Lecture slides bioethics.pdf

Federal State Budgetary Educational Establishment of Higher Education
³.XUVN6WDWH0HGLFDO8QLYHUVLW´
of The Ministry of Public Health of The Russian Federation
Department of Philosophy
Lecture in Bioethics
Ethical Aspects of Using Animals and Human
Subjects
in Medical Experiments.
Lecturer:
PhD, Assoc. Prof. of the Dep.
of Philosophy
Z. G. Simonova
Kursk 2021

Ethical Aspects of Using Animals
in Medical Experiments

Animals are widely used in modern medicine,
scientific research and in the system of education.
It will not be an exaggeration to say that for more
than a hundred years, virtually every medical
breakthrough in human and animal health has
been the direct result of researches using animals.
The use of animals in research is essential to the
development of new and more effective methods
for diagnosing and treating diseases that affect
both humans and animals.

Scientists use animals to learn more about health
problems, and to assure the safety of new medical
treatments.
Medical researchers need to understand health
problems before they can develop ways to treat
them.
Some diseases and health problems involve
processes that can only be studied in living organisms.
That is why the role of animals in research
discovery and technological advances is crucial.

Moreover, animals have been used for centuries to
train students either through demonstration or
through the direct practice by the students
themselves, because classes during which students
can study of the animal organism, and test various
medical skills are unique and can not be replaced
by any other alternatives.

History of Animal Experiments
The use of animals to study human physiology and
anatomy can be traced back to the 4th-3d century BC
the Alexandrian physicians Herophilus and
Erasistratus are recorded as having examined
functional differences between sensory nerves, motor
nerves and tendons.
Herophilus (335 BC)
Erasistratus (304 BC - 250 BC)

History of Animal Experiments
Since the Roman law did not permit dissection of
human bodies, Galen (129-199), began working on
animals.
Galen most often used pigs and primates for his
research works. As animal anatomy resembled human
anatomy to a certain extent, most of his observations
turned out to be true. It was his practice of performing
experiments on live animals that helped him to get the
title of the ³Father of Vivisection.´

Definition
Vivisection - (from Latin vivus = alive
and sectio = cutting) is surgery conducted for
experimental purposes on a living organism,
typically animals with a central nervous system, to
view living internal structure.

Thanks to his experiments Galen managed to
describe the complexities of the cardiopulmonary
system, and speculated on brain and spinal cord
function.
All such procedures of vivisection were
conducted without anaesthetics (which were
discovered only in the middle of the 19th century).
When investigating the anatomy of the brain,
Galen preferred to vivisect pigs to ... avoid seeing
the unpleasant expression of the apes ...
Nowadays the experiments conducted by
Galen are considered as unethical, he left a
significant legacy for the future scientists which had
been used by physicians and scientists till the 16th
century.

During the 12th century, the
Arabic physician -
(Avenzoar) went a step
ahead. He introduced animal
testing as an experimental
method of testing surgical
procedures before applying
them to human patients. He
practiced surgical procedures
by experimenting them on
goats.
AVENZOAR (1093 ± 1162)

In the 60s of the 17th century Robert Boyle
(an Anglo-Irish natural philosopher, chemist)
conducted many experiments with a pump to
investigate the effects of rarified air.
He listed two experiments on living animals:
³([SHULPHQW 40´ which tested the ability of insects
to fly under reduced air pressure, and the dramatic
³([SHULPHQW 41´ZKLFK demonstrated the reliance
of living creatures on air for their survival.

Boyle conducted numerous trials during which he placed a
large variety of different animals, including birds, mice,
eels, snails, and flies in the vessel of the pump and studied
their reactions as the air was removed.

LOUIS PASTEUR (1822 ʹ 1895)
Animals have been
used repeatedly
through the history
of biomedical
research.
In the 1880s, Louis
Pasteur convincingly
demonstrated the
germ theory of
medicine by inducing
anthrax in sheep.

IVAN PAVLOV (1849 ± 1936)
In the 1890s, Ivan
Pavlov famously
used dogs to
describe classical
conditioning. He
had come to learn
this concept of
conditioned reflex
when examining
the rates of
salivations among
dogs.

Pavlov had learned then when a buzzer or
metronome was sounded in subsequent time with
food being given to the dog in consecutive
sequences, the dog will initially salivate when the
food is presented.

Other Experiments on Animals
In 1780 an Italian priest
and physiologist
Lazzaro Spallanzani
± the father of artificial
insemination ±
performed a successful
experiment on dogs in
his laboratory.
Lazzaro Spallanzani

In 1902 Alexis Carrel
transplanted a kidney
from a GRJ¶V abdomen
to its neck. The kidney
produced urine
immediately, but the
animal died after a few
days from an infection.
Alexis Carrel (1873-1944) -
a French surgeon and
biologist, a pioneer of organ
transplantation.

Alexis Carrel and his colleagues also transplanted
the heart of a small dog into the neck of a larger
dog and observed effective contractions of the
transplanted ventricles within an hour of the
operation.

The knowledge gained justified the suffering of
animals.

‡ Animal experiments are widely used to develop new
medicines and to test the safety of other products.
‡ Many of these experiments cause pain to the animals
involved or reduce their quality of life in other ways.
‡ If it is morally wrong to cause animals to suffer then
experimenting on animals produces serious moral
problems.
‡ Animal experimenters are very aware of this ethical
problem and acknowledge that experiments should be
made as humane as possible.

THE THREE Rs
The Three Rs (3Rs) are guiding principles for more
ethical use of animals in testing. These were first
described by W.M.S. Russell and R.L. Burch in
1959.
‡ Replacement which refers to the preferred use of
non-animal methods over animal ones whenever it
is possible to achieve the same scientific aims.
‡ Reduction which refers to methods that enable
researchers to obtain comparable levels of
information from fewer animals, or to obtain more
information from the same number of animals.
‡ Refinement which refers to methods that
alleviate or minimize potential pain, suffering or
distress, and enhance animal welfare for the
animals used.

THE THREE Rs:
Reduction:
Reducing the number of animals used in experiments by:
‡ Improving experimental techniques
‡ Improving techniques of data analysis
‡ Sharing information with other researchers
Refinement:
Refining the experiment or the way the animals are cared to
reduce their suffering by:
‡ Using less invasive techniques
‡ Better medical care
‡ Better living conditions
Replacement:
Replacing experiments on animals with alternative techniques
such as:
‡ Experimenting on cell cultures instead of whole animals
‡ Using computer models
‡ Studying human volunteers
‡ Using epidemiological studies

Harm versus benefit
The case for animal experiments is that they
will produce such great benefits for humanity
that it is morally acceptable to harm a few
animals.
The equivalent case against is that the level of
suffering and the number of animals involved
are both so high that the benefits to humanity
don't provide moral justification.
Scientists say that banning animal
experiments would mean either:
‡ an end to testing new drugs or
‡ using human beings for all safety tests.

Ethical Aspects of Experiments on Human Beings
Lecturer:
of Philosophy
Z. G. Simonova
Kursk 2020

Plan
1. History of experiments of human beings.
2. Dramatic medicine.
3. Official documents regulating GRFWRUV¶
activities in the sphere of biomedical
experimentations on human beings.

History of Medical Experiments on
Human Beings
There is not enough data on experiments on
human beings during the period of the Antiquity.
It is known in Ancient Egypt prisoners were the
subjects of the experiments.
The Alexandrian physician Erasistratus (4-3 cent.
BC) used to conduct the experiments on slaves.

Human Beings
The Roman law did
not permit dissection
of human bodies, that
made Galen, work
on animals.

Human Beings
The experimentation with human subjects
started being treated as the purposeful
scientific method only during the period of
the Modern Age (16-17 cent.).

Human Beings
Andreas Vesalius
a 16th-
century Flemish anatomist,
physician, the father of
human anatomy, who
corrected 300 errors
which had been made by
Galen due to the material
available to him.
Andreas Vesalius

Human Beings
One of the first
medical experiments
was conducted by a
French surgeon
$PEURLVH3DUp.
$PEURLVH3DUp
(c. 1510 ± 20 December
1590)

Experiment by Ambroise 3DUp
In the 16-th c. doctors
used to seal the VROGLHUV¶
wounds by searing them
with the red-hot pitch.
One day Dr. 3DUp had
run out of pitch instead
of it he put a clean
bandage on a VROGLHU¶V
wound.
His ³H[SHULPHQW´ was a
success.

Experiment by James Lind
J. Lind was a Scottish
doctor, a pioneer of
naval hygiene and
expert on the
treatment of scurvy.
James Lind (1716-1794)

In 1747, while serving
as surgeon on a ship,
he carried out
experiments to
discover the cause of
scurvy, the symptoms
of which included
teeth loss, bleeding
gums and
haemorrhages.

J. Lind selected 12 men from the ship, all suffering
from scurvy, and divided them into groups, giving
each group different additions to their basic diet:
1) cider;
2) seawater;
3) a mixture of garlic, mustard and horseradish;
4) spoonfuls of vinegar;
5) oranges and lemons.

Those sailors who were fed with citrus fruits
experienced a remarkable recovery. J. Lind
had definitively established the superiority
of citrus fruits above all other ³UHPHGLHV´.

During the 19th century the number of
experiments with human subjects has
significantly escalated.
Self-experimentation refers to scientific
experimentation in which the experimenter
conducts the experiment on her- or himself.
History of medicine knows a lot of examples
conducted by doctors on themselves =
dramatic medicine.

Experiment by Max von Pettenkofer
Max von Pettenkofer is known
as the founder of the discipline
of hygiene in Germany.
In the 19th±century cholera
epidemics in Europe
Pettenkofer believed that
cholera was only contagious
under certain circumstances.
Max von Pettenkofer
(1818 -1901)

Experiment by Max von Pettenkofer
Pettenkofer famously
demonstrated the
strength of this belief in
1892 by drinking a
quantity of water
infected by pure cultures
of the cholera bacillus.
Though he ended up
getting somewhat ill, he
did not develop a full-
blown case of cholera.

Experiment by John Hunter
John Hunter ± a Scottish
surgeon and authority on
venereal diseases.
John Hunter
(1728 ±1793)

Experiment by John Hunter
He thought that gonorrhea and
syphilis were caused by a single
pathogen.
He inoculated himself with
gonorrhea, using a needle that
was unknowingly contaminated
with syphilis.
When he contracted both syphilis
and gonorrhea, he claimed it
proved his theory (that there was
only one venereal disease) was a
mistake.
Luckily, he championed its
treatment with mercury and
cauterization.

Experiment by Henry Head
Sir Henry Head
an English neurologist.
In 1903 he conducted a
painful self-experiment, in
which he severed the radial
nerve of his left arm, and
then charted the gradual and
faltering return of sensitivity
to the limb over the next four
and a half years.
Henry Head
(1861 ± 1940)

Unethical Experiments on Human Beings
1) The Aversion Project
for Homosexuals
In South Africa back in
1970¶V the Aversion
Project conducted by the
South African army was
one of the strangest and
worst human
experiments in history.

The Aversion Project for Homosexuals
Thought it was termed as a research it was more
like an act of exploitation or oppression.
Anyone with even the slightest possibility of being a
homosexual was selected without his/her consent
and was then sent to a military psychiatric unit for
the purpose of horrendous experiments.
During this research cells, various medications and
treatments were forced on the victims which also
included shock therapy and hormones. If these
ĚŝĚŶ͛ƚ work then synthetic emasculation and sex
reassignment surgeries would be performed.

