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

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

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

Quark Orbital Angular Momentum in the Baryon

Analytical and numerical results, for the orbital and spin content carried by different quark flavors in the baryons, are given in the chiral quark model with symmetry breaking. The reduction of the quark spin, due to the spin dilution in the chiral splitting processes, is transferred into the orbital motion of quarks and antiquarks. The orbital angular momentum for each quark flavor in the proton as a function of the partition factor $\kappa$ and the chiral splitting probability $a$ is shown. The cancellation between the spin and orbital contributions in the spin sum rule and in the baryon magnetic moments is discussed.Comment: 26 pages, 3 figures, revised version with minor eq. no and ref. no. corrections. Discussion on the $\Lambda$ spin and a new ref. are adde

Octet, decuplet and antidecuplet magnetic moments in the chiral quark soliton model revisited

We reanalyse the magnetic moments of the baryon octet, decuplet, and antidecuplet within the framework of the chiral quark-soliton model, with SU(3) symmetry breaking taken into account. We consider the contributions of the mixing of higher representations to the magnetic moment operator arising from the SU(3) symmetry breaking. Dynamical parameters of the model are fixed by experimental data for the magnetic moments of the baryon octet and from the masses of the octet, decuplet and of $\Theta^{+}$. The magnetic moment of $\Theta^{+}$ depends rather strongly on the pion-nucleon sigma term and reads $-1.19 {\rm n.m.}$ to $-0.33 {\rm n.m.}$ for $\Sigma_{\pi N} = 45$ and 75 MeV respectively. The recently reported mass of $\Xi^{--}_{\bar{10}}(1862)$ is compatible with $\Sigma_{\pi N} = 73$ MeV. As a byproduct the strange magnetic moment of the nucleon is obtained with a value of $\mu^{(s)}_N =+0.39$ n.m.Comment: RevTeX is used. 12 pages, 3 figures, final version for publication in Phys. Rev.

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

The reaction γp→π∘γ′p\gamma p \to \pi^\circ \gamma^\prime p and the magnetic dipole moment of the Δ+(1232)\Delta^+(1232) resonance

The reaction $\gamma p \to \pi^\circ \gamma^\prime p$ has been measured with the TAPS calorimeter at the Mainz Microtron accelerator facility MAMI for energies between $\sqrt{s}$ = 1221--1331 MeV. Cross sections differential in angle and energy have been determined for all particles in the final state in three bins of the excitation energy. This reaction channel provides access to the magnetic dipole moment of the $\Delta^{+}(1232)$ resonance and, for the first time, a value of $\mu_{\Delta^+} = (2.7_{-1.3}^{+1.0}(stat.) \pm 1.5 (syst.) \pm 3(theo.)) \mu_N$ has been extracted

The Singularity Problem for Space-Times with Torsion

The problem of a rigorous theory of singularities in space-times with torsion is addressed. We define geodesics as curves whose tangent vector moves by parallel transport. This is different from what other authors have done, because their definition of geodesics only involves the Christoffel connection, though studying theories with torsion. We propose a preliminary definition of singularities which is based on timelike or null geodesic incompleteness, even though for theories with torsion the paths of particles are not geodesics. The study of the geodesic equation for cosmological models with torsion shows that the definition has a physical relevance. It can also be motivated, as done in the literature, remarking that the causal structure of a space-time with torsion does not get changed with respect to general relativity. We then prove how to extend Hawking's singularity theorem without causality assumptions to the space-time of the ECSK theory. This is achieved studying the generalized Raychaudhuri equation in the ECSK theory, the conditions for the existence of conjugate points and properties of maximal timelike geodesics. Hawking's theorem can be generalized, provided the torsion tensor obeys some conditions. Thus our result can also be interpreted as a no-singularity theorem if these additional conditions are not satisfied. In other words, it turns out that the occurrence of singularities in closed cosmological models based on the ECSK theory is less generic than in general relativity. Our work is to be compared with previous papers in the literature. There are some relevant differences, because we rely on a different definition of geodesics, we keep the field equations of the ECSK theory in their original form rather than casting them in a form similar to general relativity with a modified energy momentum tensor,Comment: 17 pages, plain-tex, published in Nuovo Cimento B, volume 105, pages 75-90, year 199

Electromagnetic Moments of the Baryon Decuplet

We compute the leading contributions to the magnetic dipole and electric quadrupole moments of the baryon decuplet in chiral perturbation theory. The measured value for the magnetic moment of the $\Omega^-$ is used to determine the local counterterm for the magnetic moments. We compare the chiral perturbation theory predictions for the magnetic moments of the decuplet with those of the baryon octet and find reasonable agreement with the predictions of the large--$N_c$ limit of QCD. The leading contribution to the quadrupole moment of the $\Delta$ and other members of the decuplet comes from one--loop graphs. The pionic contribution is shown to be proportional to $I_z$ (and so will not contribute to the quadrupole moment of $I=0$ nuclei), while the contribution from kaons has both isovector and isoscalar components. The chiral logarithmic enhancement of both pion and kaon loops has a coefficient that vanishes in the $SU(6)$ limit. The third allowed moment, the magnetic octupole, is shown to be dominated by a local counterterm with corrections arising at two loops. We briefly mention the strange counterparts of these moments.Comment: Uses harvmac.tex, 15 pages with 3 PostScript figures packed using uufiles. UCSD/PTH 93-22, QUSTH-93-05, Duke-TH-93-5

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