As diretivas antecipadas de vontade para o fim da vida são documentos que expressam os desejos da pessoa relacionados aos procedimentos que podem ser aplicados a ela em uma situação de assistência médica no fim da vida. Nesse sentido, as diretivas são úteis para informar as equipes de assistência médica a respeito dos tipos específicos de tratamento que o paciente permite, ou não permite, quando não estiver apto a manifestar suas vontades em uma hipotética situação futura de incapacidade. Este tipo de documento foi elaborado nos Estados Unidos na década de 1970, e foi introduzido no ordenamento ético brasileiro pela Resolução 1995/2012 do Conselho Federal de Medicina. O objetivo desta dissertação é estudar essa norma ética sob o enfoque do direito penal, uma vez que as diretivas antecipadas de vontade para o fim da vida possuem uma íntima relação com a ortotanásia e a eutanásia, que são passíveis de sanção penal no Brasil. Assim, é fundamental analisar as diretivas antecipadas utilizando as ferramentas da doutrina penal, e princípios como os da dignidade humana e razoabilidade. O objetivo é pesquisar as qualidades, imperfeições e limites das diretivas antecipadas sob o ordenamento jurídico nacional, e também compreender as bases legais das diretivas antecipadas, que são os institutos da autonomia e do consentimento. Concluímos que, ainda que as diretivas antecipadas de vontade sejam uma norma ética bem-vinda, demandam algumas melhorias e refinamentos, que poderiam ser representados pelos planejamentos antecipados de tratamentos, um tipo de documento direcionado aos valores de vida das pessoas. Além disso, uma mudança de paradigma relacionada à eutanásia, particularmente a eutanásia passiva e a ortotanásia, no sentido de descriminalizá-las, seria importante para que as diretivas antecipadas tenham eficácia no Brasil. / Advance directives for dying patients are documents which express personal desires related to procedures that may be applied to people in a situation of medical assistance in the end of life. In this sense, they are useful to make health assistance teams know about what kind of specific treatment the patients permit, or do not permit, when they are not able to communicate their wishes in a hypothetical and future situation of disability. This kind of document was created in the United States in the seventies, and entered Brazilian ethical law by Resolution 1995/2012 of the Federal Council of Medicine. The aim of this dissertation is to study this ethical rule by means of the criminal law, because advance directives have a close relation to euthanasia and ortothanasia, which are prone to criminal sanction in Brazil. Therefore, it is paramount to analyze the advance directives using the doctrinal tools of criminal law and principles like human dignity and reasonability. The goal is surveying the qualities, inadequacies and limits of advance directives under Brazilian law, and also to understand the legal basis of the advance directives, which are the institutes of autonomy and consent. We concluded that, although advance directives for dying patients are a welcome ethical law, it demands some improvement and refinement, which could be represented by the advance care planning, a kind of document that is focused on the life values of people. Furthermore, a change of paradigm related to euthanasia, particularly passive euthanasia and ortothanasia, in the direction of making them apart of criminalization, would be vital to promote the adequate efficacy of the advance directives in Brazil.

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.

Os avanços científicos na área médica favorecem cada vez mais a preservação e a manutenção da vida humana por meios artificiais. Nesse sentido, destaca-se a importância do preparo do profissional da área da saúde para vivenciar situações que envolvem temas polêmicos como a eutanásia. Julga-se relevante também que estes profissionais embasem suas escolhas e ações em conhecimentos que vão para além do tecnocientífico, uma vez que a interdisciplinaridade proporciona um cuidado cada vez mais qualificado. A conjugação de áreas distintas, como a da saúde com o conhecimento filosófico, oferece a possibilidade de refletir de maneira mais profunda acerca de temas que até então eram abordados apenas no campo tecnocientífico. Assim, objetiva-se analisar a eutanásia voluntária sob a perspectiva e os princípios da ética utilitarista, a fim de fornecer aos profissionais da área da saúde uma abordagem da eutanásia para além do campo tecnocientífico. Trata-se de uma pesquisa bibliográfica de caráter analítico-descritivo. Explicita-se conceitos relevantes como os tipos de eutanásia e questões como liberdade e autonomia humanas, sempre analisando tais conceitos sob a ótica utilitarista. Com a presente pesquisa tem-se como finalidade, por meio da interdisciplinaridade, contribuir para o aprimoramento dos profissionais da área da saúde, uma vez que acredita-se que quanto mais qualificado for tal profissional, melhor será o cuidado oferecido pelo mesmo ao ser enfermo, especialmente àquele que vivencia o processo de morte. / The scientific advances in the medical field increasingly favor the preservation and maintenance of human life by artificial means. In this sense, we highlight the importance of the preparation of the healthcare professional to experience situations involving controversial issues such as euthanasia. It is believed that these professionals also support their choices and actions in knowledge that goes beyond the Techno-scientific field, since the interdisciplinary approach provides an increasingly qualified care. The combination of different fields, such as health with philosophical knowledge, offers the possibility to reflect more deeply on topics that were previously covered only in the technoscientific field. This way, the objetive of this work is to analyze voluntary euthanasia from the perspective and principles of utilitarian ethics, in order to provide the healthcare professionals with an approach that goes beyond the technoscientific field. It is a literature research of descriptive-analytical character. It clarifies relevant concepts such as euthanasia and human freedom and autonomy, always analyzing these concepts from an utilitarian perspective. The present work has the purpose of contributing to the improvement of healthcare professionals through an interdisciplinary approach, since it is believed that the more qualified a professional is, the better the care provided by the same will be, especially if the patient is going through the dying process.