THE TUSKEGEE SYPHILIS STUDY
This experiment was
said to be done for
research purposes
but in reality, it was
more comparable to
racial discrimination.
Between 1932 and
1972, a few
researchers decided
to use African
Americans as test
subjects.
They were injected with a sexually
transmitted disease, more
specifically Syphilis without any
official consent according to all the
records.
Since Syphilis is an STD, it affects
not only the victims but anyone that
they sexually come into contact
with.

THE TUSKEGEE SYPHILIS
STUDY
Around 400 illiterate African Americans were
chosen for this experiment during the above-
mentioned timeline.
Some of the few included assurances (proper
medical treatment and burial arrangements).
More than 120 males died as a direct result of
the experiment and several women were
effected by the disease.
As a result, twenty children inherited Syphilis.

Thalidomide Victims
Thalidomide, sold under the brand
name Immunoprin, among others, is
an immunomodulatory drug.
In 1959-1961 it was used against nausea and
to alleviate morning sickness in pregnant
women.

Thalidomide Victims
As a result of it 8000-
12ooo children with
significant defects
abnormalities were
born all over the
world.

Experiments by Joseph Mengele
Josef Mengele - a
German officer and
physician
in Auschwitz
concentration
camp during World
War II - Angel of
Death
Josef Mengele
(1911 ± 1979)

Experiments on Twins by Joseph Mengele
‡ Measurements: The twins
were forced to undress and lie
next to each other. Then every
detail of their anatomy was
carefully examined, studied,
and measured. What was the
same was deemed to be
hereditary and was different
was deemed to be the result of
the environment. These tests
would last for several hours.
‡ Blood: Blood tests included
mass transfusions of blood from
one twin to another.

Experiments by Joseph Mengele
‡ Eyes: In attempts to fabricate blue eyes, drops or
injections of chemicals would be put in the eyes. This
often caused severe pain, infections, and temporary or
permanent blindness.
‡ Shots and Diseases: Mysterious injections caused
severe pains. Injections into the spine and spinal taps
were given with no anesthesia. Diseases, including
typhus and tuberculosis, would be purposely given to
one twin and not the other. When one died, the other
was often killed to examine and compare the effects of
the disease.
‡ Surgeries: Various surgeries were performed without
anesthesia including organ removal, castration, and
amputation.௙

Official Documents
1) World Medical Association
Declaration of Helsinki (Ethical
Principles for Medical Research Involving
Human Subjects) adopted in 1964
2) The Nuremberg Code (1947) - a set
of research ethics principles for human
experimentation set as a result of
the subsequent Nuremberg trials at the end
of the Second World War.

10 Points of the Nuremberg Code
‡ The voluntary consent of the human
subject in a full legal capacity is essential.
‡ The experiment should aim at positive
results for society that cannot be procured
in some other way.
‡ It should be based on previous knowledge
(e.g., an expectation derived from animal
experiments) that justifies the experiment.

‡ The experiment should be set up in a way
that avoids unnecessary physical and mental
suffering and injuries.
‡ It should not be conducted when there is any
reason to believe that it implies a risk of
death or disabling injury.
‡ The risks of the experiment should be in
proportion to the expected humanitarian
benefits.

‡ Preparations and facilities must protect the
subjects against the H[SHULPHQW¶V risks.
‡ The staff who conduct or take part in the
experiment must be fully trained and scientifically
qualified.
‡ The human subjects must be free to immediately
quit the experiment at any point when they feel
physically or mentally unable to go on.
‡ Likewise, the medical staff must stop the
experiment at any point when they observe that
continuation would be dangerous.

Answer the following questions:
‡ Who is the Father of human anatomy? Explain why?
‡ Why was vivisection of human beings prohibited in the period
of the Antiquity?
‡ Enumerate the names of the doctors who were experimenting
on human beings? What kinds of experiments were conducted
by them?
‡ What part of medicine is treated as dramatic medicine?
‡ What do you know about the experiments conducted by Max
Von Pettenkofer?
‡ Who got the nick name of the Angel of Death? What kinds of
experiments were conducted by him?
‡ Who are considered as Thalidomide victims?
‡ Why is Tuskegee experiment treated as unethical?
‡ What documents protect the rights of human beings who are
the subjects of biomedical experiments?
‡ What are the main guidelines of the Nuremberg Code?

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ĐŽŶĐĞƌŶŝŶŐŽƌŐĂŶĂŶĚĐĞůů
ƚƌĂŶƐƉůĂŶƚĂƚŝŽŶŝŶƚŚĞ
ƚ ƌĞ Ăƚ ŵ Ğ Ŷƚ Ž Ĩ Ś Ƶ ŵ Ă Ŷ
ĚŝƐĞĂƐĞƐ͘͟
:ŽƐĞƉŚĚǁĂƌĚDƵƌƌĂǇ

‡ /ŶϭϵϲϳƚŚĞĨŝƌƐƚŝŶƚŚĞ
ŚŝƐƚŽƌǇŽĨŵĞĚŝĐŝŶĞŚĞĂƌƚ
ƚƌĂŶƐƉůĂŶƚĂƚŝŽŶǁĂƐŚĞůĚ
ŝŶƚŚĞŚŽƐƉŝƚĂů'ƌŽŽƚ
:ĞƐƚĞƌ͕ĂƉĞdŽǁŶ;^ŽƵƚŚ
ĨƌŝĐĂͿ͘/ƚǁĂƐŚĞůĚďǇ
Ɖ ƌŽ ĨĞ Ɛ Ɛ Ž ƌ Ś ƌ ŝ Ɛƚ ŝ Ă Ŷ
ĞƌŶĂƌĚ͘
‡ ŚĞĂƌƚǁĂƐƚƌĂŶƐƉůĂŶƚĞĚ
ƚŽĂϱϱͲǇĞĂƌͲŽůĚƉĂƚŝĞŶƚ
ĨƌŽŵĂĨĂƚĂůůǇǁŽƵŶĚĞĚ
ϮϱͲǇĞĂƌͲŽůĚǁŽŵĂŶ͘

‡ d Ś Ž ŵ Ă Ɛ Ă ƌ ů
^ƚĂƌǌůĂŶŵĞƌŝĐĂŶ
ƉŚǇƐŝĐŝĂŶĂŶĚĂŶĞǆƉĞƌƚ
ŽŶŽƌŐĂŶƚƌĂŶƐƉůĂŶƚƐ͘͘
, Ğ Ɖ Ğ ƌ ĨŽ ƌ ŵ Ğ Ě ƚ Ś Ğ
Ĩ ŝ ƌ Ɛ ƚ Ś Ƶ ŵ Ă Ŷ ů ŝ ǀ Ğ ƌ
ƚƌĂŶƐƉůĂŶƚĂƚŝŽŶŝŶϭϵϲϯ͘

‡ ,ĞĂƌƚƚƌĂŶƐƉůĂŶƚĂƚŝŽŶŝƐƚŚĞ
ŵŽƐƚĞǆƉĞŶƐŝǀĞƉƌŽĐĞĚƵƌĞ͘
‡ ǀĞƌǇďŽĚǇŬŶŽǁƐƚŚĞ
ZŽĐŬĞĨĞůůĞƌƐ͘
‡ ĂǀŝĚZŽĐŬĞĨĞůůĞƌŚĂĚ
ƵŶĚĞƌŐŽŶĞϴ
ƚƌĂŶƐƉůĂŶƚĂƚŝŽŶƉƌŽĐĞĚƵƌĞƐ
;ϳŚĞĂƌƚĂŶĚϭŬŝĚŶĞǇ
ƚƌĂŶƐƉůĂŶƚĂƚŝŽŶͿ͘
‡ /ŶϭϵϳϲĂƚƚŚĞĂŐĞŽĨϲϭ
ĂǀŝĚZŽĐŬĞĨĞůůĞƌ
ƵŶĚĞƌǁĞŶƚƚŚĞϭͲƐƚŚĞĂƌƚ
‡ dŚĞůĂƐƚŽŶĞǁĂƐŝŶϮϬϭϲ͘
‡ ,ĞŚĂĚĂĚƌĞĂŵƚŽůŝǀĞƚŝůů
ϮϬϬǇĞĂƌƐŽůĚ͘/ŶĨĂĐƚŚĞ
ĚŝĞĚĂƚƚŚĞĂŐĞŽĨϭϬϭ͘

ĂĐĞdƌĂŶƐƉůĂŶƚĂƚŝŽŶ
‡ EĞǁŽƉƉŽƌƚƵŶŝƚŝĞƐĨŽƌĨĂĐĞƚƌĂŶƐƉůĂŶƚƐƵƌŐĞƌǇ
ŝŶZƵƐƐŝĂǁĞƌĞŽƉĞŶĞĚŝŶϮϬϭϲ͘
‡ ĨĂĐĞƚƌĂŶƐƉůĂŶƚĂƚŝŽŶŝƐĂŵĞĚŝĐĂůƉƌŽĐĞĚƵƌĞ
ƚŽƌĞƉůĂĐĞĂůůŽƌĂƉĂƌƚŽĨĂƉĞƌƐŽŶΖƐĨĂĐĞƵƐŝŶŐ
ƚŝƐƐƵĞƐĨƌŽŵĂĐĂĚĂǀĞƌ͘
‡ ZƵƐƐŝĂŚĂƐďĞĐĂŵĞƚŚĞϴƚŚĐŽƵŶƚƌǇŝŶƚŚĞ
ǁŽƌůĚƚŽŐĂŝŶƐƵĐŚĂŶĞǆƉĞƌŝĞŶĐĞ͘

ƐĞƌǀŝĐĞŵĂŶ;EŝŬŽůĂǇͿŚĂƐƐƵĨĨĞƌĞĚĞůĞĐƚƌŝĐĂůďƵƌŶƐ͘,Ğ
ŚĂĚďĞĞŶǁĂŝƚŝŶŐĨŽƌŚŝƐŶĞǁĨĂĐĞĨŽƌĂůŵŽƐƚϰǇĞĂƌƐ͘
dŚĞŽƉĞƌĂƚŝŽŶǁĂƐŚĞůĚĂƚ^ƚ͘WĞƚĞƌƐďƵƌŐDŝůŝƚĂƌǇ
DĞĚŝĐĂůĐĂĚĞŵǇ͘
dŚĞŵĂŶ͕ǁŚŽĚŝĞĚŝŶƵƌƐŬƌĞŐŝŽŶĨƌŽŵĂƐĞǀĞƌĞ
ƚƌĂƵŵĂƚŝĐďƌĂŝŶŝŶũƵƌǇ͕ďĞĐĂŵĞEŝŬŽůĂǇ͛ƐƐĂǀŝŽƌ͘

