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Critics of medical aid in dying (MAID) often argue that it is impermissible because background social conditions are insufficiently good for some persons who would utilize it. I provide a critical evaluation of this view. I suggest that receiving MAID is a sort of “hard choice,” in that death is prima facie bad for the individual and only promotes that person’s interests in special circumstances. Those raising this objection to MAID are, I argue, concerned primarily about the effects of injustice on hard choices. I show, however, that MAID and other hard choices are not always invalidated by injustice and that what matters is whether the injustice can be remediated given certain constraints. Injustice invalidates a hard choice when it can, reasonably, be remedied in a way that makes a person’s life go better. I consider the implications of this view for law and policy regarding MAID.
In 2015, the Canadian Supreme Court declared that an absolute Criminal Code prohibition on assisted suicide and euthanasia was unconstitutional. In response, the Canadian parliament enacted Bill C-14 in 2016 permitting assisted suicide and euthanasia for the end-of-life context, which it termed “Medical Assistance in Dying” (MAiD). In 2021, Bill C-7 expanded eligibility for MAiD to those with disabilities not approaching their natural death. By 2021, MAiD accounted for 3.3% of all deaths in Canada with some areas of Canada presently reporting MAiD death rates upward of 7%. In 2021, Canada had 10,064 deaths by MAiD, surpassing all jurisdictions for yearly reported assisted deaths.
To examine the impact of the Canadian MAiD program and analyze its safeguards.
A working group of physicians from diverse practice backgrounds and a legal expert, several with bioethics expertise, reviewed Canadian MAiD data and case reports. Grey literature was also considered, including fact-checked and reliable Canadian mainstream newspapers and parliamentary committee hearings considering the expansion of MAiD.
Several scientific studies and reviews, provincial and correctional system authorities have identified issues with MAiD practice. As well, there is a growing accumulation of narrative accounts detailing people getting MAiD due to suffering associated with a lack of access to medical, disability, and social support.
Significance of results
The Canadian MAiD regime is lacking the safeguards, data collection, and oversight necessary to protect Canadians against premature death. The authors have identified these policy gaps and used MAiD cases to illustrate these findings.
This chapter is concerned with the ethics of keeping animals in zoos. It examines the ethical problems of keeping animals in captivity with particular reference to the ethics of keeping elephants in zoos. Public attitudes towards various aspects of zoos are examined, including attitudes towards dissection, live feeding, euthanasia and the culling of healthy animals. Animal sentience is also discussed, particularly in relation to the inclusion of some invertebrates in this concept.
Euthanasia review committees (Regionale Toetsingscommissies Euthanasie, RTE) scrutinise all Dutch cases of euthanasia and physician-assisted suicide (EAS) to review whether six legal ‘due care’ criteria are met, including ‘unbearable suffering without prospect of improvement’. There are significant complexities and ethical dilemmas if EAS requests are made by people with intellectual disabilities or autism spectrum disorders (ASD).
To describe the characteristics and circumstances of people with intellectual disabilities and/or ASD who were granted their EAS request; investigate the main causes of suffering that led to the EAS request; and examine physicians’ response to the request.
The online RTE database of 927 EAS case reports (2012–2021) was searched for patients with intellectual disabilities and/or ASD (n = 39). Inductive thematic content analysis was performed on these case reports, using the framework method.
Factors directly associated with intellectual disability and/or ASD were the sole cause of suffering described in 21% of cases and a major contributing factor in a further 42% of cases. Reasons for the EAS request included social isolation and loneliness (77%), lack of resilience or coping strategies (56%), lack of flexibility (rigid thinking or difficulty adapting to change) (44%) and oversensitivity to stimuli (26%). In one-third of cases, physicians noted there was ‘no prospect of improvement’ as ASD and intellectual disability are not treatable.
Examination of societal support for suffering associated with lifelong disability, and debates around the acceptability of these factors as reasons for granting EAS, are of international importance.
