安乐死立法现状及探讨

安乐死是医学、哲学等领域广泛关注的问题，安乐死的合法化是人类文明发展的结果，但目前对安乐死立法的对象、条件、立法理论基础等研究还不够充分，安乐死立法的时机尚不成熟。文章对安乐死立法现状进行分析，探讨我国安乐死立法中存在的问题。     

“临终关怀”与“安乐死”

“安乐死”已成为世界性的问题，目前“安乐死”的实现还有一定的困难，但“临终关怀”是“安乐死”通向立法过程中的桥梁，“临终关怀”的广泛实行，将全面推动包括我国在内的全世界“安乐死”合法化的进程。因此，推广和开展“临终关怀”是在现实与未来之间的最好的理想模式。     

临终，尊严乎？

最近,“尊严死”成为了大家关注的焦点。有人认为,“安乐死”和“尊严死”是在字面上玩花巧。其实不然!安乐死,也叫主动安乐死,是主动地通过注射药物等措施帮助患者结束生命;尊严死,也叫被动安乐死,只是建议在生命终末期,患者停止治疗,自然地死去。     

世界关注安乐死

到底该怎样看待“安乐死”?现在世界各国对“安乐死”持怎样的态度?本文作者向读者介绍了在荷兰、日本、加拿大、法国以及澳大利亚,人们对“安乐死”的态度和看法,能使读者朋友对“安乐死”的问题有更多的了解。     

对临终关怀与自愿“安乐死”问题的探讨

“安乐死”是个古老的命题。笔者认为实施“安乐死”的意义：①对社会文明与发展起促进和推动作用；②节约卫生资源；③尊重人对死亡方式的选择权。在这方面，西方发达国家已做了大量工作。“安乐死”涉及人们观念的改变、医学、法律、哲学、社会学、伦理学多方面。“安乐死”随着社会的进步和发展，必将合法化。作为医院应在“安乐死”合法化中发挥作用     

“人体官司”与医学立法

“人体官司”与医学立法每当医学技术取得重大进步，诸如器官移植、脑死亡概念、人工授精、试管婴儿、安乐死、优生等，同时也引出一些新的法律问题，日益受到社会各界的普遍关注。本文想通过透视光怪陆离的人体案来探讨人体组织和器官移植的医学立法的严肃性和紧迫性。活...     

我国安乐死立法势在必行

背景:1986年,一个叫王明成的男子为其身患绝症的母亲实施了“安乐死”,成为中国“安乐死第一人”。其后他和医生被检察机关以故意杀人罪提起公诉,此事在全国引起了对“安乐死”的激烈争论。幸运的是他和医生又都被法院判决无罪释放。17年后,当身患胃癌晚期的王明成再次要求给自己实行“安乐死”时,却没有医生再有勇气。2003年8月3日,形如枯槁的王明成在病痛中死去。王明成的去世,再次引起了国人对“安乐死”关注。     

慎重对待安乐死问题

“安乐死”一词源自希腊文euthanasia,原意为“安逸死亡”、“快乐死亡”、“无痛苦死亡”。现行最常见的有“主动安乐死”和“被动安乐死”之说,是根据“安乐死”实施中的“作为”和“不作为”而作的区分。医务人员或其他人在无法挽救病人生命的情况下采取措施主动结束病人的生命或加速病人的死亡的过程被称之为“主动安乐死,”也叫“积极安乐死;”终止维持病人生命的一切治疗措施,任其自然死亡被称之为“被动安乐死,”也叫“消极安乐死”。对安乐死还有其他一些解读和分类,这里不想逐一评析。安乐死是全人类所面临的一个重大课题,为人们倍…     

试论安乐死

试论安乐死黄海金杨民董秀兰作者单位：１００７１０北京市，中华医学会学术会务部（一）安乐死的概念：关于安乐死的概念、分类、实施对象、方式等问题，在整个世界范围内众说纷纭。近几年来，我国学术界呼吁安乐死应立法的呼声颇高，然而，真正要推行安乐死却步履维艰［...     

我只想有尊严地跟生命说再见

电影《桃姐》热映,很多人都开始思考“老”的问题,怎么样才能有尊严地老去甚至死去？2012年3月11日,83岁的“安乐死先驱”彼得·古德温在4个子女的陪伴下,对自己实施了安乐死。“安乐死”话题再一次被广泛提及。     

Written institutional ethics policies on euthanasia: an empirical-based organizational-ethical framework

As euthanasia has become a widely debated issue in many Western countries, hospitals and nursing homes especially are increasingly being confronted with this ethically sensitive societal issue. The focus of this paper is how healthcare institutions can deal with euthanasia requests on an organizational level by means of a written institutional ethics policy. The general aim is to make a critical analysis whether these policies can be considered as organizational-ethical instruments that support healthcare institutions to take their institutional responsibility for dealing with euthanasia requests. By means of an interpretative analysis, we conducted a process of reinterpretation of results of former Belgian empirical studies on written institutional ethics policies on euthanasia in dialogue with the existing international literature. The study findings revealed that legal regulations, ethical and care-oriented aspects strongly affected the development, the content, and the impact of written institutional ethics policies on euthanasia. Hence, these three cornerstones—law, care and ethics—constituted the basis for the empirical-based organizational-ethical framework for written institutional ethics policies on euthanasia that is presented in this paper. However, having a euthanasia policy does not automatically lead to more legal transparency, or to a more professional and ethical care practice. The study findings suggest that the development and implementation of an ethics policy on euthanasia as an organizational-ethical instrument should be considered as a dynamic process. Administrators and ethics committees must take responsibility to actively create an ethical climate supporting care providers who have to deal with ethical dilemmas in their practice.     

