With new medical advances in technology, there has been a push from the legal, medical and political communities to re-examine the policies of end-of-life-care. End-of-life-care (EOLC) is a term that refers to not only a patient’s final hours of life, but also the medical care of individuals with terminal illnesses or conditions that have become advanced and incurable. For the purpose of this paper, I will be referring to physician-assisted death and active euthanasia as forms of end-of-care. The Politics of End-of –Life-Care: Active Euthanasia and Physician-assisted Death examines the political disjuncture between the evidence presented in favour of active euthanasia (AE), physician-assisted death (PAD) and the current practice of refusing to grant AE and PAD legal status in Canada. It will examine the political dynamics underlying the disjuncture using political pressure groups, constructivism, rational choice, institutionalism and structuralism. There is empirical evidence that demonstrates support for the legalization of AE and PAD. Sixty-seven percent of Canadians support AE /PAD and 80 percent support allowing physicians to assist in AE and PAD (Angus Reid 2012) however, Parliament has not legalized AE/PAD and the CMA has not sanctioned AE /PAD. The two sides of the debate have clearly communicated their arguments. The arguments on each side are strong and have merit. Conversely, the arguments against AE and PAD appear to hold more weight with institutions than with the public. This thesis examines a number of different reasons for why AE/PAD remains illegal in Canada despite society’s widespread support for AE/PAD. The results of the research found no one method explains the disjuncture between the evidence presented in favour of active euthanasia and the current practice of refusing to grant it legal status. However, discursive institutionalism does help elites to generate and communicate the discourse of AE and PAD. It also explains how discourse can also occur from the bottom which results in a new discourse. For example, physicians, politicians, and the public who have deviated from the accepted discourse on AE and PAD can help to create a new discourse regarding AE and PAD policies.

Thesis advisor: Marc Landy / The “Death with Dignity Act,” if passed in November 2012 in Massachusetts by means of a ballot initiative, would have allowed doctors to prescribe lethal drugs to patients with fewer than six months to live. Introduced by two pro-assisted suicide organizations from the Pacific Northwest, the initiative was expected to take advantage of a political “perfect storm” brewing in the Bay State. A blue state in a presidential election year, with President Obama at the top of the Democratic ticket, Massachusetts was expected to produce an electoral outcome favorable to assisted suicide. Oregon and Washington State had legalized physician-assisted suicide in 1998 and 2008, respectively. Polling in 2011 showed a 2-1 majority among Massachusetts voters in favor of assisted suicide. Nonetheless, the Archbishop of Boston and the Bishops of Worcester, Fall River and Springfield, organized as the Massachusetts Catholic Conference, took up the challenge to oppose the initiative. Relying on the expertise of paid political consultants, they mounted a two-tiered campaign. An internal component, directed at Catholics, included the dissemination of over 2 million pieces of in-print and electronic materials urging a “no” vote on the measure. An external component, directed at the wider public, relied on a coalition of organizations representing the three major religions, health and hospice organizations, disabilities rights activists, and pharmacists. Using “flaws” in the bill identified through strategic polling, they appealed to voters even sympathetic to assisted suicide to reject the bill. When the votes were counted 2.7 million Massachusetts citizens voted on the physician-assisted suicide initiative and it was defeated by 67,891 votes, 51.1% to 48.9%. One key to the defeat was the split in the vote in the city of Boston, where Question 2 was defeated 50.9% to 49.1% . Twelve of Boston’s 22 wards voted against the measure. Leading the way among the twelve were Dorchester, Roxbury, and Hyde Park, traditionally black, liberal Democratic strongholds. This study shows that even the most effective, well-funded, Church-initiated campaign in Massachusetts in 2012 might well have foundered on the 2-1 majority in favor of assisted suicide at the polls, not for the strategic identification of “flaws in the bill,” the broad-based coalition campaign based on them, and the “split in the vote in the black community in Boston.” . / Thesis (PhD) — Boston College, 2021. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Political Science.

Extensive research has been conducted on the attitudes of physicians and nurses toward euthanasia. However, little is known on the attitudes of suicide prevention workers (SPWs). The objectives of this study were to: (1) examine the attitudes of SPWs toward euthanasia for a non-descript person versus for a loved one; (2) verify the association between personal factors (experiences, sociodemographics) and attitudes, and (3) explore personal experiences of SPWs in relation to grievous illness. A survey was sent out to all suicide prevention centres across Quebec (n=32). A majority of SPWs (55.7%) held positive attitudes toward euthanasia for a non-descript person and for a loved one (49.5%). Statistically significant differences were found in attitudes among SPWs who had personal and professional experiences. There were no other statistically significant differences in the attitudes of SPWs toward euthanasia for a non-descript person or for a loved one, and any of the sociodemographic factors. Three themes emerged from the qualitative analysis of open-ended question on personal experiences of SPWs: respect of choice, suffering/low quality of life and palliative care. While some findings may be concluded from this study, it is essential that this topic be explored further as research on SPWs’ attitudes on euthanasia is limited. Research outcomes of this study can have important short-term and long-term implications on suicide prevention and training of SPWs to improve services offered to clients.

