Bioethics and Political Ideology: The Case of Active Voluntary Euthanasia

In different countries responses to important bioethical issues are different, as exemplified by the attitudes towards the voluntary and active forms of medical euthanasia. But why is this the case? My suggestion is that the roots of the variety are, to a considerable degree, ideological.
The most important present-day political ideologies all have their roots in the prevailing doctrines of moral and social philosophy. In the paper these doctrines are outlined and the predicted response towards active voluntary euthanasia within each model is sketched. The conclusion reached is that while it would in some countries be dangerous to allow euthanasia in the prevailing circumstances, the solution is not to hinder the legalization process but to alter the circumstances.     

Hungarian paediatricians' attitudes regarding the treatment and non-treatment of defective newborns: a comparative study

Conclusion: The four compared surveys clearly show that paediatricians from different backgrounds encounter these moral dilemmas in their everyday practice. Hungarian paediatricians facing morally significant decisions of discontinuation of treatment in defective newborns were permissive toward passive euthanasia like their Australian and Canadian colleagues, but were almost unanimously against active euthanasia like their Polish colleagues. The results of our study revealed a strong paternalistic attitude among Hungarian doctors, unwillingness to include other professionals in a discussion of moral problems and neglect of the nurses' views in these matters. Many physicians in the Hungarian study group were not aware of the legal ramifications in such cases. These findings were similar to the results of the Polish study. It is plausible that the paternalistic attitude and ignorance of the relevant law is common in all 'former' socialist countries. The Australian, Canadian and Hungarian doctors displayed more understanding and tolerance towards passive euthanasia. Many physicians in all study groups seemed to be not familiar with the legal regulations of their own country. The paediatricians of the four studies showed the greatest difference in their attitudes towards active euthanasia, with the Australian community being more permissive, the Canadian, Polish and Hungarian community rejecting it.     

Active and Passive Physician‐Assisted Dying and the Terminal Disease Requirement

The view that voluntary active euthanasia and physician‐assisted suicide should be made available for terminal patients only is typically warranted by reference to the risks that the procedures are seen to involve. Though they would appear to involve similar risks, the commonly endorsed end‐of‐life practices referred to as passive euthanasia are available also for non‐terminal patients. In this article, I assess whether there is good reason to believe that the risks in question would be bigger in the case of voluntary active euthanasia and physician‐assisted suicide than in that of passive euthanasia. I propose that there is not. On that basis, I suggest that limiting access to voluntary active euthanasia and physician‐assisted suicide to terminal patients only is not consistent with accepting the existing practices of passive euthanasia.     

On euthanasia: exploring psychological meaning and attitudes in a sample of Mexican physicians and medical students

Euthanasia has become the subject of ethical and political debate in many countries including Mexico. Since many physicians are deeply concerned about euthanasia, due to their crucial participation in its decision and implementation, it is important to know the psychological meaning that the term 'euthanasia' has for them, as well as their attitudes toward this practice. This study explores psychological meaning and attitudes toward euthanasia in 546 Mexican subjects, either medical students or physicians, who were divided into three groups: a) beginning students, b) advanced students, and c) physicians. We used the semantic networks technique, which analyzed the words the participants associated with the term 'euthanasia'. Positive psychological meaning, as well as positive attitudes, prevailed among advanced students and physicians when defining euthanasia, whereas both positive and negative psychological meaning together with more ambivalent attitudes toward euthanasia predominated in beginning students. The findings are discussed in the context of a current debate on a bill proposing active euthanasia in Mexico City.     

Alberta euthanasia survey: 1. Physicians' opinions about the morality and legalization of active euthanasia.