Dentre as diversas questões éticas vivenciadas por pacientes terminais destacam-se a eutanásia e a distanásia, ambas consideradas imorais pelo personalismo ontológico proposto por Elio Sgreccia. O objetivo desta dissertação é verificar se o pensamento de Sgreccia pode ser justificado racionalmente de forma objetiva e se possui critérios de necessidade e universalidade. O método utilizado foi a análise dos próprios textos do autor e de suas fontes, tendo como técnica de abordagem a revisão histórica da ética médica desde o tempo de Hipócrates e a comparação do personalismo ontológico com as principais éticas dando ênfase aos conceitos de vida, pessoa, saúde, doença e corpo humano. Apresenta-se o personalismo ontologicamente fundamentado, com os princípios de defesa da vida, liberdade-responsabilidade, totalidade e subsidiariedade, comparando-o ao principialismo, com seus princípios de autonomia, beneficência, não maleficência e justiça. Descreve-se a proposta de Sgreccia para a solução de dilemas com o uso dos princípios secundários do mal menor e do duplo efeito, bem como a necessidade de hierarquização dos princípios primários. Destaca-se a hierarquia do benefício sobre a autonomia, demonstrando o valor intrínseco e inalienável da vida, bem como a subordinação da liberdade a esse valor. Conclui-se que, segundo o autor, os principais dilemas éticos do fim da vida em pacientes terminais são decorrentes de uma não uniformidade de termos, sendo a confusão entre eutanásia passiva e distanásia a principal. O esclarecimento ocorre com a aplicação dos conceitos iniciais que o autor busca na fonte aristotélico-tomista, bem como uma compreensão de autonomia semelhante à proposta por Kant e da morte não mais como um evento, mas como um processo que se inicia com a doença terminal. / Among the many ethical issues experienced by terminal patients, both euthanasia and dysthanasia stand out as being considered immoral by the ontological personalism proposed by Elio Sgreccia. The aim of this paper is to verify if Sgreccia’s theory can be rationally justified in an objective way and if it has necessity and universality criteria. The method used was the analysis of the author's own texts and sources, taking the historical review of medical ethics since Hippocrates as an approach technique, as well as comparing the ontological personalism with the main ethical theories, emphasizing the concepts of life, person, health, disease and the human body. The study presents the ontologically based personalism with the principles of protection of life, freedom-responsibility, totality and subsidiarity, in a comparison with the principlism and its principles of autonomy, beneficence, nonmaleficence and justice. Sgreccia’s theory is reported as a solution to dilemmas when using its secondary principles of less harm and double effect, and also presents the need to create a hierarchy system for its primary principles. The hierarchy of benefit stands out from autonomy, thus demonstrating the intrinsic and inalienable value of life, as well as the subordination of freedom to that value. Therefore, it is possible to conclude that, according to the author, the main ethical dilemmas concerning the end of life in terminal patients are due to the lack of standard expressions, especially between passive euthanasia and dysthanasia. The elucidation is given when applying the initial concepts which the author collects in the Aristotelian-Thomistic source, as well as in an understanding of autonomy similar to that proposed by Kant, and of death not as an event but as a process which starts with terminal illness.

