Euthanasia embedded in palliative care. Responses to essentialistic criticisms of the Belgian model of integral end-of-life care.

Abstract:

:The Belgian model of 'integral' end-of-life care consists of universal access to palliative care (PC) and legally regulated euthanasia. As a first worldwide, the Flemish PC organisation has embedded euthanasia in its practice. However, some critics have declared the Belgian-model concepts of 'integral PC' and 'palliative futility' to fundamentally contradict the essence of PC. This article analyses the various essentialistic arguments for the incompatibility of euthanasia and PC. The empirical evidence from the euthanasia-permissive Benelux countries shows that since legalisation, carefulness (of decision making) at the end of life has improved and there have been no significant adverse 'slippery slope' effects. It is problematic that some critics disregard the empirical evidence as epistemologically irrelevant in a normative ethical debate. Next, rejecting euthanasia because its prevention was a founding principle of PC ignores historical developments. Further, critics' ethical positions depart from the PC tenet of patient centeredness by prioritising caregivers' values over patients' values. Also, many critics' canonical adherence to the WHO definition of PC, which has intention as the ethical criterion is objectionable. A rejection of the Belgian model on doctrinal grounds also has nefarious practical consequences such as the marginalisation of PC in euthanasia-permissive countries, the continuation of clandestine practices and problematic palliative sedation until death. In conclusion, major flaws of essentialistic arguments against the Belgian model include the disregard of empirical evidence, appeals to canonical and questionable definitions, prioritisation of caregiver perspectives over those of patients and rejection of a plurality of respectable views on decision making at the end of life.

journal_name

J Med Ethics

authors

Bernheim JL,Raus K

doi

10.1136/medethics-2016-103511

subject

Has Abstract

pub_date

2017-08-01 00:00:00

pages

489-494

issue

8

eissn

0306-6800

issn

1473-4257

pii

medethics-2016-103511

journal_volume

43

pub_type

杂志文章
  • The teaching of medical ethics to medical students.

    abstract::Teaching medical ethics to medical students in a pluralistic society is a challenging task. Teachers of ethics have obligations not just to teach the subject matter but to help create an academic environment in which well motivated students have reinforcement of their inherent good qualities. Emphasis should be placed...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.20.4.239

    authors: Glick SM

    更新日期:1994-12-01 00:00:00

  • Am I my brother's gatekeeper? Professional ethics and the prioritisation of healthcare.

    abstract::At the 5th International Conference on Priorities in Health Care in Wellington, New Zealand, 2004, one resonating theme was that for priority setting to be effective, it has to include clinicians in both decision making and the enforcement of those decisions. There was, however, a disturbing undertone to this theme, n...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2006.017871

    authors: Hunter D

    更新日期:2007-09-01 00:00:00

  • A legal market in organs: the problem of exploitation.

    abstract::The article considers the objection to a commercial market in living donor organs for transplantation on the ground that such a market would be exploitative of the vendors. It examines a key challenge to that objection, to the effect that denying poor people the option to sell an organ is to withhold from them the bes...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2012-100770

    authors: Greasley K

    更新日期:2014-01-01 00:00:00

  • Expressivism at the beginning and end of life.

    abstract::Some disability rights advocates criticise prenatal testing and selective abortion on the grounds that these practices express negative attitudes towards existing persons with disabilities. Disability rights advocates also commonly criticise and oppose physician-assisted suicide (PAS) and euthanasia on the same ground...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2019-105875

    authors: Reed P

    更新日期:2020-08-01 00:00:00

  • The Groningen Protocol for newborn euthanasia; which way did the slippery slope tilt?

    abstract::In The Netherlands, neonatal euthanasia has become a legal option and the Groningen Protocol contains an approach to identify situations in which neonatal euthanasia might be appropriate. In the 5 years following the publication of the protocol, neither the prediction that this would be the first step on a slippery sl...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2013-101402

    authors: Verhagen AA

    更新日期:2013-05-01 00:00:00

  • Do-not-resuscitate decision: the attitudes of medical and non-medical students.