OBJECTIVE: To ascertain the opinions of a sample of Alberta physicians about the morality and legalization of active euthanasia, the determinants of these opinions and the frequency and sources of requests for assistance in active euthanasia. DESIGN: Cross-sectional survey of a random sample of Alberta physicians, grouped by site and type of practice. SETTING: Alberta. PARTICIPANTS: A total of 2002 (46%) of the licensed physicians in Alberta were mailed a 38-item questionnaire in May through July 1991; usable responses were returned by 1391 (69%). RESULTS: Of the respondents 44% did believe that it is sometimes right to practice active euthanasia; 46% did not. Moral acceptance of active euthanasia correlated with type of practice and religious affiliation and activity. In all, 28% of the physicians stated that they would practice active euthanasia if it were legalized, and 51% indicated that they would not. These opinions were significantly related to sex, religious affiliation and activity, and country of graduation. Just over half (51%) of the respondents stated that the law should be changed to permit patients to request active euthanasia. Requests (usually from patients) were reportedly received by 19% of the physicians, 78% of whom received fewer than five. CONCLUSIONS: This survey revealed severely disparate opinions among Alberta physicians about the morality of active euthanasia. In particular, religious affiliation and activity were associated with the polarized opinions. The desire for active euthanasia, as inferred from requests by patients, was not frequent. Overall, there was no strong support expressed by the physicians for the personal practice of legalized active euthanasia. These data will be vital to those involved in health education and public policy formation about active euthanasia in Alberta and the rest of Canada.     

ADVANCE DIRECTIVES IN THE NETHERLANDS: AN EMPIRICAL CONTRIBUTION TO THE EXPLORATION OF A CROSS‐CULTURAL PERSPECTIVE ON ADVANCE DIRECTIVES

Research Objective: This study focuses on ADs in the Netherlands and introduces a cross‐cultural perspective by comparing it with other countries. Methods: A questionnaire was sent to a panel comprising 1621 people representative of the Dutch population. The response was 86%. Results: 95% of the respondents didn't have an AD, and 24% of these were not familiar with the idea of drawing up an AD. Most of those familiar with ADs knew about the Advanced Euthanasia Directive (AED, 64%). Both low education and the presence of a religious conviction that plays an important role in one's life increase the chance of not wanting to draw up an AD. Also not having experienced a request for euthanasia from someone else, and the inconceivability of asking for euthanasia yourself, increase the chance of not wanting to draw up an AD. Discussion: This study shows that the subjects of palliative care and end‐of‐life‐decision‐making were very much dominated by the issue of euthanasia in the Netherlands. The AED was the best known AD; and factors that can be linked to euthanasia play an important role in whether or not people choose to draw up an AD. This differentiates the Netherlands from other countries and, when it comes to ADs, the global differences between countries and cultures are still so large that the highest possible goals, at this moment in time, are observing and possibly learning from other cultural settings.     

The Nazi! accusation and current US proposals

In contemporary ethical discourse generally, and in discussions concerning the legalization of physician-assisted suicide (PAS) and voluntary active euthanasia (VAE) specifically, recourse is sometimes had to the Nazi! accusation. Some disputants charge that such practices are or will become equivalent to the Nazi 'euthanasia' program in which over 73,000 handicapped children and adults were killed without consent. This paper reflects on the circumstances that lead to the use of this charge and offers reasons for putting the Nazi! charge aside in contemporary discussions of PAS and VAE. A number of the philosophical presuppositions common to both the Nazi 'euthanasia' program and the currently proposed practices of PAS and VAE are examined. Noting that racist ideology and violent coercion characterized the Nazi program, the paper concludes with a cautionary consideration of the current circumstances that would specify PAS and VAE in the US.     

The Nazi! Accusation and Current US Proposals

In contemporary ethical discourse generally, and in discussions concerning the legalization of physician-assisted suicide (PAS) and voluntary active euthanasia (VAE) specifically, recourse is sometimes had to the Nazi! accusation. Some disputants charge that such practices are or will become equivalent to the Nazi 'euthanasia' program in which over 73,000 handicapped children and adults were killed without consent. This paper reflects on the circumstances that lead to the use of this charge and offers reasons for putting the Nazi! charge aside in contemporary discussions of PAS and VAE. A number of the philosophical presuppositions common to both the Nazi 'euthanasia' program and the currently proposed practices of PAS and VAE are examined. Noting that racist ideology and violent coercion characterized the Nazi program, the paper concludes with a cautionary consideration of the current circumstances that would specify PAS and VAE in the US.     

