[PAL-PRAT study: Healthcare workers' knowledge and perception of palliative practices in a Cancer Center]. / Quelle connaissance et quelle perception ont les professionnels de santé d'un Centre de lutte contre le cancer à propos des pratiques palliatives encadrées par la loi Claeys-Leonetti : étude PAL PRAT.

INTRODUCTION: The issue of end-of-life care is the subject of a sensitive debate in French society, particularly regarding the possibility for certain patients to have access to medical assistance in dying. The aim of this study was to assess the knowledge and opinion of healthcare providers on the care practices for patients at the end of life, as well as to highlight any specificities in their discourse. METHOD: A survey of healthcare providers' opinions, composed of closed and open questions, that were analyzed using a lexicometric approach, was distributed in a cancer center. RESULTS: The results of the study reveal a good knowledge of the different procedures. Professionals considered that advance directives should be systematically collected; a majority of them differentiated euthanasia from deep continuous sedation and perceived the latter as a means of relieving patients' suffering without inducing death. The different procedures related to the active assistance in dying were known by a majority of professionals and the survey did not identify a dominant trend concerning the will to practice euthanasia if the legal framework allowed it. Half of the participants considered their training insufficient, indicating the need to fill this gap. DISCUSSION: This survey underlines the importance of training and support for the professionals caring for patients in palliative situation and their relatives in France.

People with young-onset dementia and their family caregivers discussing euthanasia: A qualitative analysis of their considerations.

OBJECTIVES: Research showed that people with young-onset dementia and their family caregivers raised the topic of euthanasia when talking about the broader topic of advance care planning. A better understanding of what people address and why may inform the evolving landscape of physician assisted dying. This study aimed to explore the considerations that people with young-onset dementia and their family caregivers expressed on euthanasia. METHODS: A secondary qualitative analysis on interviews with 10 Belgian people with young-onset dementia and 25 family caregivers, using constant comparative analysis. RESULTS: Respondents described similar contexts in which euthanasia had been discussed: the topic arose at 'key' moments, mostly with family caregivers, and was motivated by patients considering the impact of disease progression for themselves and their loved-ones. Caregivers shared opinions on the euthanasia law and discussed the emotional impact of discussing euthanasia. CONCLUSIONS: Considerations of people with young-onset dementia towards euthanasia appear rooted in personal, as well as in anticipated interpersonal and societal suffering. The negative image associated with dementia and dementia care seemed to influence people's expectations for and thoughts on the future. PRACTICE IMPLICATIONS: Patient-physician communication should include detangling motives for euthanasia requests, openly discussing fears and reflecting on prognosis.

[State of the art in palliative sedation]. / État des lieux de la sédation en situations palliatives.

The right to deep and continuous sedation maintained until death was introduced by the law known as the Claeys-Leonetti law. It is no longer a question of reversible sedation, but of maintaining the patient in a deep sleep, without waking, until death. It can be put into care in specific cases. The  borderline between euthanasia and this sedation implemented at the end of life lies in the intentionality of the medical act.

[End of life and cancer: Understanding the ethical issues of voluntary assisted dying]. / Fin de vie et cancer : comprendre en 2023 les enjeux de la demande d'aide active à mourir.

In its advice No. 139 entitled "Ethical issues related to end-of-life situations: autonomy and solidarity", the National Ethics Committee opens for the first time in France the way to a possible active assistance in dying (assisted suicide or euthanasia). Such an ethical, legal and medical evolution would have major consequences in the palliative approach proposed to cancer patients. This clarification aims to enlighten the reflection, in a very complex societal debate. About thirty issues of the supporters and opponents of the legalization of active assistance in dying are first detailed. The values of autonomy and freedom are confronted with those of medical care and solidarity; the individual approach clashes with the collective interest; the interest of the patient and the place of the physician are considered from different angles. Finally, we propose a reflective path, in order to examine step by step the stakes, by examining successively the diagnosis of end of life conditions in France, then the questions asked and the proposals about: suicide; the principle of active assistance in dying; the procedures for reviewing a request for active assistance in dying; the modalities of implementation (assisted suicide or euthanasia); the place of the physician as agent of this decision. Only an analytical approach will make it possible to avoid amalgams and cognitive biases in a debate that closely mixes rationality and emotions.

