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This final chapter covers the last two decades of Butler's life, a time of profound social change in Ireland. It notes the emerging liberalization within Irish society during the sixties and seventies, as well as its growing internationalization. It charts Butler's belated recognition both in Ireland and abroad in the 1980s as a gifted essayist and social critic after the publication of successive volumes of his essays by Lilliput Press in Dublin. It identifies him as a forerunner of the pluralistic values that came to prominence in the Republic at the time of his death.

This chapter begins by recalling several developments in Catholic moral teaching and practice (on usury, torture, and slavery), and then examines some distinctive Catholic moral convictions: about respect for life, the sexual order, truth, justice, care for the needy, human dignity, and human rights. The chapter ends by proposing two fundamental principles for forming one’s moral conscience: the following of Christ and docility to the guidance of the Holy Spirit.

This chapter focuses on rural asylums in south Germany, the former kingdom of Wuerttemberg. Various forms of patient work in psychiatric institutions are discussed in relation to their varied contexts and diverse structures. Patient work in the asylums was organised in agricultural colonies. Various forms of handicraft in and outside the asylum were part of the daily life of patients in psychiatric family care settings. Zwiefalten, the oldest asylum in Wuerttemberg, is at the core of this study, while some attention is also given to the asylums of Schussenried and Weissenau. It is shown that various aspects of the institutions‘ history are not fully in line with the development of psychiatry in other regions of the country.

This chapter discusses two recent Dutch children’s books by Koos Meinderts and Marjolijn Hof that address euthanasia and the right to self-determination at every age. The Netherlands is a country known for its relatively liberal position on euthanasia. Helma van Lierop-Debrauwer presents the books by Hof and Meinderts as interesting case studies in examining how children’s literature in the Netherlands interacts with social views of childhood and old age. Both generations have a struggle for agency in common. The analysis is framed by sociological research on ageing and ageism in contemporary Western cultures, including Dutch culture, and in particular on the issue of voluntary death among old people. The idea of so-called “rational” suicide to cut short old age is a heavily debated topic in age studies to which these two children’s books contribute.

Chapter 3 focuses on a set of more hybrid texts, which present a significant change in the literary depictions of Nazi euthanasia and its memory, as they not only focus on the life stories of actual victims but also participate in discussions about contemporary issues such as mercy killing and genetic engineering and the status of people with mental disabilities in society today. In order to recover the life stories of these victims, authors such as Hans Ulrich Dapp, Helga Schubert, and Hellmut Haasis incorporate elements of documentary, (auto)biography, and fiction, taking on the role of a “vicarious witness,” giving voice to these silent and silenced victims. Vicarious witnessing offers an alternative to the stereotypical or dehumanizing representations of disability that so often stand in the way of a genuine or appropriate commemoration of these victims.

Though the modern concept of the word euthanasia is physician-assisted suicide, it has nothing in common with what has become known as the Euthanasia Program conducted by the National Socialist regime. This chapter discusses the Euthanasia Program and the establishment of euthanasia centers in Germany. Operation 14f13 involved the killing of approximately 20,000 concentration camp inmates under the auspices of the program. Some 6,000 children perished under the children's Euthanasia Program, which provided mercy deaths for children born with deformities. The chapter also provides a brief life story of Herbert Lange, the man who eventually established the Chełmno extermination camp.

This chapter argues that the arguments on both sides of the debate about a right to die are characterized by unacknowledged contradictions, and in particular by a tension between the claims of calculation and incalculability. Those in favor of a right to die argue above all that such a right is the supreme expression of individual autonomy, freedom, and reasoned choice. They also, however, implicitly undermine this argument by also suggesting that the establishment of such a right would also conserve scarce medical resources. Those opposed to a right to die, similarly, argue above all for an unconditional principle of “always care, never kill.” But they also implicitly qualify this absolute principle by eschewing all possibility of reasoned choice, and arguing that even though some cases seem to justify a right to die, to allow even these will put on us on a “slippery slope” towards a “culture of death.” This side also undermines the principle of unconditional care even more fatally by yoking it to an ethics of the marketplace by which, in practice, such care would be distributed according to the vagaries of birth, employment and fortune.

Building on previous chapters, this chapter argues that the whole debate about a right to die is pervaded, on both sides, by a logic of sacrificial calculation. This point is elaborated by consideration of a wide variety of texts: Samuel D. Williams’ “Euthanasia” (1870), Karl Binding and Alfred Hoche’s infamous Permitting the Destruction of Unworthy Life (1920), the “Declaration on Euthanasia” of the Catholic Church (1980), the U.S. Supreme Court’s decision in Cruzan v. Director, Missouri Department of Health (1990), Ronald Dworkin’s Life’s Dominion (1993), and several others. Among other points, arguments about euthanasia and its practical details prove to be inseparable from difficult questions of time and self-presence.

This chapter focuses on the Church of Euthanasia and its radical solutions to the global population explosion: suicide, abortion, cannibalism, and sodomy. The Church of Euthanasia is a tax-exempt “educational foundation” dedicated to the proposition that all men (and women) are created superfluous. It has staked its claim on the far fringes of the negative population growth movement, alongside neo-Malthusians like the Voluntary Human Extinction Movement and deep ecologists such as the Gaia Liberation Front. According to a Church spokesperson, “The Church is devoted to restoring balance between humans and the remaining species, through voluntary population reduction.” The Church, which claims “hundreds” of card-carrying members as well as a thousand “e-members” scattered across the Net, is based in the Somerville, Massachusetts, apartment of its cross-dressing cleric, the Reverend Chris Korda. One of its notorious slogans is “Save the planet; kill yourself!” and its theological cornerstone is the single commandment “Thou shalt not procreate.” Misanthropy, it turns out, goes hand in glove with the Malthusian gospel that the Church preaches.

Palliative care of persons with HIV and AIDS has changed over the course of the first three decades of the pandemic. The most radical shifts occurred in the second decade with the introduction of combination antiretroviral therapy and other advances in HIV care. In the United States and throughout the world, progress in prevention of HIV transmission has not kept pace with progress in treatment, thus the population of persons living with AIDS continues to grow. Furthermore, economic, psychiatric, social, and political barriers leave many persons without access to adequate HIV care. As a result, persons who lack access to care may need palliative care for late-stage AIDS while persons with access to AIDS treatments are more likely to need palliative care for multimorbid medical illnesses such as cardiovascular disease, cancer, pulmonary disease, and renal disease. Palliative care of persons with HIV and AIDS cannot be confined to the end of life. We present palliative care on a continuum as part of an effort to alleviate suffering and attend to pain, emotional distress, and existential anxiety during the course of the illness. We will provide guidelines for psychiatric and palliative care and pain management to help persons with AIDS cope better with their illnesses and live their lives to the fullest extent, and minimize pain and suffering for them and their loved ones. This chapter reviews basic concepts and definitions of palliative and spiritual care, as well as the distinct challenges facing clinicians involved in HIV palliative care. Finally, issues such as bereavement, cultural sensitivity, communication, and psychiatric contributions to common physical symptom control are reviewed. The terms palliative care and palliative medicine are often used interchangeably. Modern palliative care has evolved from the hospice movement into a more expansive network of clinical care delivery systems with components of home care and hospital-based services (Butler et al., 1996; Stjernsward and Papallona, 1998). Palliative care must meet the needs of the “whole person,” including the physical, psychological, social, and spiritual aspects of suffering (World Health Organization, 1990).