    abstract:OBJECTIVES:To study the attitudes of both medical and non-medical students towards the do-not-resuscitate (DNR) decision in a university in Hong Kong, and the factors affecting their attitudes. METHODS:A questionnaire-based survey conducted in the campus of a university in Hong Kong. Preferences and priorities of part...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2005.014423

    authors: Sham CO,Cheng YW,Ho KW,Lai PH,Lo LW,Wan HL,Wong CY,Yeung YN,Yuen SH,Wong AY

    更新日期:2007-05-01 00:00:00

  • Advance commitment: an alternative approach to the family veto problem in organ procurement.

    abstract::This article tackles the current deficit in the supply of cadaveric organs by addressing the family veto in organ donation. The authors believe that the family veto matters-ethically as well as practically-and that policies that completely disregard the views of the family in this decision are likely to be counterprod...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2009.032912

    authors: De Wispelaere J,Stirton L

    更新日期:2010-03-01 00:00:00

  • Dealing with the brain-damaged old--dignity before sanctity.

    abstract::The present and future rapid increase in the hospital population of geriatric patients is discussed with particular reference to the problem of advanced brain degeneration. The consequences of various clinical management options are outlined and it is suggested that extreme attempts either to preserve or terminate lif...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.8.4.173

    authors: Robertson GS

    更新日期:1982-12-01 00:00:00

  • The teaching of medical ethics: University College, Cork, Ireland.

    abstract::Dolores Dooley Clarke describes how the course in medical ethics at University College, Cork is structured, how it has changed and how it is likely to change as time goes on. Originally, the students seemed to view it as an intrusion 'to be tolerated' in their programme of 'strictly medical' studies. However, having m...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.4.1.36

    authors: Clarke DD

    更新日期:1978-03-01 00:00:00

  • Post-recruitment confirmation of informed consent by SMS.

    abstract:BACKGROUND:To allow patients to reflect about a decision to participate in a clinical trial, guidelines suggest a 24-h delay from when they are informed about the trial to when they give consent. In certain clinical settings, this is likely to hamper recruitment. METHOD:After oral and written information about the tri...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2009.033456

    authors: Gulbrandsen P,Jensen BF

    更新日期:2010-02-01 00:00:00

  • Ethical reasoning in mixed nurse-physician groups.

    abstract:OBJECTIVES:To study the ethical reasoning of nurses and physicians, and to assess whether or not modified focus groups are a valuable tool for this purpose. DESIGN:Discussion of cases in modified focus groups, each consisting of three physicians and three nurses. The discussion was taped and analysed by content analys...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.22.3.168

    authors: Holm S,Gjersøe P,Grode G,Hartling O,Ibsen KE,Marcussen H

    更新日期:1996-06-01 00:00:00

  • Medical students' attitudes towards abortion: a UK study.

    abstract:BACKGROUND:There is little research into medical students' or doctors' attitudes to abortion, yet knowing this is important, as policy makers should be aware of the views held by professionals directly involved in abortion provision and changing views may have practical implications for the provision of abortion in the...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2007.023416

    authors: Gleeson R,Forde E,Bates E,Powell S,Eadon-Jones E,Draper H

    更新日期:2008-11-01 00:00:00

  • On the univocity of rationality: a response to Nigel Biggar's 'Why religion deserves a place in secular medicine'.

    abstract::Nigel Biggar (2015) argues that religion deserves a place in secular medicine. Biggar suggests we abandon the standard rationalistic conception of the secular realm and see it rather as "a forum for the negotiation of rival reasonings". Religious reasoning is one among a number of ways of thinking that must vie for ac...

    journal_title:Journal of medical ethics

    pub_type: 评论,杂志文章

    doi:10.1136/medethics-2015-102805

    authors: Symons X

    更新日期:2015-11-01 00:00:00

  • Whatever happened to medical politics?

