Search

The subject of euthanasia has generated many controversial debates, particularly on its legality. This has been primarily due to the doctrine of sanctity of life which is a predominant principle in many religions and is embedded in moral values. The underlying precept is that human life is sacred and demands respect, as all life comes from God and life can only be taken away intentionally through due process of law. Thus, ending a person's life, even upon his or her request, is considered in many jurisdictions as a criminal offence. Irrespective of humanitarian motives, a doctor who aids a patient in this act will be in breach of his unequivocal duty as a doctor and considered to have committed an unlawful act, which will subject him to legal sanctions. Countries such as the United Kingdom, Australia, New Zealand and Turkey have explicit legal provisions banning, in particular, active euthanasia, while countries such as the Netherlands, Belgium, Switzerland and certain states in the U.S have taken positive steps to legalise euthanasia in certain aspects. The ethical codes and laws in Malaysia have yet to develop to the fullest extent in dealing with these issues. Although Malaysian statutory legislation contains provisions banning active euthanasia, the legal position on passive euthanasia remains implicit. In the absence of indicative legal provisions and judicial precedents governing certain matters arising, it has been the practice of the Malaysian courts to refer to relevant legal principles inherent in English cases. As Islam is proclaimed as the country's official religion, the Islamic perspective is also an important and influential factor in the development of the legal framework in Malaysia as a whole. Thus, there is a need for the existence of a clear and comprehensive regulatory framework governing the legality of euthanasia in Malaysia.

I will problematize medical performances at the end of life, confronting them with the responses of Portuguese Criminal Law. By starting from a review of literature, both in Portugal and abroad, I will cross the criminal doctrine with a broader, interdisciplinary approach, including the reconsideration of medicine ethical tradition (notably the Hippocratic Writings) and the present developments in neurosciences. The frame of homeostasis (neurobiology of emotions) by Damisio, with compassion in the top, helps to clarify to which extent medical act according to legesart is becomes the centre of the problem. Indeed, it is within the medical act, understood as the meeting of two autonomies--patient's and doctor's autonomies--that the compassion takes place as a result of the agreement/compromise between the patient's will of ceasing her/his life in a situation of unbearable suffering and the doctor's duty to relieve that suffering. Compassion arises here as a "homeostasis instrument", that is, an emotion which is important in the regulation of life, even when we are speaking about end(ing) of life. This new perspective allows us to guess a shift of paradigm on the ethical and social levels. On the other hand, in so far as we have passed from the compassionate response in medical setting to its discussion, successively, in medical ethics, in the courts, and as a normative instrument, I claim that we are before the "transition from an automatic homeostasis to a deliberate homeostasis" (Damisio). Therefore, 1 seek for a balance between the spontaneous and the planned, concerning the issue of praxis. Indeed, what increasingly happens in medical praxis should be brought together with theory, whereby medical law has a word to say.

There is unanimity among states to protect the continuation of life of the individual as a safeguard against their collective extinction. The right to life is accordingly guaranteed but its antithesis, the right to die is the subject of an unending debate. The controversy over the right to die is deepened by rapid advances in medicine, creating the capability for prolongation of life beyond the span which one's natural strength can endure. Ghana's supreme law explicitly guarantees the right to life but remains ambiguous on right to die, particularly euthanasia and assisted dying. Thus, some of the other rights, such as the right to dignity and not to be tortured, can creatively be exploited to justify some instances of euthanasia. Ghana's criminal code largely proscribes euthanasia. Notwithstanding, proscription of euthanasia and assisted dying by the law, in Ghana's empirical work undertaken in some of the communities in Ghana, suggests that euthanasia is quietly practisedin health facilities and private homes, especially in the rural areas. Contrary to the popular reasons assigned in the literature of the Western world, with respect to the practice or quest for legalization of euthanasia as being a necessity for providing relief from pain or hopeless quality of life, empirical data from social and anthropological studies conducted in Ghana reveal that poverty is the motivation for informal euthanasia practice in Ghana rather than genuine desire on part of patients to die or their relatives to see to their accelerated death. Apart from poverty, traditional cultural values of African societies consider non-natural death as a taboo and ignominy to the victim and his family. Thus, any move by the government to legalize euthanasia will need to be informed by widely held consultations and a possible referendum; otherwise the law may be just a mere transplant of Western models of legislation on euthanasia without reflecting the ethos of the African people.

