Willem Lemmens

Physician-Assisted Suicide and Euthanasia: Emerging Issues From a Global Perspective

Medical professional societies have traditionally opposed physician-assisted suicide and euthanasia (PAS-E), but this opposition may be shifting. We present 5 reasons why physicians shouldn’t be involved in PAS-E. 1. Slippery slopes: There is evidence that safeguards in the Netherlands and Belgium are ineffective and violated, including administering lethal drugs without patient consent, absence of terminal illness, untreated psychiatric diagnoses, and nonreporting; 2. Lack of self-determination: Psychological and social motives characterize requests for PAS-E more than physical symptoms or rational choices; many requests disappear with improved symptom control and psychological support; 3. Inadequate palliative care: Better palliative care makes most patients physically comfortable. Many individuals requesting PAS-E don’t want to die but to escape their suffering. Adequate treatment for depression and pain decreases the desire for death; 4. Medical professionalism: PAS-E transgresses the inviolable rule that physicians heal and palliate suffering but never intentionally inflict death; 5. Differences between means and ends: Proeuthanasia advocates look to the ends (the patient’s death) and say the ends justify the means; opponents disagree and believe that killing patients to relieve suffering is different from allowing natural death and is not acceptable. Conclusions: Physicians have a duty to eliminate pain and suffering, not the person with the pain and suffering. Solutions for suffering lie in improving palliative care and social conditions and addressing the reasons for PAS-E requests. They should not include changing medical practice to allow PAS-E.

Spinoza on ceremonial observances and the moral function of religion

* This paper was originally delivered as a talk at the international workshop on Spinoza’s Tractatus Theologico-Politicus, organised by the Netherlands Organisation for Scientific Research, University of Leiden, Department of Philosophy (May 20, 2008). I thank Eric Schliesser for inviting me and the other participants for their stimulating comments. Suggestions by Ursula Goldenbaum, Herman De Dijn and Stephen Nadler on an earlier version of this text helped me a lot. I am especially indebted to an anonymous referee of Bijdragen for some clarifications and improvements. 1 All references to the Tractatus Theologico Politicus and the Ethics are to the Shirley edition: Benedict de Spinoza, Complete Works, With the Translations of Samuel Shirley, Edited by Michel L. Morgan, Hackett Publishing Company, Indianapolis/Cambridge, 2002. SPINOZA ON CEREMONIAL OBSERVANCES AND THE MORAL FUNCTION OF RELIGION*