Pope Francis insists on right to conscientious objection for abortion refuseniks

h/t to Bioedge Health workers have a non-negotiable right to conscientious objection if they are asked to participate in an abortion, Pope Francis told a conference of hospital pharmacists this week. CO is actually “fidelity to your profession, if validly motivated,” he said. “Today there is something of a tendency to think that perhaps it would be a good way to approach conscientious objection,” he said. “But this is the ethical intimacy of every health professional and this should never be negotiated, it is the ultimate responsibility of health professionals. It is also a denunciation of the injustices done to the detriment of innocent and defenceless life.” However, he acknowledged the complexity of CO, which “requires both great competence and great rectitude”. And, pushing back against accusations that Catholic doctrine is harsh and unyielding, he said that “our duty is to be close to people, our positive duty: to be close to situations, especially women, so that they do not come to think of abortion as the solution.” The Pope, who is often viewed as a progressive because of his views on the environment, on greater tolerance of LGBTQI+ people, and on inflexible clergy, is still vehemently opposed to abortion. It was at least the third time in a month that Francis has denounced abortion, which has become a major political issue in many countries, especially the United States. In an in-flight press conference in September he declared: “Abortion is more than an issue. Abortion is murder … It’s a human life, period.”

Wisconsin bishops encourage vaccination while affirming conscience rights

Interesting article from CNA about the ethical issues of COVID vacinations and Conscience. The five bishops of Wisconsin on Friday issued a message encouraging vaccination against COVID-19, while maintaining that people ought not be forced to accept a COVID vaccine. “We encourage those eligible to receive the COVID-19 vaccine to do so because it is the most effective way to combat this virus. We are all morally responsible to protect our lives and the lives of others. This is an imperative of natural law that we treasure in our faith,” the bishops wrote. They also acknowledged “many health or ethical reasons why a person may refuse COVID-19 vaccination,” but added that “it is the responsibility of the individual” to explain their decision to decline the vaccine, and recommended that clergy not intervene in such cases. “However, the Church also treasures her teaching on the sanctity of conscience,” they stated. “Nobody should violate the sanctity of conscience by forcing a person to do something contrary to his or her conscience.” In cases of conscientious objection to the COVID vaccine, “[p]astors should not feel compelled to issue documentation recognizing this conscientious objection and are recommended not to do so,” the bishops stated. The bishops stressed that anyone refusing to be vaccinated against COVID-19 must take steps to avoid spreading the virus. “Every decision has consequences; and in this case, the person claiming a religious or ethical exemption should be ready to properly assume other scientifically recommended means of avoiding infection and contagion: face-coverings, social distancing, hand sanitizing, periodic testing, and quarantine,” the bishops wrote. Bishops across the country have issued guidance for Catholics seeking conscience exemptions to COVID-19 vaccine mandates. Some bishops, including the bishops of South Dakota, have explicitly supported Catholics wishing to seek conscience exemptions. In contrast, many bishops in California, as well as in Chicago and Philadelphia, have instructed clergy not to assist parishioners seeking religious exemptions to mandates, stating that there is no basis in Catholic moral teaching for rejecting vaccine mandates on religious grounds. Quoting Pope Paul VI’s encyclical Dignitatis Humanae, the Wisconsin bishops wrote that “the Christian faithful, in common with all other men, possess the civil right not to be hindered in leading their lives in accordance with their consciences.” Given “the urgency of this pandemic and the frustration some may experience because of the number of unvaccinated people,” a person’s conscientious refusal of a COVID vaccine may offend some, the bishops said, but that decision still retains its “dignity,” they wrote. “Consequently, someone who in conscience decides that he or she should not receive the COVID-19 vaccine should be granted an exemption based on his or her beliefs or convictions,” the bishops asserted. “It is the responsibility of the individual to raise moral or ethical objections to vaccination based on the dictates of his or her conscience. Pastors should not feel compelled to issue documentation recognizing this conscientious objection and are recommended not to do so.” Before COVID-19 vaccines were authorized for use in the United States, some Catholics raised concerns about their use of cell lines likely derived from fetal tissue of an abortion decades prior. Those vaccines produced by Pfizer and Moderna were tested on the controversial cell lines, while the vaccine created by Johnson & Johnson was both tested on and directly produced with the cell lines. The U.S. Conference of Catholic Bishops, echoing guidance from the Vatican, has since stated that all three vaccines approved for use in the United States are “morally acceptable” for use despite their remote connection with abortion. If one had the ability to choose a vaccine, the bishops recommended that they choose one with the least connection to abortion. Pope Francis has strongly encouraged vaccination, collaborating with the Ad Council on a video promoting vaccination. The pope called getting vaccinated against COVID “an act of love,” in the video. December 2020 guidance from the Vatican’s Congregation for the Doctrine of the Faith stated that “vaccination is not, as a rule, a moral obligation,” and “therefore, it must be voluntary.”