There are currently high profile debates about legal and ethical aspects of end of life care and treatment in the U.K. and Brazil. Unlike some other jurisdictions, neither country has legalised assisted dying or euthanasia. We argue that it is timely to consider the issues from the perspectives of an evolving concept in bioethics, that of solidarity.

This article seeks to outline the law relating to euthanasia and assisted-suicide in New Zealand, and to critically examine whether there are any practical justifications for retaining the current prohibition. The paper initially discusses terminology, then what is and what is not permissible in New Zealand under the present legal regime. The paper then very briefly reviews the other jurisdictions which have euthanasia or assisted-suicide laws. Finally, the paper looks at the practical arguments for and against reform.

Developments in legal and medical research concerning end-of-life decisions regarding severely suffering neonates in the Netherlands provide good cause for reflection on specific items of this issue. This article deals with the outcomes of the first national survey on end-of-life practice in Dutch Neonatal Intensive Care Units (NICUs) and examines the legal aspects of the use of medication as a part of this practice. The authors particularly reflect on the application of analgesics and sedatives on the one hand and neuromuscular blockers (NMBs) on the other hand. Furthermore, they focus on different elements of medicinal use such as indication, the moment of administering, dosage, effects of combinations of drugs, the relationship to the causation of death and (failures in) documentation.

Developments in legal and medical research concerning end-of-life decisions regarding severely suffering neonates in the Netherlands provide good cause for reflection on specific items of this issue. This article deals with the outcomes of the first national survey on end-of-life practice in Dutch Neonatal Intensive Care Units (NICUs) and examines the legal aspects of the use of medication as a part of this practice. The authors particularly reflect on the application of analgesics and sedatives on the one hand and neuromuscular blockers (NMBs) on the other hand. Furthermore, they focus on different elements of medicinal use such as indication, the moment of administering, dosage, effects of combinations of drugs, the relationship to the causation of death and (failures in) documentation.

The necessity of taking into account the interest and opinion of the child was recently emphasized in the Belgian Constitution. The Belgian Act of August 22nd, 2002 on Patients' Rights introduced an important innovation concerning the minor child, in that the latter has since been authorized to exercise his or her patients' rights autonomously, as far as he or she is considered able to reasonably appreciate his or her interests. In some areas, the Belgian legislature has made certain reservations. For example, the minor child has no right to ask for euthanasia; several bills have been proposed in order to recognize it in some circumstances, but they have not been passed. Similarly, activities relating to medically assisted reproduction are not available to the minor, except in cases where there are medical indications. Finally, it might be relevant for the Belgian legislature to enact more specific protective provisions for the child participant in clinical trials.

At present, in four European countries euthanasia and/ or physician assisted suicide (PAS) are tolerated under strict legal conditions. However, in practice these patient groups are often deprived of the possibility to undergo such decisions. Particularly Catholic health care institutions have developed policies which restrict the internal application of the law. Yet, the legitimacy of such policies is questionable. From a European human rights perspective it can be defended that the freedom of association allows hospitals to develop policies elaborating their ethical stances on euthanasia and PAS. However, to respect the patient's right to self-determination the concerned hospitals should at least inform current and future patients about the restrictive policy and deal carefully with euthanasia and PAS requests. If a patient's wish remains seriously incompatible with the ethical stances of the hospital, at least reasonable and attainable alternatives (such as a referral to a tolerant regional hospital) should be offered.

