Health care ethics and health law in the Dutch discussion on end-of-life decisions: a historical analysis of the dynamics and development of both disciplines

Over the past three or four decades, the concept of medical ethics has changed from a limited set of standards to a broad field of debate and research. We define medical ethics as an arena of moral issues in medicine, rather than a specific discipline. This paper examines how the disciplines of health care ethics and health care law have developed and operated within this arena. Our framework highlights the aspects of jurisdiction (Abbott) and the assignment of responsibilities (Gusfield). This theoretical framework prompted us to study definitions and changing responsibilities in order to describe the development and interaction of health care ethics and health law. We have opted for the context of the Dutch debate about end-of-life decisions as a relevant case study. We argue that the specific Dutch definition of euthanasia as 'intentionally taking the life of another person by a physician, upon that person's request' can be seen as the result of the complex jurisdictional process. This illustrates the more general conclusion that the Dutch debate on end-of-life decisions and the development of the two disciplines must be understood in terms of mutual interaction.     

Behavioural responses of rats to gradual-fill carbon dioxide euthanasia and reduced oxygen concentrations

Carbon dioxide (CO₂) is widely used for euthanasia of laboratory rats, but little is known about the pain and distress caused by this procedure. Physiological and human self-report data suggest that CO₂ may cause pain and dyspnea, a sensation of breathlessness and increased respiratory effort, at the concentrations used for gradual-fill euthanasia. However, previous studies examining the behavioural responses of rats have reported conflicting results. In this study, detailed behavioural responses of rats were examined during gradual-fill CO₂ euthanasia and during gradual-fill with argon to produce a similar reduction in oxygen concentration. Animals were randomly allocated to the CO₂ or reduced oxygen treatment groups (n = 8 for both), and were first tested with air exposure and then with treatment gas exposure on the following day. Observations were taken for 105 s before and after gas flow began (baseline and exposure periods), as animals had ceased purposeful movement within 105 s of CO₂ flow starting. Behavioural changes from baseline during gas exposure were compared to changes during air exposure on control days. In comparison to air exposure, CO₂ resulted in increased activity, rearing, touching the nose to the chamber lid, escape behaviours and vocalizations. A small increase in touching the nose to the chamber lid was observed when oxygen concentrations were reduced with argon, but no other behavioural changes were observed. These results suggest that gradual-fill CO₂ euthanasia causes distress in rats, and that hypoxia alone is not a major cause of this distress.     

二氧化碳安乐死在实验动物中的应用与最新进展

本文概述了二氧化碳（CO2）安乐死法的作用机制、CO2使用浓度、应用范围和操作注意事项,并讨论了该方法的动物福利、设备改进等问题。     

Mammals at rescue centres in the Czech Republic: Trends in intake and outcome,causes of admission,length of stay and release rate

Rescue centres in the Czech Republic care for injured, young uninjured, and otherwise physically damaged wild animals that are temporarily or permanently incapable of looking after themselves without assistance or incapable of surviving in the wild. We evaluated the numbers of mammals admitted to 37 rescue centres in the Czech Republic in a ten year period from 2011 to 2020, the causes leading to the admission of these mammals to rescue centres, their outcomes and their length of stay at rescue centres. In total, 73,499 mammals were admitted to the Czech rescue centres in the monitored period, with an increasing trend being found in the number of admissions (rSp = 0.9030, p < 0.05). The mammals admitted in the largest numbers were Chiroptera (39.36%), primarily the common pipistrelle (Pipistrellus pipistrellus), and Insectivora (35.85%), of which the largest proportion was made up of European hedgehogs (Erinaceus europaeus). Although according to the IUCN classification only 0.26% of admitted animals belonged among Endangered or Critically Endangered species, according to the Czech legislation, 47.21% of admitted mammals belonged to species in varying degrees of endangerment in this area. The most frequent reasons for admission were the admission of young (33.18%) with differences between the Orders - the highest number of admitted young of Rodentia (72.66% of all admitted Rodentia) and the lowest number of young of Chiroptera (2.74%). Of all mammals admitted to rescue centres, 45.83% were released back into the wild, 24.52% died at rescue centres, and 9.50% were euthanized. The highest release rate was achieved in Chiroptera (74.60%) especially those that suffered from malnutrition (63.09% of all admitted Chiroptera due to malnutrition). The length of stay was longest in young Artiodactyla released back to the wild (median 87 days). The data obtained from rescue centres provide an overview of the numbers and species of animals admitted and the outcome of their rehabilitation. Since almost half of mammals admitted could not be returned to the wild, it is also important to determine correctly which individuals should be treated and what is the most efficient use of resources for wildlife rehabilitation.     

Just When You Thought the Euthanasia Debate Had Died

The death by assisted suicide in Switzerland of Australian Dr. John Elliott, in early 2007 has highlighted the inadequacy of the law pertaining to medical decisions at end-of-life, both from a legal as well as ethical perspective. Despite being illegal in most jurisdictions around the world, physician-assisted death is a reality, in part because of the flexibility, inconsistent application and, at times, invisibility, of laws surrounding it. The appropriate response to this should be greater transparency by a reform of the law.