The aim of my Master's degree thesis is to unify the total view of the question of euthanasia and assisted suicide with an emphasis on the criminal law. I am not trying to concluded if legalise euthanasia by the Czech law or not, I just would like to outline the possibility of the legislation in the Czech law for the future, after providing the analysis of the countries where euthanasia has happened legal in the last few years. This thesis consists of the six chapters. At the beginning I am trying to give a detailed description of the substance of euthanasia and other related terms as assisted suicide, do not resuscitate and then I state usual forms and divisions of euthanasia. Then I deal with the history term in the world because for understanding and clarification this is necessary. The next chapter is already about euthanasia in Czech Republic, where this question has never been legalised but there were some efforts in some forms to do that. In this chapter I am concened with a legal qualification of killing on request and assisted suicide de lege lata and de lege ferenda. I also mention the opinions of the opponents and the protagonists of the question of euthanasia. The next chapter deals with a quality paliative care as one the arguments against euthanasia. It is impossible to omit the...

LL.M. / The right to life, which is guaranteed in section 11 of the Constitution, is a particularly important right in South Africa, especially seen in the light of the human rights violations of the apartheid-era. Firstly, this study conducts an analysis of the right to life and attempts to establish who the bearers of the right are; what the protected conduct and interests of the right are; who is bound by the right and what their responsibilities are; and whether the right can legitimately be limited in terms of section 36 of the Constitution. However, when we analyse the right to life in this way, certain problematic and controversial issues become apparent. Two of these issues are discussed in this study – namely abortion and euthanasia and assisted suicide. Before these issues can be adequately addressed, however, the study takes a stance on the value of human life, which forms the moral framework for the discussion of the specific issues. However, the primary focus of the study is the analysis of the specific issues relating to the right to life. The terminology relevant to the respective issues is discussed and the current legal position, including relevant case law and legislation, with regard to the issues is indicated. The arguments, counter arguments and alternative approaches to the issues are discussed and criticized, and consideration is given to the question to what extent the right to life, in cases of abortion and euthanasia, can legitimately be limited if the principled stance regarding the value of human life is accepted. In addition, some other jurisdictions’ experiences of and responses to these issues are also discussed. Finally the study concludes that human life (in all its forms) deserves the full respect and protection of the law, regardless of the quality of life or the capabilities of the individuals whose lives are at stake. Furthermore it is submitted that the state and every member of society has a special responsibility to respect and protect the most vulnerable and marginalised members of our community – instead of suggesting ‘quick fixes’ to desperate people.

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. / Arts, Faculty of / Social Work, School of / Graduate

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.

The thesis deals with legalization of active euthanasia, its main impacts for the whole society, potential abuse and some basic concerns of specialist of various profession related to euthanasia. The thesis is focused on the medical, economic, legal and religious point of view of euthanasia and defines crucial approaches of the defenders and defendant of euthanasia. Special emphasis is on the attitude of doctors, whose opinions on legalization of active euthanasia vary. The thesis denies legalization of active euthanasia as a good solution for patients which are incurable ill or dying, calls attention to keeping the right to live in current form and disagrees with the economical argument that euthanasia is cheap and fast solution for complicated situation of the health service.

In the interplay of critical and self-conscious patients and an ever-aging society the question arises how far patient autonomy sensibly should go and which parameters are deemed to be relevant for end-of-life-decisions. The progress in medicine over the last decades has led on one hand to the possibility of saving lives and maintaining them in situations where before it seemed to be impossible. Nowadays Therefore more and more people are afraid that this boom can be to their detriment when it prolongs instead of shortens their suffering. The fear of unbearable pain and of loss of control fuels the discussion about whether or not euthanasia is morally permissible and should be legalized. This thesis deals with the questions: What speaks in favor of and against the legalization of euthanasia? What forms of treatment are subsumed under the term "euthanasia"? What is the current legal situation in Austria? How far should patient autonomy go? In order to answer these questions a literature research was done which revealed that active euthanasia is not allowed in Austria but in the Netherlands, Belgium, Luxemburg and partly allowed in Switzerland. Interviews conducted among medical staff showed that medical personnel in Austria mostly are in favor of active euthanasia because they are not satisfied with the end of life care that is provided at the moment. They also embrace the trend of patient autonomy and think that patients can have the autonomous wish to end their lives but that it is difficult to determine a patient's autonomy. The reason for this is that autonomy is a gradual value that comprises patients' capacity as well as patients' long-standing goals, values, and preferences that were developed during their life. Therefore it can be concluded that increasing the availability of appropriate end-of-life care could be a solution that prevents medical staff from taking uncomfortable decisions and still enables patients to die in a dignified way.