A diverse research literature now exists on the animals, staff and organisations involved in animal sheltering. We reviewed this research through the lens of institutional ethnography, a method of inquiry that focuses on the actual work that people do within institutions. The main topics, identified through a larger ethnographic study of animal sheltering, were: (i) research about shelter staff and officers; (ii) the relinquishment of animals to shelters; and (iii) animals’ length of stay in shelters. After reviewing the literature, we held focus groups with shelter personnel to explore how their work experiences are or are not represented in the research. The review showed that stress caused by performing euthanasia has attracted much research, but the decision-making that leads to euthanasia, which may involve multiple staff and potential conflict, has received little attention. Research on ‘compassion fatigue’ has also tended to focus on euthanasia but a granular description about the practical and emotional work that personnel undertake that generates such fatigue is missing. Published research on both relinquishment and length of stay is dominated by metrics (questionnaires) and often relies upon shelter records, despite their limitations. Less research has examined the actual work processes involved in managing relinquishment as well as monitoring and reducing animals’ length of stay. Institutional ethnography’s focus on people’s work activities can provide a different and more nuanced understanding of what is happening in animal sheltering and how it might better serve the needs of the animals and staff.
It is often argued by health professionals working within the field of palliative care that palliative care and euthanasia/assisted suicide are incompatible. Across the literature, this claim is grounded on the three claims that (1) palliative care and euthanasia/assisted suicide have different aims, (2) euthanasia/assisted suicide is at odds with the doctor’s fundamental role as a healer, and (3) euthanasia/assisted suicide constitutes patient abandonment. Furthermore, even if palliative care and euthanasia/assisted suicide are compatible, it is often argued that the availability of palliative care renders euthanasia/assisted suicide redundant. This depends on two claims that (1) palliative care is always available and effective, and (2) palliative care is always preferable to euthanasia/assisted suicide. This article argues that all of these claims are false, ultimately aiming to establish that palliative care and euthanasia/assisted suicide are complementary rather than mutually exclusive.
Issues relating to life and death go to the heart of human experience and the value we place on our own existence and that of others, especially in those relationships we care about most. This is no doubt because we are mortal and we know we are all going to die at some point in time. Our mortality makes us fundamentally vulnerable. This book has considered ethics in the context of human vulnerability. We are vulnerable because we can be affected by things across the lifespan, and we can be affected by things because we are physical beings – part of the world around us and subject to the passage of time. Consequently, a life can come to an end at any time. For this reason, death is not only completely normal, but inevitable. Nevertheless, death is typically regarded as something regrettable. As philosopher Bernard Williams notes, our experience of being alive is essentially of having an open-ended and indeterminate future. From this perspective, death is ‘an abrupt cancellation of indefinitely extensive possible goods’ (Nagel 1979: 9–10).
Controlled atmosphere (gas) stunning (CAS) has the potential to improve the welfare of poultry at slaughter but there is a lack of consensus about which gas mixtures are most humane. The aim of this study was to evaluate the welfare consequences of different gas stunning approaches. Individual broilers were exposed to gas mixtures capable of inducing unconsciousness and euthanasia while their behavioural, cardiac, respiratory and neurophysiological responses were measured simultaneously. The approaches investigated included anoxia (N2 or Ar with < 2% residual O2), hypercapnic anoxia (30% CO2 in Ar, 40% CO2 in N2) and a biphasic method (40% CO2, 30% O2, 30% N2 for 60 s followed by 80% CO2 in air). Evaluation of the welfare implications of each approach centred on the likelihood of them inducing negative states or experiences during the conscious phase. Hypercapnic mixtures were associated with strong respiratory responses, while anoxic mixtures induced vigorous wing flapping. Electroencephalogram analysis using the correlation dimension (a non-linear measure of complexity) suggested that anoxic wing flapping occurred during periods in which a form of consciousness could not be excluded. Hypercapnic hyperoxygenation (biphasic approach) exacerbated respiratory responses but eliminated the possibility of vigorous behavioural responses occurring during a conscious phase. The relative importance of respiratory discomfort versus the potential to induce significant distress due to convulsive wing flapping and associated trauma is a matter for debate. We argue that respiratory discomfort is unpleasant but may be preferable to the risk of vigorous wing flapping and associated injury while conscious in poultry during CAS.
