Decisions about life-sustaining treatment are often ethically challenging for patients, surrogate decision-makers, and health care professionals. Providing safe, effective, and compassionate care near the end of life is a priority for health care organizations. In times of uncertainty, crisis, or reflection, and in efforts to improve health care for seriously ill patients, guidelines can help. This is the first updated, expanded edition of The Hastings Center's 1987 Guidelines on the Termination of Life-Sustaining Treatment and Care of the Dying, which shaped the ethical and legal framework for decision-making on treatment and end-of-life care in the United States. The new edition, the product of an authoritative consensus process, incorporates 25 years of research, innovation, and developments in law and policy. It summarizes the current framework for making good decisions about treatment and care and identifies educational and organizational goals for health care systems. It covers care planning, decision-making for adults and for children, care transitions, the determination of death, and the policies and processes that support good care at the bedside. It also addresses the psychological and social dimensions of care near the end of life, with attention to effective communication with patients and loved ones and among team members. This book is written for physicians, nurses, and other clinicians in hospitals, nursing homes, home care, and hospice. It is structured for ease of reference during difficult clinical situations and includes extensive practical recommendations supported by print and online resources. This book is also essential reading for clinical ethicists, ethics committee members, health lawyers, and medical and nursing directors. As the U.S. confronts the challenges of health care reform, an aging population, increasing technological capacity to extend life, and serious cost implications, The Hastings Center Guidelines are invaluable to educators, scholars, and policymakers.

Physician assisted suicide occurs when a terminally ill patient takes the decision to end their life with the help of their doctor. In this book the authors argue clearly and forcefully for the legalization of physician assisted suicide.

This revealing volume explores recent historical perspectives on the modern euthanasia and assisted-suicide debate and the political arenas in which it has unfolded. Emotional public responses to widely publicized right-to-die and euthanasia cases, such as those revolving around Dr. Jack Kevorkian and Terri Schiavo, highlight their volatile mix of medical, ethical, religious, legal, and public policy issues. The Euthanasia/Assisted-Suicide Debate explores how this debate has evolved over the past 100 years as judicial approaches, legislative responses, and prosecutorial practices have shifted as a result of changes in medical technology and consumer sophistication. Emphasizing the period from the 1950s forward, the book offers an unbiased examination of the origins of the modern medical euthanasia and assisted-suicide debates, the involvement of physicians, the history and significance of medical technology and practice, and the role of patients and their families in the ongoing controversy. This illuminating exploration of concepts, issues, and players will help readers understand both sides of the debate as viewed by participants. Case studies explain contemporary legal techniques in the handling of euthanasia and assisted-suicide prosecutions, including those involving doctors, nurses, and family members A chronology shows political events and major cases of medical euthanasia and assisted suicide over the past 100 years A glossary explains key terms, such as "causation," "intent," "palliative care," and "double effect" An interdisciplinary bibliography cites significant materials from the fields of history, law, and sociology, as well as major medical journal articles

Many advocates of euthanasia consider the criminal law to be an inappropriate medium to adjudicate the profound ethical and humanitarian dilemmas associated with end of life decisions. Euthanasia, Death with Dignity and the Law examines the legal response to euthanasia and end of life decisions and considers whether legal reform is an appropriate response to calls for euthanasia to be more readily available as a mechanism for providing death with dignity. Through an analysis of consent to treatment, living wills and autonomous medical decision making, euthanasia is carefully located within its legal, medical, and social contexts. This book focuses on the impact of euthanasia on the dignity of both the recipient and the practitioner while emphasizing the legal, professional, and ethical implications of euthanasia and its significance for the exercise of clinical discretion. It will provide a valuable addition to the euthanasia debate.

This book is the first comprehensive report and analysis of the Dutch euthanasia experience over the last three decades. In contrast to most books about euthanasia, which are written by authors from countries where the practice is illegal and therefore practiced only secretly, this book analyzes empirical data and real-life clinical behavior. Its essays were written by the leading Dutch scholars and clinicians who shaped euthanasia policy and who have studied, evaluated, and helped regulate it. Some of them have themselves practiced euthanasia. The book will contribute to the world literature on physician-assisted death by providing a comprehensive examination of how euthanasia has been practiced and how it has evolved in one specific national and cultural context. It will greatly advance the understanding of euthanasia among both advocates and opponents of the practice.

