[Euthanasia in an advanced state of dementia: a verdict and its reception in the medical world].

The most controversial issue in the Dutch euthanasia practice concerns the performance of euthanasia in a case of a patient in an advanced state of dementia on the basis of a request that is laid down in an advance directive. This is particularly controversial when such a patient, although lacking decisional capacity on the matter, shows signs of a wish to live. In two important verdicts of April 21 2020 the Dutch Supreme Court has ruled that a request that has been made competently cannot be revoked incompetently.

Counting Cases of Termination of Life without Request: New Dances with Data.

This paper explores the common argument proposed by opponents of the legalization of euthanasia that permitting ending a patient's life at their request will lead to the eventual legalization of terminating life without request. The author's examination of data does not support the conclusion that a causal connection exists between legalizing ending of life on request and an increase in the number of cases without request.

When are you dead enough to be a donor? Can any feasible protocol for the determination of death on circulatory criteria respect the dead donor rule?

The basic question concerning the compatibility of donation after circulatory death (DCD) protocols with the dead donor rule is whether such protocols can guarantee that the loss of relevant biological functions is truly irreversible. Which functions are the relevant ones? I argue that the answer to this question can be derived neither from a proper understanding of the meaning of the term "death" nor from a proper understanding of the nature of death as a biological phenomenon. The concept of death can be made fully determinate only by stipulation.

Respect for autonomy in systems of postmortem organ procurement: A comment.

In 2015 Robert Veatch published the second edition of his Transplantation ethics, this time together with Lainie Ross. The chapters on postmortem organ procurement distinguish between 'giving' and 'taking' systems, and argue that 'taking' systems may promise a greater yield of organs for transplantation, but inevitably violate a requirement of respect for the deceased's autonomy. That argument has been very influential, and is also representative of a way of thinking that is widespread in the literature and in public debate.

Relieving one's relatives from the burdens of care.

It has been proposed that an old and ill person may have a 'duty to die', i.e. to refuse life-saving treatment or to end her own life, when she is dependent on the care of intimates and the burdens of care are becoming too heavy for them.

Suffering and dying well: on the proper aim of palliative care.

In recent years a large empirical literature has appeared on suffering at the end of life. In this literature it is recognized that suffering has existential and social dimensions in addition to physical and psychological ones. The non-physical aspects of suffering, however, are still understood as pathological symptoms, to be reduced by therapeutical interventions as much as possible.

Sedation Until Death: Are the Requirements Laid Down in the Guidelines Too Restrictive?

Guidelines that have been published on sedation until death take the following positions: the patient's consciousness should not be lowered more than is necessary for preventing her from suffering; it must be impossible to alleviate the suffering in any alternative way; and the patient's mere preference for dying peacefully cannot justify the procedure. Some guidelines also stipulate that purely existential suffering cannot do so either. I will discuss the (few) arguments that can be found in the literature for these restrictions.

Continuous deep sedation and homicide: an unsolved problem in law and professional morality.

When a severely suffering dying patient is deeply sedated, and this sedated condition is meant to continue until his death, the doctor involved often decides to abstain from artificially administering fluids. For this dual procedure almost all guidelines require that the patient should not have a life expectancy beyond a stipulated maximum of days (4-14). The reason obviously is that in case of a longer life-expectancy the patient may die from dehydration rather than from his lethal illness.

Do we need a threshold conception of competence?

On the standard view we assess a person's competence by considering her relevant abilities without reference to the actual decision she is about to make. If she is deemed to satisfy certain threshold conditions of competence, it is still an open question whether her decision could ever be overruled on account of its harmful consequences for her ('hard paternalism'). In practice, however, one normally uses a variable, risk dependent conception of competence, which really means that in considering whether or not to respect a person's decision-making authority we weigh her decision on several relevant dimensions at the same time: its harmful consequences, its importance in terms of the person's own relevant values, the infringement of her autonomy involved in overruling it, and her decision-making abilities.

The facilitating role of chemotherapy in the palliative phase of cancer: qualitative interviews with advanced cancer patients.

Objective: To explore the extent to which patients have a directing role in decisions about chemotherapy in the palliative phase of cancer and (want to) anticipate on the last stage of life.

Design: Qualitative interview study.

Methods: In depth-interviews with 15 patients with advanced colorectal or breast cancer at the medical oncology department in a Dutch teaching hospital; interviews were analysed following the principles of thematic content-analysis.

Understanding provision of chemotherapy to patients with end stage cancer: qualitative interview study.

Objective: To examine health professionals' experiences of and attitudes towards the provision of chemotherapy to patients with end stage cancer.

Design: Purposive, qualitative design based on in-depth interviews.

Setting: Oncology departments at university hospitals and general hospitals in the Netherlands.

In the best interests of the deceased: a possible justification for organ removal without consent?

Opt-out systems of postmortem organ procurement are often supposed to be justifiable by presumed consent, but this justification turns out to depend on a mistaken mental state conception of consent. A promising alternative justification appeals to the analogical situation that occurs when an emergency decision has to be made about medical treatment for a patient who is unable to give or withhold his consent. In such cases, the decision should be made in the best interests of the patient.

Understanding provision of chemotherapy to patients with end stage cancer: qualitative interview study.

Objective: To examine health professionals' experiences of and attitudes towards the provision of chemotherapy to patients with end stage cancer.

Design: Purposive, qualitative design based on in-depth interviews. Setting Oncology departments at university hospitals and general hospitals in the Netherlands.

Tacitly consenting to donate one's organs.

The common objection to opt-out systems of postmortal organ procurement is that they allow removal of a deceased person's organs without their actual consent. However, under certain conditions it is possible for 'silence'--failure to register any objection--conventionally and/or legally to count as genuine consent. Prominent conditions are that the consenter should be fully informed about the meaning of his or her silence and that the costs of registering dissent should be insignificant.

The role of the relatives in opt-in systems of postmortal organ procurement.

In almost all opt-in systems of postmortal organ procurement, if the deceased has not made a decision about donation, his relatives will be asked to make it. Can this decision power be justified? I consider three possible justifications. (1) We could presume the deceased to have delegated this power to his relatives.

Priority to registered donors on the waiting list for postmortal organs? A critical look at the objections.

It has often been proposed to restrict access to postmortal organs to registered donors, or at least to give them priority on the waiting list. Such proposals are motivated by considerations of fairness: everyone benefits from the existence of a pool of available organs and of an organised system of distributing them and it is unfair that people who are prepared to contribute to this public good are duped by people who are not. This paper spells out this rationale and goes on to discuss the main principled objections that have been brought forward to such proposals.

Trading with the waiting-list: the justice of living donor list exchange.

In a Living Donor List Exchange program, the donor makes his kidney available for allocation to patients on the postmortal waiting-list and receives in exchange a postmortal kidney, usually an O-kidney, to be given to the recipient he favours. The program can be a solution for a candidate donor who is unable to donate directly or to participate in a paired kidney exchange because of blood group incompatibility or a positive cross-match. Each donation within an LDLE program makes an additional organ available for transplantation.

The values of life.

In Life's Dominion Dworkin aims at defusing the controversy about abortion and euthanasia by redefining its terms. Basically it is not a dispute about the right to life, but about its value. Liberals should grant that human life has not only a personal, but also an intrinsic value; conservatives should accept the principle of toleration which requires to let people decide for themselves about matters of intrinsic value.