Physicians' Characteristics and Attitudes Towards Medically Assisted Dying for Non-Competent Patients with Dementia.

The federal and Quebec governments are both considering extending medical aid/assistance in dying (MAID) to non-competent patients who would have requested MAID prior to losing capacity. In 2016-2017, we surveyed 136 Quebec physicians (response rate: 25.5%) on their attitudes towards extending MAID to such patients. Complementing our published findings, we herein identify demographic and practice characteristics that distinguish physicians who reported being open to extending MAID to non-competent patients with dementia, or willing to administer MAID themselves should it be legal, from those who were not. We found that physicians who were older, had stronger religious beliefs, were trained in palliative care, practiced in a teaching hospital, and had not received assisted dying requests in the year preceding the survey held less favourable attitudes towards MAID for non-competent patients with dementia. These findings will inform current deliberations as to whether assistance in dying should be extended to non-competent patients in some circumstances.

[Euthanasia and assisted suicide for psychiatric disorder]. / La pratique de l'euthanasie et du suicide assisté pour motif psychiatrique.

OBJECTIVES: Assisted death has been discussed for years in medicine. Ten countries have adopted legislation that authorises some form of euthanasia or assisted suicide, and the incidence and practices vary from country to country. Consideration of psychological pain linked to psychiatric disorders as a sufficient legal condition for enabling assisted death has added a new layer of complexity to the debate. Thus, Switzerland, Netherlands, Belgium and Luxembourg legalised assisted suicide or euthanasia for psychiatric reasons. In these cases, it is not a question of choosing death conditions but the occurrence of death. This manuscript is a narrative review of the literature about characteristics of patients with psychiatric disorders who requested assisted death in these countries. METHODS: Scientific manuscripts, reports and legal documents were reviewed. RESULTS: The incidence of assisted death for psychiatric reasons was low but has increased over the years. They represented 1.1 % of assisted deaths in Belgium (n=23) and 1.3 % in Netherlands (n=83) in 2017, and 4.5 % in Switzerland in 2014 when also considering dementia. The most frequent diagnoses were depressive and personality disorders. Patients were more often women than men, unlike suicide and middle aged. CONCLUSIONS: Authors who support these practices emphasise the right to die with dignity and the inequality of ruling out patients with psychiatric reasons, whereas they meet the legal requirements, and psychological pain is as severe as somatic pain. Some major issues are highlighted: the close relationship between mood symptoms and death wish, thinking biases and cognitive disturbances that limit the ability to decide, access and consent to medical care, the difficulty of assessing psychological pain, and the definitions of incurability or treatment refractoriness in psychiatry. To date, medical knowledge and assessment tools are not sufficient to define possible indications and offer the best support possible to these patients.

Medical Assistance in Dying: Alberta Approach and Policy Analysis.

ABSTRACTThe legalization of medical assistance in dying (MAID) in Canada has presented an opportunity for physicians, policy makers, and patients to rethink end-of-life care. This article reviews the key features of the Alberta MAID framework and puts it in the context of other provinces and their MAID programs. We also compared policies and MAID practices in different provinces/territories of Canada. In addition, we used the Alberta MAID database to provide the current state of patient demographics and access to MAID services in Alberta in 2017-2018. Significant differences were identified between provincial/territorial MAID program processes and practices. Alberta, Ontario, and Quebec have more comprehensive frameworks. Alberta has dedicated resources to the support of MAID. The median age of those who received MAID service in Alberta from July 2017 to April 2018 was 70 years; a higher proportion were males (55%) and the majority included patients with a cancer diagnosis (70%). Approximately 39 per cent of MAID events happened in a hospital setting, and 38 per cent occurred in patients' homes. We have presented some recommendations on MAID program development, implementation, and review based on Alberta's experience with MAID over the past two years.

[The Role of the Medical Profession in Euthanasia, Particularly in the Prescription of Sodium Pentobarbital]. / Die Rolle der Ärzteschaft in der Sterbehilfe, insbesondere bei der Verschreibung von Natrium-Pentobarbital.