ATTITUDES TOWARDS EUTHANASIA AND ASSISTED SUICIDE: A COMPARISON BETWEEN PSYCHIATRISTS AND OTHER PHYSICIANS

Euthanasia and physician assisted‐suicide are terms used to describe the process in which a doctor of a sick or disabled individual engages in an activity which directly or indirectly leads to their death. This behavior is engaged by the healthcare provider based on their humanistic desire to end suffering and pain. The psychiatrist's involvement may be requested in several distinct situations including evaluation of patient capacity when an appeal for euthanasia is requested on grounds of terminal somatic illness or when the patient is requesting euthanasia due to mental suffering. We compare attitudes of 49 psychiatrists towards euthanasia and assisted suicide with a group of 54 other physicians by means of a questionnaire describing different patients, who either requested physician‐assisted suicide or in whom euthanasia as a treatment option was considered, followed by a set of questions relating to euthanasia implementation. When controlled for religious practice, psychiatrists expressed more conservative views regarding euthanasia than did physicians from other medical specialties. Similarly female physicians and orthodox physicians indicated more conservative views. Differences may be due to factors inherent in subspecialty education. We suggest that in light of the unique complexity and context of patient euthanasia requests, based on their training and professional expertise psychiatrists are well suited to take a prominent role in evaluating such requests to die and making a decision as to the relative importance of competing variables.     

Microtubular cytoskeleton and root morphogenesis

Although the microtubular cytoskeleton of plant cells is important in maintaining the direction of cell growth, its natural lability can be harnessed in such a way that new growth axes are permitted. In these circumstances, the system which fabricates the cytoskeleton is presumably responsive to morphogenetic information originating from outside the cell. Spatial patterns of hormonal and metabolic signals within the tissue or organ that house the responsive cells are one possible source of this information. However, a contrasting source takes the form of biophysical information, such as the supracellular patterns of stresses and strains.We examined the microtubular cytoskeleton in roots of tomato and maize to test the assumption that the cortical microtubular array of each cell would have a particular orientation relative to the cell's position within the growth field of the root apex. Accordingly, each intracellular cortical array was mapped to the overall pattern of cells within the apex. In certain areas of the meristem, the arrays seemed to be more variable than elsewhere. These are sites where morphogenetic decisions are taken, usually involving a change in the plane of cell division. Roots which have suffered disturbance to their physical structure (e.g. removal of the root cap), or which had been exposed to low temperatures or treated with certain chemicals (e.g. inhibitors of nuclear division or DNA synthesis), exhibited new patterns of microtubular arrays which in turn predicted novel patterns of cell division. In all these circumstances, the arrays showed consistent alterations within distinct regions of the root-e.g. in the quiescent centre and also in a group of cells just behind the quiescent centre, at the boundary between cortex and stele. These altered arrays indicate that there are supracellular domains in which the microtubules respond to morphogenetic signals. Studies such as these reinforce the concept of microtubule lability and the inherent responsiveness of the microtubular system to external and internal stimuli. However, at present there is no indication of how the morphogenetic programme of the root is set up in the first place. Probably, this is established and stabilized early in embryogenesis and is then perpetuated by the prevailing metabolic and biophysical conditions. The microtubules of the cytoskeleton can be regarded as intracellular automata which not only participate in mitosis and cytokinesis but also ensure the realization of an organogenetic programme. Should the root confront circumstances which temporarily destabilize this programme, the prevailing growth field is sufficiently robust to ensure that the microtubular system is attracted back to the stable, pre-existing state capable of reinstating normal morphogenesis. H Lambers Section editor     

In search of self‐reliance: Problems of marine technology transfer to the developing countries: The case of West Africa

Abstract

This study presents some of the main features of the marine technology transfer process and identifies the key factors determining the particular transfer arrangements available for developing countries of West Africa under different circumstances. Emphasis is made on the fisheries sector because of its economic importance in that region. It examines the principal characteristics of suppliers and recipients of fisheries technology and their prevailing attitudes with regard to transfers. It draws on empirical research covering several international cooperative fisheries arrangements in Mauritania, Guinea‐Bissau, and Guinea‐Conakry that have high potential to function as a technology transfer mechanism from developed to developing coastal countries.     