Policy shift in Finland for gender dysphoria treatment

The international activist group SEGM, the Society for Evidence-Based Gender Medicine, has published a review of a radical shift in the standards of care for gender dysphoric children in Finland. A year ago, the Finnish Health Authority issued new guidelines which back psychotherapy, rather than puberty blockers and cross-sex hormones, as the first-line of treatment. It took this step after a systematic review of the evidence which found the evidence for paediatric evidence “inconclusive”. Here are a few excerpts from SEGM’s summary. Although pediatric medical transition is still allowed in Finland, the guidelines urge caution given the unclear nature of the benefits of these interventions, largely reserving puberty blocker and cross-sex hormones for minors with early-childhood onset of gender dysphoria and no co-occurring mental health conditions. Surgery is not offered to those <18. Eligibility for pediatric gender reassignment is being determined on a "case-by-case basis" in two centralized gender dysphoria research clinics. The Finnish guidelines warn of the uncertainty of providing any irreversible "gender-affirming" interventions for those 25 and under, due to the lack of neurological maturity. The guidelines also raise the concern that puberty blockers may negatively impact brain maturity and impair the young person's ability to provide informed consent to the subsequent and more irreversible parts of the Dutch protocol: cross-sex hormones and surgeries. The Finnish guidelines reflect the growing international concern about the unexplained sharp rise in adolescents presenting with gender dysphoria, which is occurring in increasingly complex developmentaland mental health contexts, and often without a childhood history of gender-related distress. There are significant questions as to whether the Dutch protocol (hormonal and surgical interventions for youth), designed for a distinctly different population of high-functioning teens with childhood-onset cross-sex identification and with no significant mental health comorbidities, is appropriate for this novel population. The Finnish Health Authority states that the guidelines will not be further revised until research is able to: explain the recent sharp rise in adolescents presenting with gender dysphoria; determine whether transgender identities in this population are stable or will evolve; assess whether gender-affirming treatments are able to improve health outcomes of those who present with co-occurring mental health problems, including improvements in depression and suicide; and quantify the rate of regret. h/t to Bioedge

Vatican says getting Covid vaccine 'morally acceptable‘

H/t to The Gaurdian. 

This is will to make you think more analytically about the application of Natural Moral Law - active co-operation might need to be critically assessed. 

Catholic church says researchers’ use of cell material derived from foetuses does not amount to cooperating with abortion

The Vatican has urged Catholics to get vaccinated against coronavirus and said it is “morally acceptable” to take vaccines that use cell lines from aborted foetuses.

Cells derived from foetuses aborted decades ago have been used by some researchers working on vaccines against Covid-19.

The Vatican acknowledged that the issue was a cause of concern for some Catholics but said in a note that “it is morally acceptable to receive Covid-19 vaccines that have used cell lines from aborted foetuses in their research and production process”.

The use of such vaccines “does not constitute formal cooperation with the abortion from which the cells used in production of the vaccines derive”, it said.

The Vatican added that while vaccination “must be voluntary ... in the absence of other means to stop or even prevent the epidemic, the common good may recommend vaccination, especially to protect the weakest and most exposed”.

Those who refuse to  use vaccines “must do their utmost to avoid” spreading infection, it added.

The note also highlighted the “moral imperative” of the pharmaceutical industry, governments and international organisations to ensure that vaccines “are also accessible to the poorest countries”.

Italy will go into a nationwide lockdown during the Christmas and new year period. The whole country will be under “red-zone” lockdown between Christmas Eve and 27 December, then again between 31 December and 3 January, and several more periods into the new year.

Once again, the Vatican slams euthanasia

h/t Bioedge

 

If anyone were unsure of where the Catholic Church stood on assisted suicide and euthanasia, they can have no doubts now. In a lengthy document titled Samaritanus Bonus (“the good Samaritan”), the Vatican has released a lengthy response to the spread of “assisted dying”.