The Last Choice establishes that preemptive suicide in advanced age can be rational: that it can make good sense to evade age-related personal diminishment even at the cost of good time left. Criteria are provided to help determine whether soundly reasoned, cogently motivated,and prudently timed self-destruction can be in one's interests late in life. In our time suicide and assisted suicide are being increasingly tolerated as ways to escape unendurable mental or physical suffering, but it isn't widely accepted that suicide may be a rational choice before the onset of such suffering. This book's basic claim is that it can be rational to choose to die sooner as oneself than to survive as a lessened other: that judicious appropriation of one's own inevitable death can be an identity-affirming act and a fitting end to life. Discussion of preemptive suicide goes beyond contributing to current widespread debate about assisted suicide. It is a matter tightly interrelated with other right to die questions and one bound to become a national issue. If there are good arguments for escaping intolerable situations caused by age-related deteriorative conditions, most of those arguments will equally support avoidance of those conditions. If assisted suicide becomes more generally acknowledged and accepted, preemptive suicide will almost certainly follow. It is crucial, then, to examine whether preemptive suicide constitutes a rational option for reflective aging individuals.

Citizen Killings: Liberalism, State Policy and Moral Risk offers a ground breaking systematic approach to formulating ethical public policy on all forms of 'citizen killings', which include killing in self-defence, abortion, infanticide, assisted suicide, euthanasia and killings carried out by private military contractors and so-called 'foreign fighters'. Where most approaches to these issues begin with the assumptions of some or other general approach to ethics, Deane-Peter Baker argues that life-or-death policy decisions of this kind should be driven first and foremost by a recognition of the key limitations that a commitment to political liberalism places on the state, particularly the requirement to respect citizens' right to life and the principle of liberal neutrality. Where these principles come into tension Baker shows that they can in some cases be defused by way of a reasonableness test, and in other cases addressed through the application of what he calls the 'risk of harm principle'. The book also explores the question of what measures citizens and other states might legitimately take in response to states that fail to implement morally appropriate policies regarding citizen killings.

'I have quite a bit of understanding of white man's ways, but it is difficult for me to understand this one.' An Australian Senate committee investigation of the Northern Territory's Rights of the Terminally Ill Act 1995, the first legislation in the world that allowed doctors to actively assist patients to die, found that for the vast majority of Indigenous Territorians, the idea that a physician - or anyone else - should help end a dying, suffering person's life was so foreign that in some instances it proved almost impossible to translate. The Good Death Through Time asks how such a death became a 'thinkable'-even desirable-way to die for so many others in Western cultures. For centuries a good death - the 'euthanasia' - meant a death blessed by God that might well involve pain, for suffering was seen as ultimately redemptive. But in the Victorian age, when doctors started to treat the dying with painkillers as well as prayers, a painful death came to be thought of as an aberrant, dehumanising experience. As this book explores, the modern idea that a good death should be painless spurred sometimes troubling developments in palliative medicine as well as an increasingly well-organised assisted dying movement. Delving into what euthanasia activists, doctors, lawyers, religious leaders and lay people have thought and felt about dying, The Good Death Through Time shows that understanding the radical historical shift in Western attitudes to managing dying and suffering helps us better grasp the stakes in today's contestations over what it means to die well.

The study of death has the capacity to bring together a range of policy areas. Yet death is often overlooked within policy debates in the UK and beyond, and within gerontology. Bringing together a range of scholars engaged in policy associated with death, this collection provides a holistic account of how death factors in social policy. Within this, issues covered include inheritance, palliative care, euthanasia, funeral costs, bereavement support, marginalised deaths and disposal practices. At the heart of the book, the volume recognises that the issues identified are likely to intensify and expand over the next twenty years, as death rates continue to rise.