Finding a responsible method of population control that does not compromise animal welfare is a pressing problem for zoological institutions and conservation breeding programmes. This is exemplified by the conservation breeding programme of the golden-headed lion tamarin, Leontopithecus chrysomelas. The number of golden-headed lion tamarins in captivity is currently being limited by, among other means, the use of contraception. We have conducted a study on the effects of contraceptive methods used in golden-headed lion tamarins. Data were collected through the distribution of a survey. The use of Melengestrol acetate (MGA) implants in females was by far the most widespread contraceptive method. It was very effective in preventing reproduction, provided that females were not pregnant at the time of implantation. Pregnancies that had commenced before MGA implantation were carried to term and resulted in viable infants, as far as noted. However, the degree of reversibility was very low and, if females did conceive after MGA implantation, infant survival was lower than expected. The widespread use of MGA implants in golden-headed lion tamarins (and probably other species) should be seriously reconsidered. Alternative methods of population control should be investigated. Possible options include the use of other contraceptive methods, limiting the number of offspring through natural factors and the use of euthanasia under very strict conditions. Animal welfare implications associated with the use of euthanasia are discussed.
This pilot experiment was conducted to ascertain whether CO2-enriched high expansion foam could be an acceptable and efficient alternative in emergency killing of poultry. This method could have wide-ranging applications but with particular emphasis on small (backyard) flocks, free-range sheds or open (naturally-ventilated) housings. The objectives of the study were as follows: 1) to determine whether the injection of foam and being covered with foam leads to fear or panic reactions in birds; 2) to determine the time taken to render birds unconscious and dead and 3) to determine whether any pathological abnormalities are observed post mortem. Six laying hens were individually exposed to increasing levels of CO2 foam with an expansion rate of 300:1. The test box containing individual birds filled with foam within 30 s. During foaming, two out of six birds tried to escape from the test box (1–2 attempts per bird). Apart from displaying greater alertness, birds showed no aversive reactions to the CO2 foam. Twenty-to-thirty seconds after being covered with foam, five of the six birds demonstrated one or two forcable or convulsive movements. Movement patterns and muscle jerks immediately following this convulsive movement led us to believe that birds lost consciousness at this moment and, within approximately three minutes, all birds had ceased to have a heartbeat. Macroscopic post mortem examination of the birds revealed no abnormalities and microscopic examination showed moderate bronchiolar bleeding and a small amount of alveolar bleeding. After assessing behavioural parameters, measurements of heart rate and pathological data, it is our conclusion that CO2 foam has the potential to be an acceptable method of killing poultry. It is advisable for this method to be examined on a larger scale in order to assess the implications of physiological (EEG and ECG) measurements on welfare.
The distress experienced by animals during the induction of unconsciousness remains one of the most important and yet overlooked aspects of effective methods of anaesthesia and euthanasia. Here we show that considerable differences exist in the aversive responses elicited by 12 common methods of inhalational anaesthesia and euthanasia in laboratory rats and mice. Carbon dioxide, either alone or in combination with oxygen or argon, was found to be highly aversive to both species. The least aversive agents were halothane in rats and enflurane in mice. Exposing these animals to carbon dioxide in any form, either for anaesthesia or for euthanasia, is likely to cause considerable pain and distress and is therefore unacceptable when efficient and more humane alternatives are readily available.
Modern zoos are increasingly successful in maintaining and breeding exotic species. Many of the animals bred in captivity cannot be housed in their natal zoo nor in other recognized zoos in the region. These ‘surplus ‘ animals create a problem as zoos only have limited space at their disposal. The options open in this situation are to avoid the problem by preventing the animals from breeding (sterilization or contraception) or to dispose of the surplus animals (euthanasia; or transfer either to institutions not recognized by any national zoo federation or to a zoo outside the region, possibly using the services of an animal dealer). The pros and cons of all these options are evaluated in terms of practicality, welfare and ethics. In many cases, the judicious use of a combination of contraception and euthanasia would seem the most acceptable choice from an animal welfare point of view. Nevertheless, it is believed that considerably more research is needed into the methods and welfare aspects of contraception and sterilization.