Currently in the United States, five states have enacted physician-assisted suicide as a legal end of life option for terminal patients. Research indicates that most patients who have died under this mean have been enrolled in hospice services. With the recent enactment of California’s End of Life Option Act, hospice social workers will find themselves educating and assisting patients and/or their families with this and other end of life decisions. Research has thoroughly examined physician and nurses’ involvement and attitude in the matter, but little has been researched regarding social workers. This study aimed to identify the factors that affect hospice social workers’ attitude towards physician-assisted suicide and how California’s End of Life Option Act affects their practice. In-depth face-to- face interviews with 8 hospice social workers were conducted. The study found that all 8 participants held positive attitudes towards physician-assisted suicide, support the End of Life Option Act, and feel prepared to assist patients and handle requests for the End of Life Option. Factors such as social work values and professional experience have a positive effect and validate their attitude, and factors such as religion does not affect their attitude. Due to low participation, the overall results were limited; therefore, additionally research should be extensively conducted to gain a better understanding. Regardless, a structured physician-assisted suicide protocol for social workers would benefit micro practice and macro developments.

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This dissertation will examine the legality of assisted dying procedures performed in the Republic of South Africa. This is due to the rising awareness about terminal patients’ dignity and autonomy at the end of their life. The physician’s liability, who assists such a patient to end their life, will be examined and whether there is any legal recourse available will be explored. Comparisons will also be made between other legal systems, including Canada, the Netherlands, Oregon of the United States of America and England and Wales. These jurisdictions have been chosen to provide a wide variety of perspectives and possible alternatives that South Africa should take into consideration should parliament or the courts decide to argue the matter. Other sources are also considered, such as the influence of the history and development of the common law crime of murder, as well as the role the Health Professions Council of South Africa will play. Possibly most importantly, the material criminal law of South Africa is thoroughly studied with all forms of assisted dying in mind. This is to establish what kind of liability, criminal or otherwise, a physician might incur should they decide to assist a patient in these circumstances. Lastly, recommendations are made based on the research done throughout this dissertation, which would ideally assist in any future arguments made on the topic. / Dissertation (LLM)--University of Pretoria, 2017. / Public Law / LLM / Unrestricted

This research investigated the role religion plays in how individuals view euthanasia and physician-assisted suicide. One hundred participants from each of the three major monotheistic world religions were given a seven-question survey. The seven questions consisted of statements regarding the knowledge of their own religion, how the participants feel about terminally ill patients and those who have lost vital functions, and also whether or not they believe euthanasia is morally just. It was predicted that the participants who belong to Judaism and Islam viewed euthanasia as morally just and participants who belong to the Christianity viewed euthanasia as morally incorrect.

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.

Effective June 9, 2016, many terminally ill patients residing in the State of California will now have the legal option of terminating their life because of protections offered under The California End of Life Options Act. Social workers whose population of care includes terminally ill patients will likely be engaging in conversations about end of life options, including physician assisted death, with their patients. Little research exists addressing what factors may influence social workers perceived preparedness to discuss physician assisted death with patients, yet the expectation that social workers be prepared to discuss all available end of life options with patients is present. The purpose of this quantitative study is to explore the influence of demographic characteristics and experience with terminal illness on California social workers perceived preparedness to discuss physician assisted death as an end of life option with terminally ill patients. Convenience sampling was utilized which included sixty-two Master of Social Work level or higher social workers who are employed in medical social work positions and are providing direct care for chronically and terminally ill patients. Participants completed a voluntary paper survey that gathered demographic information, experience with terminal illness and perceived preparedness to discuss physician assisted death with patients through Likert Scale measures. The findings showed a positive relationship between California social workers who perceived themselves as prepared to discuss physician assisted death and the identification of their social work education as a source of their preparedness.

Introduction: Physician assisted suicide (PAS) is the process where the patient terminateshis/her life with the aid of a physician who provides a prescription for lethal medication thatthe patient self-administers in order to commit suicide. PAS is practiced in several countriesand is now gaining support in Sweden. The debate shows some confusion regarding thedefinition of concepts and raises several ethical concerns. Aim: To provide an empirical background and clarify concepts. To analyze the ethical arguments for and against PAS. To investigate relevant ethical differences between PAS, euthanasia and withdrawal oflife-sustaining treatment. Materials and methods: Qualitative literature study based on argumentative- and conceptualanalysis on hermeneutic ground. Materials were gathered through a literature search andconsist of scientific articles, debate articles and official materials. Results: The main ethical arguments supporting PAS are autonomy, beneficence and dignity.PAS is by supporters seen as an act of compassion, which fulfills the physician’s obligation ofnon-abandonment. Opponents emphasize that PAS goes against the duty of beneficence andnonmaleficence and fear that there may be a slippery slope where more and more people willdemand PAS. Conclusion: There is no consensus on whether PAS is considered ethically defendable or not.PAS appears to involve a conflict of interest between the principles of beneficence andautonomy. There seems to be some factual disagreements as well as different positions as tohow the ethical principles should be interpreted, and which ethical principle should be valuedthe highest.