I am a member of the research project

Rejection, integration or collaboration? Palliative care and assisted dying in Oregon and Flanders

The other members are

See WHO definition of «palliative care».

As regards the concept and definition of «assisted dying» (AD), we follow what has become the international convention:
– euthanasia (E)
– physician-assisted suicide (PAS)
– assisted suicide (AS);
hence AD = E + PAS + AS

For further detail, see Materstvedt LJ,
Magelssen M. (2016). «Medical murder in Belgium and the Netherlands». Journal of Medical Ethics; 42: 621-4.

Oregon:
law on physician-assisted suicide, 1997.

Flanders, Belgium:
law on euthanasia, 2002.

The research project is part of a main research project called
Global Interventions at the End of Life – social, comparative and historical analysis to promote global improvement. Led by the University of Glasgow, UK

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supported by the
Wellcome Trust

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and carried out by the Glasgow End of Life Studies Group, Dumfries Campus

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which is headed by Clark who holds a Wellcome Trust Senior Investigator Award in the Medical Humanities. (Watch and hear him talk about his research on ITV: «Fiona Armstrong interviews the man dubbed 'Professor Death' – one of the world's leading experts on care for the dying».)


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My work concerns clinical-ethical aspects of
rejection, integration or collaboration – the integration part of which I have previously addressed in:

the article «Palliative care ethics: the problems of combining palliation and assisted dying» in the journal Progress in Palliative Care (2013);

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Abstract: The performing of euthanasia is now offered as an option by certain palliative care service institutions in Belgium. The approach is known as the «integral» model. Although it is understandable that some physicians are in favour of it, the model is rejected in this article, for both clinical and ethical reasons. Furthermore, the idea of «palliative futility» associated with the model is shown to be incoherent. In countries where assisted dying is legal, palliative care providers should refrain from participating in such practices if they are to remain true to the basic values of such care. The widespread conception that withholding and withdrawing treatment amounts to a «hastening» of death is also rejected.

Contents:
the chapter «Euthanasia and palliative care» that I wrote with Swiss physician and bioethicist Georg Bosshard as co-author, in Cherny N, Fallon M, Kaasa S, Portenoy R, Currow D, eds. Oxford Textbook of Palliative Medicine. Oxford: Oxford University Press (2015; 5th ed.);

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Abstract: This chapter focusses on the particular relationship and interconnections between euthanasia and palliative care. The opening definition of euthanasia is followed by explanations of what is entailed by physician-assisted suicide and assisted suicide. All three categories are based on patient request, and on using drugs to intentionally induce death; they can be subsumed under the term «assisted dying». Selected key data on these practices are presented. Of central importance is the question of how requests for assisted dying should be handled within palliative care, and as part of addressing this question the chapter includes a discussion of the practice in Belgium, where euthanasia is performed within palliative care institutions. Our in-depth exploration of the requirements to be met in cases of assisted dying where such practices have been legalized demonstrates that certain crucial criteria are notoriously unclear and open to interpretation. Furthermore, we present the Swiss model, which practices a much clearer separation between assisted dying and both palliative care and clinical medical practice. Statements on assisted dying made by key palliative care organizations are then presented and analyzed. We ask whether palliative care is at risk of «sliding down a slippery slope towards euthanasia»; that is, whether the palliative care community will be more accepting of euthanasia in the future, following potential new legislation. Our concluding remarks consider the current reluctance of doctors to participate in assisted dying, and the pressures they are under – from the general public as well as legislative bodies – to accept a role in present and future practices of assisted dying.

Contents:
my chapter «Caring and killing in the clinic: the argument of self-determination», in Rehmann-Sutter C, Gudat H, Ohnsorge K, eds. The Patient’s Wish to Die. Research, Ethics, and Palliative Care. Oxford: Oxford University Press (2015);

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Abstract: This chapter looks at the issue of assisted dying ­– that is, euthanasia, physician-assisted suicide and assisted suicide –­ through the lens of the right to autonomy or self-determination. A key thinker in this connection is Immanuel Kant. It is shown how, within Kant’s philosophical system, assisted dying emerges as morally objectionable. From a legal point of view, however, it is not clear that assisted dying should be prohibited. On this author’s reading of Kant, his view of individual freedom taken together with his division of moral and legal duties, opens up the possibility of legalized assisted dying. Still, this should be based on the premise that such legislation is not a threat to the rights of other individuals. The chapter also discusses the concept of self-ownership in John Locke and Robert Nozick, and connects it with the issue of assisted dying. Further, it is shown that the idea that people are «the best judges of their own interests», which is central to the assisted dying debate, is problematic in principle as well as in practice. In the context of palliative end-of-life care, it is even more problematic, due to all the factors that may impact on the decision-making capacities of patients. The chapter ends with some reflections on inappropriate terminology sometimes used in connection with assisted dying, and calls for plain language to describe this extraordinarily complex issue.