Assisted suicide or euthanasia or both are permitted in the Netherlands, Belgium, Luxembourg, Canada, Colombia, Switzerland, eight states in the United States plus the District of Columbia, and two states in Australia. A number of other countries are considering legalisation.

The document is clear and emphatic: euthanasia is “an intrinsically evil act, in every situation or circumstance”.

As well, anyone who cooperates is guilty as well, even those who defend legalisation. 

“Euthanasia is an act of homicide that no end can justify and that does not tolerate any form of complicity or active or passive collaboration. Those who approve laws of euthanasia and assisted suicide, therefore, become accomplices of a grave sin that others will execute. They are also guilty of scandal because by such laws they contribute to the distortion of conscience, even among the faithful.”

The Church’s opposition is hardly news. More than 50 years ago the Second Vatican Council condemned euthanasia. Long before the Netherlands legalised it in 2002, Pope John Paul II forbade it in an encyclical, Evangelium Vitae (“the Gospel of Life”). However, the disagreeable reality of legalisation presents problems for Catholics – and other Christians who oppose it in theory. Should people who request assisted suicide or euthanasia receive the Church’s last rites? Should they be given a Christian funeral?

Some bishops appeared to lean toward a policy of demonstrating compassion by “accompanying” a person who chooses to die in this way.

Samaritanus Bonus puts the kibosh on this. People who request assisted suicide or euthanasia may not receive the Church’s sacraments. Even membership in an association organising “assisted dying” is forbidden. They “must manifest the intention of cancelling such a registration before receiving the sacraments”.

Whilst this sounds harsh, the document acknowledges that in extremis people may be so distressed that they are not fully responsible for choosing this kind of death. It urges priests to look for “adequate signs of conversion”. But in principle, there should be no cooperation whatsoever:

Those who spiritually assist these persons should avoid any gesture, such as remaining until the euthanasia is performed, that could be interpreted as approval of this action. Such a presence could imply complicity in this act. This principle applies in a particular way, but is not limited to, chaplains in the healthcare systems where euthanasia is practiced, for they must not give scandal by behaving in a manner that makes them complicit in the termination of human life.

Familiar stuff, perhaps, for friends and foes of Catholicism.

What’s different about this document is that it also offers a perceptive bioethical analysis of euthanasia, along with theological prescriptions.

The principal justification for euthanasia is autonomy. It’s my life; I can do what I want with it. Nobody can tell me what to do. We have to respect a patient’s autonomous decision. Choosing the time and place of death is the ultimate affirmation of autonomy, etc. The arguments are nearly always drawn straight from the playbook of the 19th century British philosopher John Stuart Mill.

The philosophy underlying the secular arguments deployed in Samaritanus Bonus is completely different. Instead of departing from the autonomy of the patient, it emphasises the universal experience of vulnerability.

For the fully autonomous man, think of lron Man in the Marvel Universe. Zipping around in his suit of armour, he is invulnerable. But what makes him interesting is the fact that Tony Stark is vulnerable. He suffers from PTSD, narcissism and loneliness. It’s not the strength of Iron Man’s armour that makes him human, but the fragility of Tony Stark’s character.

Which is more or less what the Vatican says:

“The need for medical care is born in the vulnerability of the human condition in its finitude and limitations. Each person’s vulnerability is encoded in our nature as a unity of body and soul: we are materially and temporally finite, and yet we have a longing for the infinite and a destiny that is eternal. As creatures who are by nature finite, yet nonetheless destined for eternity, we depend on material goods and on the mutual support of other persons, and also on our original, deep connection with God.“

Given this vision of what a human being is, the appropriate response to illness is not to kill a patient, but to care for him.

“Our vulnerability forms the basis for an ethics of care, especially in the medical field, which is expressed in concern, dedication, shared participation and responsibility towards the women and men entrusted to us for material and spiritual assistance in their hour of need.“

Furthermore, the document points out that measuring a patient’s dignity by his autonomy leads to the contradiction which has always bedevilled Mill’s theory. How can the highest expression of autonomy be to extinguish it? If that were true, couldn’t we choose to sell ourselves into slavery to settle our debts? No. “Just as we cannot make another person our slave, even if they ask to be, so we cannot directly choose to take the life of another, even if they request it,” it points out.