Shocked by the fact that, in the Netherlands, psychiatric patients are considered potentially appropriate candidates for physician-assisted suicide, Olevitch examines the research and data and finds that, even in the United States, the situation is threatening. She describes how the rhetoric of the assisted-suicide movement can confuse potential suicide victims and their helpers, and how surrogate medical decisions are a growing threat in the lives of incompetent patients. Olevitch argues the assisted-suicide movement is based not on the level-headed realism its advocates claim, but on a lack of information about up-to-date ways of bringing about psychological wellness, on a misguided panic about finances, a phobic view of medical procedures, a lack of understanding of the support needed by average medical patients, and a misguided belief in superficial safeguards.

Olevitch describes how Rational Emotive Behavior Therapy and Cognitive Behavior Therapy can be used to help terminally ill or disabled people overcome their profound depression. Another cognitive focus is added as she presents material answering questions including what patients are really thinking when they request assisted suicide or when they decline medical procedures. Well-known psychologist Albert Ellis says of the volume, Carefully read this unusual book and see how it can be useful to you, whether you are a physician, a mental health professional, or an unfortunate patient

The Edge of Life: Human Dignity and Contemporary Bioethics treats a number of distinct moral questions and ?nds their answer in the dignity of the person, both as an agent and as a patient (in the sense of the recipient of action). Characteristically one's view of the human being ultimately shapes one's outlook on these matters. This book addresses questions that divide a culture of life from a culture of death as well as a number of questions debated within the Catholic tradition itself. The Edge of Life offers a critique of the new bio-ethic, represented by such notable authors as Peter Singer; it also attempts to shore up some of the dif?culties leveled by critics against the traditional ethic as well as to answer some questions disputed by those within the tradition. This book does not treat the basic principles of morality but rather many of their applications and suppositions. (For an account of contemporary debates within the Catholic tradition on these matters, see Kaczor 2002). Rather, The Edge of Life seeks to address a number of disputed contemporary questions touching upon human dignity at what has been called "the margins of life. " The ?rst section of the book treats the dignity of the human person as recipient of action and as agent. Chapter two examines various accounts of when a human being becomes a person.

Kevin Yuill goes straight to the heart of a difficult issue. Critical of both sides of the discussion, this book presents an up-to-date analysis of the direction discussion is taking, showing that atheists, libertarians, those favouring abortion rights and stem-cell research should stand beside their religious compatriots in opposing legalization of assisted suicide. The author shows that the real issue behind the debate is not euthanasia but suicide. Rather than focusing on tragic cases, he indicates the real damage that will be done if we affirm the suicidal wishes of even a small segment of the population. Analyzing the movement for the right to die in historical terms, Yuill shows that, though many proponents of a change in the law believe they are rationalist heirs of such thinkers as John Stuart Mill, legalizing assisted suicide will reduce privacy and freedom. Finally, Yuill suggests a radical alternative to legalization of assisted suicide that would embrace both the cause of freedom and the anxieties of many about securing good deaths.

Hot Topic: what does the Bible say about assisted suicide and what are the practical implications - find answers in Right To Die?: Euthanasia, Assisted Suicide And End-Of-Life Care (New edition)

The case for assisted suicide can seem so compelling. Surely it can't be wrong to help desperate people to kill themselves. Don't we have a right to take our own lives in certain circumstances? There are no trite or easy answers. John Wyatt helps us to navigate the arguments with hearts and heads engaged, and above all with our Bibles open. There are practical and compassionate alternatives to assisted suicide, and as many who have gone before us have found, the end of our lives on this earth may turn out to be a strange and wonderful opportunity for growth and internal healing.