The permissibility and lawfulness of withdrawing and withholding medical treatment has attracted considerable debates and criticisms, as the legal issues are drawn into entering the slippery slope of euthanasia. Proponents of "sanctity of life" views that withdrawing and withholding medical treatment with knowledge that death would result is still within the sphere of euthanasia, whereas proponents of "quality of life" argue that it is not, as death is not intended. Their arguments maintain that for patients who are totally dependant on machines to ensure the work of some bodily functions, living may amount to little more than survival as dying is prolonged. Furthermore, the prolonging of life of the dying patient has profound implications on patients themselves, their relatives, dependants and medical providers. Thus, withdrawing and withholding medical treatment would not only respect a patient's right to self-determination, by allowing them to die in their underlying condition, but will ensure that medical providers are able to concentrate on more worthwhile treatments. This paper discusses the intractable difficulties with the moral distinction between withholding and withdrawing treatment and euthanasia, as well as makes a comparative study between the present state of law in Malaysia and England on this issue. The paper further highlights the differences between civil law and Islamic law in this controversial area.

In this article the arguments against euthanasia are examined. One of the weightiest arguments of mental health professionals against the practice of euthanasia is that a doctor's active commitment to euthanasia can be interpreted as causing harm. It is investigated whether this statement can be ethically justified on the basis of the text of the medical oath or medical declaration. Furthermore, it will be discussed whether it is ethically acceptable when doctors refuse a) to help candidates of euthanasia who (would likely) meet the legal standards of euthanasia, or b) to refer them to a colleague.

The Belgian 28 May 2002 Act has partially decriminalized euthanasia, i.e. intentionally terminating patient's life by a doctor at the individual's request. Until now, this Act has not undergone any far-reaching alterations. But it does not mean that the status quo applies. The existence of the Act was punctuated by different legal developments. The Belgian Constitutional Court made two judgments about it. Furthermore, numerous parliamentary bills were proposed in the Senate and the House of Representatives in relation with its provisions. If the contribution of the Constitutional Court's decisions to the debate on euthanasia is limited, in such a way that the Court's intervention does not contain the seeds of changes far as the Act on Euthanasia is concerned, the presented bills, on the contrary, could presage evolutions of the text.

Nowadays, health care institutions develop policies on how to deal with medical decisions concerning the patients' end-of-life stage (hereafter: "end-of-life decision policies" or "ELD-policies"). This evolution is not only noticeable in hospitals, but also in nursing homes, residential facilities for the disabled and home care services. However, these policies raise several legal issues. The developing and implementing of institutional ELD-policies are legitimated as such and imposing additional criteria or limitations on patients or physicians are allowed if all patients' rights are respected. Due to many differences in form and content, their legal value is difficult to define. Nevertheless, institutional ELD-policies are only enforceable on physicians after incorporation into a binding agreement and without violation of their (deontological and/or legal) right to professional autonomy. Patients (or their legal representatives) can never obligate physicians or health care institutions to comply with institutional ELD-policies, unless enforceable patients' rights are violated.

This article deals with the problem of euthanasia, a topic of recent interest, namely the rights of minors to make their own decision regarding to euthanasia. In fact the problem of decisions on euthanasia has always been considered an adult interest while leaving the will of minors in the hands of their parents or tutors. The purpose of this article is to underline the rights of self-determination of minors on the problem of euthanasia in Italy.

Administering pain medication to terminal patients can cause legal problems when it has a life-shortening effect, because according to some authors it equates with manslaughter. The legal basis of the acceptance of pain alleviation with life-shortening effect can be found on the grounds of necessity. In different countries physicians have been prosecuted because of their pain management, which to the public prosecutor was in fact a sort of euthanasia. On the other hand, it is not unknown that physicians administer opioids to mask euthanasia. Pain management needs some rules, which can reassure the physician who alleviates pain. The physician who alleviates pain with life-shortening effect will have to act with due care to avoid a liability risk. This implies at least an informed consent, to observe the proportionality rule, and to keep a medical record.