“Therefore, to end the life of a sick person who requests euthanasia is by no means to acknowledge and respect their autonomy, but on the contrary to disavow the value of both their freedom, now under the sway of suffering and illness, and of their life by excluding any further possibility of human relationship, of sensing the meaning of their existence, or of growth in the theologal life. Moreover, it is to take the place of God in deciding the moment of death.“

The document also makes some very shrewd observations about the implications of pretending that we are Iron Man instead of acknowledging ruefully that underneath we are really Tony Stark.

In fact, if autonomy is the highest value, people whose autonomy is impaired are in trouble.

“Those who find themselves in a state of dependence and unable to realize a perfect autonomy and reciprocity, come to be cared for as a favor to them. The concept of the good is thus reduced to a social accord: each one receives the treatment and assistance that autonomy or social and economic utility make possible or expedient. As a result, interpersonal relationships are impoverished, becoming fragile in the absence of supernatural charity, and of that human solidarity and social support necessary to face the most difficult moments and decisions of life.”

In short, the proper response to Tony Stark’s end-of-life existential crisis is not to end his life, but to lavish care upon him, to treat him as unique and precious (which is what happens in Avengers: Endgame)

US ethicists issue utilitarian manifesto for coronavirus rationing

h/t Bioedge

As the US braces itself for an exponential increase in COVID-19 cases, several US doctors and ethicists have published an article arguing forcefully for utilitarian healthcare rationing. 

The new article -- published in the New England Journal of Medicine on Monday -- deals with the complexities of the current COVID-19 crisis in the United States, and considers how scarce resources such as ventilators and vaccines should be allocated in light of our current understanding of the disease and pandemic modelling. 

The lead author of the article, academic and influential healthcare policy commentator Ezekiel Emanuel, has previously written at length about the allocation of scarce lifesaving resources, and, specifically, the allocation of vaccines in a pandemic. 

In this article, Emanuel and colleagues argue that healthcare rationing in the COVID-19 pandemic is inevitable: “...unless the epidemic curve of infected individuals is flattened over a very long period of time — the Covid-19 pandemic is likely to cause a shortage of hospital beds, ICU beds, and ventilators”. 

The real question, the authors suggest, “is not whether to set priorities, but how to do so ethically and consistently”. 

But what should our ethical framework for resource allocation look like? 

“In the context of a pandemic, the value of maximizing benefits is most important”, the authors argue.

Where we are allocating ventilators, for example, we should prioritise those patients who have the greatest likelihood of survival if given access to a ventilator, but who would be unlikely to survive otherwise. This would likely mean prioritising younger patients: 

“Operationalizing the value of maximizing benefits means that people who are sick but could recover if treated are given priority over those who are unlikely to recover even if treated and those who are likely to recover without treatment. Because young, severely ill patients will often comprise many of those who are sick but could recover with treatment, this operationalization also has the effect of giving priority to those who are worst off in the sense of being at risk of dying young and not having a full life.” 

The authors also note that rationing may mean withdrawing treatment from some patients who have a poorer prognosis than others. 

“Because maximizing benefits is paramount in a pandemic, we believe that removing a patient from a ventilator or an ICU bed to provide it to others in need is also justifiable and that patients should be made aware of this possibility at admission”.

The withdrawal of treatment is not the same as killing, they argue: 

...many guidelines agree that the decision to withdraw a scarce resource to save others is not an act of killing and does not require the patient’s consent. We agree with these guidelines that it is the ethical thing to do.” 

The authors also consider how we should allocate a coronavirus vaccine, should one be developed. The moral calculus is inverted in this case, they suggest. While younger, healthier patients should be given priority access to ICU, older patients with chronic illnesses should be given priority access to a vaccine: 

“...younger patients should not be prioritized for Covid-19 vaccines, which prevent disease rather than cure it, or for experimental post- or pre-exposure prophylaxis. Covid-19 outcomes have been significantly worse in older persons and those with chronic conditions. Invoking the value of maximizing saving lives justifies giving older persons priority for vaccines immediately after health care workers and first responders”. 

In an op-ed in the New York Times, Emanuel and two co-authors of the study stressed the importance of high-level ethical reflection on pandemic rationing, and warned of the risk of front line clinicians making “well-intentioned, but ad hoc choices under extreme pressure”.  

