A role for doctors in assisted dying? An analysis of legal regulations and medical professional positions in six European countries

An extensive debate about assisted suicide and euthanasia has been taking place in westernized countries during the last twenty years. Traditionally, the medical profession has maintained a clear distance from euthanasia and assisted suicide, but this distance can no longer be justified by simply referring to the law. This paper analyses the legal and, in particular, medical professional positions with respect to the doctor’s role in assisted dying in certain Western European countries (Belgium, Germany, Netherlands, Norway, Switzerland, United Kingdom) and discusses their implications for doctors

Medizinische Entscheidungen am Lebensende und Beihilfe zum Suizid

Medizinische Entscheidungen am Lebensende mit der Konsequenz einer möglichen Beschleunigung des Todeseintritts des Patienten können eingeteilt werden wie folgt: Behandlungsverzicht und -abbruch (passive Sterbehilfe), Opiate und Sedativa am Lebensende (indirekte Sterbehilfe, inklusive die sogenannte terminale Sedierung), Beihilfe zum Suizid, sowie die in jedem Fall verbotene aktive Sterbehilfe. Bei der passiven und indirekten Sterbehilfe ist der Wille des urteilsfähigen respektive der mutmaßliche Wille des nicht urteilsfähigen Patienten zentral. Beihilfe zum Suizid ist gemäß Schweizer Strafrecht dann nicht illegal, wenn auf Seiten des Sterbehelfers keine eigennützigen Motive vorliegen und die sterbewillige Person urteilsfähig ist. Für sich an einer Beihilfe beteiligende Ärzte gelten zudem spezifisch ärztliche Sorgfaltspflichten. Diese sind kürzlich durch einen Bundesgerichtsentscheid klarer definiert worden

Content of health status reports of people seeking assisted suicide: a qualitative analysis

Erworben im Rahmen der Schweizer Nationallizenzen (http://www.nationallizenzen.ch)Two right-to-die organisations offer assisted suicide in Switzerland. The specific legal situation allows assistance to Swiss and foreign citizens. Both organisations require a report of the person's health status before considering assistance. This qualitative study explored these reports filed to legal authorities after the deaths of individuals in the area of Zurich. Health status reports in the legal medical dossiers of the deceased were analysed using content analysis and Grounded Theory. From 421 cases of assisted suicide (2001-2004), 350 reports on health status were filed. Many cases contained diagnosis lists only. Other reports had more elaborate reports revealing that some physicians were aware about the patient's death wish and the intention to solicit assisted suicide. Physicians' attitudes ranged from neutral to rather depreciative. Few physicians openly referred the patient to the organisations and supported the patient's request by highlighting a history of suffering as well as reporting understanding and agreement with the patient's wish to hasten death. In the health status reports five categories could be identified. Some files revealed that physicians were aware of the death wish. The knowledge and recognition of the patient's death wish varied from no apparent awareness to strongly supportive. This variety might be due to difficulties to discuss the death wish with patients, but might also reflect the challenge to avoid legal prosecution in the country of origin. To require comparable health status reports as requirements for the right-to-die organisations might be difficult to pursue

Restoration Of Dual-Frequency Signals With Nonlinear Propagation In Fibers With Positive Group-Velocity Dispersion

It is shown experimentally and theoretically that a sinusoidally modulated pulse evolves with time into a train of dark soliton-like pulses and then returns to its initial sinusoidal shape on propagation through a nonlinear single-mode fiber with positive group velocity dispersion. The experimental results are in agreement with predictions from the nonlinear Schrodinger equation

Magnetic moments of the 3/2 resonances and their quark spin structure

We discuss magnetic moments of the $J=3/2$ baryons based on an earlier model for the baryon magnetic moments, allowing for flavor symmetry breaking in the quark magnetic moments as well as a general quark spin structure. From our earlier analysis of the nucleon-hyperon magnetic moments and the measured values of the magnetic moments of $\Delta^{++}$ and $\Omega^{-}$ we predict the other magnetic moments and deduce the spin structure of the resonance particles. We find from experiment that the total spin polarization of the decuplet baryons, $\Delta\Sigma(3/2)$, is considerably smaller than the non-relativistic quark model value of 3, although the data is still not good enough to give a precise determination.Comment: 13 pages, REVTeX, 2 figures, minor clarifying change

Characterization of fecal nitrogen forms produced by a sheep fed with 15N labeled ryegrass

Little is known about nitrogen (N) forms in ruminant feces, although this information is important to understand N dynamics in agro-ecosystems. We fed 15N labeled ryegrass hay to a sheep and collected 15N labeled feces. Nitrogen forms in the feces were characterized by chemical extractions, solid-state cross polarization 15N nuclear magnetic resonance spectroscopy (SS CP/MAS 15N NMR) and Curie-point pyrolysis-gas chromatography/mass spectrometry (Cp Py-GC/MS). A 4months incubation experiment was conducted to assess N release from the feces. Half of the fecal N could be ascribed to bacterial and endogenous debris and a third to undigested dietary N. About a tenth of the fecal N was mineralized during the incubation experiment. The 15N abundance of nitrate released during the incubation remained constant and close to the 15N abundance of the total feces N. The NMR analysis of the feces showed that most of the N was present in proteins, while some was present as heterocyclic N, amino acids and ammonium. The Cp Py-GC/MS analysis confirmed the presence of proteins, amino acids and heterocyclic N in the feces. Comparing these results to those obtained from the 15N labeled hay suggests that some N compounds present in the plant were not digested by the animal, and that the animal excreted de novo synthesized N compounds. The low content in ammonium and amino acids, the low rate of N release from these feces during the incubation and the relatively high fecal protein content, particularly the hard to mineralize undigested and microbially bound forms, can explain the low transfer of N from these feces to crops observed in a previous wor

Reasons why people in Switzerland seek assisted suicide : the view of patients and physicians

Background: Assisted suicide is permitted in Switzerland provided that assistance is not motivated by selfish reasons. Suicides are commonly performed with the assistance of right-to-die organisations and the use of a lethal dose of barbiturates prescribed by a participating physician. We examined the reasons physicians provided for writing the prescription and the reasons patients gave for requesting assistance in dying. Methods: We analysed all reported cases of assisted suicide that were facilitated by right-to-die organisations between 2001 and 2004 in the city of Zurich, and for which both the medical report and the optional letter written by the decedent providing information on their reasons for seeking assistance in suicide (N = 165). Results: The reasons most often reported by physicians (ph), as well as persons who sought help (p), were: pain (ph: 56% of all assisted suicides, p: 58%), need for long-term care (ph: 37%, p: 39%), neurological symptoms (ph: 35%, p: 32%), immobility (ph: 23%, p: 30%) and dyspnoea (ph: 23%, p: 23%). Control of circumstances over death (ph: 12%, p: 39%); loss of dignity (ph: 6%, p: 38%); weakness (ph: 13%, p: 26%); less able to engage in activities that make life enjoyable (ph: 6%, p: 18%); and insomnia and loss of concentration (ph: 4%, p: 13%) were significantly more often mentioned by decedents than by physicians. Conclusions: Both prescribing physicians and;patients provided with assistance to die quite often mentioned pain and other concerns, many of which were objectively assessable and related to unbearable suffering or unreasonable disability. Concerns referable to autonomy and individual judgement were more often noted by people seeking help than by the prescribing physicians