ĂĐĞdƌĂŶƐƉůĂŶƚĂƚŝŽŶ

dŚĞŽůĚĞƐƚŵĂŶǁŚŽŚĂĚƵŶĚĞƌŐŽŶĞ
ƚŚĞĨĂĐĞƚƌĂŶƐƉůĂŶƚĂƚŝŽŶ
ϲϰͲǇĞĂƌŽůĚĂŶĂĚŝĂŶDĂƵƌŝĐĞ
ĞƐũĂƌĚŝŶƐůŽƐƚŚŝƐŶŽƐĞ͕ůŝƉƐ͕ƚĞĞƚŚĂŶĚ
ƵƉƉĞƌĂŶĚůŽǁĞƌũĂǁƐǁŚĞŶŚĞǁĂƐ
ĂĐĐŝĚĞŶƚĂůůǇƐƚƌƵĐŬďǇĂďƵůůĞƚĨƌŽŵĂ
ŚƵŶƚŝŶŐƌŝĨůĞ͘
/ŶϮϬϭϴŚĞƵŶĚĞƌǁĞŶƚƚŚĞ
ƚƌĂŶƐƉůĂŶƚĂƚŝŽŶ͘dŚĞƉƌŽĐĞĚƵƌĞŝŶ
ǁŚŝĐŚϭϬϬĚŽĐƚŽƌƐǁĞƌĞƉĂƌƚŝĐŝƉĂƚŝŶŐ
ŚĂĚůĂƐƚĞĚĨŽƌϯϬŚŽƵƌƐ͘dŚĞǇ
ƚƌĂŶƐƉůĂŶƚĞĚƚŚĞũĂǁƐ͕ƚĞĞƚŚ͕ůŝƉƐ͕ĨĂĐŝĂů
ŵƵƐĐůĞƐĂŶĚŶĞƌǀĞƐ͘
EŽǁDĂƵƌŝĐĞĐĂŶĞĂƚŝŶĚĞƉĞŶĚĞŶƚůǇ͕
ƚĂůŬ͕ďƌĞĂƚŚĞĂŶĚĞǀĞŶŚĂƐƚŚĞƐĞŶƐĞŽĨ
ƐŵĞůů͘
dŚĞĨĂĐĞĨŽƌƚŚĞƚƌĂŶƐƉůĂŶƚĂƚŝŽŶǁĂƐĚŽŶĂƚĞĚďǇ
ƚŚĞdƌĂŶƐƉůĂŶƚYƵĞďĞĐŽŵƉĂŶǇǁŝƚŚƚŚĞ
ĐŽŶƐĞŶƚƚŚĞƌĞůĂƚŝǀĞƐŽĨĂĚĞĐĞĂƐĞĚŵĂŶ͘

tŽŵďdƌĂŶƐƉůĂŶƚĂƚŝŽŶ

tŽŵďdƌĂŶƐƉůĂŶƚĂƚŝŽŶ
‡ dŚĞĨŝƌƐƚͲĞǀĞƌĂƚƚĞŵƉƚĚĂƚĞƐďĂĐŬƚŽϭϵϯϭ͕
ǁŚĞŶĂƵƚĞƌŝŶĞƚƌĂŶƐƉůĂŶƚǁĂƐƉĞƌĨŽƌŵĞĚŽŶ
ŝůŝůďĞʹĂƚƌĂŶƐǁŽŵĂŶǁŚŽǁĂƐďŽƌŶĂƐĂ
ŵĂůĞŝŶĞŶŵĂƌŬ͘dŚĞƉĂƚŝĞŶƚĚŝĞĚƚŚƌĞĞ
ŵŽŶƚŚƐĂĨƚĞƌƐƵƌŐĞƌǇĂƐŚĞƌďŽĚǇƌĞũĞĐƚĞĚƚŚĞ
ŽƌŐĂŶ͘

tŽƌůĚ͛ƐĨŝƌƐƚƐƵĐĐĞƐƐĨƵůƵƚĞƌƵƐ
ƚƌĂŶƐƉůĂŶƚƉĞƌĨŽƌŵĞĚŝŶdƵƌŬĞǇ
ĞƌǇĂ^Ğƌƚ͕ǁŚŽǁĂƐďŽƌŶ
ǁŝƚŚŽƵƚĂƵƚĞƌƵƐ͕ŚĂƐďĞĐŽŵĞ
ƚŚĞĨŝƌƐƚǁŽŵĂŶŝŶƚŚĞǁŽƌůĚƚŽ
ƌ Ğ Đ Ğ ŝ ǀ Ğ Ă ǁ Ž ŵ ď Ĩ ƌ Ž ŵ Ă
ĚĞĐĞĂƐĞĚĚŽŶŽƌ͘dŚĞŽƉĞƌĂƚŝŽŶ͕
ƉĞƌĨŽƌŵĞĚŽŶƵŐƵƐƚϵ͕ϮϬϭϭ
ďǇĚŽĐƚŽƌƐĨƌŽŵŬĚĞŶŝǌ
hŶŝǀĞƌƐŝƚǇ,ŽƐƉŝƚĂůŝŶƐŽƵƚŚĞƌŶ
dƵƌŬĞǇ͕ŚĂƐďĞĞŶĂƐƵĐĐĞƐƐ͘

^ŝŶĐĞϭϵϱϬƚŚĞŽƌŐĂŶƚƌĂŶƐƉůĂŶƚĂƚŝŽŶŚĂƐďĞĞŶ
ĂĐĐŽŵƉĂŶŝĞĚďǇŵĂŶǇŚĂƌĚŝƐƐƵĞƐĂďŽƵƚĞƚŚŝĐƐ
ŽĨƚĂŬŝŶŐŽƌŐĂŶƐĨƌŽŵƚŚĞĚĞĂĚŽƌƚŚĞůŝǀŝŶŐĂŶĚ
ŐŝǀŝŶŐƚŚĞŵƚŽŽƚŚĞƌƐ͘

dŚĞEĞĞĚĨŽƌŽŶĂƚŝŽŶƐĂŶĚǀĂŝůĂďůĞ
dƌĂŶƐƉůĂŶƚƐ
‡ dŚĞŐƌŽǁŝŶŐŶĞĞĚĨŽƌƚƌĂŶƐƉůĂŶƚĂďůĞŚƵŵĂŶ
ŽƌŐĂŶƐĂƌŝƐĞƐŵĂŝŶůǇĨƌŽŵŶŽŶĨƵŶĐƚŝŽŶŝŶŐŽƌ
ƉŽŽƌůǇĨƵŶĐƚŝŽŶŝŶŐŽƌŐĂŶƐŝŶƉŽƚĞŶƚŝĂů
ƌĞĐŝƉŝĞŶƚƐ͘
‡ dŚĞŶĞĞĚĨŽƌŽƌŐĂŶƚƌĂŶƐƉůĂŶƚĂƚŝŽŶĐĂŶďĞ
ƐĞĞŶŝŶĚĂƚĂŽĨƚŚĞdƌĂŶƐƉůĂŶƚtĂŝƚŝŶŐŝƐƚ͘

^KDd^Khdt/d/E'/^d
‡ ǁĂŝƚŝŶŐůŝƐƚŝƐĂůŝƐƚŽĨƉĂƚŝĞŶƚƐǁĂŝƚŝŶŐĨŽƌĂŶ
ŽƌŐĂŶĨŽƌƚƌĂŶƐƉůĂŶƚĂƚŝŽŶ͘

ŝŶĚŝŶŐĂŶKƌŐĂŶDĂƚĐŚ
KŶĐĞŵĂƚĐŚŝŶŐƌĞĐŝƉŝĞŶƚƐĂƌĞĨŽƵŶĚ͕ƚŚĞůŝƐƚŝƐ
ĨƵƌƚŚĞƌŶĂƌƌŽǁĞĚďǇĂƉƉůǇŝŶŐĂĚĚŝƚŝŽŶĂů
ĐƌŝƚĞƌŝĂ͕ƐƵĐŚĂƐƐĞǀĞƌŝƚǇŽĨŝůůŶĞƐƐ͕ůĞŶŐƚŚŽĨ
ƚŝŵĞŽŶƚŚĞǁĂŝƚŝŶŐůŝƐƚ͕ĂŶĚĚŝƐƚĂŶĐĞďĞƚǁĞĞŶ
ƚŚĞƌĞĐŝƉŝĞŶƚĂŶĚĚŽŶŽƌŽƌŐĂŶ͘KŶĞĞǆĐĞƉƚŝŽŶ
ƚŽĚŝƐƚĂŶĐĞĐŽŶƐŝĚĞƌĂƚŝŽŶƐŝƐƚŚĞŬŝĚŶĞǇ͕ǁŚŝĐŚ
ŝƐƐĞŶƚƚŽƚŚĞďĞƐƚŵĂƚĐŚĞĚƉĂƚŝĞŶƚ͕ƌĞŐĂƌĚůĞƐƐ
ŽĨůŽĐĂƚŝŽŶ͘

ŝŶĚŝŶŐĂŶKƌŐĂŶDĂƚĐŚ
‡ sĂƌŝŽƵƐŽƌŐĂŶƐĂƌĞƉƌĞƐĞƌǀĞĚƵŶƚŝůƚƌĂŶƐƉůĂŶƚĂƚŝŽŶďǇĂ
ǀĂƌŝĞƚǇŽĨŵĞĂŶƐ͕ĂŶĚƚŚĞůĞŶŐƚŚŽĨƚŝŵĞĂŶŽƌŐĂŶĐĂŶ
ƌĞŵĂŝŶŽƵƚƐŝĚĞƚŚĞďŽĚǇǀĂƌŝĞƐ͘
‡ ĐĐŽƌĚŝŶŐƚŽhEK^;hŶŝƚĞĚEĞƚǁŽƌŬĨŽƌKƌŐĂŶ^ŚĂƌŝŶŐͿ͕
ŽƌŐĂŶƉƌĞƐĞƌǀĂƚŝŽŶƚŝŵĞƐĂƌĞ͗
‡ ,ĞĂƌƚ͗ϰʹϲŚŽƵƌƐ
‡ ŝǀĞƌ͗ϭϮʹϭϴŚŽƵƌƐ
‡ ŝĚŶĞǇ͗ϰϴŚŽƵƌƐ
‡ ,ĞĂƌƚͲƵŶŐ͗ϰʹϲŚŽƵƌƐ
‡ ƵŶŐ͗ϮʹϰŚŽƵƌƐ
‡ WĂŶĐƌĞĂƐ͗ϭϮʹϭϴŚŽƵƌƐ͘

EĞǁ/ƐƐƵĞŝŶdƌĂŶƐƉůĂŶƚĂƚŝŽŶ͗
DĂƌŐŝŶĂůKƌŐĂŶƐ
‡ dƌǇŝŶŐƚŽƐŽůǀĞƚŚĞƉƌŽďůĞŵŽĨƚŚĞŐƌŽǁŝŶŐ
ŶĞĞĚĨŽƌƚƌĂŶƐƉůĂŶƚĂďůĞŚƵŵĂŶŽƌŐĂŶƐĚŽĐƚŽƌƐ
Ɛ ƚ Ă ƌ ƚ Ğ Ě Ƶ Ɛ ŝ Ŷ Ő ŵ Ă ƌ Ő ŝ Ŷ Ă ů Ž ƌ Ő Ă Ŷ Ɛ Ĩ Ž ƌ
‡ DĂƌŐŝŶĂůŽƌŐĂŶƐʹĂƌĞƚŚĞŽƌŐĂŶƐƚĂŬĞŶĨƌŽŵĂ
ĐĂĚĂǀĞƌŽůĚĞƌƚŚĂŶϲϬŽƌĂĚŽŶŽƌŽůĚĞƌƚŚĂŶ
ϱϬďƵƚǁŚŽƐƵĨĨĞƌĞĚĨƌŽŵŬŝĚŶĞǇĨĂŝůƵƌĞ͕Žƌ
ŚǇƉĞƌƚĞŶƐŝŽŶĚƵƌŝŶŐŚŝƐůŝĨĞƚŝŵĞ͘