This timely work is a balanced overview of end-of-life issues related to euthanasia and assisted suicide.Physician-assisted suicide is not only a crime in most U.S. states, it is also a blistering controversy. One side insists that no one, including the patient, has the right to decide when and how death should occur. The other side contends that patients should have the option to choose assisted suicide as a means of ending life.Except for the Oregon Death with Dignity Act, there are no U.S. laws that allow physicians to assist patients in hastening death. Many who support physician-assisted suicide ask, Why not? After all, the Netherlands permits both euthanasia and physician-assisted suicide, and polls suggest that many Americans want that choice available to them.Euthanasia: A Reference Handbook, Second Edition explores that question through a balanced, thoughtful discussion of the legal, medical, and spiritual components of end-of-life questions. What are the potential pitfalls of legalizing assisted suicide? How can the expenses of a lingering death impact an uninsured family? How would physician-assisted suicide impact healthcare costs? Through its objective exploration of these issues, as well as its historical and international perspective, this volume helps readers answer the difficult questions related to the end of life.

Rapid changes in medical care and in society's attitudes about death have made the right-to-die debate a timely topic, but its roots can be traced back to the founding of this country. High school and college students can explore the history of this debate through this unique collection of primary documents. Government reports, court cases, statements from religious groups, and many other contributions provide a thorough examination of the arguments for and against allowing people to make their own decisions about how and when they die. An explanatory introduction precedes each document to aid the user in understanding the various arguments that have been put forth in this debate, encouraging consideration of all sides when drawing conclusions.

Such issues as attitudes toward death, mercy killings, euthanasia, the development of living wills, and advance directives are explored in detail and are traced back to their early roots. Each of the volume's six parts examines a different subject within the debate and provides records ranging from the high profile court cases of Karen Quinlan and Nancy Cruzan to samples of living wills to a statement from Pope Pius II. Zucker presents the reader with a variety of ideas from many different people, including doctors, patients, religious leaders, and government officials, and presents a broad range of perspectives that will be a welcome resource for students wishing to explore this highly emotional topic from as many different angles as possible.

End-of-life decision making is often viewed from an academic perspective, which can obscure the debate's central human concerns. This guide introduces general readers to people with personal stakes in the right-to-die conundrum. Putnam provides practical assistance to readers and their loved ones, simultaneously incorporating the abstract and theoretical analysis essential to examining how we die in contemporary Western society. She also presents the backgrounds of the Hospice and Right-to-Die (Hemlock) Movements.

To elucidate the human side of the debate, Putnam profiles and interviews six important figures:

Dame Cicely Saunders, founder of the modern Hospice Movement

Derek Humphry, founder of The Hemlock Society in the U.S.

Herbert Cohen, an early leader in euthanasia circles in The Netherlands

Timothy Quill, whose assistance in a patient suicide resulted in a case before the U.S. Supreme Court

Joanne Lynn, founder of Americans for Better Care for the Dying

Jack Kevorkian (profiled, but unavailable for interview)

Another unique feature of this book is the application of philosopher Judith Jarvis Thomson's general theory of rights to the very specific right to die. Pointing to potential compatibilities between the two positions, she concludes that heroic compassion does not require a final choice between Hospice and Hemlock--there may be room enough for both.

This is an original contribution to the much debated area of the value that we should place on human life. With the euthanasia issue highlighted in the public arena this book argues for a non-absolutist highest value on life ethic and how that fits with society's current emphasis on individual autonomy. By the use of everyday examples the impact of placing a high value on life is explored. It will be useful for students of ethics, nursing and medicine and those engaged in the public debate on euthanasia.

Dying Right is the first work to provide a comprehensive and first-hand account of the Death with Dignity movement in the US and around the world. The book also provides an in-depth look at Oregan, the first place to legalise physician-assisted suicide. Engaging the question of how to balance a patient's sense about the right way to die, a physician's role as a healer, and the state's interest in preventing killing, Dying Right captures the ethical, legal, moral and medical complexities involved in this ongoing debate.