But some commentators are concerned that the high-level ethical reflection so far has missed some of the most serious ethical challenges presented by the COVID-19 crisis. In a letter to the Times, Former Democratic Congressman Tony Coelho said some medical professionals were trying to marginalize seniors and the disabled: 

“Even in a crisis, self-designated “experts” are trying to marginalize people with disabilities and seniors. Instead, let’s develop policies that “flatten the curve” and prepare to treat all those who may find themselves vulnerable to Covid-19”.  

Xavier Symons is Deputy editor of BioEdge 

Is euthanasia an essential service?

h/t Bioedge

Is euthanasia an essential service? That is the question that Canadian health officials are grappling with in the coronavirus epidemic.

At least two clinics in Ontario have stopped providing euthanasia (or medical assistance in dying, as it is called in Canada) to prevention transmission and to free up health-care resources. Others regard it as essential and are relaxing the rules to allow “virtual assessments of eligibility”.

“It’s not a decision that we have taken lightly,” said Andrea Frolic, of Hamilton Health Sciences, which has shuttered its program. “It’s heartbreaking for us, as it is for patients and families seeking this care."

“I think it’s really unfortunate. I don’t know their rationale for having shut it down completely," Chantal Perrot, a Toronto MAID provider, told the Globe and Mail. “I don’t understand how they could not see MAID as an essential service for people who are at end of life.”

The University Health Network in Toronto is continuing to provide MAID to inpatients during the pandemic. “We had to make some very difficult decisions with respect to other services and programs that were put on hold or shuttered during this pandemic," said Mark Bonta, who is in charge of euthanasia at UHN. "Given that MAID is something that is listed as a human right for our patients … we recognized it was important that this be deemed an essential service.”

Stefanie Green, a Victoria doctor and the president of the Canadian Association of MAID Assessors and Providers (CAMAP,) said the health authority on Vancouver Island has also deemed assisted dying an essential service. Officials there are even providing protective equipment to doctors who are still willing to help patients access euthanasia.

Michael Cook is editor of BioEdge

Catholic, Jewish, and Muslim leaders sign declaration against euthanasia, physician-assisted suicide

By Hannah Brockhaus
Vatican City, Oct 28, 2019 / 12:15 pm (CNA).

Leaders of Christianity, Judaism, and Islam presented a signed declaration to Pope Francis Monday expressing their total opposition to euthanasia and any form of physician-assisted suicide, as well as voicing their support of palliative end-of-life care.

The document was signed at the Vatican Oct. 28 by Archbishop Vincenzo Paglia, head of the Pontifical Academy for Life, along with representatives of the Jewish and Islamic faiths. It was given to Pope Francis during an audience.  

The position paper states that the three Abrahamic religions “oppose any form of euthanasia – that is the direct, deliberate and intentional act of taking life – as well as physician assisted suicide – that is the direct, deliberate and intentional support of committing suicide – because they fundamentally contradict the inalienable value of human life, and therefore are inherently and consequentially morally and religiously wrong, and should be forbidden without exceptions.”

The paper also affirms the right of healthcare workers to not be coerced or pressured into directly or indirectly assisting in the intentional death of a patient through assisted suicide or any form of euthanasia, especially when doing so would violate the provider’s religious beliefs.

Even if accepted by the local legal system, “moral objections regarding issues of life and death certainly fall into the category of conscientious objection that should be universally respected,” the paper declares.

Healthcare providers, it notes, have the responsibility “to provide the best possible cure for disease and maximal care of the sick.”

The idea for the declaration came from Rabbi Avraham Steinberg, an Israeli medical ethicist, who proposed it to Pope Francis. The pope entrusted the project to the Pontifical Academy for Life, which organized an interreligious committee to create the document.

In the nearly 2,000-word position paper, it is stated that the Catholic, Jewish, and Islamic faiths “share common goals and are in complete agreement in their approach to end-of-life situations.” It also notes that these principles are sometimes in conflict with “current secular humanistic values and practices.”

The preamble to the report notes that “the moral, religious, social and legal aspects of the treatment of the dying” are among the most complex and most widely discussed in medicine today.

The issues surrounding the end of life include “difficult dilemmas,” which have increased in recent years, it argues, because of scientific-technological developments, changes in the patient-doctor relationship, cultural changes, and a growing scarcity of resources related to the expense of medical care.

These dilemmas are not primarily medical or scientific, but “social, ethical, religious, legal, and cultural,” it declares, adding that human intervention in the form of medical treatment and technologies “are only justified in terms of the help they can provide.”

