Table 2.

Healthcare workers’ ethical considerations regarding euthanasia

Stakeholder	Ethical values voiced in favour of euthanasia	Ethical values voiced in critical considerations
The Patient	Individual Autonomy - Self-determination - Freedom of choice	Relativizing Autonomy - Relational account of autonomy - Bounded rationality due to ‘susceptibility’, ‘subliminality’ - Internalised downside of ‘autonomy’: ‘self-sacrifice’, ‘duty to die’
	Dignity - A ‘dignified death’, consistent with one’s own sense of integrity, belief-system, etc. - A ‘good death’: a ‘soft and gentle passing’	Dignity - Dignified dying not exclusive to euthanasia
	Quality of Life/Well-being - Life not being prolonged unnecessarily - Prevention of meaningless suffering - Continued support to complete (a full and good) life	Quality of Life/Well-being - Protection-worthiness of life - Suffering is an inherent feature of human life
	Compassion - Relief of meaningless suffering - Cessation of meaningless suffering - Compensation for a life gone wrong	Meaning and Transformative Value of Suffering - Providing support in the realisation of self-actualising development amidst the suffering and through hardship/adversity in life - Providing support to find meaning in and acceptance of suffering
The Inner Circle	Involvement - Providing support to the patient and her inner circle - Quality of involvement, continued connectedness and care during the euthanasia procedure - Quality for consciously being present and sharing goodbyes at the very end	Connectedness - Being aware of the trap of false assumptions: words left unspoken, bottling up own feelings/needs for the sake of the other - Balancing respect for autonomy and individual choice with responsibility and accountability to take care for one another
	Attentiveness - Better prepared for the death of a loved one - Better coping and adjusting in bereavement	Attentiveness - Continued grappling with unresolved feelings - Protection of the bereaved facing helplessness after a fast-track to death
The field of medicine	Deontology - Physician’s duty to provide good (end-of-life) care	Deontology 2 - Physicians’ duty is to save life
	Responsibility to alleviate suffering - Evidence of the limits of palliative care as regards to pain relief	Responsibility to alleviate suffering - Proper palliative care is available
	Subsidiarity - Knowledge on the limits of palliative care	Subsidiarity - The use of a palliative filter
	Professional integrity (executive autonomy) - Not deciding on life and death, only on allowing and assisting in dying - Pharmacological and technical know-how to end lives	Professional integrity (executive autonomy) - Not playing God: not a physician’s mandate to decide on life/death2 - Pharmacological and technical know-how to save lives
	Dialogical approach - Dyadic dialogue (patient-physician)1 no intermediary should be tolerated when death is reasonably foreseeable - Triadic dialogue: extended relational autonomy (patient-health professionals-inner circle) when death is not foreseeable	Medical paternalism: - Patient’s impaired decision-making capacity and/or undue pressure2 - Physicians have a more intimate knowledge of the patient and may act in their best interests2
The society	Protection - Legal framework for an ‘underground’ practice before 2002 - Protection against malicious practices - Protection against brutal suicides	Protection of the most vulnerable - Especially the mentally ill and the elderly (not an exemption but fully integrated in society) - Extension of scope: first minors then dementia and being tired of life?
	Dignified dying - Nascent movement of death literacy and reclaiming control of the dying process - Quality over quantity of life: euthanasia as counterreaction to a prolonged life due to medical advancements	Dignified dying - Fast track to death results in the trivialisation of death in the face of ‘Ars Moriendi’ (cf.: fear of dying/death, to avoid suffering, to hold a wake before death) - Romanticised image of euthanasia masks the economics of the death system (‘patients not wanting to be a burden to society’)
	Solidarity - Civic engagement preceded the legal framework (points to the need of death literacy)	Solidarity - Autonomy as’ societal negligence in disguise’: citizens no longer urged to take care of others (“trek uw plan”) - Equating autonomy and dignity leads to the trap of viewing the ill or the elderly as having ‘undignified’ lives - Neoliberal approach leads to wealth over health: the law discourages further investments in health care (‘commodification’ of health care)
		(distributive) Justice - Need to uncover existing misperceptions and misconceptions regarding medical end-of-life options

¹ Only reported by (some) non-physicians

² Only reported by (some) physicians