Does Euthanasia Go Agains the Hippocratic Oath

Neither volition I administer a poison to

everyone when asked to do so, nor will

I propose such a course

The Hippocratic Oath.

Introduction

These lines in the Hippocratic Oath seem clear enough. The oath prohibits physicians to facilitate for their sick patients to accept their lives. This conclusion has been questioned, suggesting that what is meant is a warning for the administration of drugs with serious side effects. However, evidence supports that the Hippocratic physicians did not participate in what we call assisted suicide (van Hooff 2014).

There may, at present as in the Greek antique, be degrees of suffering that make life very hard to alive, and which may occasionally plough decease from existence a threat into being a last resort. Such suffering may be ameliorated or even made disappear through medical intervention, or by the appearance of some strongly meaning-giving person or insight. In Lev Tolstoy'south The Death of Ivan Iljitj, the terminally ill protagonist screams during several days out of pure desperation, when, finally, a beau appears and with his words and his presence manages to requite peace to the tormented soul (Tolstoy 1887). If such endeavors are unsuccessful persons may die in agony and despair.

The ascension of medical ideals in the 70's and 80'due south was, as could be expected, followed by a vitalized argue on end of life decisions. New techniques for life sustaining handling and better remedies for chronic disorders gave rise to expectations of a longer life with less suffering. New groups of professionals appeared at the bedside of the seriously ill person, enervating influence on decisions apropos life and death matters (Rothman 1991). But in spite of improved palliative care, suffering at the cease of life was all the same in that location, and withal potent analgesic drugs that were used, there remained some persons who suffered at the end of their lives.

The last two or iii decades take seen a gradual shift of attitudes on cease of life bug. Value surveys, like World Value Survey, from Western Europe and N America disclose a design of a boring shift towards more permissive attitudes apropos the active shortening of seriously sick persons' lives under certain circumstances (Cohen et al. 2013). The tendency over fourth dimension is so articulate that the conclusion tin hardly be questioned. This has been followed by a legislative shift in country afterward country, making the right to some kind of medically assisted shortening of life for seriously ill persons on their request more than common. It is, withal, of import to notice that at that place are several models for this, and that these differ essentially concerning their upstanding foundation. "The Benelux model", the far-reaching euthanasia practice of holland and Belgium, is, many argue, ethically distinct from the express and restrictive practice of dr. assisted suicide (PAS) in, for example, the American state of Oregon.

In the intense debate about different practices of euthanasia the ethical principle of autonomy has played a major function. It has been proposed that the correct to determine most the moment of one'south death is a consequence of the right to have decisions concerning one's body and what the wellness care arrangement should, or should non, exercise with it. "My death is mine" may be a summary of this mental attitude, and if this includes the wish to exist helped to die earlier the disease itself takes life abroad, then be it so and physicians take a duty to aid in that. Confronting this has been argued while there is a right to cocky-conclusion in the wellness care organization, this does certainly not include the right to demand of someone, in this case a doctor, to kill you or to give you the means to terminate your own life.

The aforementioned statement can exist made, instead relying on the concepts mercy or dignity. When a person risks losing, or has already lost, his or her nobility, and this process is judged irreversible, it is an deed of mercy following the best ethical traditions of medicine to shorten that suffering. In line with this, information technology is emphasized that the prolonging of life, the fight against death, has never been and should never be a task that triumphs over the duty to relieve suffering, and if this cannot be done in whatsoever other style, then the shortening of life is ethically adequate, or fifty-fifty mandatory. Once again, arguments against this position assert that dignity can exist restored, that human dignity may remain besides in actual disuse and dependency and that bold terminal illness to be undignified may go a self-fulfilling prophecy.

