New Zealand bioethics journal最新文献

Following the recent revival of virtue ethics, a number of ethicists have discussed the moral problems surrounding euthanasia by drawing on concepts such as compassion, benevolence, death with dignity, mercy, and by inquiring whether euthanasia is compatible with human flourishing. Most of these writers assert, or simply assume, that their arguments concerning the morality of euthanasia also support their views with regard to legislation. I argue, against these writers, that legislation cannot and should not be based on our moral and religious beliefs concerning whether euthanasia allows a person to die a good death. I then outline an Aristotelian approach to the role of law and government in a good society, according to which the task of the legislator is not to ensure that people actually act virtuously, but is instead to make it possible for them to choose to live (and die) well by ensuring that they have access to the goods that are necessary for flourishing. In the second half of the paper I apply this approach to the question of whether voluntary active euthanasia should be legalised by asking (1) whether euthanasia always deprives people of the necessary conditions for flourishing, and (2) whether the option to request euthanasia is ever necessary for flourishing.

Divergent perspectives of the nature of substance use have shaped societal attitudes and legislative action toward management of the implications of drug abuse and addiction at an individual and societal level. When it comes to substance abuse issues, policy and ethical analysis become intertwined. The current review entails an ethical evaluation of drug addiction, involving a comparison of different perspectives of substance use and an assessment of the treatment approaches and legal policies derived from these models. The aims of substance use policy directives will be ethically considered in terms of the balance of harm versus benefit, patient/client autonomy and rights and the duties or role of the health care provider in dealing with the problems of addiction.

In New Zealand opioid users obtain their drugs by extraction from codeine-based products, prescribed medication and poppies (in season) as geographical isolation and efficient border protection mean that street heroin is expensive and irregularly available. Hospital run methadone programmes have a virtual monopoly on the provision of opioid substitution programmes leaving clients with limited options if they want to leave methadone programmes. This leads to high client retention rates and provides an opportunity to explore the characteristic conflict that occurs between clients and providers of these programmes. Methadone providers are open to charges of paternalism as they exercise power in what they perceive as the best interests of their clients. Paternalism can be justifiable in treatment where a patient faces serious risks that can be reliably predicted, where these risks are irreversible and where patients have impairment in their autonomy. There may be a degree of impaired autonomy in clients entering a Methadone Maintenance Programme (MMP) as a product of the desperate circumstances of clients on entry to the programme and as a result of opioid dependency. However the risks of not participating in the programme cannot be reliably predicted for an individual client and the impairment in autonomy is of a temporary nature, making paternalism unjustifiable in these programmes. It is suggested that paternalism may be more than a perception in methadone programmes and that it may contribute to conflict between providers and clients. Aspects of MMPs that may indicate paternalism are: confusion between the long term and short term aims of the programmes, assumptions regarding client autonomy on entry and after clients stabilise on the programme, confusion over the application of harm minimisation aims and the inflexibility and social invasiveness of programmes. Preventative ethics is a process whereby programme structures are examined to identify and eliminate those which may lead to unacceptable treatment for clients. This paper examines aspects of MMPs that have the appearance of paternalism and suggests a number of programme design strategies that might assist in eliminating unjustifiable paternalism from MMPs.