EĞǁ/ƐƐƵĞŝŶdƌĂŶƐƉůĂŶƚĂƚŝŽŶ͗
DĂƌŐŝŶĂůKƌŐĂŶƐ
‡ /ƚŚĞůƉƐƚŽƐŽůǀĞƚŚĞƉƌŽďůĞŵŽĨŽƌŐĂŶ
ƉƌŽĐƵƌĞŵĞŶƚďƵƚĐĂƵƐĞƐŽƚŚĞƌĞƚŚŝĐĂůŝƐƐƵĞƐ͘dŚĞ
ďĞŶĞĨŝƚĨƌŽŵƚƌĂŶƐƉůĂŶƚĂƚŝŽŶŝƐĞůŝŵŝŶĂƚĞĚ͘
‡ ŽĐƚŽƌƐƐŚŽƵůĚĞǀĂůƵĂƚĞďĞŶĞĨŝƚƐĂŶĚƌŝƐŬƐŽĨƚŚĞ
‡ ŝƐƚƌŝďƵƚŝŽŶŽĨŽƌŐĂŶƐƐŚŽƵůĚďĞƌĞŐƵůĂƚĞĚďǇƚŚĞ
ƉƌŝŶĐŝƉůĞŽĨũƵƐƚŝĐĞ;ŵĂƌŐŝŶĂůŽƌŐĂŶƐʹƐĞƌŝŽƵƐůǇŝůů
ƉĂƚŝĞŶƚƐ͖ŚĞĂůƚŚǇŽƌŐĂŶƐʹƚŚĞŵŽƐƚƐĞƌŝŽƵƐůǇŝůů
ƉĂƚŝĞŶƚƐͿ͘
‡ /ŶĨŽƌŵĞĚĐŽŶƐĞŶƚ;ŝŶĨŽƌŵĂƚŝŽŶĂďŽƵƚƚŚĞ
ŵĂƌŐŝŶĂůŽƌŐĂŶƐĐĂŶĐĂƵƐĞƐƚƌĞƐƐͿ͘

yĞŶŽƚƌĂŶƐƉůĂŶƚĂƚŝŽŶ
dŚĞƉƌŽďůĞŵŽĨƚŚĞƐŚŽƌƚĂŐĞŽĨŽƌŐĂŶƐŵŝŐŚƚ
Ś Ă ǀ Ğ ď Ğ Ğ Ŷ Ɛ Ž ů ǀ Ğ Ě ď Ǉ ŵ Ğ Ă Ŷ Ɛ Ž Ĩ
ǆĞŶŽƚƌĂŶƐƉůĂŶƚĂƚŝŽŶďƵƚƚŚĞĞǆƉĞƌŝŵĞŶƚƐƉƌŽǀĞ
ǆĞŶŽŐƌĂĨƚƐĚŽŶ͛ƚ͞ůŝǀĞ͟ůŽŶŐ;ĨƌŽŵĂĨĞǁĚĂǇƐƚŽĂ
ĨĞǁǁĞĞŬƐͿ͘

dŚĞĨŝƌƐƚǆĞŶŽƚƌĂŶƐƉůĂŶƚĂƚŝŽŶ
;ĂďǇĂĞĂƐĞͿƚŽŽŬƉůĂĐĞĂƚ
ƚŚĞŽŵĂŝŶĚĂhŶŝǀĞƌƐŝƚǇ
;ĂůŝĨŽƌŶŝĂͿŝŶϭϵϴϰ͘
^ƚĞƉŚĂŶŝĞĂĞĞĂƵĐůĂŝƌ;ĂďǇ
ĂĞͿǁĂƐďŽƌŶŝŶϭϵϴϰǁŝƚŚĂ
ŚǇƉŽƉůĂƐƚŝĐůĞĨƚŚĞĂƌƚƐǇŶĚƌŽŵĞ
ͲĂĨĂƚĂůŚĞĂƌƚĚĞĨĞĐƚ͘dŚĞ
ĚŽĐƚŽƌƐŐĂǀĞŚĞƌĂĨĞǁǁĞĞŬƐ
ƚŽůŝǀĞ͘

‡ dŚĞŚŝƐƚŽƌŝĐƐƵƌŐĞƌǇƚŽŽŬ
ƉůĂĐĞŽŶKĐƚŽďĞƌϮϲ͕ϭϵϴϰ͕
ǁŚĞŶ^ƚĞƉŚĂŶŝĞĂĞ
ƌĞĐĞŝǀĞĚƚŚĞŚĞĂƌƚŽĨĂ
ďĂďŽŽŶ͘^ŚĞŶŽƚŽŶůǇ
ƐƵƌǀŝǀĞĚƚŚĞƐƵƌŐĞƌǇ͕ďƵƚ
ƚŚƌŝǀĞĚĨŽƌŵŽƌĞƚŚĂŶƚǁŽ
ǁĞĞŬƐ͘

‡ dŚĞŶ͕ĨŽƌƌĞĂƐŽŶƐƚŚĂƚƌĞŵĂŝŶĂ
ŵǇƐƚĞƌǇƚŽƚŚŝƐĚĂǇ͕ƐŚĞďĞŐĂŶ
ƚŽĚĞƚĞƌŝŽƌĂƚĞ͘KŶĞďǇŽŶĞ͕ŚĞƌ
ĞƐƐĞŶƚŝĂůŽƌŐĂŶƐƐŚƵƚĚŽǁŶƵŶƚŝů͕
ŽŶEŽǀĞŵďĞƌϭϲ͕ϭϵϴϰ͕ƐŚĞ
ƉĂƐƐĞĚĂǁĂǇ͘
‡ EŽǁĂĚĂǇƐƚŚĞǇƚƌĂŶƐƉůĂŶƚ
ƚŝƐƐƵĞƐƚŽĐƵƌĞĚŝƐĞĂƐĞƐŽĨ
ŚƵŵĂŶďĞŝŶŐƐ͘

dŚĞ^ŽƵƌĐĞƐŽĨKƌŐĂŶƐ
‡ 'ĞƚƚŝŶŐŽƌŐĂŶƐĨƌŽŵĂůŝǀŝŶŐĚŽŶŽƌ
‡ ŝǀŝŶŐĚŽŶŽƌƐƵƐƵĂůůǇŐŝǀĞĂŬŝĚŶĞǇŽƌĂƉĂƌƚŽĨ
ƚŚĞůŝǀĞƌ͕ĂŶĚůĞƐƐŽĨƚĞŶ͕ĂůŽďĞŽĨĂůƵŶŐ͘/ƚŝƐĂ
ĚŝƌĞĐƚĞĚŐŝĨƚ;ƚŚĂƚŝƐ͕ƚŚĞŽƌŐĂŶŝƐĨŽƌĂƌĞůĂƚŝǀĞͿ͕
ĂŶĚďŽƚŚƚŚĞĚŽŶŽƌĂŶĚƚŚĞƌĞĐŝƉŝĞŶƚŵƵƐƚ
ĨƌĞĞůǇĐŽŶƐĞŶƚƚŽƚŚĞƉƌŽĐĞĚƵƌĞ͘
‡ dŚĞŽƌŐĂŶŝƐƌĞŵŽǀĞĚŽŶůǇŝĨƐƵĐŚĂƉƌŽĐĞĚƵƌĞ
ĚŽĞƐŶŽƚĞŶĚĂŶŐĞƌƚŚĞůŝĨĞŽĨƚŚĞĚŽŶŽƌ͘

ƌĞĞŽŶƐĞŶƚ
ŽŶƐĞŶƚĐĂŶŽŶůǇďĞǀĂůŝĚŝĨŝƚŝƐŐŝǀĞŶŝŶĨƌĞĞĚŽŵ͘
/ƚŵĂǇďĞƚŚĞĐĂƐĞƚŚĂƚŽŶĞŝƐƌĞĂĚǇƚŽ͞ĚŽŶĂƚĞ͟
ŽŶĞ͛ƐŽƌŐĂŶƐ͘dŚĞĚĞĐŝƐŝŽŶĐĂŶďĞƚŚĞƌĞƐƵůƚŽĨ
ĨĂŵŝůŝĂůŽƌŵŽƌĂůƉƌĞƐƐƵƌĞ͕ŽƌŝŶƐŽŵĞĐĂƐĞƐ
ĨŝŶĂŶĐŝĂůƉƌĞƐƐƵƌĞ͘/ŶƐŽŵĞƉĂƌƚƐŽĨƚŚĞǁŽƌůĚƚŚĞ
ƐĂůĞŽĨŽƌŐĂŶƐĨƌŽŵůŝǀŝŶŐƉĞƌƐŽŶƐŝƐĂƉƌŽĨŝƚĂďůĞ
ďƵƐŝŶĞƐƐ͘dŚŝƐŝƐĂĚŝƌĞĐƚǀŝŽůĂƚŝŽŶŽĨƚŚĞĚŽŶŽƌ͕
ǁŚŽŝƐŽĨƚĞŶƉĂŝĚďǇ͞ďƌŽŬĞƌƐ͟ǁŚŽƚŚĞŶƐĞůůƚŚĞ
ŽƌŐĂŶƐĂƚŵƵĐŚŚŝŐŚĞƌƉƌŝĐĞƐ͘dŚŝƐůĞĂĚƐƚŽ
͞ƚƌĂŶƐƉůĂŶƚƚŽƵƌŝƐŵ͕͟ǁŚŝĐŚŚĂƐďĞĞŶĐŽŶĚĞŵŶĞĚ
ďǇƚŚĞtŽƌůĚ,ĞĂůƚŚKƌŐĂŶŝǌĂƚŝŽŶĂŶĚ
ƉƌŽĨĞƐƐŝŽŶĂůƚƌĂŶƐƉůĂŶƚŽƌŐĂŶŝǌĂƚŝŽŶƐ͘

'ĞƚƚŝŶŐŽƌŐĂŶƐĨƌŽŵƚŚĞĚĞĂĚ
‡ ǀĞŶĂĨƚĞƌĚĞĂƚŚŚĂƐŽĐĐƵƌƌĞĚ͕ƚŚĞďŽĚǇŵĂǇ
ďĞŬĞƉƚ͞ďŝŽůŽŐŝĐĂůůǇĂůŝǀĞ͟ǁŝƚŚŵĂĐŚŝŶĞƐƐŽ
ƚŚĞŽƌŐĂŶƐĚŽŶ͛ƚĚĞĐĂǇďĞĨŽƌĞƚŚĞĨĂŵŝůǇĐĂŶ
ďĞĐŽŶƐƵůƚĞĚƌĞŐĂƌĚŝŶŐƚŚĞŝƌǁŝƐŚĞƐ͘

‡ tŚĞŶƐŽŵĞŽŶĞĚŝĞƐŝŶƚŚĞŚŽƐƉŝƚĂů͕ŚŝƐĨĂŵŝůǇ
ŵŝŐŚƚďĞĂƐŬĞĚƚŽĂůůŽǁĂŵĞĚŝĐĂůƚĞĂŵƚŽ
ƌĞŵŽǀĞƐŽŵĞŽĨƚŚĞŽƌŐĂŶƐĂŶĚƚƌĂŶƐƉůĂŶƚ
ƚŚĞŵŝŶƚŽĂŶŽƚŚĞƌƉĂƚŝĞŶƚ͘