    abstract::This paper argues the case for coming to see 'medical politics' as a topic or subject within medical education. First, its absence is noted from the wide array of paramedical subjects (medical ethics, history of medicine, the medical humanities, etc) currently given attention in both the medical education literature a...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2010.041277

    authors: Emmerich N

    更新日期:2011-10-01 00:00:00

  • Towards a European code of medical ethics. Ethical and legal issues.

    abstract::The feasibility of a common European code of medical ethics is discussed, with consideration and evaluation of the difficulties such a project is going to face, from both the legal and ethical points of view. On the one hand, the analysis will underline the limits of a common European code of medical ethics as an inst...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2015-102963

    authors: Patuzzo S,Pulice E

    更新日期:2017-01-01 00:00:00

  • Betting on CPR: a modern version of Pascal's Wager.

    abstract::Many patients believe that cardiopulmonary resuscitation (CPR) is more likely to be successful than it really is in clinical practice. Even when working with accurate information, some nevertheless remain resolute in demanding maximal treatment. They maintain that even if survival after cardiac arrest with CPR is extr...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2019-105558

    authors: Harari DY,Macauley RC

    更新日期:2020-02-01 00:00:00

  • Patients' perceptions of information provided in clinical trials.

    abstract:BACKGROUND:According to the Declaration of Helsinki, patients who take part in a clinical trial must be adequately informed about the trial's aims, methods, expected benefits, and potential risks. The declaration does not, however, elaborate on what "adequately informed" might amount to, in practice. Medical researcher...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.28.1.45

    authors: Ferguson PR

    更新日期:2002-02-01 00:00:00

  • Ethical issues in long-term psychiatric management.

    abstract::Two general ethical problems in psychiatry are thrown into sharp relief by long term care. This article discusses each in turn, in the context of two anonymised case studies from actual clinical practice. First, previous mental health legislation soothed doubts about patients' refusal of consent by incorporating time ...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.23.5.300

    authors: Dickenson D

    更新日期:1997-10-01 00:00:00

  • Wish-fulfilling medicine in practice: the opinions and arguments of lay people.

    abstract:BACKGROUND:Wish-fulfilling medicine appears to be on the rise. It can be defined as 'doctors and other health professionals using medical means (medical technology, drugs, and so on) in a medical setting to fulfil the explicitly stated, prima facie non-medical wish of a patient'. Some instances of wish fulfilling medic...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2013-101480

    authors: Asscher EC,Schermer M

    更新日期:2014-12-01 00:00:00

  • Assessing research risks systematically: the net risks test.

    abstract::Dual-track assessment directs research ethics committees (RECs) to assess the risks of research interventions based on the unclear distinction between therapeutic and non-therapeutic interventions. The net risks test, in contrast, relies on the clinically familiar method of assessing the risks and benefits of interven...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2005.014043

    authors: Wendler D,Miller FG

    更新日期:2007-08-01 00:00:00

  • Attitudes toward euthanasia and physician-assisted suicide: a study of the multivariate effects of healthcare training, patient characteristics, religion and locus of control.

    abstract::Public and healthcare professionals differ in their attitudes towards euthanasia and physician-assisted suicide (PAS), the legal status of which is currently in the spotlight in the UK. In addition to medical training and experience, religiosity, locus of control and patient characteristics (eg, patient age, pain leve...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2012-100729

    authors: Hains CA,Hulbert-Williams NJ

    更新日期:2013-11-01 00:00:00

  • The ethics and politics of mindfulness-based interventions.

    abstract::Recently, there has been a lot of enthusiasm for mindfulness practice and its use in healthcare, businesses and schools. An increasing number of studies give us ground for cautious optimism about the potential of mindfulness-based interventions (MBIs) to improve people's lives across a number of dimensions. This paper...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2015-102942

    authors: Schmidt AT

    更新日期:2016-07-01 00:00:00

  • Can artificial parthenogenesis sidestep ethical pitfalls in human therapeutic cloning? An historical perspective.

