanding of eugenics. Nearly 300,000 patients were assassinated during this period. Nurses executed this program through their everyday practice. However, suspicions have been raised that psychiatric patients were already assassinated before and after the Nazi regime, suggesting that the motives for these killings must be investigated within psychiatric practice itself. My research aims to highlight the mechanisms and scientific discourses in place that allowed nurses to perceive patients as unworthy of life, and thus able to be killed. Using Foucauldian concepts of “biopower” and “State racism,” this discourse analysis is carried out on several levels. First, it analyzes nursing notes in one specific patient record and interprets them in relation to the kinds of scientific discourses that are identified, for example, in nursing journals between 1900 and 1945. Second, it argues that records are not static but rather produce certain effects; they are “performative” because they are active agents. Psychiatry, with its need to make patients completely visible and its desire to maintain its dominance in the psychiatric field, requires the utilization of writing in order to register everything that happens to individuals, everything they do and everything they talk about. Furthermore, writing enables nurses to pass along information from the “bottom-up,” and written documents allow all information to be accessible at any time. It is a method of centralizing information and of coordinating different levels within disciplinary systems. By following this approach it is possible to demonstrate that the production of meaning within nurses’ notes is not based on the intentionality of the writer but rather depends on discursive patterns constructed by contemporary scientific discourses. Using a form of “institutional ethnography,” the study analyzes documents as “inscriptions” that actively interven in interactions in institutions and that create a specific reality on their own accord. The question is not whether the reality represented within the documents is true, but rather how documents worked in institutions and what their effects were. Third, the study demonstrates how nurses were actively involved in the construction of patients’ identities and how these “documentary identities” led to the death of thousands of humans whose lives were considered to be “unworthy lives.” Documents are able to constitute the identities of psychiatric patients and, conversely, are able to deconstruct them. The result of de-subjectification was that “zones for the unliving” existed in psychiatric hospitals long before the Nazi regime and within these zones, patients were exposed to an increased risk of death. An analysis of the nursing notes highlights that nurses played a decisive role in constructing these “zones” and had an important strategic function in them. Psychiatric hospitals became spaces where patients were reduced to a “bare life;” these spaces were comparable with the concentration camps of the Holocaust. This analysis enables the integration of nursing practices under National Socialism into the history of modernity. Nursing under Nazism was not simply a relapse into barbarism; Nazi exclusionary practices were extreme variants of scientific, social, and political exclusionary practices that were already in place. Different types of power are identifiable in the Nazi regime, even those that Foucault called “technologies of the self” were demonstrated, for example, by the denunciation of “disabled persons” by nurses. Nurses themselves were able to employ techniques of power in the Nazi regime.

Bakgrund: Eutanasi är idag förbjudet i de flesta länder, däribland Sverige. Frågan diskuteras ofta och är ett kontroversiellt ämne. Dessa diskussioner förs dock alltjämnt utifrån läkarens perspektiv och sjuksköterskans delaktighet hamnar i skymundan. Syfte: Syftet med föreliggande studie är att belysa sjuksköterskors uppfattning om eutanasi i länder där det tillämpas respektive där det inte tillämpas. Metod: Denna metod är en systematisk litteraturstudie som omfattar 12 artiklar från åren 2000-2011. Analysen har skett med via kodning och kategorisering av artiklarnas text. Katie Erikssons vårdteori har utgjort den teoretiska utgångspunkten för diskussion av resultatet. Resultat: Sjuksköterskor känner en ovisshet i vad eutanasi verkligen innebär. Det vanligaste argumentet mot eutanasi i länder där det är olagligt är att sjuksköterskorna tror att det kan komma att missbrukas samt bli ett alternativ för patienter som känner att de är till belastning för samhället. Oavsett om sjuksköterskorna arbetar i länder där eutanasi är lagligt eller olagligt är de som har en religiös trosuppfattning mer säkra i var de står i eutanasifrågan. De sjuksköterskor som arbetar inom hemsjukvård tenderar att vara mer positivt inställda till eutanasi än sjuksköterskor som arbetar på sjukhus, oberoende av vilket land de arbetar i. Slutsats och diskussion: Oavsett om sjuksköterskorna jobbade i ett land där eutanasi var lagligt eller olagligt var det inte mycket som skiljde sig i deras uppfattning rörande ämnet.  Mer information om vad eutanasi innebär skulle kunna bidra till att sjuksköterskor blir bättre rustade och kan förmedla adekvat information till patienten och dess anhöriga, samt känna sig trygga i sin sjuksköterskeroll.