Shortening of life to provide escape from suffering is, not surprisingly, nix entirely new, as likewise seen from the quotation above from the Hippocratic adjuration. A well-known case is the death of Sigmund Freud, who died in London in 1939. The yr before, he had fled from the Nazi occupied Austria in company with his friend and dr. Max Schur and his daughter Anna. Freud was seriously, probably terminally, ill with an epithelioma of the hard palatine. He had been operated many times and was now inoperable. Only severe and intensified suffering remained. He then asked his physician friend to give him loftier doses of morphine so that he slept deeply until death came. Schur did that, using the means that he had at paw, later on Freud had taken goodbye of those of his family unit who were as well at that place. On the 3rd day, later ii more injections, Freud peacefully died (Gay 1988, pp. 648–651). Freud was conspicuously in pain but it seems that mental turn down and bodily decay were the major sources of his suffering. Thirty years before, he had written in a letter to a friend about what to do when "…thoughts fail and words will not come?". Freud admitted that he could not avoid to

…tremor before that possibility. That is why, with all the resignation before destiny that suits an honest man, I have one wholly secret entreaty: just no invalidism, no paralysis of ane'due south powers through actual misery. Let united states die in harness, every bit Male monarch Macbeth says (p. 651).

Freud asked for what is now chosen final sedation, defined as an intentional lowering of a terminally sick person's consciousness in guild to relieve pain, merely he could just as well had asked Schur for a number of pills that he knew would be enough to let death come. The ethical divergence between these ii options is much discussed and will not be dealt with further here. What we will explore is how a suffering similar Freud's tin can exist understood, and whether the notion of authenticity may assist u.s. overcome some of the limitations of an argument based primarily on the right to self-determination.

Doc assisted suicide

Before approaching the concept of authenticity, some conceptual clarity must be accomplished. Physician assisted suicide, PAS, is by some seen as i distinct model of euthanasia. It is, however, not an immediate active intervention of a physician that kills the patient, it is the action (taking a drug) of the sick person himself or herself. The physician makes possible an activeness that ends life, and—the proponents insist—cannot be said to be ultimately responsible for it. Definitions are crucial here. Often euthanasia is used just to designate a physician'due south momentary and intentional ending of a seriously ill person´s life on his or her request. This would exclude PAS. Medico assisted suicide may be defined as: "A physician intentionally helping a person to terminate his/her life by providing drugs for self-administration, at that person'due south voluntary and competent request" (Radbruch et al. 2016).

In Oregon around 130 terminally ill persons take their life yearly with the help of medico prescribed drugs. Considerably more patients (effectually 200) had been afforded the pick, but in the finish, not all utilise it. The office of the physician extends beyond the prescription. S(he) is also supposed to have ruled out depression as a cause of the sick person´s suffering. The patient must be judged competent by two physicians and this must exist done with a time interval of at least 2 weeks. Furthermore, a prognosis must exist established from best medical judgement, that life expectancy for the sick person is less than 6 months (Ganzini et al. 2001).

In Switzerland, like for case for Dignitas in Zurich, this latter requirement does not exist. Persons with chronic disorders and rather long estimated remaining life fourth dimension but deep suffering may be immune to receive PAS. Mutual to both models is that the sick person must endure deeply, and that no relief for this is in sight. Both include the evaluation of controlling competency past 2 independent physicians.

The critique against PAS has developed forth at least three interrelated lines. I is that prognosis for both remaining life time and the possibility of new options actualization for remedy and alleviation are by necessity uncertain factors. This critique implies that persons who could accept received support to help them want to live, or who might have passed into a better situation, instead are invited to take their lives. A second objection is that if, for instance, PAS is allowed, palliative care volition be less prioritized and thereby persons who could actually have been helped to live decent lives volition non be and so. A third argument proposes that PAS violates the central medical ethical principle of respect for life. Doctors should not take lives, and should not help persons to take their lives. They should save lives, and make lives more worth living. To this is ofttimes linked a slippery slope argument, claiming that assuasive PAS will pave the way for other, even more than ethically dubious, measures from physicians to shorten their patients' lives. Sick persons, it is said, volition ask for this as they translate the possibility to choose death also every bit a demand not to be a burden on those alive and on their society's health intendance costs.