Electrocution of an animal is inhumane if it is not rendered instantaneously insensible by the application of sufficient current density within vital centres of the brain. Application of electric current which does not achieve this, is likely to cause severe pain. The humane aspects of electrical lancing have aroused widespread concern and debate.
For an electrically lanced whale of the size of those currently hunted, previous research has indicated that the current densities produced in the heart and brain are unlikely to reliably render the animal insensible or stop its heart. This study supports these findings and demonstrates that the presence of salt water/immersion may further reduce current densities. Evidence for the failure of the electric lance includes the necessity for multiple and prolonged applications of electric current.
Reasons for the failure of the electric lance include non-optimal current injection sites, insufficient current injected, the presence of salt water, and the trauma caused by the explosive harpoon. The efficacy of the electric lance may be falsely exaggerated for reasons associated with blood loss and misdiagnosis of death. All evidence clearly indicates that attempts to stop the heart by electrocution will cause severe pain to an already traumatized animal.
We suggest that the use of the electric lance is clearly inhumane, and are pleased to announce that its use in Japanese whaling operations was reportedly discontinued as from 1997.
High concentrations of carbon dioxide (CO2), used for killing laboratory rodents, are known to be more strongly aversive to rats than sweet food items are attractive. This study investigated whether the maintenance of a high oxygen (O2) concentration, using a gas mixture of 70% CO2 and 30% O2, would reduce aversion to CO2 during a gradual-fill procedure. Eight male Wistar rats, aged 10 months, were housed individually in an apparatus consisting of two cages, one higher than the other and joined by a tube. In a series of trials, subjects entered the lower cage for a reward of 20 sweet food items. The gas was turned on at the moment the rat started eating the reward items and flowed into the lower cage at a fixed rate. There were four treatments: 1) 100% CO2 at 14.5% cage volume min–1; 2) gas mixture at 14.5% min–1; 3) gas mixture at 21.0% min–1, which delivered CO2 at approximately 14.5% min–1 and 4) air, with each subject tested with each treatment four times. Measures of willingness to stay and eat in the lower cage (latency to stop eating, latency to leave and the number of reward items eaten) were much lower in all three gas treatments than in air, indicating that the CO2 and the CO2 + O2 mixture were both more strongly aversive than sweet food items were attractive. Comparing the gas mixture with 100% CO2, the latency to leave and the number of reward items eaten were slightly higher in the CO2 + O2 mixture at 21% min–1 than in CO2 at 14.5% min–1, indicating that the addition of O2 slightly reduced the aversiveness of CO2 in the gradual-fill procedure. This reduction is not enough to warrant recommending the use of CO2 + O2 mixtures for killing rats.
In many situations choices must be made that will have an impact on the welfare of companion animals. Often one of the options will be to euthanase the animal in question. The way in which one views this option will depend not only on one's assessment of the quality of the animal's life (or the lives of other affected parties), but also on how one values an animal life as such. Clearly, a companion animal may be valued by a human being or by another animal. A dog's death may affect its owner's quality of life (QoL), or it may affect the QoL of other animals in the household. But does the life of an animal have any value other than that? Is anything lost, for example, when a dog that lived with a sole owner, now deceased, is euthanased? Conversely, would anything be gained if the dog were re-homed (apart from the potentially positive contribution to the new owners' QoL)? More generally, in prolonging, or refraining from ending, the life of an animal, is it thereby ensured that something of value persists? There seem to be three main views on this matter. The first is that animal life has no value in itself. The second is that animal life has value to the extent that the life in question is worth living for the animal. The third view is that the life of an animal has a value that exceeds what is ‘in it’ for the animal in question. The view one accepts here will have a dramatic impact on one's attitude to many of the choices to be made about the treatment of companion animals — choices in which one must balance quality of life against, as it were, quantity of life. So the heart of the matter is not only quality of life. It is also value of life. Unfortunately it may prove much more difficult to agree about the value of animal life than it is to agree about the significance of animal welfare.