    abstract::The aim of regenerative medicine is to reconstruct tissue that has been lost or pathologically altered. Therapeutic cloning seems to offer a method of achieving this aim; however, the ethical debate surrounding human therapeutic cloning is highly controversial. Artificial parthenogenesis-obtaining embryos from unferti...

    journal_title:Journal of medical ethics

    pub_type: 历史文章,杂志文章,评审

    doi:10.1136/jme.2004.010199

    authors: Fangerau H

    更新日期:2005-12-01 00:00:00

  • Ethical considerations in international HIV vaccine trials: summary of a consultative process conducted by the Joint United Nations Programme on HIV/AIDS (UNAIDS).

    abstract::Research that is initiated, designed or funded by sponsor agencies based in countries with relatively high social and economic development, and conducted in countries that are relatively less developed, gives rise to many important ethical challenges. Although clinical trials of HIV vaccines began ten years ago in the...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.26.1.37

    authors: Guenter D,Esparza J,Macklin R

    更新日期:2000-02-01 00:00:00

  • Direct-to-consumer genomics on the scales of autonomy.

    abstract::Direct-to-consumer (DTC) genetic services have generated enormous controversy from their first emergence. A dramatic recent manifestation of this is the Food and Drug Administration's (FDA) cease and desist order against 23andMe, the leading provider in the market. Critics have argued for the restrictive regulation of...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2014-102026

    authors: Vayena E

    更新日期:2015-04-01 00:00:00

  • Evidence of broad-based family support for the use of archival childhood tumour samples in future research.

    abstract:OBJECTIVES:This study aimed to determine the ability to successfully contact past paediatric patients and their families to request participation in research, to assess familial views on the use of previously collected archival clinical samples for research purposes, and to highlight the ethical and practical issues in...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/medethics-2015-103141

    authors: Sexton-Oates A,Dodgshun A,MacGregor D,Ludlow LE,Sullivan M,Saffery R

    更新日期:2016-07-01 00:00:00

  • Potential research participants' views regarding researcher and institutional financial conflicts of interest.

    abstract:BACKGROUND:Financial conflict of interest in clinical research is an area of active debate. While data exist on the perspectives and roles of academic institutions, investigators, industry sponsors, and scientific journals, little is known about the perspectives of potential research participants. METHODS:The authors ...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2002.001461

    authors: Kim SY,Millard RW,Nisbet P,Cox C,Caine ED

    更新日期:2004-02-01 00:00:00

  • The teaching of medical ethics.

    abstract::Students at Newcastle are exposed to patients during their first week at medical school and attached to a family within the first month. The object is to sensitise them to patients as people rather than vehicles of disease. Medical ethics is introduced as part of the multidisciplinary Human Development, Behaviour and ...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.11.1.35

    authors: Smith A

    更新日期:1985-03-01 00:00:00

  • The impact of physician denial upon patient autonomy and well-being.

    abstract::It is now widely accepted that a patient's ability to engage in autonomous decision-making can be seriously threatened when she denies significant aspects of her medical condition. In this paper I use a true case to reveal the harmful effects of physician denial upon patient autonomy and well-being. I suggest further ...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.18.3.135

    authors: Meyers C

    更新日期:1992-09-01 00:00:00

  • A comparison of journal instructions regarding institutional review board approval and conflict-of-interest disclosure between 1995 and 2005.

    abstract:OBJECTIVES:To compare 2005 and 1995 ethics guidelines from journal editors to authors regarding requirements for institutional review board (IRB) approval and conflict-of-interest (COI) disclosure. DESIGN:A descriptive study of the ethics guidelines published in 103 English-language biomedical journals listed in the A...

    journal_title:Journal of medical ethics

    pub_type: 杂志文章

    doi:10.1136/jme.2008.024299

    authors: Rowan-Legg A,Weijer C,Gao J,Fernandez C

    更新日期:2009-01-01 00:00:00