The Role of the Medical Profession in Euthanasia, Particularly in the Prescription of Sodium Pentobarbital Abstract. The delivery of sodium pentobarbital as part of assisted suicide requires a doctor's prescription. This prescription must meet the legal and professional requirements as well as the corresponding ethical guidelines. Current legal practice restrictively permits suicide assistance in this form, especially in the case of patients who are willing to die and whose death is foreseeable. The new guidelines of the SAMS (2018) extend the possibility to patients who suffer intolerably due to disease symptoms and/or functional restrictions. The prescription of NaP in other cases or in violation of the duty of care provided for in the guidelines may result in supervisory, professional and criminal consequences. Suicide assistance itself is a decision of conscience, not a medical task, which is why there is no entitlement to it.

[End-of-life debate: Citizen's point of view about deep and continuous sedation]. / Débat sur la fin de vie en France : regard du citoyen sur la sédation profonde et continue.

INTRODUCTION: Sedation in palliative care meets a precise definition and corresponds to a medical practice. We assessed the comprehension of this practice by the French population. METHOD: In 2015, citizen expressed their views on the Claeys-Leonetti bill by means of a consultative forum made available on the Internet site of the National Assembly. The content of the messages filed, regarding the right to deep and continuous sedation until death was analyzed using the ALCESTE textual data analysis software, supplemented by a thematic analysis in order to identify the perception that Internet users had of this practice. RESULTS: Among the 1819 Internet users who participated in the forum, 67 expressed their views as Health professionals, 25 of whom were directly involved in palliative care, as well as 10 sick persons. Analysis with the ALCESTE software highlighted two classes of statements. The first dealing with deep and continuous sedation, reflecting the specificity of the discourse of the Internet users. The second one consisted of textual units in which the modal verbs were dominant and overrepresented, thus providing information on the participants' perceptions. The thematic analysis highlighted four themes: death, intent, treatment and fear. CONCLUSION: Deep and continuous sedation is perceived as a euthanasic practice or raises fear of such a drift. Provision of extended and accurate information to the population and health professionals is essential to ensure that this new model of sedation is integrated into the care of the terminally ill patients and their families.

Nazi Medical Research in Neuroscience: Medical Procedures, Victims, and Perpetrators.

Issues relating to the euthanasia killings of the mentally ill, the medical research conducted on collected body parts, and the clinical investigations on living victims under National Socialism are among the best-known abuses in medical history. But to date, there have been no statistics compiled regarding the extent and number of the victims and perpetrators, or regarding their identities in terms of age, nationality, and gender. "Victims of Unethical Human Experiments and Coerced Research under National Socialism," a research project based at Oxford Brookes University, has established an evidence-based documentation of the overall numbers of victims and perpetrators through specific record linkages of the evidence from the period of National Socialism, as well as from post-WWII trials and other records. This article examines the level and extent of these unethical medical procedures as they relate to the field of neuroscience. It presents statistical information regarding the victims, as well as detailing the involvement of the perpetrators and Nazi physicians with respect to their post-war activities and subsequent court trials.

[Euthanasia 2002-2014: The situation in Belgium]. / Euthanasie 2002­2014 : état de la situation en Belgique.

INTRODUCTION: Since 2002, Belgian law has authorized the practice of euthanasia under certain clear conditions. All cases have to be reported to the Assessment and Control Commission (ACC). To date, more than 9000 cases have been reported. AIM: To make a statement about the Belgian experience requires consideration of several different essential points: detailed data and information from the ACC reports, their analysis, consequences on medical practice, problems experienced, legal and medical perspectives, criticism and attacks. The concept of individual and institutional conscience is also considered. Euthanasia for minors has been permitted since March 2014 but, to date, no case has been reported. In the light of what has happened in Belgium, we propose to analyse the legal situation in France. MAIN POINTS AND CONCLUSIONS: The Belgian experience is much more than an example and shows that, in difficult and painful situations, it is possible to meet the expectations of patients experiencing intolerable suffering with great respect and without imposing dogmatically something they do not wish.

[Euthanasia and the abuse of conscience clause concept]. / L'euthanasie et le détournement de la clause de conscience.