'ĞƚƚŝŶŐŽƌŐĂŶƐĨƌŽŵƚŚĞĚĞĂĚ
‡ KŶĐĞƚƌƵĞĚĞĂƚŚŽĨƚŚĞƉĂƚŝĞŶƚŚĂƐďĞĞŶ
ĚĞƚĞƌŵŝŶĞĚƵƐŝŶŐĐƌŝƚĞƌŝĂƚŚĂƚŚĂǀĞďĞĞŶ
ĐĂƌĞĨƵůůǇĞƐƚĂďůŝƐŚĞĚďƵƚďĞĨŽƌĞƚŚĞŝŶĚŝǀŝĚƵĂů
ŽƌŐĂŶƐŚĂǀĞĚĞƚĞƌŝŽƌĂƚĞĚ͕ƚŚĞƚƌĂŶƐƉůĂŶƚƚĞĂŵ
ŵĂǇƚĂŬĞƚŚĞŽƌŐĂŶƐĨƌŽŵƚŚĞĚŽŶŽƌ͛ƐďŽĚǇ͘

'ĞƚƚŝŶŐŽƌŐĂŶƐĨƌŽŵĂĚĞĂĚĚŽŶŽƌ
ZĞƐƉĞĐƚĨŽƌƚŚĞĚĞĐĞĂƐĞĚĚŽŶŽƌ͘
ZĞŵŽǀĂůŽĨŽƌŐĂŶƐǀŝŽůĂƚĞƐƚŚĞŝŶƚĞŐƌŝƚǇŽĨƚŚĞ
ŚƵŵĂŶďŽĚǇĂŶĚŵƵƐƚŶŽƚďĞĐŽŶƐŝĚĞƌĞĚ
ǁŝƚŚŽƵƚĂŐŽŽĚƉƵƌƉŽƐĞ͘ZĞƐƉĞĐƚĨŽƌƚŚĞ
ŝŶƚĞŐƌŝƚǇŽĨƚŚĞďŽĚǇĐŽŶƚŝŶƵĞƐĂĨƚĞƌĚĞĂƚŚ͘/Ŷ
ĨĂĐƚ͕ǀŝŽůĂƚŝŽŶŽĨĂĚĞĂĚƉĞƌƐŽŶŝƐŝůůĞŐĂů͘
ŽƌŽƌŐĂŶƌĞŵŽǀĂůƚŽďĞĞƚŚŝĐĂů͕ƚŚĞĚŽŶŽƌŵƵƐƚ͕
ĚƵƌŝŶŐŚŝƐŽƌŚĞƌůŝĨĞƚŝŵĞ͕ŵĂŬĞĂĨƌĞĞĐŚŽŝĐĞƚŽ
ĚŽŶĂƚĞŽƌŐĂŶƐĨŽƌƚŚĞŐĞŶĞƌŽƵƐŝŶƚĞŶƚŝŽŶŽĨ
ƐĂǀŝŶŐĂŶŽƚŚĞƌŚƵŵĂŶůŝĨĞ͘

KƌŐĂŶƌĞŵŽǀĂů
/ŶŽƌĚĞƌĨŽƌŽƌŐĂŶƌĞŵŽǀĂůƚŽďĞĞƚŚŝĐĂů͕
ƚŚĞƌĞŵƵƐƚďĞĨƌĞĞĂŶĚŝŶĨŽƌŵĞĚĐŽŶƐĞŶƚŽŶ
ƚŚĞƉĂƌƚŽĨƚŚĞĚŽŶŽƌŽƌŚŝƐĨĂŵŝůǇ͘dŚŝƐ
ƌĞƋƵŝƌĞŵĞŶƚĂƉƉůŝĞƐƚŽďŽƚŚůŝǀŝŶŐĂŶĚ
ĚĞĐĞĂƐĞĚĚŽŶŽƌƐ͘/ŶŽƌĚĞƌƚŽƌĞŵŽǀĞŽƌŐĂŶƐ
ĨƌŽŵĂĚĞĂĚƉĞƌƐŽŶ͕ƚŚĞƌĞŵƵƐƚďĞĂůƐŽĂ
ŵŽƌĂůĐĞƌƚĂŝŶƚǇŽĨĚĞĂƚŚ͘/ŶƚŚĞĐĂƐĞŽĨŽƌŐĂŶ
ƌĞŵŽǀĂůĨƌŽŵĂůŝǀŝŶŐƉĞƌƐŽŶ͕ƚŚĞƌŝƐŬƐŵƵƐƚ
ďĞĞǀĂůƵĂƚĞĚďĞĨŽƌĞƉĞƌĨŽƌŵŝŶŐƚŚĞ
ƉƌŽĐĞĚƵƌĞ͘

ŽŶŽƌĂƌĚ
Ž Ŷ Ž ƌ Ă ƌ Ě Ͳ Ă
ƉŝĞĐĞŽĨĞǀŝĚĞŶĐĞ
ǁŚŝĐŚƐŚŽǁƐŝƚƐ
ŽǁŶĞƌǀŽůƵŶƚĂƌŝůǇ
ĂŐƌĞĞƐƚŚĂƚŚŝƐŽƌ
ŚĞƌŽƌŐĂŶƐĂŶĚͬŽƌ
ƚ ŝ Ɛ Ɛ Ƶ Ğ Ɛ Đ Ă Ŷ
ďĞƚƌĂŶƐƉůĂŶƚĞĚ
ĂĨƚĞƌŚŝƐŽƌŚĞƌ
ĚĞĂƚŚ͘

WƌĞƐƵŵĞĚŽŶƐĞŶƚ
dŽƐŽůǀĞƚŚĞƉƌŽďůĞŵŽĨƚŚĞƐŚŽƌƚĂŐĞŽĨŽƌŐĂŶƐĨŽƌ
ƚƌĂŶƐƉůĂŶƚĂƚŝŽŶĂůŽƚŽĨĐŽƵŶƚƌŝĞƐĂůůŽǀĞƌƚŚĞ
ǁŽƌůĚƉĂƐƐĞĚƚŚĞůĂǁŽĨƉƌĞƐƵŵĞĚĐŽŶƐĞŶƚ͘
WƌĞƐƵŵĞĚĐŽŶƐĞŶƚŵĞĂŶƐƚŚĂƚĞǀĞƌǇŝŶĚŝǀŝĚƵĂů
;ǁŚŽĚŝĚŶŽƌĨŽƌŵĂůůǇƌĞŐŝƐƚĞƌĂŶŽƉƉŽƐŝƚŝŽŶƚŽ
ŽƌŐĂŶĚŽŶĂƚŝŽŶďĞĨŽƌĞŚĂŶĚͿďĞĐŽŵĞƐĂĚŽŶŽƌ
ǁŚĞŶŚĞͬƐŚĞŝƐĚĞĐůĂƌĞĚĚĞĂĚŽŶŶĞƵƌŽůŽŐŝĐĂů
ĐƌŝƚĞƌŝĂ;͞ďƌĂŝŶĚĞĂƚŚ͟ͿďǇϯƐƉĞĐŝĂůŝƐƚ͘

ƌŝƚĞƌŝĂŽĨƌĂŝŶĞĂƚŚ

tŚŽŚĂĚƚŚĞƌŝŐŚƚƚŽĚĞƚĞƌŵŝŶĞ
ďƌĂŝŶĚĞĂƚŚ͍
EŽƚůĞƐƐƚŚĂŶϮƐƉĞĐŝĂůŝƐƚƐŝŶĐůƵĚŝŶŐĂŶ
ĂŶĞƐƚŚĞƐŝŽůŽŐŝƐƚͲƌĞƐƵƐĐŝƚĂƚŽƌĂŶĚŶĞƵƌŽůŽŐŝƐƚǁŚŽ
ǁŽƌŬŝŶƚŚĞŚŽƐƉŝƚĂůǁŚĞƌĞĂƉĂƚŝĞŶƚĚŝĞĚŚĂǀĞƚŚĞ
ƌŝŐŚƚƚŽĚĞƚĞƌŵŝŶĞďƌĂŝŶĚĞĂƚŚ͘
dŚĞƐƉĞĐŝĂůŝƐƚƐƐŚŽƵůĚǁŽƌŬŝŶĚĞƉĞŶĚĞŶƚůǇ͘
dŚĞĚŽĐƚŽƌƐǁŚŽĂƌĞŝŶǀŽůǀĞĚŝŶŚĂƌǀĞƐƚŝŶŐƚŚĞ
ŽƌŐĂŶƐĂŶĚƚŚĞƉƌŽĐĞĚƵƌĞŽĨƚƌĂŶƐƉůĂŶƚĂƚŝŽŶĚŽŶŽƚ
ŚĂǀĞƚŚĞƌŝŐŚƚƚŽĚĞƚĞƌŵŝŶĞďƌĂŝŶĚĞĂƚŚ;ƚŽĂǀŽŝĚ
ƚŚĞĐŽŶĨůŝĐƚŽĨŝŶƚĞƌĞƐƚƐͿ͘

‡ dŚĞƉĂƚŝĞŶƚ;ƉŽƚĞŶƚŝĂůĚŽŶŽƌͿǁŚŽŝƐĚĞĐůĂƌĞĚ
ƚŽďĞĚĞĂĚŽŶŶĞƵƌŽůŽŐŝĐĂůĐƌŝƚĞƌŝĂŝƐĂĐĂĚĂǀĞƌ
ŝŶǁŚŽŵůŝĨĞŝƐƐƵƉƉŽƌƚĞĚďǇůŝĨĞƐƵƉƉŽƌƚŝŶŐ
ŵĂĐŚŝŶĞƐǁŚŝůĞĚŽĐƚŽƌƐĂƌĞŐĞƚƚŝŶŐƌĞĂĚǇĨŽƌ
ƚŚĞƉƌŽĐĞĚƵƌĞŽĨƚƌĂŶƐƉůĂŶƚĂƚŝŽŶ͘

/ŶƚĞƌŶĂƚŝŽŶĂůWƌĞƐƵŵĞĚŽŶƐĞŶƚWŽůŝĐŝĞƐ
dŚĞƉƌĞƐƵŵĞĚͲĐŽŶƐĞŶƚůĂǁǁĂƐƉĂƐƐĞĚŝŶϭϵϳϵ
ŝŶ^ƉĂŝŶ͘
^ƉĂŝŶŚĂƐƚŚĞǁŽƌůĚΖƐŚŝŐŚĞƐƚƌĂƚĞŽĨĂĐƚƵĂů
ĚŽŶĂƚŝŽŶ͘
dŚĞƉƌĞƐƵŵĞĚͲĐŽŶƐĞŶƚƉŽůŝĐǇŝŶ^ƉĂŝŶŝƐĐŽƐƚͲ
ĞĨĨĞĐƚŝǀĞ͕ƐĂǀŝŶŐƚŚĞEĂƚŝŽŶĂů,ĞĂůƚŚ^ĞƌǀŝĐĞ
ŵŽƌĞƚŚĂŶϮϬϬϬϬϬĞƵƌŽƐŝŶŵĞĚŝĐĂůĐŽƐƚƐĨŽƌ
ĞĂĐŚŬŝĚŶĞǇƚƌĂŶƐƉůĂŶƚƉƌĞĨŽƌŵĞĚŽŶĂƉĂƚŝĞŶƚ
ŽŶĚŝĂůǇƐŝƐ͘