Some of these arguments have a factual component, which can exist empirically assessed. For case, no trend for palliative care to be less prioritized is seen in for instance Oregon, though it cannot be established without doubt that palliative care in Oregon would not exist even better off if PAS had not been allowed. At that place has been only a slight increase in the number of PAS during the 21 years that the law has existed, and the level is still on less than 0.5% of the total number of deaths (Ganzini 2016). More difficult to judge is the possible touch on on ill persons' view of themselves. We do non know whether the possibility to cull PAS by those seriously ill is experienced every bit something that makes suffering easier to bear, as the ill person knows that in that location may be a self-controlled end—or whether some persons may see the pick to apply PAS as more than than just an option simply rather as a duty, in order non to be a brunt on family or on the health intendance arrangement. The very fact that this may be the instance constitutes a serious claiming to the ethics of PAS.

Autonomy in wellness care

In the context of health care, autonomy is usually interpreted every bit the correct to self-determination, and when this is not possible, to co-conclusion. Autonomy in health care is seen both as a capacity, linked to a person'southward cerebral and emotional condition, and as a right among other rights in a society that has increasingly acknowledged individuals as cocky-governing units within a social-political framework. Medical ethics has consequently during the terminal two or three decades largely focused on issues around autonomy—its limits, its preconditions, its expressions. To judge conclusion-making capacity has been seen every bit one of the central capacities involved in clinical judgement (Ahlzén 2010).

The patient has an absolute right to say no to a suggested handling, in instance (south)he is competent, just in that location is no corresponding correct to demand a sure intervention. If this brake is accustomed, the principle of autonomy can, as noted higher up, hardly exist recruited equally sole support for the correct to receive assist to PAS. A person cannot require a physician to initiate a handling which (s)he judges to exist medically dangerous and hence unethical. If, nevertheless, the same physician reaches the conclusion that beneficence and mercy dictate that the terminally ill person is given this possibility, and if such an action is legal—then the ideals will rely on whether this is really a beneficent act and if the ill person expresses his or her true self, that is: if the choice stems out of the persons central values, her deepest orientation in life.

As we have seen, where PAS has been legally accepted information technology has without exception been tied to an evaluation of competency. In practice, this has meant that clinically relevant depression as far equally possible is ruled out, and that no serious impairment of cognitive capacities can be discerned. Low is and so seen as a condition where an individual, due to a pathological process changing his or her manner of looking at herself and the world (loss of promise, loss of time to come, inertia, feelings of guilt and loss of self-esteem), is obstructed from using those combined emotional and cognitive capacities that are the foundation of autonomy. If there is no clinically recognizable low and if no other cognitively disturbing procedure can be identified, the patient is judged competent. But questions remain about the origins of the will to die, the congruence betwixt this wish and the person'south identity, "true self".

The concept competency is clearly linked to autonomy. But information technology may be argued that a decision can be autonomous, that is: exist fabricated by a competent person, for example non suffering from a serious mental disorder, but nonetheless not be authentic. If so, this opens a possibility to have the word in the case of PAS ane pace further. It is, in this example, non but necessary to attempt to guess whether an individual is autonomous in the usual, "emocognitive", meaning of the word—reasonably rational and emotionally stable—but (s)he should also be sufficiently authentic, in some meaning of this concept. If such a need for a qualification of the "autonomy condition" is accustomed, nosotros then confront the claiming to approximate whether exactly the concept authenticity is a suitable candidate for this.

Authenticity

To bring in the concept actuality into this give-and-take is to invite ambiguity. Few concepts have been so radically differently interpreted as authenticity. Is this difficulty so deep-going that it makes the concept unsuitable in this context?

In philosophical encyclopedias, the usual subdivision includes a strong emphasis on the existentialist apply of the concept, which in turn is heterogeneous, for case the obvious differences between Kierkegaard's and Heidegger's use of the notion. One will likewise encounter psychological and religious interpretations. One result of this array of suggestions on the meaning of authenticity is that the critique against the "the cult of authenticity" seems to strike only sure interpretations, and not necessarily others. Social historian Christopher Lasch, for example, associates the cult of authenticity with an increased self-indulgence, with the growth of a narcissistic personality blazon in Western societies (Lasch 1982). In a similar vein, political theorist Harold Bloom maintains that the wish to be accurate leads to self-centeredness and makes the minds "narrower and flatter" (Bloom 1988, p. 61). But if authenticity is not seen as referring to a self that is an atomistic self-governing unit, maximizing its pleasure irrespective of consequences for others, as these two authors imply, then authenticity is not necessarily connected to egocentricity and narcissism. On the contrary, it may be connected to social values and a motivation to grow in maturity and cognition of the world, while remaining true to oneself.

