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\"This book examines the reactions of the friends and family of those who elect to die due to terminal illness. These surviving spouses, partners, relatives, and friends, in addition to coping with the death of a loved one, must also deal with the loved one's decision to die, thus severing the relationship. C. G. Prado examines how reactions to elective death are influenced by cultural influences and beliefs, particularly those related to life, death, and the possibility of an afterlife. Understanding the role of these cultural influences on the grieving processes of survivors is a crucial step in allowing them to accept both intellectually and emotionally the finality of elective death and to deal with the decision of their loved one\"-- Provided by publisher.

The concept of 'unbearable suffering' is central to legislation governing whether euthanasia requests may be granted, but remains insufficiently understood, especially in relation to psychiatric patients. To provide insights into the suffering experiences of psychiatric patients who have made a request for euthanasia. Testimonials from 26 psychiatric patients who requested euthanasia were analysed using QualiCoder software. Five domains of suffering were identified: medical, intrapersonal, interpersonal, societal and existential. Hopelessness was confirmed to be an important contributor. The lengthy process of applying for euthanasia was a cause of suffering and added to experienced hopelessness, whereas encountering physicians who took requests seriously could offer new perspectives on treatment. The development of measurement instruments to assess the nature and extent of suffering as experienced by psychiatric patients could help both patients and physicians to better navigate the complicated and sensitive process of evaluating requests in a humane and competent way. Some correlates of suffering (such as low income) indicate the need for a broad medical, societal and political debate on how to reduce the burden of financial and socioeconomic difficulties and inequalities in order to reduce patients' desire for euthanasia. Euthanasia should never be seen (or used) as a means of resolving societal failures.

\"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\"--Provided by publisher.

Currently, active euthanasia is legalized in only 7 countries worldwide. These countries have encountered problems in its implementation. The study aims to summarize the practical clinical problems in the literature on active euthanasia. A systematic literature review was conducted using 140 works consisting of 130 articles from PubMed and EthxWeb and data from 10 euthanasia laws. After reviewing the specific problems reported to be associated with euthanasia in each country, 5 problems were extracted: many ambiguous conditions with room for interpretation, insufficient assurance of voluntariness, response to requests for euthanasia due to psychological distress, conscientious objection, and noncompliance by medical professionals. Multiple ambiguous conditions that are open to interpretation can result in a \"slippery slope phenomenon.\" An insufficient guarantee of voluntariness violates the principle of respect for autonomy, which is the underlying justification for euthanasia. In cases of euthanasia due to mental anguish, a distinction between a desire for death caused by psychological pain alone prompted by mental illness and a desire for death caused by mental symptoms prompted by physical illness is essential. Conscientious objection should remain an option because of the heavy burden placed on doctors who perform euthanasia. Noncompliance by medical professionals due to ignorance and conflicts regarding euthanasia is contrary to procedural justice.

Chris, a film composer and widower, returns to the Yorkshire Dales to grieve his wife and write his piano sonata. He soon finds himself distracted, though, when he discovers that a murder was committed in his rented house by a woman who was one of the last women hanged in England.

As euthanasia and assisted suicide (EAS) become legal in more countries, conscientious objection (CO) of healthcare professionals is gaining increasing attention. While some argue that CO safeguards professionals' moral integrity, others view it as a barrier to patients' access to desired healthcare. This review provides a comprehensive synthesis of the ethical literature regarding CO to EAS and answers three key questions: What is the meaning of CO and how is it used in EAS? What ethical positions support or challenge it? What underlying presuppositions shape the debate?. We used the PRISMA guidelines, RESERVE standards, and TARCiS statement to conduct a systematic review of argument-based publications retrieved from 13 major databases covering biomedical, philosophical, and theological literature. No date or language restrictions were applied. Titles and abstracts were independently screened by the two authors, and complete articles were selected based on predefined inclusion and exclusion criteria. We identified 58 pertinent articles that were included in our review. Of these, 51 were published in the last decade, from 2015 through 2024. Our findings highlight three key dimensions. First, while there is general agreement on the definition of CO, its interpretation and application in EAS remain highly contested. Second, the ethical debate revolves around three main positions: conscience absolutism, the compromise approach, and the incompatibility thesis. Each of these is supported by distinct ethical arguments. Third, the debate is shaped by several underlying presuppositions, including divergent views on conscience, morality, religion, medicine, and end-of-life care. Our results highlight the risk of polarization in the debate on CO in EAS. It emphasizes the importance of dialogue between theoretical and context-sensitive perspectives to support more effective implementation of CO. Clearer guidelines are needed to balance respect for conscience, patient rights, and professional responsibilities in this complex issue.