Instances of euthanasia or mercy killing date back to antiquity. However, it is only recently that the unprecedented grassroots efforts to legalize euthana sia have begun building. "Terminal Illness, Assistance with Dying," a California ballot initiative for the No vember 1992 election, might for the first time in modem history legalize euthanasia and assisted suicide by physicians. Similar initiatives are planned in other states. To vote intelligently, citizens in California and throughout the United States need to learn who is likely to request euthanasia or assisted suicide, and why. How we care for the terminally ill eventually af fects us all. In over half of all deaths, a chronic dis ease process such as cancer or congestive heart failure leads to a terminal phase that may last for days, weeks, or months. Most people are more afraid of the suffering associated with this terminal phase than they are afraid of dying itself. When polled, most Americans tell us they would prefer to die at home, surrounded by loved ones, rather than in a hospital receiving high-tech tests and treatments until the last. Yet the majority of people, even those with term inal illnesses, die in the hospital. What factors in our culture and health care system have led to this dichotomy? Unrelieved suffering is also the primary reason for euthanasia requests."

George P. Smith's "Palliative Care and End-of-Life Decisions" completes a Bioethics-Health Care epistemology begun in 1989, which addresses the specific issue of managing palliative care at the end-stage of life. Smith argues forcefully that in order to palliate the whole person (encompassing physical and psychological states), an ethic of adjusted care requires recognition of a fundamental right to avoid cruel and unusual suffering from terminal illness. Specifically, this book urges wider consideration and use of terminal sedation as efficacious medical care and as a reasonable procedure in order to safeguard a 'right' to a dignified death. The principle of medical futility is seen as a proper construct for implementing this process.
The state legislative responses of California, Vermont, and Washington in enacting Death with Dignity legislation - allowing those with end-stage terminal illness to receive pharmacological assistance in ending their own lives - is held by Smith to be not only commendable, but the proper response for enlightened state action.

In this book, Christian Erk examines the ethical (im)permissibility of killing human beings in general and of selected killings in particular, namely suicide, lethal selfdefence, abortion and euthanasia, as well as organ transplantation and assisted suicide. He does so by addressing a range of important ethical questions: What does it mean to act? Of what elements is an action comprised? What is the difference between a good or evil action and a permissible or impermissible action? How can we determine whether an action is good or evil? Is there a moral duty not to kill? Is this duty held by and against all human beings or only persons? What and who is a person? What is human dignity and who has it? What is it that is actually taken when somebody is killed, i.e. what is life? And closely related to that: What and when is death? By integrating the answers to these questions into an argumentative architecture, the book offers a comprehensive exploration of one of the most fundamental questions of mankind: Under which conditions, if any, is killing human beings ethically permissible?

This book offers an examination of physician-assisted death, but it also extends the discussion to a broader range of end-of-life decisions including suicide, palliative care and sedation until death.

"Ball's arguments are concise, compelling, and backed with considerable case law. This volume is highly recommended for upper-level undergraduates and above in law, philosophy, and the medical humanities interested in the 'right to die' debates. Summing up: Highly recommended." -Choice Over the past hundred years, average life expectancy in America has nearly doubled, due largely to scientific and medical advances, but also as a consequence of safer working conditions, a heightened awareness of the importance of diet and health, and other factors. Yet while longevity is celebrated as an achievement in modern civilization, the longer people live, the more likely they are to succumb to chronic, terminal illnesses. In 1900, the average life expectancy was 47 years, with a majority of American deaths attributed to influenza, tuberculosis, pneumonia, or other diseases. In 2000, the average life expectancy was nearly 80 years, and for too many people, these long lifespans included cancer, heart failure, Lou Gehrig's disease, AIDS, or other fatal illnesses, and with them, came debilitating pain and the loss of a once-full and often independent lifestyle. In this compelling and provocative book, noted legal scholar Howard Ball poses the pressing question: is it appropriate, legally and ethically, for a competent individual to have the liberty to decide how and when to die when faced with a terminal illness? At Liberty to Die charts how, the right of a competent, terminally ill person to die on his or her own terms with the help of a doctor has come deeply embroiled in debates about the relationship between religion, civil liberties, politics, and law in American life. Exploring both the legal rulings and the media frenzies that accompanied the Terry Schiavo case and others like it, Howard Ball contends that despite raging battles in all the states where right to die legislation has been proposed, the opposition to the right to die is intractable in its stance. Combining constitutional analysis, legal history, and current events, Ball surveys the constitutional arguments that have driven the right to die debate.