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.

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.

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

After the Nancy Cruzan case was decided by the Supreme Court in 1990, and ultimately resolved by the Courts of the State of Missouri, the decision to withhold or withdraw life-prolonging nutrition and hydration appeared to many to be as noncontroversial as decisions to refuse respirators or dialysis. Even the Catholic Church held that, although there should be a presumption in favor of providing nutrition and hydration, the patient or the patient's surrogate could overrule this presumption, if either believed the treatment was disproportionate or burdensome. The Schiavo case changed all that. Although the decision to remove Terri Schiavo's nutrition and hydration was made by her husband - her legal surrogate - based on his wife's belief that such treatment was disproportionate, Schiavo's immediate family protested so much that the case took years to resolve. It eventually involved all branches of government at both the state and federal levels. The ethical dilemmas that such cases pose continue to stir great controversy. This in-depth examination of these dilemmas provides information and documentation from many perspectives. The editors have included a foreword by Dr. Jay Wolfson, Terri Schiavo's court-appointed guardian ad litem, as well as Dr. Wolfson's report to Gov. Jeb Bush on the case and Gov. Bush's reply; public statements by President George Bush and Senators David Weldon, Rick Santorum, Tom DeLay, Bill Frist, and Barney Frank; statements by the pope and other representatives of the Catholic Church on this issue; plus much medical and legal background material on both precedents to the Schiavo case and its aftermath, including the results of the autopsy report. For anyone wishing an in-depth understanding of these complex ethical issues, issues many of us will have to confront in our own families, this volume is indispensable.

"Mercy killing," "assisting a suicide," "planning your own death," and "euthanasia" are once again high-profile issues. Recent popular referendums have sought to legalize doctor-assisted suicide, while best-selling books have been published about how to kill yourself. In short, Americans are searching for more control over their own mortality.
Hemlock's Cup is the first history of the active euthanasia movement in America, as represented by its most visible proponent, the Hemlock Society. Donald W. Cox traces the growth of the society from its beginnings as a three-person cause to its current world-wide fame. The work of Derek Humphrey, the society's founder, is reviewed and the publicity surrounding Dr. Jack Kevorkian and his controversial "suicide machine" is discussed.
Cox also addresses the Washington and California initiatives to legalize doctor-assisted suicide and the ethical questions they pose. He reflects on the impact of the Quinlan and Cruzan cases to establish the "right to die" for all Americans and he explores the reasons for the delays in enacting living-will laws in various states. In addition, Cox examines the significant connections among AIDS, abortion, and assisted suicide.

Patricia Rosier died at her home in Fort Myers, Florida, in January of 1986, having sought the help of her prominent physician husband, Peter, to end her cancer-ravaged life with some measure of dignity. By November 1987, Peter had been indicted for first degree murder and faced death in Florida's electric chair. How could it happen? How does a loving husband and father get charged with first degree murder? This compelling true story shows just how easy it is in America's legal system. "Euthanasia" remains a crime in Florida and in most other states, yet the majority of such "criminals" are never prosecuted. But Dr. Rosier was singled out because he "confessed", both in a television interview and in writing, to believing in euthanasia and to assisting his wife's suicide. In Murder of Mercy every heart-pounding moment of Dr. Rosier's legal ordeal is vividly captured by famed trial attorney Stanley M. Rosenblatt, who, together with his wife and law partner, Susan, represented the accused. Describing an intriguing array of legal twists and turns, this riveting book is more than just gripping courtroom drama. Find out why Patricia's father and brothers sought immunity before they would testify. Feel the rush, the exhilaration, of planning defense strategy: How could anyone explain away Dr. Rosier's confessions? Could the Fort Myers judge be persuaded to change the location of the trial? Should Peter Rosier testify in his own defense? The powerful arguments of the State and the defense are laced with ridicule, sarcasm, and scorn: each side accusing the other of treacherous character assassination. Rosenblatt's penetrating assessment of judges, the use of expert witnesses, the exclusion ofrelevant evidence, attorney-client privilege, and the granting of immunity serve as the foundation for a searing critique of America's criminal justice system and the society it is designed to protect.

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.

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."

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?

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.

"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.

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.

Providing a thorough, well-researched investigation of the socio-legal issues surrounding medically assisted death for the past century, this book traces the origins of the controversy and discusses the future of policymaking in this arena domestically and abroad. Should terminally ill adults be allowed to kill themselves with their physician's assistance? While a few American states-as well as Holland, Switzerland, Belgium, and Luxembourg-have answered "yes," in the vast majority of the United States, assisted death remains illegal. This book provides a historical and comparative perspective that not only frames contemporary debates about assisted death and deepens readers' understanding of the issues at stake, but also enables realistic predictions for the likelihood of the future diffusion of legalization to more countries or states-the consequences of which are vast. Spanning a period from 1906 to the present day, Dying with Dignity: A Legal Approach to Assisted Death examines how and why pleas for legalization of "euthanasia" made at the beginning of the 20th century were transmuted into the physician-assisted suicide laws in existence today, in the United States as well as around the world. After an introductory section that discusses the phenomenon of "medicalization" of death, author Giza Lopes, PhD, covers the history of the legal development of "aid-in-dying" in the United States, focusing on case studies from the late 1900s to today, then addresses assisted death in select European nations. The concluding section discusses what the past legal developments and decisions could portend for the future of assisted death. Provides comprehensive, well-researched, and accessible information on a timely and controversial topic Presents a socio-legal explanation rather than a simple description of the emergence and evolution of the legal concepts involved with medically assisted death Offers invaluable historical perspective for academics in the fields of sociology, criminal justice, law, and related disciplines as well as practitioners who deal with end-of-life decision-making and lay readers

This book explores the judicial treatment of suicides in early modern Sweden, with a focus on the criminal investigation and selective treatment of suicides in the lower courts in the seventeenth and early eighteenth centuries. Riikka Miettinen shows that reactions and attitudes towards suicides varied considerably despite harsh condemnation by officials. The indictment, investigation, and classification of suspected suicides and the mental state of a person already deceased were challenging, and depended on local co-operation and lay testimonies. Not all suicides were considered alike; a widespread view on the heinousness of suicide was not the same as agreement about specific cases, and did not result in uniform handling of them. The social status and local ties of the deceased influenced the interpretations and responses at the local lower courts and communities. Esteemed local community members had a better defence and greater chance to escape the shameful penalties.