Since 2002, the Belgian legal framework authorizes the practice of euthanasia, under cer tain clear conditions. All cases have to be reported to the Assessment and Control Commission (ACC). To date, more than 10.000 cases have been reported since 2002. The concept of individual conscience clause is of concern and its use in an institutional dimension is analysed. The role of moral integrity and conscience clause in health care should be downplayed in the field of medicine's core values.

La loi belge qui dépénalise l'euthanasie sous conditions a quatorze ans. Depuis sa mise en application en septembre 2002, plus de 10.000 cas ont été rapportés à la commission fédérale de contrôle et d'évaluation (CFCEE). Le concept de clause de conscience est abordé dans sa dimension individuelle mais également dans le cadre d'un usage institutionnel potentiel. Indépendamment de l'importance que revêtent la clause de conscience et l'intégrité morale, leur usage dans le cadre des soins de santé s'avère parfois abusif et devrait davantage être encadré.

[Euthanasia and/or medically assisted suicide: Reflection on the new responsibility of the hospital pharmacist]. / Euthanasie et/ou suicide médicalement assisté : réflexion sur la nouvelle responsabilité du pharmacien hospitalier.

CONTEXT: Concern about euthanasia and medically assisted suicide is currently growing around the world and particularly in France. Though not authorized at present in France, the role of hospital pharmacist in this issue needs to be discussed. OBJECTIVES: This article aims to gather medical and legal literature of European Union member states on these issues and particularly in France. To propose a practical thinking on the possible role of hospital pharmacist. RESULTS: Among European Union, euthanasia and/or assisted suicide have already been introduced in some member states' laws. In France, Leonetti law currently sets the legal framework for the management of end of life. To address the society's demand on these issues, French President F. Hollande made two ethics committees responsible for working on it. Both were mainly against euthanasia and assisted suicide. Though a bit forgotten in this debate, hospital pharmacist needs to be associated in the thinking, as the main "drug-keeper". Indeed, guidelines are necessary to outline and ensure a safe drug use, complying with professional ethics, if lethal doses are voluntarily prescribed. CONCLUSION: Pharmaceutical work is in constant evolution and is addressing new issues still unanswered, including assisted suicide and euthanasia. French pharmaceutical authorities should seize upon them, in order to guarantee pharmaceutical ethics. These practices, if authorized by law, should remain exceptional, and law strictly enforced. The pharmacist could be one of these "lawkeepers".

Eutanásia, finitude e biopolítica / Euthanasia, finitude and biopolitic / Eutanasia, finitud y biopolítica / Euthanasie, finitude et la politique

Atualmente nossa compreensão acerca do que denominamos vida e morte tem sido pautada por três grandes sistemas de pensamentos. O primeiro, denominado de modelo médico-biológico, parte de três perspectivas distintas, a saber: a perspectiva orgânica, a perspectiva neurosensitiva e a perspectiva singular, todos elas baseadas na doutrina do vitalismo. Na perspectiva vitalista, há uma força ou impulso vital inerente à própria vida e atuando diretamente sobre a matéria organizada, cuja força ou impulso vital traria como consequência a vida em si mesma no que se refere aos seres humanos ou animais. O segundo modelo, o religioso, é pautado na ideia da sacralidade da vida e da vida indigna de ser vivida e são baseados nos preceitos judaico-cristãos. Por fim, o terceiro modelo, o jurídico-político, legitima ações de preservação da vida e punição da morte, operando fraturas nos dois modelos anteriores. Vida e morte, neste modelo, passam a ser compreendidas a partir do dispositivo da lei e da ordem jurídica. Assim, o presente artigo objetiva analisar a questão da eutanásia e da finitude, discutindo-os do ponto de vista teórico-filosófico e tentando mostrar o lugar da negatividade na subjetividade humana. Apresentamos alguns dados atuais sobre a eutanásia no Brasil e no mundo para, por fim, analisar a mudança de paradigma de biopolítica para tanatopolítica a partir dos referenciais de Giorgio Agamben. Concluímos que o avanço da tecnologia médica tem forçado cada vez mais o sistema jurídico-político a converter a política sobre a vida (biopolítica) em uma política sobre a morte (tanatopolítica), trazendo como consequência a necessidade de se pensar: a) o manejo dos cuidados paliativos (ortotanásia); b) o apoio (psicológico) a pacientes e seus familiares; c) a institucionalização da doação de órgãos e d) uma política que legalize a eutanásia e a ortotanásia.(AU)

