安乐死案例分析

本文就一例被动安乐死案例,从患者心理、家属心理等诸方面进行探讨.并对安乐死的社会价值阐述自己的观念.提出实行安乐死的可行性和值得注意的问题.     

不同年级护生对安乐死的认知与伦理教育的启示

目的 了解不同年级护生对安乐死认知情况及影响因素,为护理伦理教育提供参考依据.方法 采用整群抽样,对四年制护理本科二、三及四年级学生就其对安乐死的认知和态度进行典型案例测试.结果 717名本科护生,绝大多数护生对安乐死持积极态度,有正确的认识,赞成安乐死的648人,占90.4%,持中立观点的15人,占2.1%.但不同年级的护生对安乐死的认知程度有所不同.二年级护生中赞成安乐死的占93.2%;三年级护生中赞成安乐死的占77.1%;四年级护生中赞成安乐的占82.7%.结论 护生随着受教育的程度及走向临床,对安乐死的态度发生着改变,存在着差异.护理伦理教学中应加以正确的引导,使护士对安乐死有科学的认识.妥善面对和解决伦理问题,提升对患者的护理品质.     

营养支持中的伦理道德困境

营养支持作为维持生命的基本技术在危重患者的处理中扮演重要角色,同时也面临伦理道德困惑。患者自愿停止饮食(VSED)是否可行?患者无意识状态下家属代为请求撤除营养支持是否可行?通过对被动安乐死、自愿与非自愿安乐死的伦理问题进行分析,探讨自愿停止饮食(VSED)在实施中存在的困惑。     

我国安乐死立法的障碍分析

安乐死是目前伦理学、法学讨论的焦点问题;也是医生、患者和社会关注的热点问题.本文介绍安乐死立法的历史及现状,并从传统观念、医生角度和法律角度三方面剖析了我国对安乐死立法存在的障碍.     

护理大专生对安乐死的态度及意向调查分析

目的 了解护理大专生对安乐死的态度及意向情况,为护理伦理教育提供参考依据.方法 采用自行设计的问卷对长沙市某职业学院的护理大专三年级全体学生共350人进行现场自填式问卷调查.结果 350名护理大专生中,64.9%的学生赞同安乐死,70%的护生表示如果自己患不治之症愿意选择安乐死,如果亲人要求安乐死,45.1%的护生会同意,绝大部分护生认为安乐死应该合法化.而对于对濒临死亡患者实施主动安乐死和被动安乐死的回答,持反对态度者（44.3%和64.8%）均多于持赞同态度者（31.1%和13.7%）.男女生在是否同意亲人安乐死方面存在差异（P〈0.05）,不同家庭住址的学生在是否支持亲人安乐死、是否赞同主动安乐死和被动安乐死方面存在差异（均P〈0.05）,而是否学习过〈护理伦理学〉课程的学生除了在是否支持亲人安乐死方面无差异外,其他方面均有差异（均P〈0.05）.结论 绝大多数护理大专生支持安乐死,且对安乐死意向较明确.应加强对其护理伦理学的教学,积极正确引导护生,使护生对安乐死有科学的认识.     

论患者安乐死的自决权

安乐死涉及患者的生命权益和人格尊严,从法理角度来看,患者在无法忍受极端痛苦时,依据生命自主原则,为维护其合法权益和人格尊严,应具有安乐死的自决权.     

安乐死权的性质及伦理法理评价

安乐死权指的是死亡状态权,而不是所谓的“死亡权“与生命权.把安乐死视为“致死行为“作为前置条件,不论是将安乐死权归类于生命权还是“死亡权“,从而做出对安乐死权肯定或否定回答,都不符合安乐死权属于死亡状态权的含义.安乐死权的认定,不能离开安乐死作为优化死亡状态的合理内涵.法律应当赋予个人安乐死的权利,这不仅在于安乐死作为优化死亡状态的本质不违背现行法律,也在于不论从个人、他人及社会角度分析,安乐死权的认可有其合理性基础.     

国外安乐死的实施现状及其对我国的启示

随着荷兰安乐死法案的通过,各国对安乐死问题的争论日趋激烈,安乐死开始成为当代世界的一个热点问题.文章在分析安乐死的概念及其相关问题分析研究的基础上,考察了各国各地区实际存在的大量事实,指出了实施安乐死的合理性,并列举了实施安乐死需要的条件,具体地说是要确认安乐死的对象、安乐死的形式和方法、以及实施安乐死的程序和法律后果.     

安乐死人群调查刍议

安乐死(Euthanasia)系指患有不治之症而又处在危重濒死状态的患者,由于不堪忍受精神上及肉体上的极端痛苦,在本人要求和亲属同意下,经医生用人为方法使患者无痛苦地终止生命的一种方式。安乐死可划分为积极安乐死和消极(被动)安乐死两种。前者是指患者疾病在近期内没有丝毫希望,用积极的办法(如注射杜冷丁)加速其死亡;后者是指撤除维持病人生命的一切医疗措施,致其死亡。     

安乐死的合法化之路

安乐死涉及伦理、道德、医学、法律诸多领域,关乎生命权的处分.实施安乐死会带来一系列的社会和法律后果,但立法的历程举步维艰.通过对安乐死正反两方面的阐述,提出了自己鲜明的观点及安乐死立法建议,为安乐死早日走向合法化提供依据.     

