This dissertation examines from a Vattimian perspective the challenge that euthanasia and assisted suicide posed to the sanctity of life ethos in Canada from 1972–2005. Gianni Vattimo’s central themes—metaphysics (absolute values), “event of being” (lived experiences that call absolute values into question), and passive-reactive nihilism (the use of “masks” or “disguises” to prevent the dissolution of metaphysics)—are pivotal to understanding the way religious and secular beliefs are interwoven within ethical, medical, legal and political discourses in Canada. Vattimo’s philosophico-ethical approach was specifically chosen because as a theoretical tool, it helps to illuminate the presence, weakening, and resilience of metaphysics in discourses surrounding an intentionally hastened death. To demonstrate how Vattimo’s major themes apply empirically to the research, a social constructionist approach was adopted in the form of a discourse analysis. Particular emphasis was placed on an examination of the three most important cases of death and dying in Canada, namely, Nancy B., Sue Rodriguez and Robert Latimer. The bulk of the evidence suggests that when these “events of being” challenged the sanctity doctrine as the ultimate foundation for life-terminating decisions, ethical, medical, legal and political discourses converged to promote three normative positions or authorizing discourses used in the tradition of Christian ethics: (1) stewardship—the view that since life is a “loan from God,” sacred, and of infinite worth, death cannot be intentionally hastened (“nature must take its course”); (2) value in prolonged suffering—the view that since suffering possesses transcendent meaning or purpose, its prolongation is justified in individual circumstances; and (3) the “slippery slope”—the view that any weakening of the sanctity of life ethos inevitably harms or threatens the community. Generally speaking, religious and secular advocates of the sanctity of life ethos reacted similarly in cases involving an intentionally hastened death. In other words, both the religious and the secular embraced metaphysics (absolute values), condoned and rationalized the prolongation of suffering, and relied on the “slippery slope” as a “mask” to maintain the sanctity of human life as first principle. The research strongly suggests that Canada is still significantly indebted to Christian notions when it comes to discussions surrounding the decriminalization of euthanasia and assisted suicide.

This dissertation examines from a Vattimian perspective the challenge that euthanasia and assisted suicide posed to the sanctity of life ethos in Canada from 1972–2005. Gianni Vattimo’s central themes—metaphysics (absolute values), “event of being” (lived experiences that call absolute values into question), and passive-reactive nihilism (the use of “masks” or “disguises” to prevent the dissolution of metaphysics)—are pivotal to understanding the way religious and secular beliefs are interwoven within ethical, medical, legal and political discourses in Canada. Vattimo’s philosophico-ethical approach was specifically chosen because as a theoretical tool, it helps to illuminate the presence, weakening, and resilience of metaphysics in discourses surrounding an intentionally hastened death. To demonstrate how Vattimo’s major themes apply empirically to the research, a social constructionist approach was adopted in the form of a discourse analysis. Particular emphasis was placed on an examination of the three most important cases of death and dying in Canada, namely, Nancy B., Sue Rodriguez and Robert Latimer. The bulk of the evidence suggests that when these “events of being” challenged the sanctity doctrine as the ultimate foundation for life-terminating decisions, ethical, medical, legal and political discourses converged to promote three normative positions or authorizing discourses used in the tradition of Christian ethics: (1) stewardship—the view that since life is a “loan from God,” sacred, and of infinite worth, death cannot be intentionally hastened (“nature must take its course”); (2) value in prolonged suffering—the view that since suffering possesses transcendent meaning or purpose, its prolongation is justified in individual circumstances; and (3) the “slippery slope”—the view that any weakening of the sanctity of life ethos inevitably harms or threatens the community. Generally speaking, religious and secular advocates of the sanctity of life ethos reacted similarly in cases involving an intentionally hastened death. In other words, both the religious and the secular embraced metaphysics (absolute values), condoned and rationalized the prolongation of suffering, and relied on the “slippery slope” as a “mask” to maintain the sanctity of human life as first principle. The research strongly suggests that Canada is still significantly indebted to Christian notions when it comes to discussions surrounding the decriminalization of euthanasia and assisted suicide.