Charles Taylor is the contemporary philosopher who has done most to reinvigorate actuality every bit a tool for understanding Western culture in the tardily twentieth and early twenty-first century. His The Ethics of Authenticity came in 1991, at a time when this debate had gained considerable momentum. Taylor describes the rise of actuality as a event of the ongoing increase of individualism, and also as a reaction against the "disenchantment" of the world, that is as an attempt to counteract what was seen every bit an instrumentalized view of guild and the man condition. But the reaction was risky, and "… new modes of dependence ascend among people who are striving to be themselves, and beyond this new forms of dependence…" (p. 15). Emphasizing autonomy, a notion seen as an expression of actuality, besides has its dangers: "…the notion of cocky-determining freedom, pushed to its limits, doesn't recognize any boundaries…." (p. 68). Taylor agrees with the critique against a widely spread relativism connected to this mode of looking at the accurate cocky. Yet, he does non desire to do away with the concept altogether only rather reinterpret information technology. "Rather, we face a continuous struggle to realize higher and fuller modes of actuality against the resistance of the flatter and shallower forms." (p. 94)

Taylor hence wants the concept to be reinterpreted in a far less self-indulgent way than was usually washed at the fourth dimension. Accurate is a person who past beingness true to himself or herself too actualizes the best in her human nature, who connects to sources outside herself, who strives to identify a common good and piece of work for it. Information technology is not difficult to discern a connexion to Heidegger where an authentic life form is one where authenticity has to exercise with being a person of a particular sort, with a sense of wholeness, with being connected to the ongoing life. There is no pregiven, "true", inner nature to connect to hither, rather an ongoing way of being in one's life which presupposes a prepare of capacities, values, orientations and dispositions. (Stanford Encyclopedia of Philosophy 2019) When these are seriously threatened or destroyed, the possibility of an accurate life is no longer at that place. The individual is, in the deepest sense of the word, no longer himself or herself.

For the sake of this discussion of PAS, I suggest that the ethic of PAS depends, amidst several circumstances, on whether the ill person expresses an authentic will. The will is accurate simply if it is deeply connected to values, orientations, emotions, motivations and dispositions that the person holds in a more or less reflected way, and identifies equally his or her ain, as part of and expressed in an ongoing flow of life-events. Self-deceit, illusions, delusions, self-destructiveness, and ignorance, sometimes merely not always parts of cerebral decline and grave mood disturbances, threaten authenticity. Being authentic is a wider notion than being competent. A decision tin can be competent but still not necessarily authentic. This fact raises demands on those who deal with persons who want help to finish their lives due to intractable suffering. Judging actuality is extremely difficult and hence this may be both an statement for, and against, the legalization of PAS. Information technology must be kept in mind that several of the arguments against PAS remain even if the volition to receive it is judged to be authentic.

Suffering and actuality

Eric Cassell has suggested that we ascertain suffering as"…the state of severe distress associated with events that threaten the intactness of the person" (Cassell (1991), p. 33). Why is in that location a threat to an private's "intactness" associated with suffering? I suggest it is because being intact, in Cassell's sense, makes it possible to be authentic. Information technology is the very precondition for realizing i's core values, evaluating one´south inclinations, scrutinizing i's very ground for orientation in life—in result, for existence true to oneself. Lost intactness means lost core functions, lost abilities to reach fundamental goals in life, loss of that "rhythm" in everyday life that characterizes the authentic life. Cassell discerns several strategies to reduce suffering—living in the present, denial, developing indifference, flexibility—but neither of these necessarily work very successfully in the confront of suffering at the very stop of life.