To understand life and death in current life, the author point out three major systems of thoughts. The first one, called medical-biological model, is pointed out from three different perspectives, namely: the organic, the neurosensitive and the singular perspective. All of them is based on the doctrine of vitalism. In vitalism perspective, there is a strength or inherent to life and vital impulse acting directly on organized matter which force or vital impulse would result in life itself in relation to humans or animals . The second one, the religious model, is founded on the idea of sacredness of life and unworthy of life and are based on Judeo-Christian precepts. Finally, the third model, the legal and political, legitimate actions preservation of life and penalty of death, operating fractures in the two previous models. Life and death in this model are understood from the device of law and legal system. Thus, this paper aims to analyze the issue of euthanasia and finitude, discussing them from a theoretical and philosophical view, trying to show the place of negativity in human subjectivity. It then presents some current data on euthanasia in Brazil and in the world to finally analyze the issue through the paradigm shift from biopolitics to tanatopolitic in Giorgio Agamben approuch. We conclude that the advancement of medical technology has forced more and more legal and political system to convert the policy on the life (biopolitics) in a policy on death (tanatopolitic), bringing as a result the need to think about: a) the management of palliative care (orthotanasia); b) psychological support to patients and their families; c) the institutionalization of organ donation and e) the policy to legalize euthanasia and orthotanasia.(AU)

Actualmente nuestra comprensión acerca de lo que llamamos la vida y la muerte ha estado marcada por tres grandes sistemas de pensamientos. El primero, llamado el modelo biológico, desde tres perspectivas diferentes, a saber: la perspectiva orgánica, la perspectiva neurosensitiva y perspectiva singular, todas ellas basadas en la doctrina del vitalismo. Perspectiva vitalista, existe una fuerza o impulso vital inherente a la propia vida y trabajar directamente sobre el tema organizado, cuya fuerza o impulso vital conduciría a la vida misma en relación con los seres humanos o animales. El segundo modelo, el religioso, se basa en la idea de la sacralidad de la vida y de la vida digna de vivir y se basan en principios Judeo-cristiana. Finalmente, el tercer modelo, el político y jurídico, legitima las acciones de preservación de la vida y la pena de muerte, operando en los dos modelos anteriores de fracturas. Vida y muerte, en este modelo, deben ser entendidos desde el dispositivo de la ley y el ordenamiento jurídico. El presente artículo pretende analizar la cuestión de la eutanasia y finitud, discutiendo el punto de vista teórico y filosófico y tratando de mostrar el lugar de la negatividad en la subjetividad humana. Presentamos algunos datos actuales sobre la eutanasia en Brasil y en el mundo para, finalmente, analizar el cambio de paradigma biopolítico de tanatopolítica de los referentes de Giorgio Agamben. Concluimos que el avance de la tecnología médica ha insistido cada vez más el sistema político y legal para convertir la política en la vida (biopolítica) una política acerca de la muerte (tanatopolítica), trayendo como consecuencia la necesidad de pensar: a) la gestión de cuidados paliativos (ortotanásia); b) soporte (psicologico) a los pacientes y sus familias; c) institucionalización de la donación de órganos y d) una política de legalización de la eutanasia y ortotanásia.(AU)