Par une approche analytique, cette étude en éthique clinique a examiné la problématique de la demande d’assistance médicalisée pour mourir formulée dans le cadre des soins de fin de vie. Partant du fait que cette demande sollicite les soignants dans leur savoir et leur savoir-faire, surtout dans leur savoir-être, cette étude rend d’abord compte d’un fait : bon gré mal gré l’interdit de l’euthanasie par la loi et la déontologie médicale, ainsi que le débat contradictoire à son sujet qui dure déjà voici quelques décennies, il arrive de temps à autres que les soignants œuvrant en soins de fin de vie, soient confrontés à une demande d’assistance médicalisée pour mourir. Cette demande qui émane de certaines personnes en fin de vie et / ou de leurs proches, est souvent source de malaise pour les soignants à l’endroit de qui elle crée des défis majeurs et fait naître des dilemmes éthiques importants. Plus particulièrement, cette demande interroge toujours la finalité même des soins de fin de vie : est-ce que l’aide pour mourir fait partie de ces soins ? En réponse à cette question difficile, cette démarche réflexive de soignant chercheur en éthique montre qu’il est difficile de donner une réponse binaire en forme de oui / non ; il est difficile de donner une réponse d’application universalisable, et de définir une généralisable conduite à tenir devant une telle demande, car chaque cas est singulier et unique à son genre. Cette étude montre prioritairement que l’humanisation de la mort est à la fois un enjeu éthique important et un défi majeur pour notre société où la vie des individus est médicalisée de la naissance à la mort. En conséquence, parce que la demande d’assistance médicalisée pour mourir sollicite les soignants dans leur savoir et leur savoir-faire, cette étude montre toute l’importance de la réflexivité et de la créativité que doivent développer les soignants pour apporter une réponse constructive à chaque demande : une réponse humanisant le mourir et la mort elle-même, c’est-à-dire une réponse qui soit, sur le plan éthique, raisonnable et cohérente, une réponse qui soit sur le plan humain, porteuse de sens. D’où, outre l’axiologie, cette démarche réflexive montre que l’interdisciplinarité, la sémantique, l’herméneutique et les grilles d’analyse en éthique, constituent des outils réflexifs efficaces pouvant mieux aider les soignants dans leur démarche. Sur quelles bases éthiques, les soignants doivent-ils examiner une demande d’assistance médicalisée pour mourir, demande qui se présente toujours sous la forme d’un dilemme éthique? Cette question renvoie entre autre au fait que cette demande sollicite profondément les soignants dans leur savoir-être en relation des soins de fin de vie. Aussi bonnes les unes que les autres, qu’on soit pour ou contre l’euthanasie, plusieurs stratégies et méthodes d’analyse sont proposées aux soignants pour la résolution des conflits des valeurs et des dilemmes éthiques. Mais, ce n’est pas sur cette voie-là que cette étude invite les soignants. C’est plutôt par leur réflexivité et leur créativité, enrichies principalement par leur humanisme, leur expérience de vie, leur intuition, et secondairement par les différentes méthodes d’analyse, que selon chaque contexte, les soignants par le souci permanent de bien faire qui les caractérisent, trouveront toujours par eux-mêmes ce qui convient de faire dans l’ici et maintenant de chaque demande. C’est pourquoi, devant une demande d’assistance médicalisée pour mourir qui leur est adressée dans le cadre des soins de fin de vie, cette démarche éthique invite donc les soignants à être « des cliniciens créatifs, des praticiens réflexifs» . C’est pour cette raison, sur le plan proprement dit de la réflexion éthique, cette étude fait apparaître les repères de l’éthique humaniste de fin de vie comme bases axiologiques sur lesquels les soignants peuvent construire une démarche crédible pour répondre au mieux à cette demande. L’éthique humaniste de fin de vie située dans le sillage de l’humanisme médical , où l’humain précède le médical, renvoie au fait qu’en soins de fin de vie où émerge une demande d’aide à la mort, entre le demandeur de cette aide et le soignant, tout doit être basé sur une confiante relation d’homme à homme, même si du côté du soignant, son savoir être dans cette relation est aussi enrichi par sa compétence, ses connaissances et son expérience ou son savoir-faire. Basée sur l’humanité du soignant dans la démarche de soins, l’éthique humaniste de fin de vie en tant que pratique réflexive émerge de la créativité éthique du soignant lui-même et de l’équipe autour de lui ; et cette éthique se situe entre interrogation et transgression, et se définit comme une éthique « du vide-de-sens-à-remplir » dans un profond souci humain de bien faire. Car, exclue l’indifférence à la demande de l’assistance médicalisée pour mourir, son acceptation ou son refus par le soignant, doit porter sur l’humanisation de la mort. Cette dernière étant fondamentalement définie par rapport à ce qui déshumanise la fin de vie. / In an analytical approach, this clinical ethics study analyzes the issue of medical assistance request in dying in the context of end-of-life care. Runner of the fact that this request seeks the healthcare professionals in their knowledge and their know-how as well as in their knowledge-being in relation of the end-of-life care, this study gives first account of a fact: like it or not the prohibition of voluntary euthanasia by law and ethics, and the controversial debate about it in the last few decades, healthcare professionals involved in end-of-life care every so often are faced with a request of medical assistance to die. The request from some dying patients and / or their relatives often causes discomfort for the healthcare professionals to the point that it creates challenges and raises significant ethical dilemmas. Specifically, this request always challenges the very purpose of end-of-life care: Is medical assistance to dying part of the end-of-life care? In response to this difficult question, my reflexive ethics as medical researcher shows that: it is difficult to give a binary response yes / no. It is difficult to answer by a universalized application and define a generalized course of action, because each case is singular and unique to its kind. Accordingly, this study demonstrates the importance of reflexivity and creativity to be developed by the healthcare professionals to respond constructively to every request: a response humanizing dying and death itself. Hence, because the request of the assistance provided with medical care to die seeks the healthcare professionals in their knowledge and their know-how, in addition to axiology, this reflexive approach shows that interdisciplinarity, semantics, hermeneutics and analysis grids in ethics are effective reflexive tools that can better assist healthcare professionals in their approach. On what ethical basis, the healthcare professionals have to consider a request of medical assistance to dying, request that always presents itself as an ethical dilemma? This question sends back among others to the fact that this request seeks the healthcare professionals in their knowledge-being in relation of the end of life care. Several strategies and analysis methods, all equally good, are available to healthcare professionals for the resolution of ethical dilemmas. However, this is not the perspective this study invites healthcare professionals to discuss. Rather, it is through their reflexivity and creativity, enriched mainly by their humanity, life experience, intuition, and secondly helped by the different methods, that, according to each context, healthcare professionals in their ongoing effort to do right, that characterizes them, always find by themselves what is best to do here and now for each request. That is why, in front of a request of the assistance provided with medical care to die which is sent to them within the framework of the care of the end of life, this ethical approach thus invites the healthcare professionals to be “creative clinicians, reflexive practitioners " . Also, that is why, in terms of ethical reflection, this study exposes the framework of the humanistic ethics in end-of-life issues as axiological foundations on which health care providers can build their approach to best meet the request of medical assistance to die that they may receive in the context of end-of-life care. The humanistic ethics in end-of-life issues studied in the context of medical humanism , in which human precedes medical, refers to the fact that end-of-life care from which emerges a request for assisted death, between the one requesting such an assistance and the healthcare professional, everything must be based on a trusting human relationship between two persons, even if on the healthcare professional’s side, his personal and practical skills in this relationship are also enriched by his competence, knowledge and experience. Based on the humanity of the healthcare professionals in the medical process, humanistic ethics of end of life as a reflexive practice emerges from the ethical creativity of the healthcare professional himself and the team around him. This ethics is between query and transgression, and is defined as an ethics "vide-de-sens-à-remplir" in a deep human desire to do right. For, excluding indifference towards the request of medical assistance to dying, its acceptance or its rejection by the healthcare professionals must be a reasoned response and meaningful to the person who makes the request, whoever he may be, the dying patient or his relatives, and for the caregiver himself.