“Therefore, their use requires responsible judgment about when life-sustaining and life-prolonging treatments truly support the goals of human life, and when they have reached their limits,” it claims.

The declaration states that “when death is imminent despite the means used, it is justified to make the decision to withhold certain forms of medical treatments that would only prolong a precarious life of suffering.”

However, both medical providers and society should respect the wish of a dying patient to prolong or preserve his/her life even for an additional short period of time by clinically appropriate medical measures,” it continues.

The Catechism of the Catholic Church teaches that a person may legitimately choose to discontinue medical procedures which are “over-zealous,” meaning “burdensome, dangerous, extraordinary, or disproportionate to the expected outcome..”

The position paper defines a “dying patient” as someone who has “a fatal, incurable, and irreversible disease” and is at a stage when their death will likely occur within a few months “as a result of the disease or its directly related complications, despite the best diagnostic and therapeutic efforts.”

The report offers encouragement and support for professional palliative care for everyone, everywhere and to commend laws and policies which protect the dignity of a dying person.

It also declares a commitment to engage with communities on the issue of bioethics, and to raise public awareness about palliative care.

The paper states a belief that society has an obligation to help patients not to feel like a burden and to know the value and dignity of their life, “which deserves care and support until its natural end.”

The declaration also calls on policymakers and healthcare providers to familiarize themselves with the perspective and teaching of these religions in order to better provide medical assistance in accord with their patients’ beliefs.

“While we applaud medical science for advances to prevent and cure disease, we recognize that every life will ultimately experience death,” it states. “Care for the dying is both part of our stewardship of the Divine gift of life when a cure is no longer possible, as well as our human and ethical responsibility toward the dying (and often) suffering patient.”

h/t to CNA

Organ donation and euthanasia make a good team in Ontario

h/t to BioEdge by Michael Cook | 20 Oct 2019 | 

There is a startling statistic tucked away in Ontario’s September quarter euthanasia statistics. A total of 519 people were euthanised from July 1 to September 30.

Nothing too surprising.

But of the total euthanised, it appears, from government’s sketchy summary, 30 donated organs. In other words, somehow the euthanising doctor and the transplant surgeons coordinated their efforts so that these people could give their organs to others. The time period is unclear. 

Presumably the donation was not the cause of death, as this is illegal under Canada’s euthanasia legislation. But there is pressure from doctors to change this. A year ago two Ontario physicians and Robert Truog, a bioethicist from Harvard Medical School, published an article in the New England Journal of Medicine listing all the advantages of “organ donor euthanasia”.

It would be necessary to do away with the dead donor rule – that a patient must be dead before donating. In Canada a euthanasia death must be caused by the administration of a “substance”, not by organ retrieval. The law would have to be amended to take account of this medical and ethical development.

This has been bitterly criticised, of course. Last month Dr E. Wesley Ely, of Vanderbilt University, published an opinion piece in the journal Intensive Care Medicine. He argued: “When physicians are participating in a procedure designed to take a person’s life, will patients feel 100% certain that their physician is firmly on the side of healing? What message does it send about the value of every human life when physicians endorse the exchange of one life for another? What effect has it already had on physicians complicit in such death-causing procedures?”

Michael Cook is editor of BioEdge

Bioethicists defend euthanasia for mentally ill

by Xavier Symons | 9 Oct 2019 | h/t Bioedge

A new edition of the American Journal of Bioethics explores the theme of euthanasia for mentally ill persons. Several well-known commentators on euthanasia argue that in principle euthanasia should not be prohibited for people suffering from severe psychiatric disorders. 

The journal discussion is built around a target article by Brent Kious and Marget Battin from the University of Utah. Battin is a long-time proponent of voluntary euthanasia, while Kious is a psychiatrist who specialises in severe and persistent mental illness. The authors argue that euthanasia for the mentally ill is morally indistinct from euthanasia for physical terminal illness: 

“We think it is clear that the suffering associated with mental illnesses can sometimes be as severe, intractable, and prolonged as the suffering due to physical illnesses. Accordingly, it seems to us that if severe suffering can justify [physician assisted dying] for some persons with terminal physical illnesses, it should justify [physician assisted dying] for some persons with mental illnesses, too. Call this the parity argument.” 