/ŶƚĞƌŶĂƚŝŽŶĂůWƌĞƐƵŵĞĚŽŶƐĞŶƚWŽůŝĐŝĞƐ
KƚŚĞƌĐŽƵŶƚƌŝĞƐǁŝƚŚƉƌĞƐƵŵĞĚͲĐŽŶƐĞŶƚƉŽůŝĐŝĞƐ
ŝŶĐůƵĚĞƵƐƚƌŝĂ͕ƌĂŶĐĞ͕ŽůƵŵďŝĂ͕EŽƌǁĂǇ͕/ƚĂůǇ͕
ĂŶĚ^ŝŶŐĂƉŽƌĞ͘
/Ŷ^ŝŶŐĂƉŽƌĞĂůůƌĞƐŝĚĞŶƚƐƌĞĐĞŝǀĞĂůĞƚƚĞƌǁŚĞŶ
ƚŚĞǇƌĞĂĐŚƚŚĞĂŐĞŽĨϭϴƚŚĂƚƐƚĂƚĞƐƚŚĞǇĂƌĞ
ƉƌĞƐƵŵĞĚƚŽĐŽŶƐĞŶƚƚŽŽƌŐĂŶĚŽŶĂƚŝŽŶƵŶůĞƐƐ
ƚŚĞǇĞǆƉůŝĐŝƚůǇŽďũĞĐƚƚŽŝƚ͘

tŽƌůĚDĞĚŝĐĂůƐƐŽĐŝĂƚŝŽŶ͕ĞĐůĂƌĂƚŝŽŶŽŶ
,ƵŵĂŶKƌŐĂŶdƌĂŶƐƉůĂŶƚĂƚŝŽŶ;ϭϵϴϳͿ͘
ĚŽƉƚĞĚďǇƚŚĞϯϵƚŚtŽƌůĚDĞĚŝĐĂůƐƐĞŵďůǇ
DĂĚƌŝĚ͕^ƉĂŝŶ͕KĐƚŽďĞƌϭϵϴϳ
dŚĞtŽƌůĚDĞĚŝĐĂůƐƐŽĐŝĂƚŝŽŶƌĞĐŽŵŵĞŶĚƐƚŚĞ
ĨŽůůŽǁŝŶŐŐƵŝĚĞůŝŶĞƐĨŽƌƚŚĞŐƵŝĚĂŶĐĞŽĨ
ƉŚǇƐŝĐŝĂŶƐĞŶŐĂŐĞĚŝŶƚŚĞƚƌĂŶƐƉůĂŶƚĂƚŝŽŶŽĨ
ŚƵŵĂŶŽƌŐĂŶƐ͘

ƚŚŝĐĂůZƵůĞƐĨŽƌWŚǇƐŝĐŝĂŶƐ
dŚĞŽƌŐĂŶƐĂŶĚƚŝƐƐƵĞƐĨŽƌƚƌĂŶƐƉůĂŶƚĂƚŝŽŶƐŚŽƵůĚŶŽƚďĞ
ƚĂŬĞŶĨƌŽŵ͗
ͲƚŚĞďŽĚŝĞƐŽĨƉƌŝƐŽŶĞƌƐĞǆĞĐƵƚĞĚŝŶĂƉƉůŝĐĂƚŝŽŶŽĨĂĚĞĂƚŚ
ƐĞŶƚĞŶĐĞǁŝƚŚŽƵƚƉƌĞǀŝŽƵƐůǇŽďƚĂŝŶŝŶŐƚŚĞŝƌĐŽŶƐĞŶƚŽƌ
ŐŝǀŝŶŐƚŚĞŵĂŶŽƉƉŽƌƚƵŶŝƚǇƚŽƌĞĨƵƐĞ͖
ͲƚŚĞďŽĚŝĞƐŽĨŚĂŶĚŝĐĂƉƉĞĚƉĞƌƐŽŶƐǁŚŽƐĞĚĞĂƚŚƐĂƌĞ
ďĞůŝĞǀĞĚƚŽŚĂǀĞďĞĞŶĐĂƵƐĞĚƚŽĨĂĐŝůŝƚĂƚĞƚŚĞŚĂƌǀĞƐƚŝŶŐŽĨ
ƚŚĞŝƌŽƌŐĂŶƐ͖
ͲƚŚĞďŽĚŝĞƐŽĨƉŽŽƌƉĞŽƉůĞǁŚŽŚĂǀĞĂŐƌĞĞĚƚŽƉĂƌƚǁŝƚŚ
ƚŚĞŝƌŽƌŐĂŶƐĨŽƌĐŽŵŵĞƌĐŝĂůƉƵƌƉŽƐĞƐ͖
ͲƚŚĞďŽĚŝĞƐŽĨǇŽƵŶŐĐŚŝůĚƌĞŶŬŝĚŶĂƉƉĞĚĨŽƌƚŚŝƐƉƵƌƉŽƐĞ͘

ϭ͘dŚĞƉƌŝŵĂƌǇĐŽŶĐĞƌŶŽĨƉŚǇƐŝĐŝĂŶƐŵƵƐƚĂƚĂůů
ƚŝŵĞƐďĞƚŚĞŚĞĂůƚŚŽĨƚŚĞŝƌƉĂƚŝĞŶƚƐ͘dŚĞ
ĐŽŶĐĞƌŶŵƵƐƚďĞƉƌĞƐĞƌǀĞĚŝŶĂůůŵĞĚŝĐĂů
ƉƌŽĐĞĚƵƌĞƐ͕ŝŶĐůƵĚŝŶŐƚŚŽƐĞǁŚŝĐŚŝŶǀŽůǀĞƚŚĞ
ƚƌĂŶƐƉůĂŶƚĂƚŝŽŶŽĨĂŶŽƌŐĂŶĨƌŽŵŽŶĞƉĞƌƐŽŶ
ƚŽĂŶŽƚŚĞƌ͘ŽƚŚĚŽŶŽƌĂŶĚƌĞĐŝƉŝĞŶƚĂƌĞ
ƉĂƚŝĞŶƚƐĂŶĚĐĂƌĞŵƵƐƚ͕ƚŚĞƌĞĨŽƌĞ͕ďĞƚĂŬĞŶƚŽ
ƉƌŽƚĞĐƚƚŚĞƌŝŐŚƚƐŽĨďŽƚŚ͘

Ϯ͘tŚĞŶĂŶŽƌŐĂŶŝƐƚŽďĞƚƌĂŶƐƉůĂŶƚĞĚĨƌŽŵĂ
ĚŽŶŽƌĂĨƚĞƌƚŚĞĚŽŶŽƌΖƐĚĞĂƚŚ͕ƚŚĞĚĞĂƚŚŽĨ
ƚŚĞĚŽŶŽƌƐŚĂůůŚĂǀĞďĞĞŶĚĞƚĞƌŵŝŶĞĚ
ŝŶĚĞƉĞŶĚĞŶƚůǇďǇƚǁŽŽƌŵŽƌĞƉŚǇƐŝĐŝĂŶƐǁŚŽ
ĂƌĞŶŽƚŝŶǀŽůǀĞĚŝŶƚŚĞƚƌĂŶƐƉůĂŶƚĂƚŝŽŶ
ƉƌŽĐĞĚƵƌĞ͘ĞĂƚŚƐŚĂůůďĞĚĞƚĞƌŵŝŶĞĚďǇƚŚĞ
ũƵĚŐŵĞŶƚƐŽĨĞĂĐŚƉŚǇƐŝĐŝĂŶ͘

ϯ͘dƌĂŶƐƉůĂŶƚƉƌŽĐĞĚƵƌĞƐŽĨďŽĚǇŽƌŐĂŶƐƐŚŽƵůĚ
ďĞƵŶĚĞƌƚĂŬĞŶ͗
;ĂͿŽŶůǇďǇƉŚǇƐŝĐŝĂŶƐǁŚŽƉŽƐƐĞƐƐƐƉĞĐŝĂů
ŵĞĚŝĐĂůŬŶŽǁůĞĚŐĞĂŶĚƚĞĐŚŶŝĐĂůĐŽŵƉĞƚĞŶĐĞ
ĚĞǀĞůŽƉĞĚƚŚƌŽƵŐŚƐƉĞĐŝĂůƚƌĂŝŶŝŶŐ͕ƐƚƵĚǇĂŶĚ
ƉƌĂĐƚŝĐĞ͕
;ďͿŝŶŵĞĚŝĐĂůŝŶƐƚŝƚƵƚŝŽŶƐǁŝƚŚĂĚĞƋƵĂƚĞ
ĨĂĐŝůŝƚŝĞƐĨŽƌŽƌŐĂŶƚƌĂŶƐƉůĂŶƚĂƚŝŽŶ͘

ϰ͘dƌĂŶƐƉůĂŶƚĂƚŝŽŶŽĨďŽĚǇŽƌŐĂŶƐƐŚŽƵůĚďĞ
ƵŶĚĞƌƚĂŬĞŶŽŶůǇĂĨƚĞƌĐĂƌĞĨƵůĞǀĂůƵĂƚŝŽŶŽĨƚŚĞ
ĂǀĂŝůĂďŝůŝƚǇĂŶĚĞĨĨĞĐƚŝǀĞŶĞƐƐŽĨŽƚŚĞƌƉŽƐƐŝďůĞ
ƚŚĞƌĂƉǇ͘

ϱ͘dŚĞƉƵƌĐŚĂƐĞĂŶĚƐĂůĞŽĨŚƵŵĂŶŽƌŐĂŶƐĨŽƌ
ƚƌĂŶƐƉůĂŶƚĂƚŝŽŶŝƐĐŽŶĚĞŵŶĞĚ͘

ZĞůŝŐŝŽƵƐƚƚŝƚƵĚĞƚŽKƌŐĂŶŽŶĂƚŝŽŶ
‡ ZĞůŝŐŝŽŶĂŶĚĐƵůƚƵƌĞďŽƚŚƉůĂǇĨƵŶĚĂŵĞŶƚĂů
ƌŽůĞƐŝŶƚŚĞĚĞĐŝƐŝŽŶŽĨĂŶŝŶĚŝǀŝĚƵĂůŽƌĨĂŵŝůǇ
ƚŽĚŽŶĂƚĞŽƌǁŝƚŚŚŽůĚŽƌŐĂŶƐĂŶĚƚŝƐƐƵĞƐ͘
DŽƐƚŵĂũŽƌǁŽƌůĚƌĞůŝŐŝŽŶƐƐƵƉƉŽƌƚĂŶĚ
ĞŶĐŽƵƌĂŐĞŽƌŐĂŶĚŽŶĂƚŝŽŶĂƐĂŶĂĐƚŽĨ
ƐĞůĨůĞƐƐŶĞƐƐ͘