Ethics policies on euthanasia in nursing homes: a survey in Flanders, Belgium

In many European countries there is a public debate about the acceptability and regulation of euthanasia. In 2002, Belgium became the second country after the Netherlands to enact a law on euthanasia. Although euthanasia rarely occurs, the complexity of the clinical-ethical decision making surrounding euthanasia requests and the need for adequate support reported by caregivers, means that healthcare institutions increasingly need to consider how to responsibly handle euthanasia requests. The development of written ethics policies on euthanasia may be important to guarantee and maintain the quality of care for patients requesting euthanasia. The aim of this study was to determine the prevalence, development, position, and communication of written ethics policies on euthanasia in Flemish nursing homes. Data were obtained through a cross-sectional mail survey of general directors of all Catholic nursing homes in Flanders, Belgium. Of the 737 nursing homes invited to participate, 612 (83%) completed the questionnaire. Of these, only 15% had a written ethics policy on euthanasia. Presence of an ethics committee and membership of an umbrella organization were independent predictors of whether a nursing home had such a written ethics policy. The Act on Euthanasia and euthanasia guidelines advanced by professional organizations were the most frequent reasons (76% and 56%, respectively) and reference sources (92% and 64%, respectively) for developing ethics policies on euthanasia. Development of ethics policies occurred within a multidisciplinary context. In general, Flemish nursing homes applied the Act on Euthanasia restrictively by introducing palliative procedures in addition to legal due care criteria. The policy was communicated to the consulting general practitioner and nurses in 74% and 89% of nursing homes, respectively. Although the overall prevalence of ethics policies on euthanasia was low in Flemish nursing homes, institution administrators displayed growing awareness of bearing responsibility for stimulating dialogue and reflection about how to deal with euthanasia requests within their institution.     

Ethics policies on euthanasia in hospitals--A survey in Flanders (Belgium)

OBJECTIVE: To determine the prevalence, development, stance, and communication of written institutional ethics policies on euthanasia in Flemish hospitals. METHODS: Cross-sectional mail survey of general directors of all hospitals (n=81) in Flanders, Belgium. RESULTS: Of the 81 hospitals invited to participate, 71 (88%) completed the questionnaire. Of these, 45 (63%) had a written ethics policy on euthanasia. The Belgian Act on Euthanasia and centrally developed guidelines of professional organisations were the most frequently mentioned reasons for and sources used in developing ethics policies on euthanasia in hospitals. Up to one-third of hospitals reported that they developed the policy upon request from physicians or nurses, or after being confronted with a euthanasia request. Development and approval of institutional ethics policies occurred within a multidisciplinary context involving clinicians, ethicists, and hospital administrators. The majority of hospitals restrictively applied the euthanasia law by introducing palliative procedures in addition to legal due care criteria. Private Catholic hospitals, in particular, were more likely to be restrictive: euthanasia is not permitted or is permitted only in exceptional cases (in accordance with legal due care criteria and additional palliative care procedures). The majority of hospitals took the initiative to communicate the policy to hospital physicians and nurses. CONCLUSIONS: Since the enactment of the Belgian Act on Euthanasia in 2002, the debate on how to deal with euthanasia requests has intensified in Flemish hospitals. The high prevalence of written institutional ethics policies on euthanasia and other medical end-of-life decisions is one possible outcome of this debate.     

Ethics policies on euthanasia in hospitals—A survey in Flanders (Belgium)

ObjectiveTo determine the prevalence, development, stance, and communication of written institutional ethics policies on euthanasia in Flemish hospitals.MethodsCross-sectional mail survey of general directors of all hospitals (n = 81) in Flanders, Belgium.ResultsOf the 81 hospitals invited to participate, 71 (88%) completed the questionnaire. Of these, 45 (63%) had a written ethics policy on euthanasia. The Belgian Act on Euthanasia and centrally developed guidelines of professional organisations were the most frequently mentioned reasons for and sources used in developing ethics policies on euthanasia in hospitals. Up to one-third of hospitals reported that they developed the policy upon request from physicians or nurses, or after being confronted with a euthanasia request. Development and approval of institutional ethics policies occurred within a multidisciplinary context involving clinicians, ethicists, and hospital administrators. The majority of hospitals restrictively applied the euthanasia law by introducing palliative procedures in addition to legal due care criteria. Private Catholic hospitals, in particular, were more likely to be restrictive: euthanasia is not permitted or is permitted only in exceptional cases (in accordance with legal due care criteria and additional palliative care procedures). The majority of hospitals took the initiative to communicate the policy to hospital physicians and nurses.ConclusionsSince the enactment of the Belgian Act on Euthanasia in 2002, the debate on how to deal with euthanasia requests has intensified in Flemish hospitals. The high prevalence of written institutional ethics policies on euthanasia and other medical end-of-life decisions is one possible outcome of this debate.     