This paper focuses on the idea of pro-life arguments and the sanctity of life doctrine in the context of debates on end-of-life law. Advocates of the sanctity doctrine are often thought of as being pro-life, which has potentially troublesome implications in policy debate. I explore what it means to be pro-life, and consider sanctity's relation to this. I question the coherence and appeal of truly pro-life law, and law that is premised on the sanctity doctrine. The analysis allows me to examine and reject the idea that the sanctity doctrine is reasonably described as a 'middle way' that we should enshrine in policy and practice.

In the last five to ten years there has been increasing debate on terminal sedation, a medical practice that is difficult to place between other decisions at the end of life, like alleviating pain, withholding treatment, and (in jurisdictions where this is allowed) euthanasia or physician-assisted suicide. Terminal sedation is the administration of sedative drugs with the aim to reduce the consciousness of a terminal patient in order to relieve distress. It is frequently accompanied by the withdrawal (or withholding) of life-sustaining interventions, such as hydration and nutrition. It is typically a measure of the last resort, to be considered in situations where all other measures to reduce pain and suffering have failed. While similar to palliative measures as far as the sedation itself is concerned, withholding of hydration and nutrition brings terminal sedation into the realm of non treatment decisions. At the same time, to the extent that the combination of these two measures may shorten the patient's life, the practice may be easily associated with euthanasia. It is no surprise therefore, that terminal sedation has been called (and has been disqualified as) 'slow euthanasia' or 'backdoor euthanasia'. This paper addresses the question how terminal sedation may be looked upon from a legal point of view. Is it indeed a disguised form of euthanasia, or should it be considered as a practice in its own right? In the latter case, what does it imply in legal terms, and under which conditions and safeguards could it be legally justified? To answer these questions, I will look first at the different clinical realities that may be brought under the heading 'terminal sedation'. Then I will deal with its two components--sedation on the one hand, and withholding artificial feeding on the other--in a legal perspective. The paper ends with conclusions on terminal sedation as a whole.

The international press has been full of blood chilling accounts concerning a supposedly new practice in the Netherlands of terminating the life of severely defective newborn babies with a protocol. Our aim is to give insight into the medical and legal aspects of this protocol and to describe its contents. The legal developments concerning termination of life in newborns in the Netherlands are being discussed.

The paper deals with some of the more common arguments used for the legalisation of voluntary euthanasia. It looks at these arguments from an ethical and philosophical point of view. First, the argument that to offer a person the possibility of euthanasia is to respect that person's autonomy is questionable. Can a person's decision on euthanasia be really autonomous? If euthanasia were legal everybody would be conscious of this option: the patient, the doctor, the family and the nursing staff. Thus, there could be indirect pressure on the patient to make a decision. The choice is meant to be free but the patient is not free not to make the choice. Secondly, a choice that seeks to alleviate suffering and thus improve life by annihilating it is irrational. Thirdly, autonomy as to one's own death is hardly exercised freely. Even an otherwise competent person may not be competent in deciding on his own death on account of despair, hopelessness, fear or maybe a feeling of being weak, superfluous and unwanted. This is a very uncertain base for decision-making, especially in the irrevocable decision of euthanasia. Finally, a competent person usually makes any choice in a responsible way and after due consideration; a 'good' decision should consider and respect the wishes and feelings of others. This will be no less the case in making a decision on the so-called free choice of euthanasia. Thus 'normal' behaviour in decision making will only add to the tendency of the already depressed person to feel a burden on his family, the staff and even on society.

As jurists, doctors, and ethicists are increasingly engaged in the debate as to whether and how to legalize euthanasia as a matter of public policy, less debate takes place on what it is submitted ought naturally to come before, i.e. the affirmation of a legal right to palliative care. In Israel, the draft law The Terminally Ill Patient (2001) includes a palliative care provision. It is submitted that such provision, laudable as it is, appears within a euthanasia-oriented framework and is given too limited a scope. Hence the suggestion that palliative care be given an autonomous role, and be recognized as a positive legal right.

