Bioethics for clinicians: 11. Euthanasia and assisted suicide

Euthanasia and assisted suicide involve taking deliberate action to end or assist in ending the life of another person on compassionate grounds. There is considerable disagreement about the acceptability of these acts and about whether they are ethically distinct from decisions to forgo life-sustaining treatment. Euthanasia and assisted suicide are punishable offences under Canadian criminal law, despite increasing public pressure for a more permissive policy. Some Canadian physicians would be willing to practise euthanasia and assisted suicide if these acts were legal. In practice, physicians must differentiate between respecting competent decisions to forgo treatment, providing appropriate palliative care, and acceeding to a request for euthanasia or assisted suicide. Physicians who believe that euthanasia and assisted suicide should be legally accepted in Canada should pursue their convictions only through legal and democratic means.     

Dream Content and Political Ideology

This pilot study focuses on the relationship of dream content and political ideology in a contemporary U.S. context. The study involved 56 people, 28 (14 male and 14 female) who identified themselves as members of the political right and 28 (14 male and 14 female) who identified themselves as members of the political left. Most recent dream reports from these subjects were analyzed using Hall and Van de Castle content analysis categories. Following that quantitative analysis, each dream was analyzed in terms of its narrative qualities (themes, images, emotional patterns, etc.). Although the small size of the study makes it impossible to offer definitive interpretations, the findings are suggestive: people on the political right had more nightmares, more dreams in which they lacked personal power, and a greater frequency of lifelike dreams; people on the political left had fewer nightmares, more dreams in which they had personal power, and a greater frequency of good fortunes and bizarre elements in their dreams. These findings have plausible correlations to certain features of the political ideologies of people on the left and the right, and merit future investigation in larger-scale studies.     

Language Ideology: The Case of Spanish in Departments of Foreign Languages

In this article we investigate language ideology in a department of Spanish. We are concerned with examining the acquisition and transmission of linguistic culture in departments of foreign languages within university settings and the ways in which views about non-English languages that are part of the American cultural dialogue are maintained and nurtured by educational institutions. Using long-term participant-observation data and focused interviews, we contend that foreign language departments in U.S. colleges and universities, although involved in a nonhegemonic practice—that is, in the teaching of non-English languages—are nevertheless working in concert with deeply held American ideologies about bilingualism and monolingualism.     

Language, Ideology, and Political Economy

After sharply defining and contrasting an "analytic-scientific" and an "emotional-ethical" approach and their interrelations, this article goes on to explore some possible interconnections among the three main phenomena, before discussing each in more detail. The first is political economy in several important senses; germane problems are noted that deal with (ethno) quantification and the innovative individual. The second phenomenon is ideology, in three senses: (1) notional ideology, (2) ideology for maintaining or changing a sociopolitical order, and (3) ideology for masking a structure of domination. The third phenomenon is language, again in various senses, but particularly as (1) a symbolism with a structure analogous in some ways to that of economics, and (2) a mediator between ideology and political economy; considerable attention is given to the political-economic functions of language figures such as irony and synecdoche. A fourth, analytically crucial kind of ideology, "linguacultural ideology," fills in the foregoing structure. Alternative logics, alternative combinations of variables, and alternative complementary theories are suggested throughout, particularly in the final section.     

Political Regimes,Political Ideology,and Self-Rated Health in Europe: A Multilevel Analysis

Background

Studies on political ideology and health have found associations between individual ideology and health as well as between ecological measures of political ideology and health. Individual ideology and aggregate measures such as political regimes, however, were never examined simultaneously.

Methodology/Principal Findings

Using adjusted logistic multilevel models to analyze data on individuals from 29 European countries and Israel, we found that individual ideology and political regime are independently associated with self-rated health. Individuals with rightwing ideologies report better health than leftwing individuals. Respondents from Eastern Europe and former Soviet republics report poorer health than individuals from social democratic, liberal, Christian conservative, and former Mediterranean dictatorship countries. In contrast to individual ideology and political regimes, country level aggregations of individual ideology are not related to reporting poor health.

Conclusions/Significance

This study shows that although both individual political ideology and contextual political regime are independently associated with individuals'' self-rated health, individual political ideology appears to be more strongly associated with self-rated health than political regime.     

The Nature and Value of Bioethics Expertise

In this article, I address the extent to which experts in bioethics can contribute to healthcare delivery by way of aid in clinical decision‐making and policy‐formation. I argue that experts in bioethics are moral experts, in that their substantive moral views are more likely to be correct than those of non‐bioethicists, all else being equal, but that such expertise is of use in a relatively limited class of cases. In so doing, I respond to two recent arguments against the view that bioethicists are moral experts, one by Christopher Cowley and another by David Archard. I further argue that bioethics experts have significant additional contributions to make to healthcare delivery, and highlight a hitherto neglected aspect of that contribution: amelioration of moral misconception among clinicians. I describe in detail several aspects of moral misconception, and show how the bioethicist is in a prime position to resolve that sort of error.     