Fredrik Svenaeus' position is close to Cassell'south. He suggests we await upon suffering as "…an alienating mood overcoming a person and engaging her in a struggle to remain at home in the face up of loss of meaning and orientation in life." (Svenaeus 2017, p. 33) He finds it important to evaluate the degree of severity. Not all negative moods entail suffering. Suffering appears when the embodied "being-in-the-world" of a person is alien, "unhomelike". Such a mood "… affects the entire existence of the ill person" (p. 31). With no meaningful orientation and with cadre life values obstructed, life is inauthentic, and suffering will result.

What makes a life worth living? Svenaeus deals with this question, inspired past Charles Taylor who in his volume Sources of the Self describes how our selves, our identities, rest on what he calls potent evaluations (Taylor 1989, p. iv). Such strong evaluations are like the supporting pillars for our sense of meaningfulness, the necessary preconditions for finding life worth living. If terminal disease strikes against these, why does a person want to keep the months until the liberating death comes? Because of a hope that things will come to look differently in a curt time? But fourth dimension is already brusk. Serious life-threatening disease with a prognosis for less than 6 months more to live—the criteria for PAS in Oregon—is not. Long time for reorientation. But then over again, is not the in a higher place description of obstructed "strong evaluations" a description of depression, a condition at least in principle possible to treat—and 1 of the exclusion criteria for PAS? This could be the case but non necessarily. Not all experiences of inauthenticity are secondary to depression, just of course loss of actuality in life- threatening disease may prompt depressive symptoms.

Authenticity and PAS

Being accurate, every bit we noted, ways being "at abode" in that rhythm of life, that uniquely personal way of relating to the world, that is securely embedded in a person's values, desires, inclinations, beliefs. Nosotros likewise draw the conclusion that major depressive disorder is not uniform with existence authentic, and neither are other serious psychiatric disorders or afterward stages of dementia. It is characteristic of such states that close relatives do not recognize the ill person as the ane (southward)he "really is". "He is another person", is a common remark, or, in such cases where there has been a recovery: "I was not myself". Such means of beingness inauthentic are largely due to pathophysiological processes affecting the encephalon. Patients even with accelerate stages of dementia may accept proficient lives, though they are clearly inauthentic, again reminding usa that inauthenticity does not in itself equal loss of life quality. Inauthenticity tin can likewise effect from other debilitating diseases, like for example late stage cancer, ALS and grave forms of MS, certain progressive neuromuscular disorders, serious trauma with severe loss, which profoundly change a person's possibility to live an authentic life characterized by that "rhythm", that resonance, that was there before the disease.

It may seem strange that, if nosotros accept low every bit an obvious source of inauthenticity, this condition should all the same serve as a counter-indication for PAS. But depressions tin be often be cured and about of them have a limited natural span too without treatment. Authenticity, and with this the will to go along living, may and then return—albeit in a more than or less transformed course. Information technology is unlike with an inauthenticity that is the result not primarily of a depressive mood, but of fundamental and irreversible losses in life, like the capacity to movement reasonably freely without pain, to control basic actual functions, manage the intake of food and liquid, to carry everyday cognitive operations, to think and react to memories shared with other persons. They may find new means to compensate for and find meaning in. this—or they may not.

A wish for PAS should, co-ordinate to legislation in countries where such assistance is allowed, be, in the formal sense, competent. If PAS is accepted—should it, in addition to that, be up to the physician(s) to guess the patient'due south caste of authenticity? Such a judgement demands that the physician has a reasonably practiced knowledge of the ill person, which is probably seldom the instance. In the Netherlands, where about cases of euthanasia are performed past GP:s with a knowledge of the ill person over many years, this may sometimes be possible. In Sweden, as a contrast, few patients have a primary intendance physician since a long time, if at all, and hither the evaluation whether a person's wish for help to end life past an action of his or her own faces a greater challenge. Those who advocate PAS must, I debate, make plausible that the physicians who perform this have the noesis, the involvement and the feel to judge how authentic the wish of the sick person is, and not but formal competency.