Euthanasia: above ground, below ground

The key to the euthanasia debate lies in how best to regulate what doctors do. Opponents of euthanasia frequently warn of the possible negative consequences of legalising physician assisted suicide and active euthanasia (PAS/AE) while ignoring the covert practice of PAS/AE by doctors and other health professionals. Against the background of survey studies suggesting that anything from 4% to 10% of doctors have intentionally assisted a patient to die, and interview evidence of the unregulated, idiosyncratic nature of underground PAS/AE, this paper assesses three alternatives to the current policy of prohibition. It argues that although legalisation may never succeed in making euthanasia perfectly safe, legalising PAS/AE may nevertheless be safer, and therefore a preferable policy alternative, to prohibition. At a minimum, debate about harm minimisation and the regulation of euthanasia needs to take account of PAS/AE wherever it is practised, both above and below ground.     

Mahātmā Gandhi's view on euthanasia and assisted suicide

To many in India and elsewhere, the life and thoughts of Mohandas Karamchand Gandhi are a source of inspiration. The idea of non-violence was pivotal in his thinking. In this context, Gandhi reflected upon the possibility of what is now called 'euthanasia' and 'assisted suicide'. So far, his views on these practices have not been properly studied. In his reflections on euthanasia and assisted suicide, Gandhi shows himself to be a contextually flexible thinker. In spite of being a staunch defender of non-violence, Gandhi was aware that violence may sometimes be unavoidable. Under certain conditions, killing a living being could even be an expression of non-violence. He argued that in a few rare cases it may be better to kill people who are suffering unbearably at the end of life. In this way, he seems to support euthanasia and assisted suicide. Yet, Gandhi also thought that as long as care can be extended to a dying patient, his or her suffering could be relieved. Since in most cases relief was thus possible, euthanasia and assisted suicide were in fact redundant. By stressing the importance of care and nursing as an alternative to euthanasia and assisted suicide, Gandhi unconsciously made himself an early advocate of palliative care in India. This observation could be used to strengthen and promote the further development of palliative care in India.     

Euthanasia in Holland: an ethical critique of the new law.

In the Netherlands the government's proposal for the legal regulation of euthanasia, assisted suicide and the termination of a patient's life without request has been approved by Parliament. The defence of this proposal is to a large extent based on a specific interpretation of data about the practice of euthanasia in that country, published in 1991 (the Remmelink Report). This paper discusses both the interpretation of the data and the new law. On the basis of that and other data, the author concludes that many cases of euthanasia, assisted suicide and termination of a patient's life without request remain unnotified and therefore unreviewed by the legal authorities. It is argued that the new law will not guarantee an improvement to this situation. In short, the new law will not protect effectively the lives of patients, and must, therefore, be open to ethical and legal objection.     

What people close to death say about euthanasia and assisted suicide: a qualitative study

OBJECTIVE: To explore the experiences of people with a "terminal illness", focusing on the patients' perspective of euthanasia and assisted suicide. METHOD: A qualitative study using narrative interviews was conducted throughout the UK. The views of the 18 people who discussed euthanasia and assisted suicide were explored. These were drawn from a maximum variation sample, who said that they had a "terminal" illness, malignant or non-malignant. RESULTS: That UK law should be changed to allow assisted suicide or voluntary euthanasia was felt strongly by most people. Those who had seen others die were particularly convinced that this should be a right. Some had multiple reasons, including pain and anticipated pain, fear of indignity, loss of control and cognitive impairment. Those who did not want to be a burden also had other reasons for wanting euthanasia. Suicide was contemplated by a few, who would have preferred a change in the law to allow them to end their lives with medical help and in the company of family or friends. The few who opposed a change in UK law, or who felt ambivalent, focused on involuntary euthanasia, cited religious reasons or worried that new legislation might be open to abuse. CONCLUSION: Qualitative research conducted on people who know they are nearing death is an important addition to the international debate on euthanasia and assisted suicide. Those who had seen others die were particularly convinced that the law should be changed to allow assisted death.     

When is physician assisted suicide or euthanasia acceptable?