Transmission and control of African horse sickness in The Netherlands: a model analysis

African horse sickness (AHS) is an equine viral disease that is spread by Culicoides spp. Since the closely related disease bluetongue established itself in The Netherlands in 2006, AHS is considered a potential threat for the Dutch horse population. A vector-host model that incorporates the current knowledge of the infection biology is used to explore the effect of different parameters on whether and how the disease will spread, and to assess the effect of control measures. The time of introduction is an important determinant whether and how the disease will spread, depending on temperature and vector season. Given an introduction in the most favourable and constant circumstances, our results identify the vector-to-host ratio as the most important factor, because of its high variability over the country. Furthermore, a higher temperature accelerates the epidemic, while a higher horse density increases the extent of the epidemic. Due to the short infectious period in horses, the obvious clinical signs and the presence of non-susceptible hosts, AHS is expected to invade and spread less easily than bluetongue. Moreover, detection is presumed to be earlier, which allows control measures to be targeted towards elimination of infection sources. We argue that recommended control measures are euthanasia of infected horses with severe clinical signs and vector control in infected herds, protecting horses from midge bites in neighbouring herds, and (prioritized) vaccination of herds farther away, provided that transport regulations are strictly applied. The largest lack of knowledge is the competence and host preference of the different Culicoides species present in temperate regions.     

‘SETTING A PRINCIPLED BOUNDARY’? EUTHANASIA AS A RESPONSE TO ‘LIFE FATIGUE’

The Dutch case of Brongersma presents novel challenges to the definition and evaluation of voluntary euthanasia since it involved a doctor assisting the suicide of an individual who was (merely?) ‘tired of life’. Legal officials had called on the courts to ‘set a principled boundary’, excluding such cases from the scope of permissible voluntary euthanasia, but they arguably failed. This failure is explicable, however, since the case seems justifiable by reference to the two major principles in favour of that practice, respect for autonomy and beneficence. Ultimately, it will be argued that those proponents of voluntary euthanasia who are wary of its use in such circumstances may need to draw upon ‘practical’ objections, in order to erect an otherwise arbitrary perimeter. Furthermore, it will be suggested that the issues raised by the case are not peculiarly Dutch in nature and that, therefore, there are lessons here for other jurisdictions too.     

Legal developments concerning active euthanasia on request in the Netherlands

The author describes social and legal developments in the debate over active euthanasia in the Netherlands. There, as in all of Western Europe, euthanasia is a crime. Although the medical profession in several European countries has rejected efforts to change the situation, the Dutch Medical Association in 1984 issued a statement indicating an increased willingness to accept euthanasia under stringent guidelines. Some court decisions have been lenient in applying penal law to doctors acting at the wish of their patients. The Netherlands State Commission on Euthanasia published a 1985 report advocating modification of the Penal Code. [An English summary of the report appears in the same issue of Bioethics]. An emotional debate is underway in medical and legal journals and in the mass media, but the Council of State has advised against any legislative change for now. Meanwhile, euthanasia continues to occur in the Netherlands at an estimated rate of 5,000 to 8,000 cases a year.     

Modern plant cultivation technologies in agriculture under controlled environment: a review on aeroponics

This review paper describes a novel approach to plant cultivation under soil-less culture. At present, global climate change is expected to raise the risk of frequent drought. Agriculture is in a phase of major change around the world and dealing with serious problems. In future, it would be difficult task to provide a fresh and clean food supply for the fast-growing population using traditional agriculture. Under such circumstances, the soil-less cultivation is the alternative technology to adapt effectively. The soil-less system associated with the Hydroponic and Aeroponics system. In the aeroponics system, plant roots are hanging in the artificially provided plastic holder and foam material replacement of the soil under controlled conditions. The roots are allowed to dangle freely and openly in the air. However, the nutrient rich-water deliver with atomization nozzles. The nozzles create a fine spray mist of different droplet size at intermittently or continuously. This review concludes that aeroponics system is considered the best plant growing method for food security and sustainable development. The system has shown some promising returns in various countries and recommended as the most efficient, useful, significant, economical and convenient plant growing system then soil and other soil-less methods.     

Alberta euthanasia survey: 2. Physicians' opinions about the acceptance of active euthanasia as a medical act and the reporting of such practice.