A suffering beekeeper

The novel past Lars Gustafsson, The Decease of a Beekeeper, appeared in 1978 every bit the last in a series of five novels, The Cracks in the Wall. Information technology has been extensively dealt with by Bondevik et al. (2016) equally an example of how literature may capture the ambiguity and complication of a person´s reaction to very serious bodily symptoms. This assay will not exist repeated here, but the novel is also an invitation to reverberate on what it means to have, or not to have, an authentic life, when this aforementioned life is seriously threatened by illness. The novel is a reminder of how difficult it may be to capture a person's inner globe and to judge the degree of accurate sense of life that (s)he experiences. It is to be remembered, of course, that this fictive apiculturist is as unique in his reaction in his struggle for meaning and coherence as any other person who would suffer increasing distortion of the patterns of everyday life.

In fragmented notes, the reader is presented with glimpses of Lars Westin's life. He now lives alone in a rural trivial house with his dog, manifestly subsisting on the minor earnings from his bee hives. His life narrative is offered us as fragments and so are his reactions to the increasingly alarming symptoms. While post-obit him in the mundane matters of everyday life, we can see how these are transformed in an alien way by the illness, which is increasingly invasive into his thoughts and dreams, and come across how he struggles to make some sense of what is going on. Clearly enough, his life becomes increasingly inauthentic. The intactness, his sense of life as a whole, breaks downwards. A passage illustrates this:

What I experience is total dissolution, total confusion. Upwardly to at present, I never really grasped that the possibility of experiencing ourselves as something clearly divers, ordered, as a human self, depends on the possibility of a future. The foundation of the unabridged concept of the cocky is that information technology will keep to exist tomorrow. (p. 79)

Who is really Lars Westin? He strikes the reader as an enigmatic person. The scattered notes in the left books bear witness him every bit a human being who maybe never really has taken place in his own life. He studies, he marries (the wrong woman), he divorces (seemingly without any sentiments), he leaves his job as a teacher to live lonely with his dog and his beehives. Is his life inauthentic or is it rather the opposite? Has the beekeeper really stepped out of an increasingly inauthentic social life, to really get more of himself? If so, how shall we understand the fact that when the alphabetic character with the final verdict on his disease finally comes, later on months of investigations, he burns it, in an oddly indifferent and distanced way?

It is clear that inauthenticity often makes life less worth living. However, this is not necessarily the case. One may imagine an inauthentic life, a person who loses contact with who (s)he really is, but stills feels fine, enjoys life. Far reaching cocky-betrayal may deed this style, merely in the longer run, inauthenticity probably tends to erode besides life quality.

When the future is seriously threatened, the self is under assault. Any diagnosis, or in the beekeeper's case potent suspicion, of a life-threatening disorder will bear such a challenge. The reader of the novel is invited to see how the fragments (s)he is presented of the beekeeper's life narrative offer clues to an understanding of his reactions. Finally, the novel leaves us with a question: Was his decision not to undergo treatment for what we know was a cancer of the spleen really an authentic determination? Did it mirror his "true cocky", reflect the core values of his life? If he had accustomed handling, and thereby received some more time, would this have deeply changed his cocky-understanding? If a relapse then had occurred, and all promise for curative handling was gone, would he then have asked for PAS? Arthur Frank calls the constructive answer to a break of life narrative due to the experience of a life-threatening illness—a "quest story" (Frank 1995). Would at that place have been such a story at mitt for the beekeeper during his last months alive?

Decision

I have argued that loss of authenticity often accompanies serious disorders, particularly debilitating such. Such loss, and also the threat of it, often but not always causes suffering. If the affliction is life-threatening the time for reorientation is often curt. A person may want death to come before the destruction of his or her self has been completed. He or she may inquire for help to finish his life earlier the disease does. Should such a wish be respected?

The concepts authentic and authenticity may seem promising in connection to sentence of such a need. At the aforementioned time, it is obvious that authenticity is a securely ambiguous concept, and judging what is an authentic or inauthentic life may be filled with pitfalls. The apiculturist in Gustafsson's novel illustrates this. The reader is left in uncertainty about his sense of self, his cadre personality, his basic values. This dubiety adds depth to the reflection on what an authentic determination may be in the example of PAS. It must too be noted that another aspect of the novel involves the gimmicky society from which Westin has tried to withdraw. In glimpses nosotros are shown a society of lies and alienation, and of diminishing sense of direction and meaning. In this way, the possible loss of identity and authenticity in the apiculturist's life is paralleled past the same procedure in the surrounding lodge.