中国医学伦理学研究论纲

对医学伦理学的概念、学科性质、研究内容、研究方法进行了简要的描述;对我国医学伦理学研究涉及的脑死亡、安乐死、克隆人、器官移植、基因治疗、健康伦理、卫生资源分配等研究成果及存在争议的问题进行了探讨和梳理。     

Prevalence and content of written ethics policies on euthanasia in Catholic healthcare institutions in Belgium (Flanders)

BACKGROUND: Euthanasia is performed worldwide, regardless of the existence of laws governing it. Belgium became the second country in the world to enact a law on euthanasia in 2002. Healthcare institutions bear responsibility for guaranteeing the quality of care for patients at the end of life, and for ensuring support for caregivers involved. Therefore, institutional ethics policies on end-of-life decision-making, especially on euthanasia, may be useful. METHODS: A cross-sectional mail survey of general directors of Catholic hospitals and nursing homes in Belgium was used to describe the prevalence and content of written ethics policies for competent terminally ill, incompetent terminally ill, and non-terminally ill patients. RESULTS: Of the 298 targeted institutions, 81% of hospitals and 62% of nursing homes returned complete questionnaires. Of these, 79% of hospitals and 30% of nursing homes had a written ethics policy on euthanasia. Of hospitals 83% and of nursing homes 85% permitted euthanasia for competent terminally ill patients only in exceptional cases in accordance with legal due care criteria and provisions outlined by the palliative filter procedure. Euthanasia for incompetent terminally ill patients was prohibited by 27% of the hospitals and by 60% of the nursing homes. For non-terminally ill patients, these figures were 43 and 64%, respectively. CONCLUSIONS: Catholic healthcare institutions in Belgium (Flanders) made great efforts to develop written ethics policies on euthanasia. Only a small group of institutions completely prohibited euthanasia. Most of the institutions considered euthanasia to be an option if all possible alternatives (e.g., palliative filter procedure, which contains more rigorous criteria than those in the Belgian Euthanasia Act), have been thoroughly investigated.     

生物技术时代安乐死研究的新趋向

当前安乐死的研究实现了从隐问题向显问题的转变,随着大量安乐死案例的出现,对其进行理论的思考成为可能.与此同时,安乐死问题的复杂性使得科技、政治和法律等参与其中共同解决"安乐死难题",而从道德伦理角度的思考是解决这一难题的基础和前提.对于安乐死的研究不仅在于探究死亡中的相关概念、范畴等,更是希望通过对临终患者死亡状态的探究,引导人们正视死亡和死亡之前的生命.     

Content analysis of euthanasia policies of nursing homes in Flanders (Belgium)

Objectives To describe the form and content of ethics policies on euthanasia in Flemish nursing homes and to determine the possible influence of religious affiliation on policy content. Methods Content analysis of euthanasia policy documents. Results Of the 737 nursing homes we contacted, 612 (83%) completed and returned the questionnaire. Of 92 (15%) nursing homes that reported to have a euthanasia policy, 85 (92%) provided a copy of their policy. Nursing homes applied the euthanasia law with additional palliative procedures and interdisciplinary deliberations. More Catholic nursing homes compared to non-Catholic nursing homes did not permit euthanasia. Policies described several phases of the euthanasia care process as well as involvement of caregivers, patients, and relatives; ethical issues; support for caregivers; reporting; and procedures for handling advance directives. Conclusion Our study revealed that euthanasia requests from patients are seriously considered in euthanasia policies of nursing homes, with great attention for palliative care and interdisciplinary cooperation.     

安乐死问题研究

安乐死作为一种使病人在无痛苦状态下度过死亡阶段而终结生命的人为方法,在医学、伦理、社会以及法律等方面具有十分重要的意义。一方面它可以减少那些生存无望的病人在精神上和躯体上遭受的极端痛苦,减轻病人家属所承受的经济负担,减轻社会医疗机构的压力,但另一方面它作为一种他人作为或者不作为而结束病人生命的方法,如使用不慎则会导致谋杀等许多社会问题。本文对安乐死的定义,主动安乐死,被动安乐死,目前安乐死在世界各国的立法及执行现状进行了较全面地阐述,指出对安乐死进行立法的必要性毋庸置疑。     

安乐死问题研究

安乐死作为一种使病人在无痛苦状态下度过死亡阶段而终结生命的人为方法,在医学、伦理、社会以及法律等方面具有十分重要的意义。一方面它可以减少那些生存无望的病人在精神上和躯体上遭受的极端痛苦,减轻病人家属所承受的经济负担,减轻社会医疗机构的压力,但另一方面它作为一种他人作为或者不作为而结束病人生命的方法,如使用不慎则会导致谋杀等许多社会问题。本文对安乐死的定义,主动安乐死,被动安乐死,目前安乐死在世界各国的立法及执行现状进行了较全面地阐述,指出对安乐死进行立法的必要性毋庸置疑。