‡ ŚƌŝƐƚŝĂŶŝƚǇWƌŽƚĞƐƚĂŶƚ͕ĂƚŚŽůŝĐ͕ĂŶĚ
KƌƚŚŽĚŽǆĐŚƵƌĐŚĞƐƐƵƉƉŽƌƚŽƌŐĂŶĚŽŶĂƚŝŽŶ
ĂŶĚǀŝĞǁŝƚĂƐĞǆƉƌĞƐƐŝŶŐŚƌŝƐƚŝĂŶǀĂůƵĞƐŽĨ
ƐĞůĨůĞƐƐƐĞƌǀŝĐĞƚŽŶĞŝŐŚďŽƌƐŽƌƐƚƌĂŶŐĞƌƐ͘
^ŽŵĞĚĞŶŽŵŝŶĂƚŝŽŶƐŚĂǀĞĂĐƚŝǀĞƉŽůŝĐŝĞƐ
ƉƌŽŵŽƚŝŶŐĚŽŶĂƚŝŽŶǁŚŝůĞŽƚŚĞƌƐƐĞĞŝƚĂƐĂ
ŵĂƚƚĞƌŽĨŝŶĚŝǀŝĚƵĂůĐŚŽŝĐĞ͘

/ƐůĂŵ
‡ dŚĞƌĞŝƐĂƐƚƌŽŶŐďĞůŝĞĨŝŶƚŚĞƉƌŝŶĐŝƉůĞŽĨƐĂǀŝŶŐ
ŚƵŵĂŶůŝǀĞƐĂŶĚŝŶƐĞĞŬŝŶŐŵĞĚŝĐĂůŚĞůƉĨŽƌ
ŝůůŶĞƐƐ͘hŶĚĞƌƚŚĞƐĞƉƌŝŶĐŝƉůĞƐďŽƚŚƚŚĞďƌĂŶĐŚĞƐ
ŽĨ/ƐůĂŵǀŝĞǁŽƌŐĂŶĚŽŶĂƚŝŽŶĂƐƉĞƌŵŝƐƐŝďůĞ
ƉƌŽǀŝĚĞĚƚŚĞŐŝĨƚŝƐĨƌĞĞůǇŐŝǀĞŶ͘KƌŐĂŶĚŽŶĂƚŝŽŶŝƐ
ŐĞŶĞƌĂůůǇƐƵƉƉŽƌƚĞĚŝŶƌĂďĐŽƵŶƚƌŝĞƐ͖ŚŽǁĞǀĞƌ͕
ƐŽŵĞDƵƐůŝŵƐĐŚŽůĂƌƐ͕ƉĂƌƚŝĐƵůĂƌůǇŽŶƚŚĞ/ŶĚŝĂŶ
ƐƵďĐŽŶƚŝŶĞŶƚ͕ŚĂǀĞŶŽƚďĞĞŶƐƵƉƉŽƌƚŝǀĞŽĨ
ĚĞĐĞĂƐĞĚŽƌŐĂŶĚŽŶĂƚŝŽŶ͘

:ƵĚĂŝƐŵ
‡ ůůŵĂũŽƌďƌĂŶĐŚĞƐŽĨ:ƵĚĂŝƐŵ;KƌƚŚŽĚŽǆ͕
ŽŶƐĞƌǀĂƚŝǀĞ͕ĂŶĚZĞĨŽƌŵͿƐƵƉƉŽƌƚŽƌŐĂŶ
ĚŽŶĂƚŝŽŶŶŽƚŽŶůǇĂƐďůĞƐƐŝŶŐďƵƚĂƐĂŶ
ŽďůŝŐĂƚŝŽŶƵŶĚĞƌƚŚĞ:ĞǁŝƐŚĚƵƚǇƚŽƐĂǀĞĂůŝĨĞ͘

,ŝŶĚƵŝƐŵ
dŚĞƌĞĂƌĞŶŽƌĞůŝŐŝŽƵƐƉƌŽŚŝďŝƚŝŽŶƐĂŐĂŝŶƐƚ
ĚŽŶĂƚŝŽŶ͕ĂŶĚƚŚĞďĞůŝĞĨŝŶĐŽŶƚŝŶƵĂůƌĞďŝƌƚŚŽƌ
ƌĞŝŶĐĂƌŶĂƚŝŽŶĚŽĞƐŶŽƚĂƉƉĞĂƌƚŽĐŽŶĨůŝĐƚǁŝƚŚ
ĚŽŶĂƚŝŽŶ͘,ŝŶĚƵŵǇƚŚŽůŽŐǇŝŶĐůƵĚĞƐĞǆĂŵƉůĞƐ
ŽĨƵƐŝŶŐďŽĚǇƉĂƌƚƐĨŽƌƚŚĞďĞŶĞĨŝƚŽĨŽƚŚĞƌ
ŚƵŵĂŶƐĂŶĚƐŽĐŝĞƚǇ͘

ƵĚĚŚŝƐŵ
‡ ƵĚĚŚŝƐƚƐƐƵƉƉŽƌƚŽƌŐĂŶĚŽŶĂƚŝŽŶ͕ďƵƚƚŚĞ
ĐŽŶĐĞƉƚƐƌĞŐĂƌĚŝŶŐŶĞƵƌŽůŽŐŝĐĚĞƚĞƌŵŝŶĂƚŝŽŶ
ŽĨĚĞĂƚŚŵĂǇƐĞĞŵƚŽĐŽŶƚƌĂĚŝĐƚƚŚĞƵĚĚŚŝƐƚ
ǀŝĞǁŽĨƚŚĞŝŶƚĞƌĐŽŶŶĞĐƚĞĚŶĞƐƐŽĨůŝĨĞĂŶĚ
ĚĞĂƚŚ͘

ŽŶĨƵĐŝĂŶŝƐŵĂŶĚdĂŽŝƐŵ
KĨĨŝĐŝĂůĚĞĐůĂƌĂƚŝŽŶƐƌĞŐĂƌĚŝŶŐŽƌŐĂŶĚŽŶĂƚŝŽŶ
ŚĂǀĞŶŽƚďĞĞŶŵĂĚĞŝŶŽŶĨƵĐŝĂŶŝƐŵĂŶĚ
dĂŽŝƐŵ͘dƌĂĚŝƚŝŽŶĂůŽŶĨƵĐŝĂŶǀŝĞǁƐĂĐĐĞƉƚƚŚĞ
ŝŶĞǀŝƚĂďŝůŝƚǇŽĨĚĞĂƚŚ͕ǁŚŝůĞdĂŽŝƐŵƐƵƉƉŽƌƚƐ
ŵŽƌĞĂŐŐƌĞƐƐŝǀĞŵĞĂƐƵƌĞƐƚŽƉƌŽůŽŶŐůŝĨĞ͘
dŚĞƐĞƚƌĂĚŝƚŝŽŶƐĂƌĞĂůƐŽĐůŽƐĞůǇŝŶƚĞƌƚǁŝŶĞĚ
ǁŝƚŚƚƌĂĚŝƚŝŽŶĂůŚŝŶĞƐĞŵĞĚŝĐŝŶĞ͕ǁŚŝĐŚ
ĞŵƉŚĂƐŝǌĞƐƉƌĞƐĞƌǀŝŶŐƚŚĞŝŶƚĞŐƌŝƚǇŽĨƚŚĞ
ďŽĚǇ͘

Lecture in Bioethics
Ethical, Religious and Philosophical Views
on the Problem of Euthanasia
Palliative Care/Hospice
Lecturer:
of Philosophy
Zh. G. Simonova
Kursk 2021

Tanatos (Thanatos) ± the God of
Death
A young fellow who
comes for the dying or
dead people

͞Thanatos͟WĂůĂĐĞ-,ƀƚĞů/
,ŽƚĞů͞Thanatos͟
ŶĚƌĠMaurois (1885Ͷ1967)
The hotel ± is a special place where
people who are in difficult situations
are assisted with suicide (painless
death). The overriding term is that
the characters never know when they
will die. The hotel is a peaceful place,
where some people start feeling the
desire to continue living, but it is too
ODWH««
The death machine is already started.
1937

Euthanasia ± the Right to Die

Definition
The term µHXWKDQDVLD¶ comes from the Greek
language: µeu¶ means µJRRG¶ and µthanatos¶ means
µGHDWK¶.
Euthanasia is the intentional termination of life
by another person at the explicit request of the
person who dies.

³,will neither give a
deadly drug to
anybody who asked
for it, nor will I
make a suggestion to
this HIIHFW´
Hippocrates

Francis Bacon (16 century) coined the
WHUP³HXWKDQDVLD´ JRRGGHDWK
... I am absolutely convinced that
the duty of a doctor is not only to
restore health, but also to alleviate
the suffering and torment caused by
diseases, and this is not only when
such a relief of pain as a dangerous
symptom of the disease can lead to
recovery, but even in the case when
there is no hope for cure and you
can only make the death easier,
because this euthanasia ... is itself a
considerable KDSSLQHVV´ F. Bacon
wrote.
F. Bacon (1561-1626)

Till World War II euthanasia was widely
spread in European countries during the
war activities
A misericorde - a long, narrow knife used
from the High Middle Ages to deliver the death
stroke (the mercy stroke, hence the name of
the blade, derived from the Latin misericordia,
act of mercy) to a seriously wounded knight.
This weapon was used to dispatch knights who
had received mortal wounds.

S. Freud was a heavy smoker. Despite
warnings, Freud continued smoking
which eventually caused him to suffer
from oral cancer. By September 1939,
)UHXG¶V cancer was causing him severe
pain and was termed as inoperable.
On September 21, S. Freud asked his
doctor, Max Schur, to administer a
dose of morphine large enough to ease
him out of life. Anna Freud wanted to
postpone her IDWKHU¶V death but Schur
convinced her that it was pointless.
On 21 and 22 September Schur
administered doses of morphine that
resulted in )UHXG¶V death on 23
September 1939.
S. Freud

Forms of Euthanasia
‡ Passive euthanasia is the withdrawing of medical
equipment and treatment with the intention to
cause death.
‡ Active euthanasia occurs when one person
performs the act of ending another SHUVRQ¶V life
(for example, a nurse injecting the lethal dose of
a substance with the intention to end a SDWLHQW¶V
life).
‡ Physician assisted suicide ± the termination of
RQH¶V life with the help of the physician (gives
tips, prescribes a lethal dose of medicine.)

EUTHANASIA IS ALSO
CLASSIFIED INTO:
‡ Voluntary
euthanasia ± it is
when a clearly
competent person
makes a voluntary
request to be
helped to die.

EUTHANASIA IS ALSO
CLASSIFIED INTO:
‡ Non-voluntary
euthanasia ± the
examples of
euthanasia when a
person is unable to
express a wish
about euthanasia
(e.g. the patient is in
coma or in a vegetative
state).

EUTHANASIA IS ALSO
CLASSIFIED INTO:
‡ Involuntary
euthanasia, when a
SHUVRQ¶VOLIHLV
brought to an end
despite an explicit
expression of
opposition to
euthanasia.

Francis Bacon
(16 century)
coined the term
³HXWKDQDVLD´
Jack Kevorkian =
Dr. Death (20 century)
thanatron ± death machine

Jack Kevorkian,
commonly known as
Dr. Death, was an
American pathologist
and euthanasia activist.
He is best known for
supporting a terminal
patient's right to die via
physician-assisted
suicide; he claimed to
have assisted at least
130 patients to that
end. He said, dying is
not a crime.

In 1999, Kevorkian was
arrested for his direct
role in a case of
voluntary euthanasia.
He was convicted of
second-degree murder
and served eight years
of a 10-to-25-year
prison sentence. He was
released in 2007, on
condition he would not
offer suicide advice to
any other person.

