Puzzling many, Portugal has experienced a “permissiveness wave” on morality issues, despite its population’s high religiosity and the Portuguese Catholic Church’s (PCC) strength. The involvement of this institution in those debates is therefore crucial for understanding this puzzle. This study thus examines the intervention strategies (direct or indirect) and arguments (predominantly moral or rational) the PCC employed during the recent debates on euthanasia and gender identity by analyzing its publications on two institutional websites. Findings indicate that the PCC was active in both debates—particularly in critical political moments during the euthanasia debate—primarily deploying moral arguments and indirect strategies, but occasionally using rational claims and direct actions, like appeals to veto players. This substantial involvement—comparatively higher than in previous debates, given a more interventionist/conservative Patriarch—was nevertheless unable to halt permissive policy changes, mainly due to a secular parliamentary majority and lack of strong ties with political parties.

What is euthanasia? Basically, killing someone for their own good. The aim here is first to clarify this and second to explore the relationship between this killing and that envisaged under the proposed assisted dying scheme. There are important differences. With euthanasia the focus is on the patient’s best interests, doing what is good for her, while with assisted dying the emphasis is on autonomy, and doing what she wants. A suggestion is that the former concern is the one to prioritize.

Rodents remain the predominant mammalian species used for biomedical research and must be humanely killed upon completion of the scientific work. Across the UK, cervical dislocation is reported as the most common method for humanely killing laboratory rodents. Cervical dislocation involves the separation of the vertebrae at the top of the spine and can be achieved manually or mechanically (e.g. using a tool). There is no standardised method for achieving consistent cervical dislocation in the desired location, and no dedicated tool specifically designed, validated and commercially available to achieve accurate and effective dislocation. Previous work has highlighted inaccuracy in method application and, as such, has the potential to risk animal welfare at killing. The aim of this work was to identify the techniques used by personnel across UK institutions for performing cervical dislocation using an online questionnaire. We found marked inconsistencies in technique and the use of tools to aid the application. Mice are predominantly killed via manual operation (i.e. without the aid of a tool), while rats are more often killed using mechanical aids. A wide range of improvised tools (i.e. not designed for killing) were reported, including pens, scissors, and cage scrapers. Further, there was little or no consensus regarding which physical actions are essential for a successful dislocation (i.e. a stretch and/or a twist), and a lack of reported institutional standard operating procedures. Further work is needed to establish validated methods and clear standards to ensure this common method is applied humanely and consistently.

During commercial harvesting (shooting) of kangaroos, pouch young of shot females must be euthanased to prevent suffering. The current euthanasia method, manually applied concussive (or blunt force) trauma to the head, can be effective but is not always applied consistently and is often perceived by observers to be inhumane. The captive-bolt device (CBD), which fires a steel bolt that either penetrates or impacts the skull, could provide a more suitable alternative. We reviewed a range of potentially suitable CBDs and assessed the effectiveness of four types on live animals. Effectiveness of CBDs was determined by assessing behaviour, electroencephalogram (EEG) and evaluating brain and skull trauma post mortem. Pouch young were also euthanased using manual blunt force trauma for comparison. Shooting with a penetrating CBD produced brain activity that was inconsistent with consciousness in 100% (n = 20) of animals. Behavioural indicators of consciousness and normal-like EEG were not detected after shooting with the CBD and damage to the brain was extensive. Seven out of 29 (24%) joeys shot with a non-penetrating CBD were either still breathing (n = 1) or recovered breathing (n = 6) after shooting. All seven animals had no or only mild damage to the medulla. We conclude that a cartridge-powered, penetrating CBD and manual blunt force trauma can both achieve immediate unconsciousness in pouch young, but a second step to exsanguinate the animal must still be performed. Penetrating CBDs are preferred to manual blunt force trauma since they are more repeatable, less reliant upon operator skill and confidence and more likely to reduce animal (and observer) distress.

While the concept of futility has been used widely in somatic medicine, to date, there has been limited consideration of its relevance to psychiatry. We summarize the findings of an international, multidisciplinary workshop involving clinicians, ethicists, philosophers, patient advocates, and persons with lived experience, which was focused on describing futility in psychiatry and developing ethical guidelines for making futility judgments. We outline three leading concepts of futility as they have been used in somatic medicine: physiological futility, quantitative futility, and qualitative futility. We examine the application of these concepts to the care of persons with mental illness, finding that the notion of qualitative futility is most likely to be fruitful. We consider how the concept of qualitative futility in psychiatry could relate to other ethically salient concepts such as terminal mental illness and recovery. We consider (1) who should have authority to make futility judgments in psychiatry (i.e. patients, providers, others), (2) what the process for introducing and evaluating futility judgments should be, and (3) how futility assessments should respond to patients’ goals and values. We identify potential risks of futility assessments, including psychological harms and premature treatment discontinuation, as well as potential benefits, such as reductions in harmful treatments and helpful reevaluation of the goals of care. Workshop participants regarded the concept of psychiatric futility as potentially useful. They identified how the concept could be applied to psychiatric care, as well as ethical limits on doing so.

As assisted dying moves towards legalisation, it is imperative that research be undertaken to inform eligibility and ensure that proper safeguards are instituted. To achieve a meaningful understanding of physician-assisted suicide, such research must draw on professionals with a wide range of expertise and include people with lived experience.

Voluntary assisted dying (VAD) is an end-of-life care option available to eligible Australians living with a terminal condition, though people living with dementia are typically ineligible to choose VAD as part of their end-of-life care. In order to develop equitable research-informed policy and practice, it is crucial to include the perspectives of all key stakeholders, including living experience experts whose voices are currently excluded from Australian VAD research. This study aims to capture the perspectives of people living with dementia by exploring their VAD-related needs and preferences. The study is grounded in a critical and phenomenological conceptual framework that prioritizes inclusive research design. Thirty-six people living with dementia in Australia self-selected to participate in an online survey. It found that the vast majority of participants wanted the option to access VAD themselves, and most wanted provisions for accessing VAD through advance care directives. Through open text responses, the participants expressed many concerns about potential end-of-life suffering and loss of dignity, with their VAD preferences often aligned with their wish to maintain autonomy and human rights. This is the first known Australian study to explore VAD from the perspective of people living with dementia, providing critical insights into their experiences as stakeholders in a highly contested policy and practice environment that is dominated by medico-legal voices. Centring on people living with dementia challenges misconceptions about their capacity to contribute to VAD research, demonstrating their importance as living experience experts and key stakeholders with clear needs and preferences for their end-of-life care.

The article “Is Assisted Dying Really a Matter for Medical Regulation” provides four arguments for the demedicalization of Assisted Dying (AD). Giwa, Myers, and Teaster counter, arguing that demedicalization will increase regulatory complexities if “non-medics” are at the helm and that AD will not be any less susceptible to healthcare economics.