To resist the parity argument, some scholars claim that terminality (i.e., the presence of a terminal illness) is morally relevant as patients who request euthanasia are dying already. Yet Kious and Battin argue that suffering, not terminality, is the ultimate justification that motives lawmakers to legalise euthanasia: “Terminality is...merely a safeguard, and not a rationale, for [physician assisted dying]”.

Other scholars argue that persons with mental illness lack the capacity to make decisions about ending their own life. Kious and Battin acknowledge that severe mental illness can greatly affect capacity, but they suggest that this does not rule out the possibility that some persons with severe psychiatric disorders are capable of making an autonomous decision to end their life. Indeed, in some cases we may be denying competent persons the right to a humane death:  

“by forbidding [physician assisted death] in [cases of] mental illness we could [be denying] much-needed succor to a person who is suffering severely and whose request for death is reasonable and made with full capacity”.

While several of the open peer commentaries are supportive of Kious and Battin’s basic proposal, a commentary by Charles Foster (University of Oxford) takes the parity argument in the opposite direction. Foster argues that the parity argument is in fact a reason to prohibit euthanasia all together: 

“Kious and Battin are right to assert that there is no distinction of substance between physical and psychiatric suffering, and that the presence of psychiatric suffering does not necessarily connote incapacity (although in practice it often will)...[yet the authors] have reached precisely the wrong conclusion using, in part, precisely the right reasoning. The right conclusion is not that the ambit of legally sanctioned physician-assisted suicide (PAS) should be widened, but that it should be narrowed: Indeed, PAS should be unlawful”.

Is the campaign for euthanasia a byproduct of neoliberalism?

h/t Bioedge

Debates about the ethics of euthanasia often centre on the issue of patient autonomy. One common argument made by proponents of legalised euthanasia is that patients should have the right to choose when and how they die, particularly when they are terminally ill and suffering intolerably.

Yet perhaps there more to the euthanasia debate than just individual autonomy. A new article in ABC Religion and Ethics presents a novel socio-economic critique of euthanasia rhetoric, analysing the global campaign for assisted dying from the perspective of contemporary economic theory.

St Vincent’s Health Australia ethicist Daniel Fleming argues that the push to legalise euthanasia is symptomatic of an ideology known as neo-liberalism. While the precise meaning of the term is debated, neo-liberalism is usually used to denote an approach to economic and social policy -- popular in the late 20th Century -- that seeks to profoundly augment consumer choice and market freedom. It has been criticised for reducing the human person to a self-regulating economic actor with no connection to community or history.

Fleming argues that this mentality is reflected in the way in which people use terms like ‘compassion’ in the euthanasia debate. Compassion, in the context of arguments for euthanasia, is really just a byword for a desire to augment the autonomy of individuals at the end of life -- as if the way in which we die were just one more market choice. Fleming writes,

“...According to [the neoliberal narrative], physical suffering is less a concern than the suffering incurred by the dependency that fragility and illness entails, and its consequent loss of autonomy, self-regulation and self-surveillance. To be compassionate according to the neoliberal narrative is to suffer with these particular concerns. The commitment following such suffering with is to open up hitherto unavailable options for the exercise of autonomy in order to reinstate what has been lost, even to the extent of that ultimate expression of individual choice: to end one's life.”

Fleming analyses assisted suicide statistics from Oregon, and comes up with some interesting conclusions. It appears that the quintessential neoliberal actor -- a white, well-educated male -- is exceedingly more likely to request euthanasia than a member of a minority group:  

“...on balance white people are over 35 times more likely to access this option at the end of their lives compared to the African American population…[those with a university] degree or higher...are 36 per cent more likely to access VAD than the rest of the population”.

It’s a long article, but well worth the read. 

Assisted dying: Doctors' group adopts neutral position

Image copyrightGETTY IMAGES

Hospital doctors have dropped their 13-year opposition to the concept of helping terminally ill patients die.

Following a poll of its members, the Royal College of Physicians has now adopted a neutral stance on the issue of assisted dying.

Some groups have spoken out against the change, saying a respected medical body's reputation has been damaged. Others called the decision "absurd".

Under UK law, it is illegal to encourage or assist a suicide.

Nearly 7,000 doctors voted in the online poll:

• 43% thought the college should oppose a change in the law
• 32% wanted the college to support a change
• 25% were neutral

And the college has shifted to a neutral stance because neither side achieved a majority of 60%.