The legal status of living wills and advance directives in South African Law will be considered. Presently there is no reported judgment of a court in South Africa which has directly ruled on the validity of an advance directive or living will. In a case decided in 1992 the issue as to whether to discontinue life supporting treatment was decided with reference to the legal persuasions of society and whether, in light of these, it would be reasonable to discontinue artificial feeding of the patient. The judge indicated that just as a living person has an interest in the disposal of his body so did he think that the patient's wishes as expressed when he was in good health should be given effect. In South African law every person is legally entitled to refuse medical treatment even if the consequences may be to hasten death. The South African Law Convention has extensively investigated the issue in its report entitled Report on Euthanasia and the Artificial Preservation of Life in 1998. Certain problems were identified and a draft bill was suggested.

Since 1999 reported cases of euthanasia in The Netherlands are examined in five regional review committees. In these committees a lawyer, an ethicist and a medical doctor investigate whether the cases reported are in correspondence with the so-called criteria for careful practice. Issues to be investigated include the patient's suffering, the nature of the patient's request, the consultation by another doctor and the way in which the termination of life has been performed. Since April 2002 the judgment of the committees is final. This paper describes the working of the review committees. It also discusses the relevance of experiences in the committee for issues of social and public debate, such as the role of the consulting doctor, the relation between euthanasia and palliative care, and the place of patient autonomy.

Law as a Way to Survive is a comprehensive evolution-theory orientated philosophy of law and state that is tested in this article on its pertinence and explanatory power for the following issues: animal rights, abortion, euthanasia and assisted suicide. These subjects are suitable as tests precisely because they are not those for which LWS or rival theories, with which it will be compared, and for which it was primarily developed for. It will be concluded that LWS is very superior in pertinence and explanatory power both because it is much less metaphysical and much more complex than its rivals.

This paper describes current problems in Israel in the fields of geriatric medicine and elder law. The background to the problems is discussed, with a commentary on the deficiencies in everyday practice. The author presents proposals for change both in the legislative system and in application of acceptable standards of medical care and practical use of improved legal provision.

During the summer of 1999, extensive interviews with some of the leading authorities on the euthanasia policy were conducted in the Netherlands. They were asked: The British Medical Association, in its memorandum before the House of Lords, held that in regard to Holland, "all seem to agree that the so-called rules of careful conduct (official guidelines for euthanasia) are disregarded in some cases. Breaches of rules range from the practice of involuntary euthanasia to failure to consult another practitioner before carrying out euthanasia and to certifying the cause of death as natural". What do you think? Most of the interviewees conceded that this assertion is, indeed, correct. Two interviewees didn't pay much notice to the issue and three others said that the British critique is both true and untrue.

Is active euthanasia an expression of respect for human dignity and freedom or not? Liberal utilitarians and catholic personalists differ on this question because they use different concepts of freedom and have different attitudes to whether life has a sense beyond material utility. While the former can claim that one has no duty to go on living an unpleasant and useless life against one's will, for the latter even a materially substandard life is a chance for spiritual growth not to be discarded because human suffering is meaningful too, and not a mere senseless disutility. Patient autonomy will not, for a personalist doctor, imply a duty to fulfil the patient's wish for euthanasia, because his moral duty towards his own soul overrides all other considerations. The threshold argument, commonly appealed to by personalists against legalizing euthanasia, should not be interpreted as a factual conjecture of the worst possible scenario but rather as a principal claim according to which a state which lets citizens to be reified as means for utility is thereby already entirely immoral.

One of the reasons why ethics is so much spoken about nowadays is that the moral certainties of previous times no longer exist. Recent events in South Africa have called into question many of the values and principles formerly adhered to. Formerly, we had confidence in the moral consensus that was shared by our families, religious organizations, educational institutions, professional associations and judicial system. Nowadays we have pluralism, and we live in a society with many competing moralities. Whereas in traditional societies, there is considerable agreement on values, in pluralistic societies, such as South Africa, individuals are subject to a clash of values and have the difficult task of deciding which should prevail. Euthanasia and assistance in suicide are currently hot issues in South Africa. Ethical conduct of medical practitioners dealing with cases of AIDS is an ongoing task. New issues like Telemedicine and the ethics involved therein, are a concept in South Africa and will receive much attention in this year.