Contents
in my guest blog article «The EAPC on euthanasia, 2003 and 2016» (2016) at http://endoflifestudies.academicblogs.co.uk,

and in Materstvedt LJ, Kaasa S. (2016). «Palliasjon og eutanasi» [Palliative care and euthanasia]. Kap. 5 i Kaasa S, Loge JH, red. Palliasjon. Nordisk lærebok [Palliation. Nordic Textbook]. 3. utgave. Oslo: Gyldendal Akademisk, s. 83-96.

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Innledning: Et kontroversielt tema innen palliasjon er forholdet mellom palliasjon og eutanasi. Det er også meget aktuelt, av minst tre grunner. For det første har man i nyere tid flere steder legalisert eutanasi og/eller assistert selvmord. Eksempelvis ble begge deler lovlig i Canada fra og med juni 2016 (se faktaboks 5.3). Dette gjør det maktpåliggende for helsearbeidere innen palliasjon å ha et avklart forhold til fenomenene – rimeligvis der praksisene er tillatt, men også steder de er forbudt, men kan bli lov. I England, hospicebevegelsens hjemland, kan det i nær fremtid bli vedtatt en lov som tillater legeassistert selvmord (en handling som ligger nær opp til eutanasi; se faktaboks 5.1). The Association for Palliative Medicine of Great Britain and Ireland er sterkt imot at leger i så fall skal delta i praksisen. For det andre er kreftpasienter den desidert største pasientgruppen innen palliasjon, samtidig som hele 83,1% av dem som døde som følge av eutanasi i Nederland i 2010 var kreftpasienter. For det tredje praktiseres eutanasi på en del palliative avdelinger i Belgia, noe som enkelte ser som en modell til etterfølgelse, mens den for andre er et skrekkeksempel på hva som må unngås om eutanasi skulle bli legalisert (se faktaboks 5.4). Dessuten tillot Belgia i 2014 eutanasi for terminalt syke barn, uten noen nedre aldersgrense. Dermed er temaet også blitt aktuelt for helsearbeidere innen pediatri. Tradisjonelt har eutanasi og palliasjon blitt oppfattet som rake motsetninger, like uforenlige som ild og vann. Grunnleggeren av hospicebevegelsen, legen Dame Cicely Saunders (1918-2005), hevdet tidlig at eutanasi både er moralsk galt og klinisk unødvendig dersom terminalt syke kreftpasienter gis kompetent behandling og pleie. Før det er mulig å danne seg en oppfatning av dette komplekse temaet, må vi imidlertid starte med begrepsavklaringer.

Innhold
Les anmeldelse av boken i Tidsskrift for Den norske legeforening.

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Medforfatter Stein Kaasa, professor dr.med., NTNU, og tidligere seksjonsoverlege, Seksjon lindrende behandling (SLB), Kreftklinikken, St. Olavs Hospital, Trondheim. Tidligere president i European Association for Palliative Care (EAPC). Mottok Kong Olav Vs kreftforskningspris i 2005, overrakt av Gro Harlem Brundtland. I mitt postdoc-prosjekt i Kreftforeningen var Kaasa min medisinske hovedveileder og viktigste samarbeidspartner.

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Leder av www.ntnu.edu/prc
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Pågående forskning innen normativ etikk, herunder feltets relasjon til metaetikk, anvendt etikk og deskriptiv etikk. Følgende normative teorier er sentrale:

deontologi
konsekvensialisme
etisk egoisme
etisk intuisjonisme
dydsetikk

Se også beskrivelsene Ethics i The Internet Encyclopedia of Philosophy (IEP) og Medical Ethics i MedlinePlus, National Institutes of Health, en del av U.S. Department of Health & Human Services.

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