
Contents
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Introduction: definition of ‘euthanasia’ Introduction: definition of ‘euthanasia’
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Medicalized killing without request Medicalized killing without request
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Assisted dying in practice Assisted dying in practice
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Frequency Frequency
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Age groups Age groups
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Cancer predominant Cancer predominant
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Relevance for palliative care Relevance for palliative care
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Why patients request assisted death Why patients request assisted death
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What is a ‘request’? What is a ‘request’?
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How should palliative care deal with requests for assisted dying? How should palliative care deal with requests for assisted dying?
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The negative approach The negative approach
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The World Health Organization stance The World Health Organization stance
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Belgium: offering euthanasia in a palliative care setting Belgium: offering euthanasia in a palliative care setting
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‘Palliative care and euthanasia are neither alternatives nor opposites’ ‘Palliative care and euthanasia are neither alternatives nor opposites’
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Suffering that ‘cannot be alleviated’ Suffering that ‘cannot be alleviated’
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Refractory symptoms Refractory symptoms
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Scope of suffering Scope of suffering
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No ‘reasonable’ alternative to euthanasia No ‘reasonable’ alternative to euthanasia
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‘Medical futility’ and the legal requirements of assisted dying ‘Medical futility’ and the legal requirements of assisted dying
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Concept of futility Concept of futility
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Criterion of medically ‘futile’ or ‘hopeless’ condition Criterion of medically ‘futile’ or ‘hopeless’ condition
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‘No prospect of improvement’ ‘No prospect of improvement’
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‘Unbearable’ suffering ‘Unbearable’ suffering
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No requirement of limited life expectancy No requirement of limited life expectancy
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Requirement of ‘terminal’ illness Requirement of ‘terminal’ illness
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PAS versus euthanasia PAS versus euthanasia
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The idea of ‘palliative futility’ The idea of ‘palliative futility’
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A basic challenge for palliative care, and the model of ‘integral’ palliative care A basic challenge for palliative care, and the model of ‘integral’ palliative care
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The Swiss model of assisted suicide The Swiss model of assisted suicide
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Role of the doctor Role of the doctor
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Role of right-to-die organizations Role of right-to-die organizations
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‘Suicide tourism’ ‘Suicide tourism’
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De-medicalizing assisted suicide De-medicalizing assisted suicide
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Statements on assisted dying by some palliative care organizations Statements on assisted dying by some palliative care organizations
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The future: palliative care on the ‘slippery slope’ towards euthanasia? The future: palliative care on the ‘slippery slope’ towards euthanasia?
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Impact of new legislation Impact of new legislation
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Concluding remarks Concluding remarks
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Acknowledgement Acknowledgement
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References References
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5.7 Euthanasia and palliative care
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Published:March 2015
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Abstract
This chapter focuses on the particular relationship and interconnections between euthanasia and palliative care. Selected key data on assisted dying are presented. Of central importance is the question of how requests for assisted dying should be handled within palliative care, and as part of addressing this question the chapter includes a discussion of the practice in Belgium, where euthanasia is performed within palliative care institutions. Furthermore, the chapter presents the Swiss model, which practises a much clearer separation between assisted dying and both palliative care and clinical medical practice. Statements on assisted dying made by key palliative care organizations are then presented and analysed. The chapter asks whether the palliative care community will be more accepting of euthanasia in the future, following potential new legislation. The concluding remarks consider the current reluctance of doctors to participate, and the pressures they are under to accept a role, in assisted dying.
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