This dissertation examines from a Vattimian perspective the challenge that euthanasia and assisted suicide posed to the sanctity of life ethos in Canada from 1972–2005. Gianni Vattimo’s central themes—metaphysics (absolute values), “event of being” (lived experiences that call absolute values into question), and passive-reactive nihilism (the use of “masks” or “disguises” to prevent the dissolution of metaphysics)—are pivotal to understanding the way religious and secular beliefs are interwoven within ethical, medical, legal and political discourses in Canada. Vattimo’s philosophico-ethical approach was specifically chosen because as a theoretical tool, it helps to illuminate the presence, weakening, and resilience of metaphysics in discourses surrounding an intentionally hastened death. To demonstrate how Vattimo’s major themes apply empirically to the research, a social constructionist approach was adopted in the form of a discourse analysis. Particular emphasis was placed on an examination of the three most important cases of death and dying in Canada, namely, Nancy B., Sue Rodriguez and Robert Latimer. The bulk of the evidence suggests that when these “events of being” challenged the sanctity doctrine as the ultimate foundation for life-terminating decisions, ethical, medical, legal and political discourses converged to promote three normative positions or authorizing discourses used in the tradition of Christian ethics: (1) stewardship—the view that since life is a “loan from God,” sacred, and of infinite worth, death cannot be intentionally hastened (“nature must take its course”); (2) value in prolonged suffering—the view that since suffering possesses transcendent meaning or purpose, its prolongation is justified in individual circumstances; and (3) the “slippery slope”—the view that any weakening of the sanctity of life ethos inevitably harms or threatens the community. Generally speaking, religious and secular advocates of the sanctity of life ethos reacted similarly in cases involving an intentionally hastened death. In other words, both the religious and the secular embraced metaphysics (absolute values), condoned and rationalized the prolongation of suffering, and relied on the “slippery slope” as a “mask” to maintain the sanctity of human life as first principle. The research strongly suggests that Canada is still significantly indebted to Christian notions when it comes to discussions surrounding the decriminalization of euthanasia and assisted suicide.