Demographic evolution and scientific progress in the treatment of fatal diseases have brought about a large number of disabled old persons and of greatly dependent persons. Nowadays, the dying process of people in such conditions is slower, though irreversible, and it has created a new form of medical care known as palliative medicine. Seven situations of this kind are discussed, with the corresponding ethical appraisal of the possible medical decisions in each case. The opinion on this matter by the Portuguese National Council of Ethics for the Life Sciences, based on the initial report, is then reproduced. It is against euthanasia strictu sensu being legalised and no longer a criminal offence, recommending however the development of all forms of palliative medicine.

Part I of this paper considers three competing ethical approaches to the valuation of human life: "Vitalism', 'Inviolability', and 'Worth'. Part II argues that, largely as a result of the case of Airedale NHS Trust v Bland, English law relating to 'euthanasia' (the intentional shortening of a patient's life, by act or omission, as part of his/her medical care) is in a morally and intellectually inconsistent state, incorporating Inviolability by prohibiting doctors from intentionally killing patients by an act but adopting Worth by permitting them intentionally to kill certain patients by omission. Part III maintains that the recent Report of the House of Lords Select Committee on Medical Ethics missed an opportunity to recommend the resolution of this inconsistency.

The idea that the permissibility of an action (or an omission) depends on the agent's intention has played an important role in traditional moral thinking and the law and determines, at least in part, the permissibility of medical end-of-life decisions. I argue that there are good reasons why the law ought not, in end-of-life decisions, focus on the doctor's intention. The patient's interests or rights are a more appropriate focus.

The constitutional justifiability of euthanasia will depend upon interpretation of the right to life and the right to respect for and protection of one's dignity. Pertinent issues arising hereto are: In our new value-based constitutional interpretation, what are the values underlying our multi-cultural society? Issues of death and dying are inter-linked to a civilization's world view and its approach to human dignity. Western, African and Islamic approaches will be compared. Does euthanasia negate the essential content of the right to life and is its limitation on such right reasonable/justifiable in an open and democratic society based on freedom and equality.

On March 28, 1995 at the Yokohama District Court in Japan, four legal requisites for active euthanasia were newly established by the chief judge, when he rendered the judgment on the murder case of a physician, Tokunaga. The case has been reported by the news media as a so-called euthanasia. In order to make the legal distinction between murder and euthanasia for this case, the 1962 six legal requisites for euthanasia established 33 years ago at the Nagoya High Court in Japan were revised into the four new legal requisites. The judgment was influenced by the current international situation and Japanese sentiment concerning euthanasia.

The birth of a normal child is an event full of happiness and joy for its family, yet the birth of a handicapped baby can be a terrible human tragedy, since it entails difficult problems to be faced by the infant and its parents. Euthanasia of newborn handicapped babies is an ethically, morally, clinically and legally complex issue, involving decisions to be taken by doctors, parents and lawyers. Modern medicine is a technological marvel. Procedures unheard of and unthought of some 30 years ago are today common practice, among them is neonatal intensive care. Neonatal intensive care includes resuscitation, mechanical ventilation, artificial tube feeding and other technologically sophisticated means of maintaining seriously handicapped and seriously ill, or low birth-weight neonates. These advanced medical technologies, while they have led to the saving of many lives, have also caused the source of the dilemma because they enable the survival of severely handicapped babies, who otherwise would have died. The question to be addressed is whether life is to be chosen for the severely handicapped infant or whether life for the handicapped infant is correctly regarded as worse than death; treatment being regarded as tantamount to cruelty, since it envisages no beneficial future for the infant, but rather life full of pain and distress, so that death should be chosen for it.