Actuellement, notre compréhension de ce que nous appelons la vie et la mort a été marquée par trois grands systèmes de pensées. Le premier, appelé le modèle biologique, sous trois angles différents, à savoir: le point de vue biologique, la perspective neurosensitiva et point de vue singulier, chacun d'eux basé sur la théorie du vitalisme. Perspective vitaliste, il y a une force ou une impulsion vitale inhérente à la vie elle-même et travailler directement sur la question organisé, dont la force ou l'impulsion vitale conduirait à la vie elle-même en ce qui concerne la santé humaine ou animale. Le deuxième modèle, le religieux, repose sur l'idée du caractère sacré de la vie et de la vie indigne de vivre et reposent sur des principes judéo-chrétiens. Enfin, le troisième modèle, le politique et juridique, légitime les actions de préservation de la vie et des fractures de la peine de mort, opérant sur les deux modèles précédents. Vie et mort, dans ce modèle, doivent être compris entre l'appareil de droit et système juridique. Le présent article vise à analyser la question de l'euthanasie et la finitude, discuter du point de vue théorique et philosophique et en essayant de montrer la place de la négativité sur la subjectivité humaine. Nous présentons des données actuelles sur l'euthanasie au Brésil et dans le monde pour, enfin, analysent le changement de paradigme biopolitique pour tanatopolítica des repères de Giorgio Agamben. Nous concluons que l'avance de la technologie médicale a souligné plus en plus le système politique et juridique pour convertir la politique sur la vie (biopolitique) à une politique sur la mort (tanatopolítica), apportant ainsi la nécessité de penser : un) la gestion des soins palliatifs (ortotanásia) ; b) soutien (psychologique) pour les patients et leurs familles ; c) institutionnalisation du don d'organes et d) une politique de légalisation de l'euthanasie et ortotanásia.(AU)

Eutanásia, finitude e biopolítica / Euthanasia, finitude and biopolitic / Eutanasia, finitud y biopolítica / Euthanasie, finitude et la politique

Atualmente nossa compreensão acerca do que denominamos vida e morte tem sido pautada por três grandes sistemas de pensamentos. O primeiro, denominado de modelo médico-biológico, parte de três perspectivas distintas, a saber: a perspectiva orgânica, a perspectiva neurosensitiva e a perspectiva singular, todos elas baseadas na doutrina do vitalismo. Na perspectiva vitalista, há uma força ou impulso vital inerente à própria vida e atuando diretamente sobre a matéria organizada, cuja força ou impulso vital traria como consequência a vida em si mesma no que se refere aos seres humanos ou animais. O segundo modelo, o religioso, é pautado na ideia da sacralidade da vida e da vida indigna de ser vivida e são baseados nos preceitos judaico-cristãos. Por fim, o terceiro modelo, o jurídico-político, legitima ações de preservação da vida e punição da morte, operando fraturas nos dois modelos anteriores. Vida e morte, neste modelo, passam a ser compreendidas a partir do dispositivo da lei e da ordem jurídica. Assim, o presente artigo objetiva analisar a questão da eutanásia e da finitude, discutindo-os do ponto de vista teórico-filosófico e tentando mostrar o lugar da negatividade na subjetividade humana. Apresentamos alguns dados atuais sobre a eutanásia no Brasil e no mundo para, por fim, analisar a mudança de paradigma de biopolítica para tanatopolítica a partir dos referenciais de Giorgio Agamben. Concluímos que o avanço da tecnologia médica tem forçado cada vez mais o sistema jurídico-político a converter a política sobre a vida (biopolítica) em uma política sobre a morte (tanatopolítica), trazendo como consequência a necessidade de se pensar: a) o manejo dos cuidados paliativos (ortotanásia); b) o apoio (psicológico) a pacientes e seus familiares; c) a institucionalização da doação de órgãos e d) uma política que legalize a eutanásia e a ortotanásia.

To understand life and death in current life, the author point out three major systems of thoughts. The first one, called medical-biological model, is pointed out from three different perspectives, namely: the organic, the neurosensitive and the singular perspective. All of them is based on the doctrine of vitalism. In vitalism perspective, there is a strength or inherent to life and vital impulse acting directly on organized matter which force or vital impulse would result in life itself in relation to humans or animals . The second one, the religious model, is founded on the idea of sacredness of life and unworthy of life and are based on Judeo-Christian precepts. Finally, the third model, the legal and political, legitimate actions preservation of life and penalty of death, operating fractures in the two previous models. Life and death in this model are understood from the device of law and legal system. Thus, this paper aims to analyze the issue of euthanasia and finitude, discussing them from a theoretical and philosophical view, trying to show the place of negativity in human subjectivity. It then presents some current data on euthanasia in Brazil and in the world to finally analyze the issue through the paradigm shift from biopolitics to tanatopolitic in Giorgio Agamben approuch. We conclude that the advancement of medical technology has forced more and more legal and political system to convert the policy on the life (biopolitics) in a policy on death (tanatopolitic), bringing as a result the need to think about: a) the management of palliative care (orthotanasia); b) psychological support to patients and their families; c) the institutionalization of organ donation and e) the policy to legalize euthanasia and orthotanasia.