OBJECTIVES: To discover what factors affect lay people's judgments of the acceptability of physician assisted suicide and euthanasia and how these factors interact. DESIGN: Participants rated the acceptability of either physician assisted suicide or euthanasia for 72 patient vignettes with a five factor design--that is, all combinations of patient's age (three levels); curability of illness (two levels); degree of suffering (two levels); patient's mental status (two levels), and extent of patient's requests for the procedure (three levels). PARTICIPANTS: Convenience sample of 66 young adults, 62 middle aged adults, and 66 older adults living in western France. MAIN MEASUREMENTS: In accordance with the functional theory of cognition of N H Anderson, main effects, and interactions among patient factors and participants' characteristics were investigated by means of both graphs and ANOVA. RESULTS: Patient requests were the most potent determinant of acceptability. Euthanasia was generally less acceptable than physician assisted suicide, but this difference disappeared when requests were repetitive. As their own age increased, participants placed more weight on patient age as a criterion of acceptability. CONCLUSIONS: People's judgments concur with legislation to require a repetition of patients' requests for a life ending act. Younger people, who frequently are decision makers for elderly relatives, place less emphasis on patient's age itself than do older people.     

Physician-assisted death.

Physician-assisted death includes both euthanasia and assistance in suicide. The CMA urges its members to adhere to the principles of palliative care. It does not support euthanasia and assisted suicide. The following policy summary includes definitions of euthanasia and assisted suicide, background information, basic ethical principles and physician concerns about legalization of physician-assisted death.     

The emotional impact on physicians of hastening the death of a patient.

OBJECTIVE: To investigate the emotional feelings reported by physicians in The Netherlands after having performed euthanasia or other medical end-of-life decisions. DESIGN: Nationwide interview study in The Netherlands, November 1995 through February 1996. PARTICIPANTS AND SETTING: A random sample of 405 physicians (general practitioners, nursing home physicians, and clinical specialists). MAIN OUTCOME MEASURES: Subsequent feelings of physicians about their most recent cases (if any) of euthanasia, assisted suicide, life-ending without an explicit request from the patient, and alleviation of pain and other symptoms with high doses of opioids. RESULTS: The response rate was 89%. In 52% of all cases of hastening death, physicians had feelings of comfort afterwards, which included feelings of satisfaction in 44% and of relief in 13%. Feelings of discomfort were reported in 42%, most frequently referred to as emotional (28%) or burdensome (25%). Feelings of discomfort were highest for euthanasia (75%; P<0.000). 95% of physicians were willing to perform euthanasia or assisted suicide again in similar situations. Afterwards, 5% had doubts, but none had regrets, about performing euthanasia. CONCLUSIONS: Hastening the death of a patient evokes different feelings among physicians. Although performing euthanasia is often experienced as burdensome and emotional, granting the ultimate wish of a competent patient may also give physicians a feeling of having contributed to the quality of the dying process.     

Murder-suicide involving BC doctor raises troubling questions about euthanasia.

The deaths last September of a British Columbia physician and his wife have raised troubling questions about euthanasia and Alzheimer's disease. Police described the deaths of Dr. Tom Powell and his wife Dr. Lorraine Miles, a retired dentist, as a murder-suicide. Friends of the couple wonder if more lenient laws concerning euthanasia and assisted suicide might have saved Miles' life.     

The body as unwarranted life support: a new perspective on euthanasia

It is widely accepted in clinical ethics that removing a patient from a ventilator at the patient's request is ethically permissible. This constitutes voluntary passive euthanasia. However, voluntary active euthanasia, such as giving a patient a lethal overdose with the intention of ending that patient's life, is ethically proscribed, as is assisted suicide, such as providing a patient with lethal pills or a lethal infusion. Proponents of voluntary active euthanasia and assisted suicide have argued that the distinction between killing and letting die is flawed and that there is no real difference between actively ending someone's life and "merely" allowing them to die. This paper shows that, although this view is correct, there is even less of a distinction than is commonly acknowledged in the literature. It does so by suggesting a new perspective that more accurately reflects the moral features of end-of-life situations: if a patient is mentally competent and wants to die, his body itself constitutes unwarranted life support unfairly prolonging his or her mental life.     

The acceptability of ending a patient's life

Objectives: To clarify how lay people and health professionals judge the acceptability of ending the life of a terminally ill patient.

Design: Participants judged this acceptability in a set of 16 scenarios that combined four factors: the identity of the actor (patient or physician), the patient's statement or not of a desire to have his life ended, the nature of the action as relatively active (injecting a toxin) or passive (disconnecting life support), and the type of suffering (intractable physical pain, complete dependence, or severe psychiatric illness).

Participants: 115 lay people and 72 health professionals (22 nurse's aides, 44 nurses, six physicians) in Toulouse, France.

Main measurements: Mean acceptability ratings for each scenario for each group.

Results: Life ending interventions are more acceptable to lay people than to the health professionals. For both, acceptability is highest for intractable physical suffering; is higher when patients end their own lives than when physicians do so; and, when physicians are the actors, is higher when patients have expressed a desire to die (voluntary euthanasia) than when they have not (involuntary euthanasia). In contrast, when patients perform the action, acceptability for the lay people and nurse's aides does not depend on whether the patient has expressed a desire to die, while for the nurses and physicians unassisted suicide is more acceptable than physician assisted suicide.

Conclusions: Lay participants judge the acceptability of life ending actions in largely the same way as do healthcare professionals.