In recent years, there exists a world-wide tendency to stress patient's autonomy instead of doctor's paternalism in daily medical practice. This tendency must be appreciated as "every human being of adult years and sound mind has a right to determine what shall be done with his own body". But this autonomy sometimes conflicts with the doctor's personal integrity which is essentially a pro-life one. In some western countries, this autonomy is legally admitted even in life-shortening procedures such as an abortion or euthanasia in the terminally ill patients. In 1994 a Japanese scientific council made a report concerning "death with dignity" and declared that the withdrawal of foods from PVS patients should be proceeded under his or his supposed will, and in a criminal case decision in 1995, criteria for the active euthanasia in the terminal patients are proposed. In both situations, the actor should be a doctor. These life-shortening procedures might be appreciated for the autonomy of patient and be legally permitted. But conscientious refusal of doctor against proceeding these acts must be also admitted, as the philosophy of each doctor about the sanctity of terminal life is different from doctor to doctor as in lay persons.

The hospice believes in the concept of a gentle and harmonious death. In most hospice settings there is also a rejection of active euthanasia. This set of two apparently conflicting principles can be defended on the basis of two arguments. The first is that doctors should not foster the intent to kill as part of their moral and clinical character. This allows proper sensitivity to the complex and difficult situation that arises in many of the most difficult terminal care situations. The second argument turns on the seduction of technological solutions to human problems and the slippery slope that may arise in the presence of a quick and convenient way of dealing with problems of death and dying.

The existence of treatments which now make it possible to prolong life beyond the point when it would previously have ended, gives rise to particular questions in the context of the care of aged patients: the distinction between curative and palliative treatment, the evaluation of incurability, the right to refuse treatment, competence to make such a decision and the use of the limited objective and pure objective tests in the event of incompetence. The natural role of the physician as protector adds a further ethical dimension to what is also a medicolegal question.

Advancements in techniques of medical technology have made it possible to postpone death, which, in many situations, amounts to nothing more than a protracted process of dying rather than a prolonging of life. This, together with the fact that these techniques are prohibitively expensive has brought to the fore difficult and extremely uncomfortable problems in medical ethics, especially with regard to who should have and who should not have high technology medical treatment. The principles of autonomy and informed consent, in the context of a shared resource such as intensive care, are particularly thorny issues. Normally it is imperative that individuals make their own autonomous decisions in respect of medical treatment but there are times when consent is of secondary importance and when autonomy must of necessity be limited. However, information concerning medical decisions in intensive care should always be freely available to patients and their surrogates.

This article is one of two which report findings of research which examined the attitudes and practices of health professionals in South Australia towards the management of death, dying and euthanasia. The focus in this article is on findings related to nurses. Conducted in August 1991, mail-back, self-administered questionnaires were posted to a sample of 500 nurses on the general nurses register held by the Nurses Board of South Australia. A total response rate of 57.8% was obtained, and 55% (278) were usable returns. The survey found that 47% of the respondents had received requests from patients to hasten their deaths by withdrawing treatment, and 30% had received request from patients for active euthanasia. 'Persistent and irrelievable pain' was the main reason for such requests. The majority either would or did discuss such requests with relatives, other medical practitioners and nursing staff. Nineteen per cent had taken active steps which had brought about the death of a patient. Eighty-two per cent thought that guidelines for withholding and withdrawal of treatment should be established. Sixty per cent were in favour of legalization of active euthanasia under certain circumstances.

Active euthanasia has been discussed in China from 1980. Some investigations show that many people, especially medical workers, accept active euthanasia. Active euthanasia is not yet legally permissible in China but research in ethics and public views will promote developments in this direction.

In this article euthanasia is defined and classified. Each of the classification is examined in relation to the relevant South African law as are the possible defences to criminal charges flowing from a euthanasia situation. Further, the validity of the so-called 'living will' is examined. While most declarations or bills of human rights seek to protect an individual's right to life, this article shows that an individual enjoys no right (from a human right point of view) enabling him to choose the time and condition of his death, irrespective of whether he is terminally ill. The reason for this negative attitude to euthanasia by society is considered. In conclusion it is observed that due to the plurality of society in South Africa, it will be no easy task for the legislature to pass acceptable laws regarding euthanasia, however limited. Finally, positive suggestions are made for the implementation of a valid 'living will'.