You Don't Know Jack
is a 2010
American television film
directed by Barry
Levinson and starring Al
Pacino as Jack Kevorkian,
based in part on the
book, Between the Dying
and the Dead: Dr. Jack
Kevorkian's Life and the
Battle to Legalize
Euthanasia.

WMA DECLARATION ON EUTHANASIA
Adopted by the 39th World Medical Assembly, Madrid,
Spain, October 1987
and reaffirmed by the 170th WMA Council Session,
Divonne-les-Bains, France, May 2005
and reaffirmed by the 200th WMA Council Session,
Oslo, Norway, April 2015
Euthanasia, that is the act of deliberately ending
the life of a patient, even at the SDWLHQW¶V own
request or at the request of close relatives, is
unethical. This does not prevent the physician
from respecting the desire of a patient to allow the
natural process of death to follow its course in the
terminal phase of sickness.

WMA STATEMENT ON PHYSICIAN-ASSISTED
SUICIDE
‡ Adopted by the 44th World Medical Assembly, Marbella, Spain, September 1992
and editorially revised by the 170th WMA Council Session, Divonne-les-Bains,
France, May 2005
and reaffirmed by the 200th WMA Council Session, Oslo, Norway, April 2015
‡ Physician-assisted suicide, like euthanasia, is unethical and
must be condemned by the medical profession. Where the
assistance of the physician is intentionally and deliberately
directed at enabling an individual to end his or her own life,
the physician acts unethically.
‡ However the right to decline medical treatment is a basic right
of the patient and the physician does not act unethically even
if respecting such a wish results in the death of the patient.

LEGALIZATION OF EUTHANASIA
1984: The Netherlands became the first country in
the world to legalize euthanasia (the
Termination of Life on Request and Assisted
Suicide Act). Euthanasia and physician-assisted
suicide are legalized in certain circumstances.
1997: legislation was introduced in Oregon in the
United States.
2002: the Belgian parliament legalizes euthanasia.
2016: Child euthanasia was legalized in Belgium.

LEGALIZATION OF
EUTHANASIA
Passive euthanasia is legal in:
‡ Israel
‡ India
‡ Ireland
‡ Switzerland

LEGALIZATION OF
EUTHANASIA
The historic event happened in 2011.
On 7 March 2011 the Supreme Court of India,
passed a judgement-law permitting passive
euthanasia in the country.
Refusing mercy killing of Aruna Shanbaug, who
had been lying in a vegetative state in a
Mumbai Hospital for 37 years, a two-judge
bench laid down a set of tough guidelines under
which passive euthanasia could be legalized.

$UXQD¶V Case
‡ In 1973, Aruna ± a medical nurse- was
raped and chocked by the janitor at the
hospital where she was working. The
incident caused her severe brain stem
injury and left her blind and deaf. She had
been in this state for four decades.

Case of Mexico
‡ Passive euthanasia has been legalized in Mexico since
2008.
‡ However, active euthanasia is still banned and
considered illegal.
‡ Doctors are required to advise the patient to choose life
over death.
‡ Pentobarbital is a drug used to euthanize animals if used
in concentrated form.
‡ Veterinary shops sell this liquid form of drug to
individuals willing to end their lives. Pentobarbital could
be purchased by both local citizens and tourists. The
drug is sold for a very affordable price of $35 to $50.

‡ Pentobarbital is viewed as the most peaceful, cost effective
and easy way to die.
‡ It makes the person fall asleep and within one hour the
individual will lose breath and die without suffering.
‡ Mexico is rated as the number one country for the
accessibility and Pentobarbital ease of use. In fact, Mexico is
viewed as one of the most competing tourism suicidal
destination

‡ In 2002, Netherlands enacted the law of
³7HUPLQDWLRQ of Life on Request and
Assisted Suicide $FW´. This law aims at
regulating euthanasia and assisted suicide
for locals and tourists.

Euthanasia Tourism
‡ Euthanasia Tourism ± a medical tourism
product that implies the idea of the
termination of the lives of patients who
arrive for this purpose in the countries
where euthanasia is legal.

Dignitas
Ludwig A. Minelli - ƚŚĞĨŽƵŶĚĞƌŽĨƚŚĞĐůŝŶŝĐ͞Dignitas͟ŝŶ
Zurich (Switzerland) where the medical workers help people to
die peacefully.

The ³7HUPLQDWLRQRI/LIHRQ5HTXHVWDQG$VVLVWHG
6XLFLGH$FW´SHUPLWVHXWKDQDVLDDQGDVVLVWHGVXLFLGH
under the following circumstances:
‡ 1) The patient is suffering badly, and no expected
improvement can be forecasted.
‡ 2) The request of the patient for euthanasia or assisted
suicide must not be taking place under the effect of
drugs, psychological illness, or by the influence of others.
In other words, the request must persist over time, and
should be voluntary.
‡ 3) Doctors must make sure that the patient is fully aware
of his/her situation and the available treatment options.

The ³7HUPLQDWLRQRI/LIHRQ5HTXHVWDQG$VVLVWHG6XLFLGH
$FW´SHUPLWVHXWKDQDVLDDQGDVVLVWHGVXLFLGHXQGHUWKH
following circumstances:
‡ 4) After the completion of the diagnosis process with the first
doctor, the file of the patient will be presented to another
independent doctor for approval or denial.
‡ 5) The death procedures are to take place with medical
appropriateness. Committing suicide might be done by the
patient himself or with the aid of a doctor; however, in all
cases, the presence of a doctor is compulsory.
‡ 6) Assisted dying is not allowed for those less than 12 years
old. Moreover, patients belonging to the age group [12-16]
years are supposed to have parental approval.

RELIGIOUS VIEWS ON EUTHANASIA.
CHRISTIANITY
Catholic teaching condemns euthanasia as a
crime against life and a crime against God.
The teaching of the Catholic Church on
euthanasia rests on several core principles of
Catholic ethics, including:
‡ the sanctity of human life,
‡ the dignity of the human person,
‡ human rights,
‡ the unavoidability of death,
‡ the importance of charity.

RELIGIOUS VIEWS ON EUTHANASIA. ISLAM.
Islam categorically forbids all forms of suicide and
any action that may help another to kill
themselves.
It is forbidden for a Muslim to plan, or come to
know through self-will, the time of his own death
in advance.

RELIGIOUS VIEWS ON EUTHANASIA.
HINDUISM.
There are two Hindu points of view on euthanasia.
By helping to end a painful life a person is
performing a good deed and so fulfilling the moral
obligations.
On the other hand, by helping to end a life, even
one filled with suffering, a person is disturbing the
timing of the cycle of death and rebirth. This is a
bad thing to do, and those involved in the
euthanasia will take on the remaining karma of the
patient.

THE CENTRAL ETHICAL ARGUMENT FOR
EUTHANASIA
The respect for persons demands respect for
their autonomous choices.
Autonomy presupposes competence.
In exercising autonomy of self-determination
people take responsibility for their lives.
Since death is a part of life, people should take a
responsibility for their lives.

OBJECTIONS TO EUTHANASIA
‡ It involves killing, and all
killing is morally wrong;
‡ There is always the
possibility of an incorrect
diagnosis or the discovery
of a treatment that will
permit either survival or
recovery;
‡ The legislation of assisted
suicide will discourage
the search for new
medicines for the
terminally ill patients.

FACT:
Patients who struggle to recover have better
recovery rates than those who have given up
hope.
The legislation of assisted suicide and active
voluntary euthanasia will encourage the patients
to give up, and thus significantly decrease their
chances to recovery.

Definition
‡ Palliative Care (Latin palliare ʹ to cover) ʹ is any
form of medical care that focuses on relieving
and preventing the suffering of patients.
‡ Palliative Care is health care treatment, including
consultation with patients and family members,
to prevent or relieve pain and suffering and to
enhance the patient's quality of life, including
hospice care at the end of life.

Some characteristics of palliative care
(PC)
‡ Palliative care is specialized medical care for
people with serious illnesses. It is focused on
providing patients with relief from the
symptoms, pain, and stress of a serious illness
Ͷ whatever the prognosis is.

Some characteristics of palliative care
(PC)
‡ The goal of PC is to improve quality of life for
both the patient and the family as they are
the central system for care.

Characteristics of palliative care (PC)
‡ Palliative care is medical care provided by an
interdisciplinary team, including the
professions of medicine, nursing, social work,
chaplaincy, counseling, nutrition,
rehabilitation, pharmacy, therapists, and other
health care professions.
‡ PC is appropriate at any age and at any stage
in a serious illness and can be provided along
with curative treatment.

‡ The terms ͚ƉĂůůŝĂƚŝǀĞ ĐĂƌĞ͛ and ͚ŚŽƐƉŝĐĞ͛ are
often used to describe an approach to care of
the patients who can die in the relatively near
future from serious, incurable disease.
‡ The principal focus of palliative care is quality
of life and support for the ƉĂƚŝĞŶƚ͛Ɛ family.

‡ dŚĞǁŽƌĚ͚hospice͛ĐŽŵĞƐĨƌŽŵƚŚĞĂƚŝŶǁŽƌĚ
͚hospitum͛ŵĞĂŶŝŶŐguesthouse.
‡ It was first used to describe a place of shelter
for the sick travelers returning from religious
pilgrimages.

Hospice
‡ Cicely Saunders is the pioneer
of the first modern hospice
center.
‡ Cicely Saunders emphasized
focusing on the patient rather
than the disease and
introduced the notion of 'total
pain' , which included
psychological and spiritual as
well as the physical aspects.

Total pain
‡ Physical Pain (side effects, symptoms)
‡ Social Pain (worries about families)
‡ Psychological Pain (depression, fear of dying
and death)
‡ Spiritual (why me? Does God exist?)

HOSPICE PHILOSOPHY
Hospice care is palliative care at the end of life.
Hospice care is a type and philosophy of care
that focuses on the palliative care of a terminally
ill or seriously ill patient's pain and symptoms,
and attending to their emotional and spiritual
needs.

Thank you for your attention!!!!

Psychiatry ( (gr.) psyche - soul, iatreia -
healing) ± the field of clinical medicine that
studies the pathology, etiology, pathogenesis of
the psyche; the diagnoses, prevention of mental
illnesses; the organization of psychiatric care,
examination; and the legal status of mentally ill
patients.

The term ³3VFKLDWU´ was coined by a
German physician, physiologist, anatomist, and
psychiatrist Johann Christian Reil in 1808 (1759±
1813),
Johann Christian Reil (1759±1813)

The relevance of psychiatry is very high, due to the
number of people who are in need of psychiatric help.
According to the World Health Organization (WHO),
there are approximately 500 million people on the
Earth; who suffer from psychiatric diseases and
disorders (such as neuroses, mental retardation, severe
mental illnesses, dementia).

Among the clinical medical disciplines, psychiatry is
the most social one according to the character of its
concept, research methodology and practical actions.
Its object is a man in his deep interrelation with
biological, psychological, spiritual and social aspects of
life.

Starting from the 5th century BC, mental disorders,
especially those with psychotic traits, were considered
supernatural in origin, a view which existed
throughout ancient Greece and Rome.

Since ancient times doctors had been trying not only to
diagnose a number of mental illnesses (epilepsy,
melancholia, mania, hysteria etc.), but also using
various natural methods of treatment of these diseases
such as:
€ blood-letting,
€ emetic drugs,
€ purgative drugs,
€ massage,
€ baths,
€ gymnastics,
€ work, etc.

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