Actualmente nuestra comprensión acerca de lo que llamamos la vida y la muerte ha estado marcada por tres grandes sistemas de pensamientos. El primero, llamado el modelo biológico, desde tres perspectivas diferentes, a saber: la perspectiva orgánica, la perspectiva neurosensitiva y perspectiva singular, todas ellas basadas en la doctrina del vitalismo. Perspectiva vitalista, existe una fuerza o impulso vital inherente a la propia vida y trabajar directamente sobre el tema organizado, cuya fuerza o impulso vital conduciría a la vida misma en relación con los seres humanos o animales. El segundo modelo, el religioso, se basa en la idea de la sacralidad de la vida y de la vida digna de vivir y se basan en principios Judeo-cristiana. Finalmente, el tercer modelo, el político y jurídico, legitima las acciones de preservación de la vida y la pena de muerte, operando en los dos modelos anteriores de fracturas. Vida y muerte, en este modelo, deben ser entendidos desde el dispositivo de la ley y el ordenamiento jurídico. El presente artículo pretende analizar la cuestión de la eutanasia y finitud, discutiendo el punto de vista teórico y filosófico y tratando de mostrar el lugar de la negatividad en la subjetividad humana. Presentamos algunos datos actuales sobre la eutanasia en Brasil y en el mundo para, finalmente, analizar el cambio de paradigma biopolítico de tanatopolítica de los referentes de Giorgio Agamben. Concluimos que el avance de la tecnología médica ha insistido cada vez más el sistema político y legal para convertir la política en la vida (biopolítica) una política acerca de la muerte (tanatopolítica), trayendo como consecuencia la necesidad de pensar: a) la gestión de cuidados paliativos (ortotanásia); b) soporte (psicologico) a los pacientes y sus familias; c) institucionalización de la donación de órganos y d) una política de legalización de la eutanasia y ortotanásia.

Actuellement, notre compréhension de ce que nous appelons la vie et la mort a été marquée par trois grands systèmes de pensées. Le premier, appelé le modèle biologique, sous trois angles différents, à savoir: le point de vue biologique, la perspective neurosensitiva et point de vue singulier, chacun d'eux basé sur la théorie du vitalisme. Perspective vitaliste, il y a une force ou une impulsion vitale inhérente à la vie elle-même et travailler directement sur la question organisé, dont la force ou l'impulsion vitale conduirait à la vie elle-même en ce qui concerne la santé humaine ou animale. Le deuxième modèle, le religieux, repose sur l'idée du caractère sacré de la vie et de la vie indigne de vivre et reposent sur des principes judéo-chrétiens. Enfin, le troisième modèle, le politique et juridique, légitime les actions de préservation de la vie et des fractures de la peine de mort, opérant sur les deux modèles précédents. Vie et mort, dans ce modèle, doivent être compris entre l'appareil de droit et système juridique. Le présent article vise à analyser la question de l'euthanasie et la finitude, discuter du point de vue théorique et philosophique et en essayant de montrer la place de la négativité sur la subjectivité humaine. Nous présentons des données actuelles sur l'euthanasie au Brésil et dans le monde pour, enfin, analysent le changement de paradigme biopolitique pour tanatopolítica des repères de Giorgio Agamben. Nous concluons que l'avance de la technologie médicale a souligné plus en plus le système politique et juridique pour convertir la politique sur la vie (biopolitique) à une politique sur la mort (tanatopolítica), apportant ainsi la nécessité de penser : un) la gestion des soins palliatifs (ortotanásia) ; b) soutien (psychologique) pour les patients et leurs familles ; c) institutionnalisation du don d'organes et d) une politique de légalisation de l'euthanasie et ortotanásia.