Bakgrund. Ordet eutanasi betyder dödshjälp och detta ämne väcker stor debatt världen över. Holland, Belgien, Luxemburg och delstaten Oregon i USA har legaliserat eutanasi. Riktlinjer som beskriver sjuksköterskors roll i eutanasiprocessen har utformats, dock syns stora skillnader länderna emellan. Syfte. Att belysa sjuksköterskors upplevelse av delaktigheten i eutanasiprocessen, samt hur omvårdnaden av patienten såg ut under denna process. Metod. En allmän litteraturstudie utfördes med induktiv innehållsanalys. Resultat. Studien belyser flera aspekter av sjuksköterskors upplevelser kring omvårdnaden av patienter under eutanasiprocessen. Kategorierna visar sjuksköterskors reaktioner på eutanasiförfrågan, vikten av ett gott samtal mellan patient och sjuksköterska, hur sjuksköterskor vårdar patienten under processen som leder fram till eutanasi samt hur hon finns som stöd för patienten och agerar patientens ”advokat”. Det framkom att sjuksköterskor åsidosätter sina egna åsikter om eutanasi och ställer upp för patienten samt hur de finner stöd i kollegor för att klara av den psykiskt påfrestande uppgift som eutanasiprocessen innebär. Slutsats. I flera studier anser sjuksköterskor det svårt att ge patienten bästa omvårdnad då riktlinjer som beskriver deras arbetsuppgifter under eutanasiprocessen är bristfälliga. / Background. Euthanasia can be translated into the meaning of helping a person to end his/her life. Holland, Belgium, Luxembourg and the State of Oregon (USA) have legalized euthanasia. Guidelines describing the nurses’ role in the process of euthanasia exists, though great differences can be seen between countries. Aim. To illuminate the nurses’ perception on their involvement in the euthanasiaprocess and what the care during this process looked like. Method. A general review of qualitative literature was conducted with analysis of the articles. Result. This study showed the nurses’ first reaction to the euthanasia request, the importance of in-depth conversations between the patient and the nurse, the nurses’ care for the patient during the process, how they stood by their patients’ side at all times and sometimes acted the role of the patients’ lawyer. This study raised issues about how nurses’ sometimes sat their negative thoughts about euthanasia aside to care for the patient and how they found support and comfort in their colleagues. Conclusion. Many nurses feel they cannot give the patient proper care due to failing guidelines describing their tasks during the euthanasia process.

Thesis (doctoral)--Johannn Wolfgang Goethe-Universität, Frankfurt, 2000. / Includes bibliographical references and index.

Thesis (doctoral)--Universität, Kiel, 2003. / Includes bibliographical references (p. xiii-xxxiii).

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.

Medical social workers from health care institutions in the urban lower mainland of British Columbia were asked about their views, values and practice regarding passive and active euthanasia. This qualitative, exploratory study focused on the attitudes, values and structures that influence professional social work practice with clients requesting euthanasia. During the months of August to November, 1994, seventeen medical social workers, who were experienced in this area, were interviewed. An interview guide format was used that was previously tested in a pilot study of this project. Within the pre-selected categories; views, values and practice, responses were described and emerging themes were identified through content analysis. The study results confirm medical social workers are playing an active professional role with terminally-ill patients, families and staff when requests are made for euthanasia in the health care system. In this study population, in most cases, the social worker's views, whether for or against euthanasia, did not determine his/her practice with patients. Instead, it was the social worker's willingness to give up his/her control in the patient/professional relationship in an effort to support the patient's decision to die with dignity. This practice was based on the value of patient self-determination being paramount against all other interests. Self-determination was ranked as the most influential factor in determining practice by most of the participants. Responses revealed there was a lack of understanding by health care professionals at all levels regarding the process of separating personal values from the professional obligation to respect patient self-determination. Feminist medical ethics suggests that all health care professionals need to engage in self-evaluation to address any need they may have for power and control in the professional/patient relationship. Furthermore, medical social workers should recognize their own such needs, particularly when their personal views and values come into conflict with a patient's decision regarding euthanasia. This study not only presents the issues of power and control that social workers and other health care professsionals experience in the medical system, it also explores and describes the contributions social workers have made in their practice with patients who request the right to die with dignity.