Our view of which individuals should be the subjects of our moral actions is expanding to include more people and more species. Animal welfare is the subject of rapidly increasing concern in most countries in the world, and this concern is resulting in changes in the ways in which animal users keep and treat animals. Ethical decisions about whether the killing of an animal is justifiable should be considered separately from those about how poor welfare can be and still be acceptable. The term ‘euthanasia’ should be restricted to killing an animal for its own benefit. Quality of life (QoL) in humans is generally taken to include: physical condition and any impairment of this resulting from injury or disease; capacity to function; perception of functioning; and satisfaction with functioning in relation to what is believed possible. If the welfare of an individual is its state as regards its attempts to cope with its environment, then welfare is essentially the same as QoL. Both include the state of the individual's coping systems, including those responding to pathology, various behavioural and physiological responses, and cognitive processes associated with suffering or pleasure. Hence, both welfare and QoL include health and the extent of positive and negative feelings. Many papers referring to animal welfare include objective quantification whilst few papers referring to QoL do so. Some human studies assess QoL by the less objective method of questions asked of subjects. Neither QoL nor welfare should be assessed using solely subjective measures. Assessment of welfare must take account of the wide variety of coping systems and coping strategies used. A range of measures including those of behaviour, physiology, brain function, immune system function, and damage is needed. The ease or difficulty of coping should be interpreted within the framework of the abilities of the animal. Animals with more sophisticated cognitive functioning may have the best abilities to cope with problems. The scheme presented here for assessing welfare over time facilitates ethical decisions regarding whether welfare is good or whether it is unacceptably poor.
The decision to perform euthanasia in geriatric zoo mammals is usually a highly complex procedure involving ethical, medical, emotional and sometimes political factors. However, subsequent necropsies show that the pathological changes of organs and/or the musculoskeletal system are often already advanced. Therefore, we hypothesise that euthanasia is often delayed to the detriment of the animal's welfare. The purpose of this study was to facilitate and establish an initial, objective, decision-making framework for the euthanasia of geriatric zoo mammals. A scoring-system to assess the physical condition and quality of life in ageing zoo mammals is presented, based on retrospective and prospective investigation of 70 geriatric zoo mammals in five European zoos. Medical records and necropsy reports were studied in retrospective cases. Symptoms were monitored and recorded in prospective cases. Radiographic investigations under general anesthesia or at necropsy were performed additionally. A significant association between symptoms and pathological findings revealed that 36.9% (n = 24/65) of examined animals (n = 41/65) had pathological alterations to the musculoskeletal system and 26.2% (n = 17/65) suffered from neoplasia. Based on the individual reports, 28 veterinarians from different fields of veterinary medicine concluded that these animals had mild to severe pain, discomfort and a significantly reduced quality of life, thus strongly reducing welfare. The proposed scoring system includes all of these factors and offers a simple and reliable tool to support decision-making for euthanasia in geriatric zoo mammals.
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.
Significance of results
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.
Currently recommended landmarks for captive-bolt euthanasia of cattle often result in failure to penetrate the brainstem. The purpose of this study was to evaluate the ability to disrupt the brainstem by placing the shot at a higher position on the head. Intact heads from euthanased animals or natural mortalities were used for this study. Heads were grouped as adult (> 2 years), young (6-24 months) and neonate (< 1 month) and randomly assigned to either the LOW group (the intersection of two lines drawn from the medial canthus to the top of the opposite ear) or the HIGH group (midline halfway between the top of the poll and an imaginary line connecting each lateral canthus). Each head received a single shot from a CASH penetrating captive bolt with bolt length and power load selected based on manufacturer's recommendations. Computed tomography images of each head were evaluated independently by two veterinary radiologists. Brainstem disruption was assumed to occur if the bolt passed caudal to the presphenoid bone and deep to the third ventricle and was within 1.5 cm of midline. Brainstem disruption occurred in 16/18 adult HIGH and 7/14 adult LOW heads, 13/16 young HIGH and 11/19 young LOW heads, and 11/11 neonate HIGH and 14/14 neonate LOW heads. The higher shot location landmarks used in this study increased the probability of disrupting the brainstem when adult cattle were shot with a penetrating captive bolt which should reduce the risk of regaining sensibility. Reliable brainstem disruption is a precondition for considering penetrating captive bolt as a single-step euthanasia method. Further research is needed to determine if this method will reliably ensure a humane death.