However, a group of doctors opposed to any change in the college's position are planning to challenge the decision to ask for a majority result.

Royal College of Physicians (RCP) president Prof Andrew Goddard said: "It is clear that there is a range of views on assisted dying in medicine, just as there is in society.

"We have been open from the start of this process that adopting a neutral position will mean that we can reflect the differing opinions among our membership.

"Neutral means the RCP neither supports nor opposes a change in the law and we won't be focusing on assisted dying in our work.

"Instead, we will continue championing high-quality palliative care services."

'Absurd decision'

Dr Gordon Macdonald, chief executive of Care Not Killing, said most doctors didn't want a change in the law on assisted suicide or euthanasia.

"We hope that the RCP will listen to this message from their members and reverse their absurd decision to adopt a position that is the least popular and commands the support of just one in four of doctors," he said.

"This is why our view is clear, society should be doing everything in our power to prevent suicide, not assist it."

Campaign group Living and Dying Well said the shift had damaged the college's reputation as a professional body.

Analysis by Fergus Walsh, BBC medical correspondent

This shift by the Royal College of Physicians has no effect on the law and does not bring assisted dying any closer.

But it is symbolic that a respected body should change its stance and has been warmly welcomed by campaigners aiming to change the law.

The decision has infuriated and dismayed those opposed to the change, however, who argue that it is unreasonable to demand a supermajority in order to maintain the status quo.

The RCP has revealed that only one of the 39 specialisms it represents met the 60% threshold.

Of palliative medicine doctors, 80% voted to maintain the college's opposition to assisted dying.

This is a group who will spend more time than any other with patients at the end of life, so their view is significant.

The RCP also pointed out that it had adopted a neutral position until 2006 and so this move was a return to its previous stance.

The BMA, the doctors' trade union, is opposed to assisted dying. Motions calling for it to adopt a neutral position have been repeatedly rejected.

Dr John Chisholm, BMA medical ethics committee chair, said: "Our focus remains on improving the standard of palliative care available for patients, through calling for greater investment and support to enable staff to deliver the highest quality end-of-life care."

From the BBC news website

Organ donation euthanasia is gaining traction

h/t to Bioedge

You should be able to read both Kantian and Utilitarian ideas being articulated. Whilst you need to refer to Natural Moral Law and Situation Ethics in your exam this could be a useful read.

by Xavier Symons | 2 Feb 2019 |

The idea of organ donation euthanasia (ODE) is slowly garnering support in academic bioethics. In 2012, Oxford bioethicists Dominic Wilkinson and Julian Savulescu argued that chronic organ shortages provided good utilitarian justification for permitting ODE. More recently, Harvard bioethicist Robert Truog and two doctors from Western University argued in the New England Journal of Medicine that Canadian euthanasia legislation should be amended to allow for ODE.

Now a group of transplant surgeons have written an article defending ODE in one of the world’s leading transplantation journals, The Journal of Heart and Lung Transplantation.

The authors -- several doctors and ethicists from universities and hospitals in the Benelux region -- discuss both the ethics and legality of ODE. They focus in particular on Belgium and the Netherlands, where euthanasia has been legal for several years.

Currently ODE is not explicitly legal in either of these countries, though the authors suggest that there may be potential loopholes in the law.

While ODE may violate the dead donor rule, the authors argue that it is still compatible with respect for persons:

"...it is our belief that a physician should always inform a patient who is medically suitable about the possibility of organ donation, even if this could disrupt the trust relationship, as many patients may choose not to ask about donation because they assume it is not possible in this context”. 

They authors claim that organ donation euthanasia does not amount to an instrumentalisation of patients:

“[One] ethical objection to living donation and euthanasia is that people are instrumentalized to obtain organs; people could be pressured to undergo euthanasia in order to donate, whereas the public may believe euthanasia was only granted to make organ donation possible. The topic of organ donation is therefore only to be discussed after a positive decision on euthanasia has been made". 

The authors also suggest that the benefits of ODE -- in terms of lives saved -- may potentially outweigh any negative impacts that the procedure may have on public trust.

Bioethicist Wesley Smith said the article was a confirmation of his concerns about a ‘euthanasia slippery slope’. In a blog post, he warned against accepting ODE:

"May the public never be ready to accept doctors’ taking a living patient — who may not even be physically ill — into a surgical suite, anesthetizing him, and then harvesting his beating heart".