This Dutch study is a qualitative interview study. It aims to contribute to our understanding of the day-to-day experiences by providing an idiographic description of what it means existentially to be in the world as a person affected by a form of dementia, taking into account the contextual nature of these embodied experiences. We used a combination of narrative accounts of people from dementia. We first collected 322 recorded messages of 16 diarists who joined the Dutch Dementia Diaries project. This data was supplemented with 37 interview accounts. Our data analysis was inspired by Van Manen's existential phenomenological approach. The findings show that living with dementia-from a first-person perspective-can be understood as a severely unsettling experience: the people concerned enter a very uncertain, unpredictable and ambiguous period of life. They have to face all kinds of losses that considerably change and disrupt their relationships with 1) their own body, 2) with others and 3) with the surrounding world. This experience is explicated in the following themes: 1a) scrutinizing your disrupted body; 1b) trying to control your bodily loss-of-control; 2a) feeling scrutinized by the suspicious gaze of others; 2b) drifting away from significant others; 2c) having difficulties sharing the struggle; 2d) longing to be taken seriously; 2e) engaging in a world of peers; and 3a) sensing disorientation in an alien place; 3b) feeling closed in within a shrinking space; 3c) trying to control a dreaded future; 3d) trying to control a dreaded future by means of euthanasia. Our study demonstrates how the people with dementia are affected by 'the eyes of others'. They longed for a safe and accepting environment, but quite often felt scrutinized by inquisitive and disapproving looks. The outcomes also reveal a connection between dominant social imaginaries and people's self-understanding of dementia. Much of the suffering stems from living under the shadow of negative imaginaries. Furthermore, our study supports the demand for a socio-relational approach by demonstrating that-from a first-person perspective-dementia can be seen a disorder that is related in particular to questions about selfhood, social relations and social roles. For the people involved, instead of what dementia is, the focus is on what Alzheimer's disease means and does and how it affects daily life.

Some have challenged the validity of labelling suicidal thoughts and behaviours (STB) as pathological. In this paper, we argue that STB is indeed pathological, thereby, situating suicide prevention within the realm of medicine, complicating calls for the legalisation of medical assistance in dying for individuals whose sole condition is psychiatric (psychiatric medical assistance in dying (MAID)). Evidence shows STB predicts the risk of suicide; moreover, several mental illnesses are associated with STB, and 70%–90% of suicide deaths are linked to psychiatric illness. Treating psychiatric illnesses can prevent suicide. We contend that this clinical evidence not only warrants the classification of STB as pathological but also necessitates its treatment and prevention. This perspective poses a challenge to legislation that would legalise psychiatric MAID.

Understanding healthcare professionals’ attitudes toward euthanasia, especially within teams assisting patients who request it, is essential for providing appropriate support throughout the process. The objectives of this study were to re-adapt and validate the Attitude Towards Euthanasia Scale for the Spanish context, to examine its dimensional structure, and to estimate its reliability, particularly in light of the 2021 regulation of euthanasia in Spain. A cross-sectional study was conducted with a non-probabilistic sample of 778 healthcare professionals from the Balearic Health Service. Data collection involved a self-reported sociodemographic questionnaire and the Attitude Towards Euthanasia Scale. The scale’s psychometric properties were assessed through reliability and validity tests, including confirmatory factor analysis. The Attitude Towards Euthanasia Scale demonstrated strong reliability, with a Cronbach’s alpha of α = 0.889 and item homogeneity ranging from 0.66 to 0.78. Factor loadings were reported for four models, including a unidimensional model and models with two, three, and four factors. The two-factor model explained 64.51% of the variance, with a Kaiser-Meyer-Olkin (KMO) value of 0.873. Fit indices indicated good model fit: root mean square residual = 0.040, goodness-of-fit index = 0.960, adjusted goodness-of-fit index = 0.927, and root mean square error of approximation = 0.069. After performing a Parallel Analysis, two loading factor were found. The adapted version of the Attitude Towards Euthanasia Scale, aligned with the current societal and legislative context, is a valid and reliable tool for assessing healthcare professionals’ attitudes toward euthanasia, with psychometric properties consistent with the original version.

The debate regarding euthanasia and physician-assisted suicide (E/PAS) raises key issues about the role of the doctor, and the professional, ethical, and clinical dimensions of the doctor-patient relationship. This review aimed to examine the published evidence regarding the response of doctors who have participated in E/PAS. Original research papers were identified reporting either qualitative or qualitative data published in peer-reviewed literature between 1980 and March 2018, with a specific focus on the impact on, or response from, physicians to their participation in E/PAS. PRISMA and CASP guidelines were followed. Nine relevant papers met selection criteria. Given the limited published data, a descriptive synthesis of quantitative and qualitative findings was performed. Quantitative surveys were limited in scope but identified a mixed set of responses. Where studies measured psychological impact, 30-50% of doctors described emotional burden or discomfort about participation, while findings also identified a comfort or satisfaction in believing the request of the patient was met. Significant, ongoing adverse personal impact was reported between 15% to 20%. A minority of doctors sought personal support, generally from family or friends, rather than colleagues. The themes identified from the qualitative studies were summarized as: 1) coping with a request; 2) understanding the patient; 3) the doctor's role and agency in the death of a patient; 4) the personal impact on the doctor; and 5) professional guidance and support. Participation in E/PAS can have a significant emotional impact on participating clinicians. For some doctors, participation can contrast with perception of professional roles, responsibilities, and personal expectations. Despite the importance of this issue to medical practice, this is a largely neglected area of empirical research. The limited studies to date highlight the need to address the responses and impact on clinicians, and the support for clinicians as they navigate this challenging area.