Autonomy and authenticity are interdependent concepts just ought to be kept autonomously. Autonomy includes a number of cognitive capacities, and also demands a basic caste of emotional stability. Authenticity can be intact while autonomy is reduced, and the other mode around. Still, whatever legislation on PAS must include criteria concerning competency. Loss of autonomy due to serious cognitive disturbances should be a relative obstacle to PAS.

We need to develop a richer and fuller understanding of what the conditions are for leading an authentic life in serious affliction. I suggest that the give-and-take on the ideals of PAS must not restrict itself to a word on the meaning and limits of autonomy, but to include also considerations on the relation between autonomy and authenticity.

References

• Ahlzén, R. 2010. Why should physicians read? Understanding clinical sentence in relation the literary experience. Durham and Karlstad: Karlstad Academy.

  Google Scholar

• Bloom, A. 1988. The closing of the American heed: How higher education has failed democracy and impoverished the souls of today's students. Harmondsworth: Penguin.

  Google Scholar

• Cassell, E. 1991. The Nature of Suffering and the Goals of Medicine. New York, Oxford: Oxford Academy Press.

  Google Scholar

• Cohen, J., et al. 2013. Different trends in euthanasia acceptance across Europe. A study of 13 western and 10 central and eastern European countries, 1981–2008. European Journal of Public Health 23: 378–380.

  Commodity  Google Scholar

• Frank, A. 1995. The wounded storyteller: Torso, illness and ethics. Chicago: Academy of Chicago Press.

  Book  Google Scholar

• Ganzini, L., et al. 2001. Oregon physicians' attitudes about and experiences with end-of-life acresince the passage of the Oregon Expiry with Dignity Human action. JAMA 285: 2363–2369.

  Commodity  Google Scholar

• Ganzini, L. 2016. Legalised md-assisted death in Oregon. QUT Police force Review 16 (one): 76–83.

• Gay, P. 1988. Freud. A life for our time. London: Dent.

  Google Scholar

• Lasch, C. 1979 (1982). The Civilisation of Narcissism: American Life in an Historic period of Diminishing Expectations. London: Acabus.

• Radbruch, L., et al. 2016. Euthanasia and dr.-assisted suicide: A white newspaper from the European Clan for Palliative Care. Palliative Medicine 30: 104–116.

  Article  Google Scholar

• Rothman, D. 1991. Strangers at the bedside: A history of how constabulary and bioethics transformed medical determination making. New York: Basic Books.

  Google Scholar

• Stanford Encyclopedia of Philosophy, "authenticity". 2019.

• Svenaeus, F. 2017. Phenomenological bioethics. Medical technologies, human suffering, and the meaning of being alive. London, New York: Routledge.

  Book  Google Scholar

• Taylor, C. 1989. Sources of the cocky: The making of the mod identity. Cambridge, MA: Harvard Academy Printing.

  Google Scholar

• Taylor, C. 1991. The Ethics of Actuality. Cambridge, Massachusetts & London, England: Harvard University Press.

  Google Scholar

• Tolstoy, L. 2012 (1887). The Death of Ivan Ilyich. (Trans: Louise and Aylmer Maude). Scotts Valley, Us: CreateSpace.

• van Hooff, A.J. 2014. Ancient euthanasia: 'Skilful decease' and the doctor in the graeco-Roman globe. Social Science & Medicine 58 (5): 975–985.

  Article  Google Scholar

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   R. Ahlzen

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Ahlzen, R. Suffering, authenticity, and physician assisted suicide. Med Health Care and Philos 23, 353–359 (2020). https://doi.org/ten.1007/s11019-019-09929-z

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• Published: 13 July 2020

• Issue Date: September 2020

• DOI : https://doi.org/10.1007/s11019-019-09929-z

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