Implicit and Explicit Illusory Correlation as a Function of Political Ideology

Research has demonstrated that people who embrace different ideological orientations often show differences at the level of basic cognitive processes. For instance, conservatives (vs. liberals) display an automatic selective attention for negative (vs. positive) stimuli, and tend to more easily form illusory correlations between negative information and minority groups. In the present work, we further explored this latter effect by examining whether it only involves the formation of explicit attitudes or it extends to implicit attitudes. To this end, following the typical illusory correlation paradigm, participants were presented with members of two numerically different groups (majority and minority) each performing either a positive or negative behaviour. Negative behaviors were relatively infrequent, and the proportion of positive and negative behaviors within each group was the same. Next, explicit and implicit (i.e., IAT-measured) attitudes were assessed. Results showed that conservatives (vs. liberals) displayed stronger explicit as well as implicit illusory correlations effects, forming more negative attitudes toward the minority (vs. majority) group at both the explicit and implicit level.     

Australian Anthropology,Ideology and Political Repression: The Cold War Experience of Frederick G. G. Rose

It is more than half a century since Frederick G. G. Rose (1915–1991) published his classic text, The classification of kin, age structure and marriage amongst the Groote Eylandt Aborigines: A study in method and a theory of kinship (1960) in the former German Democratic Republic. Although the fieldwork for his thesis had been carried out in Australia on Groote Eylandt in 1938 and 1941, a conservative academic establishment and the political climate of the Cold War postponed its publication until 1960. Why were Rose's fieldwork findings suppressed by the powerful gate-keeper of Australian anthropology, Professor Adolphus Peter Elkin (1891–1979)? Moreover, why was Rose later denied a government permit to revisit Groote Eylandt and Central Australia to further his research? This paper examines the early work of the communist anthropologist, Frederick Rose, within the broad context of Western post-war anthropological developments, an expanding capitalist economy and the political tensions of the Cold War era. As a communist and public servant from 1938 to 1954, Rose was forced, after the Petrov Royal Commission cast him under a cloud of suspicion, to seek institutional support for his academic career in the German Democratic Republic.     

The Bioethics of Diagnosis: A Biocultural Critique of Certainty

This article argues that traditional models of diagnosis are incomplete in their reliance on a models of certainty that are no longer tenable in a postmodern world. Further, it argues that the current form of diagnosis, as applied to psychiatric and affective disorders, reduces patient agency and reinscribes the effects of biopower.     

Bioethics and culture: an African perspective

The project of Bioethics seems to me to require paying attention to the cultural realities and assumptive frame of reference of different peoples. I assume that this must be one of the views of the organizers of this conference too and that this is why the idea of country reports is taken seriously. If I am right about this, then it makes sense for me to start my discussion with a very brief discussion of some aspects of the cultural realities of Africa with particular reference to the Yoruba of Nigeria. Then I will discuss how this world view raises issues for bioethics. Two aspects of people's worldview relevant to bioethical issues are their conception of the human person and their conception of cause. What they consider themselves to be, and what they consider to be the principles of causation will normally influence their attitudes to health and illness and their choices regarding health care. I will briefly discuss these issues with regard to the Yoruba worldview.     

Bioethics and law: a developmental perspective

In most Western countries, health law bioethics are strongly intertwined. This strong connection is the result of some specific factors that, in the early years of these disciplines, facilitated a rapid development of both. In this paper, I analyse these factors and construe a development theory existing of three phases, or ideal-typical models.
In the moralistic-paternalistic model, there is almost no health law of explicit medical ethics and the little law there is is usually based on traditional morality, combined with paternalist motives, the objections to this modal are that its paternalism and moralism are unacceptable, that it is too static and knows no external control mechanisms.
In the liberal model, which is now dominant on most Western countries, law and ethics closely cooperate and converge, both disciplines use the same framework for analysis: they are product-oriented rather than practice-oriented; they use the same conceptual categories, they focus on the minimally decent rather than the ideal, and they are committed to the same substantive normative theory in which patient autonomy and patient rights are central. However, each of these four characteristics also result in a certain one-sidedness.
In some countries, a third model is emerging. In this postliberal model, health law is more modest and acknowledges its inherent and normative limits, whereas ethics takes a richer and most ambitious self image. As a result health law and ethics will partly diverge again.