This work deals with the problems of conception, gravidity and abortion in the first part and in the second part than deals with problems of death and dying. It concerns two cut-off points, which are component parts of human life. The first part surveis the biginning of human life and tries to find answers for questions, which have a connection with the conception, artifical insemination, surrogative maternity and abortion. It describes paradoxes, which comes from such situations. It appreciates this paradoxes in the wiev of medicin, ethics, psychology and law. The second part describes the end of the human life in several forms. It broods killing, suicide and euthansia in aspects of the psychology, medicine, law and ethics. In the end it describes the palliative care as an alternativ to euthansia.

The thesis deal with the topic of induced abortion and euthanasia as the basic issue of the theme of process of dying and death. The theoretical part presents how an acceptation of death have been changing during the human history, deals with the concept of after-life in five world religions, presents how death is perceived in different life period, gives the analysis of abortion and euthanasia as an issue of ethics. The second part od the thesis is to serve as the background material to design lessons of ethics for the secondary schools according to the RWCT program (Reading and Writing Critical Thinking). The aim is to depict the topicality and importance of these issues that a disciple is not only to meet during the lesson, but also to be able to handle, to judge and to draw conclusions for his behaviour.

This Thesis deals with the issue of illness and dying, and the care for the dying in different hospice facilities. In describes typical features of palliative medicine, it´s practical use in hospices and also the lack thereof in current Czech Medicine. The legislative side of this issue is discussed in this thesis as well.

The theses deal with the last period of the person´s life and the possibilities of the care focused on the spiritual, psychic, physical and social aspect of the issue. It offers possibilities of ethical way how to cope with this life´s stage having the help of social workers, family and also the dying person. The practical part compares opinions of the hospice workers with the views of the workers from old people´s homes with respect to this issue. It also points at the demnad of the work and some of its difficulties.

The main subject of this thesis is a reflection issue of the terminal care ethics. The structure of the thesis consists of four thematic units. The first part is the introduction to the concept of medical ethics: the description of the subject, the historical development and its principles. The second block of the thesis focuses on the biggest existential event of human life ? death, and the human approach to death and dying. The search for the meaning of life and for the meaning of suffering be

Au cours du dernier siècle, les circonstances de la mort ont changé. La plupart des décès surviennent maintenant à des âges élevés. Ils ont principalement lieu en institution et sont souvent précédés d’une longue maladie chronique accompagnée de souffrances et d’angoisses qui ne peuvent être soulagées. Ces mêmes sentiments se retrouvent aussi chez les personnes accidentées de la vie. C’est pourquoi, désormais, les patients privilégient la qualité de la mort à la prolongation de la vie dans la souffrance. Ainsi, de plus en plus fréquemment, le corps médical est confronté à des demandes d’euthanasie ou de suicide assisté de la part des souffrants. C’est dans ce contexte qu’il est intéressant de s’interroger sur la législation française en matière de fin de vie et sur la place donnée tant aux professionnels de santé, qu’aux patients. Si la loi Leonetti du 22 avril 2005 a constitué une avancée considérable en la matière, elle ne répond malheureusement pas à l’ensemble des situations existantes et demeure actuellement insuffisante face aux requêtes constantes des personnes souffrantes et de la majorité de la population française. En témoigne la récente affaire Vincent Lambert dans laquelle, l’équipe médicale confrontée à des avis discordants au sein de la famille proche du patient et à l’absence de volonté exprimée de celui-ci, a été amenée à prendre une décision collégiale sur la poursuite ou non du traitement délivré à ce patient tétraplégique en état de conscience minimale, qui semble-t-il ne voulait plus survivre. S’en sont suivies plusieurs mêlées judiciaires qui ont permis de relancer le débat sur l’évolution de la législation en matière de fin de vie / During the last century, the circumstances of the death changed. Most of the deaths arise now at high ages even very high. They mainly take place in institution and are often preceded by a long chronic disease accompanied with sufferings and with fears which cannot be relieved. The same feelings also find themselves at the more or less young people, damaged by the life.That is why, from now on, the patients favor the quality of the death to the extra time of the life in the suffering. So, more and more frequently, the medical profession is confronted with requests of euthanasia or suicide assisted on behalf of the suffering.It is in this context that it is interesting to wonder on the French legislation regarding the end of life and on the place given as long to the healthcare professionals, and the patients.If the Leonetti’s law of April 22nd, 2005 constituted a considerable advance on the subject, she does not unfortunately answer all the existing situations and currently not sufficient in front of constant requests of the suffering people and the majority of the French population. The recent affair Vincent Lambert shows it in which, the medical team confronted with clashing notices within the family close to the patient and in the absence of will expressed by this one, was brought to make a collective decision on the pursuit or not of the treatment delivered to this patient tetraplegic in state of minimal consciousness, who it seems did not want to survive any more. Followed itself several judicial scrums which allowed to boost the debate on the evolution of the legislation regarding the end of life