Splitting the Difference? Principled Compromise and Assisted Dying

Compromise on moral matters attracts ambivalent reactions, since it seems at once laudable and deplorable. When a hotly‐contested phenomenon like assisted dying is debated, all‐or‐nothing positions tend to be advanced, with little thought given to the desirability of, or prospects for, compromise. In response to recent articles by Søren Holm and Alex Mullock, in this article I argue that principled compromise can be encouraged even in relation to this phenomenon, provided that certain conditions are present (which I suggest they are). In order to qualify as appropriately principled, the ensuing negotiations require disputants to observe three constraints: they should be suitably reflective, reliable and respectful in their dealings with one another. The product that will result from such a process will also need to split the difference between the warring parties. In assisted dying, I argue that a reduced offence of ‘compassionate killing’ can achieve this. I acknowledge, however, that splitting the difference can induce splitting headaches, as there remain certain questions to be answered. Hopefully, however, sufficient work is done here to defend attempts to occupy the middle ground, whether these relate to assisted dying specifically or to other disputed moral matters.     

MORAL FICTION OR MORAL FACT? THE DISTINCTION BETWEEN DOING AND ALLOWING IN MEDICAL ETHICS

Opponents of physician‐assisted suicide (PAS) maintain that physician withdrawal‐of‐life‐sustaining‐treatment cannot be morally equated to voluntary active euthanasia. PAS opponents generally distinguish these two kinds of act by positing a possible moral distinction between killing and allowing‐to‐die, ceteris paribus. While that distinction continues to be widely accepted in the public discourse, it has been more controversial among philosophers. Some ethicist PAS advocates are so certain that the distinction is invalid that they describe PAS opponents who hold to the distinction as in the grip of ‘moral fictions’. The author contends that such a diagnosis is too hasty. The possibility of a moral distinction between active euthanasia and allowing‐to‐die has not been closed off by the argumentative strategies employed by these PAS advocates, including the contrasting cases strategy and the assimilation of doing and allowing to a common sense notion of causation. The philosophical debate over the doing/allowing distinction remains inconclusive, but physicians and others who rely upon that distinction in thinking about the ethics of end‐of‐life care need not give up on it in response to these arguments.     

Somatic gonad sheath cells and Eph receptor signaling promote germ-cell death in C. elegans

Programmed cell death eliminates unwanted cells during normal development and physiological homeostasis. While cell interactions can influence apoptosis as they do other types of cell fate, outside of the adaptive immune system little is known about the intercellular cues that actively promote cell death in healthy cells. We used the Caenorhabditis elegans germline as a model to investigate the extrinsic regulators of physiological apoptosis. Using genetic and cell biological methods, we show that somatic gonad sheath cells, which also act as phagocytes of dying germ cells, promote death in the C. elegans germline through VAB-1/Eph receptor signaling. We report that the germline apoptosis function of VAB-1 impacts specific cell death pathways, and may act in parallel to extracellular signal-regulated kinase MAPK signaling. This work defines a non-autonomous, pro-apoptotic signaling for efficient physiological cell death, and highlights the dynamic nature of intercellular communication between dying cells and the phagocytes that remove them.     

Why not Commercial Assistance for Suicide? On the Question of Argumentative Coherence of Endorsing Assisted Suicide

Most people who endorse physician‐assisted suicide are against commercially assisted suicide – a suicide assisted by professional non‐medical providers against payment. The article questions if this position – endorsement of physician‐assisted suicide on the one hand and rejection of commercially assisted suicide on the other hand – is a coherent ethical position. To this end the article first discusses some obvious advantages of commercially assisted suicide and then scrutinizes six types of argument about whether they can justify the rejection of commercially assisted suicide while simultaneously endorsing physician‐assisted suicide. The conclusion is that they cannot provide this justification and that the mentioned position is not coherent. People who endorse physician‐assisted suicide have to endorse commercially assisted suicide as well, or they have to revise their endorsement of physician‐assisted suicide.     

Suicide and attempted suicide among South Asians in England: who is at risk?

Evidence from both large-scale and small-scale studies suggests differences and similarities in patterns of suicide and attempted suicide between South Asians and the total population in England. Among South Asians, the excess of females among both suicides and attempted suicides is even more marked; the traditional view of a strong family structure among Asians is confirmed, although cultural conflict between generations is apparent. The technique of suicide by burning among Asians appears to be waning. Asians who attempt or complete suicide are more likely to be suffering from stress, but less likely to have been diagnosed as mentally ill. Their psychological problems appear to have been frequently overlooked by general practitioners, or not presented to them. Differences in religion, with Hindus producing higher rates than Muslims, and demographic, geographical, financial and cultural differences, contribute to the need for disaggregation and up-to-date research.     

Debating death: religion, politics, and the Oregon Death With Dignity Act

In 1994, Oregon passed the Oregon Death With Dignity Act, becoming the first state in the nation to allow physician-assisted suicide (PAS). This paper compares the public discussion that occurred in 1994 and during the Act's implementation in 1997 and examines these debates in relation to health care reform under the Obama administration. I argue that the 1994 and 1997 Oregon PAS campaigns and the ensuing public debate represent the culmination of a growing lack of deference to medical authority, concerns with the doctor-patient relationship, and a desire for increased patient autonomy over decisions during death. The public debate over PAS in Oregon underscored the conflicts among competing religious, political, and personal interests. More visible and widespread than any other American debate on PAS, the conflict in Oregon marked the beginning of the now nationwide problem of determining if and when a terminally ill person can choose to die.     

Introduction to "Cruelty, Suffering, Imagination: The Lessons of J. M. Coetzee"

For over two decades, Nobel laureate J. M. Coetzee has brilliantly addressed issues of interest to anthropologists: the brutal effects of racist tyranny and injustice in South Africa; the reach of empire; guilt and revenge; and the problem of language in particular historical and political moments. In his recent work Elizabeth Costello (2003a), Coetzee confronts a particularly pressing set of contemporary political and ethical concerns, ones to which anthropologists have much to add. In this "In Focus," anthropologists from each of the subdisciplines use Elizabeth Costello as a lens for working through such concerns, addressing a range of questions—including the nature of evil and its relationship to state power, the burden of belief, the legacy of colonialism, the ethical limits of representations of horror, what it means to live in a world of cruelty and suffering, and the power of humans' sympathetic imagination to confront such a world.