OBJECTIVE: To ascertain the opinions of Alberta physicians about the acceptance of active euthanasia as a medical act (the "medicalization" of active euthanasia) and the reporting of colleagues practising active euthanasia, as well as the sociodemographic correlates. DESIGN: Cross-sectional survey of a random sample of Alberta physicians, grouped by site and type of practice. SETTING: Alberta. PARTICIPANTS: A total of 2002 (46%) of the licensed physicians in Alberta were mailed a 38-item questionnaire in May through July 1991; usable responses were returned by 1391 (69%). RESULTS: Although only 44% of the respondents considered active euthanasia morally "right" at least 70% opted to medicalize the practice if it were legal by restricting it to be performed by physicians and to be taught at medical sites. Even though active euthanasia is criminal homicide in Canada, 33% of the physicians stated that they would not report a colleague participating in the act of anyone, and 40% and 60% stated that they would not report a colleague to medical or legal authorities respectively. Acceptance or rejection of active euthanasia as a medical act was strongly related to religious affiliation and activity (p < 0.01). CONCLUSIONS: This survey about active euthanasia revealed profound incongruities in the opinions of the sample of Alberta physicians concerning their ethical and social duties in the practice of medicine. These data highlight the need for relevant modifications of health education policies concerning biomedical ethics and physicians'' obligations to society.     

Root decisions

Root systems have recognizable developmental plans when grown in solution or agar; however, these plans often must be modified to cope with the prevailing conditions in the soil environment such as the avoidance of obstacles and the exploitation of nutrient-rich patches or water zones. The modular structure of roots enables them to respond to their environment, and roots are very adaptive at modifying growth throughout the root system to concentrate their efforts in the areas that are the most profitable. Roots also form associations with microorganisms as a strategy to enhance resource capture. However, while the responses of roots in nutrient patches are well-recognized, overall 'rules of response' and variation in strategy among plant species that can be applied in a number of different environments are still lacking. Finally, there is increasing evidence that root–root interactions are much more sophisticated than previously thought, and the evidence for roots to identify self from non-self roots will be briefly discussed.     

The social and economic origins of genetic determinism: a case history of the American Eugenics Movement, 1900–1940 and its lessons for today

Eugenics, the attempt to improve the genetic quality of the human species by ‘better breeding’, developed as a worldwide movement between 1900 and 1940. It was particularly prominent in the United States, Britain and Germany, and in those countries was based on the then-new science of Mendelian genetics. Eugenicists developed research programs to determine the degree to which traits such as Huntington's chorea, blindness, deafness, mental retardation (feeblemindedness), intelligence, alcoholism, szhiophrenia, manic depression, rebelliousness, nomadism, prostitution and feeble-inhibition were genetically determined. Eugenicists were also active in the political arena, lobbying in the United States for immigration restriction and compulsory sterilization laws for those deemed genetically unfit; in Britain they lobbied for incarceration of genetically unfit and in Germany for sterilization and eventually euthanasia. In all these countries one of the major arguments was that of efficiency: that it was inefficient to allow genetic defects to be multiplied and then have to try and deal with the consequences of state care for the offspring. National Socialists called genetically defective individuals ‘useless eaters’ and argued for sterilization or euthanasia on economic grounds. Similar arguments appeared in the United States and Britain as well. At the present time (1997) much research and publicity is being given to claims about a genetic basis for all the same behaviors (alcoholism, manic depression, etc), again in an economic context – care for people with such diseases is costing too much. There is an important lesson to learn from the past: genetic arguments are put forward to mask the true – social and economic – causes of human behavioral defects. This revised version was published online in August 2006 with corrections to the Cover Date.     

‘Alive by default’: An exploration of Velleman’s unfair burdens argument against state sanctioned euthanasia

In this article we critically evaluate an argument against state-sanctioned euthanasia made by David Velleman in his 1992 paper ‘Against the right to die’. In that article, Velleman argues that legalizing euthanasia is morally problematic as it will deprive eligible patients of the opportunity of staying ‘alive by default’. That is to say, those patients who are rendered eligible for euthanasia as a result of legislative reform will face the burden of having to justify their continued existence to their epistemic peers if they are to be perceived as ‘reasonable’. We discuss potential criticisms that could be made of the argument, and consider how a defender of the view might respond. Velleman’s argument is particularly interesting as it is a consequentialist argument against state-sanctioned euthanasia, challenging the many consequentialist arguments that have been made in favour of legalizing the procedure. We conclude by suggesting that further research on the question of unfair burdens is important to adequately evaluating the potential harms of legalizing euthanasia for patients at the end of life.