安乐死的法律思考

安乐死并不是新问题,人们对安乐死的争议也没有停止过,本文对安乐死持赞成态度.本文从安乐死定义入手,分析了安乐死的理论基础,安乐死与相关概念,最后对安乐死作一理性的思考,并就我国安乐死立法提出一管之见.     

安乐死离我们还遥远临终关怀离我们却很近

我国自20世纪80年代就开始了对安乐死立法的讨论，有的人赞同安乐死，有的人反对安乐死。就我国现阶段的社会状况来说，尚不具备为安乐死立法的社会条件。而对于那些身患绝症、救治无望、极度痛苦的濒临死亡而又惧怕死亡的病人，如何解决他们生理的、心理的、生活的痛苦、焦虑与不安？临终关怀是最好的选择。     

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…     

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。     

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。     

对我国安乐死立法的几点思考

“安乐死”已成为世界性的问题，涉及到医学、法律、社会学、哲学、伦理学等多方面。随着社会的进步和发展，人们不但关注优生，也开始关注“优死”，即安乐死。文章从法理、伦理以及实施安乐死的意义等方面，对我国安乐死立法问题进行了剖析。     

安乐死合法化的法理探析

安乐死涉及伦理、道德、医学、法律诸多领域,关乎生命的处分.实施安乐死会带来一系列的社会和法律问题,因此,应该审慎对待安乐死合法化的立法.本文通过分析安乐死正反两方的观点和理由,提出自己对安乐死合法化的立法建议.     

严重缺陷新生儿处理的伦理思考

在当今的医疗实践中 ,对严重缺陷新生儿的处理 ,人们遇上了前所未有的难题。该文从严重缺陷新生儿出生的预防与控制 ;严重缺陷新生儿处理的现状伦理学评析 ;严重缺陷新生儿安乐死的伦理论证等三个方面 ,对中国严重缺陷新生儿处理的伦理问题进行了理论联系实际的研究。     

医学院校学生安乐死观念调查初步分析——以皖南医学院为例

目的 研究在校大学生对安乐死的了解和认知程度,研究不同人口学特征下对该观念的认知差异以及可能导致该差异的原因.方法 采取自行设计的《有关安乐死的调查问卷》,在学生开班会的时候随机发放调查问卷,当场填写,当场回收.于2013年10月10日、10月11日和10月12日分别对医学类、法学类和理学类的学生进行了调查.调查结束后,有针对性的留下一部分同学进行访谈,访谈的重点内容为对安乐死态度的形成原因.结果 仅有10.9％的学生对安乐死非常了解,且赞同安乐死的仅有45.5％.届别、性别和学科都会影响学生对安乐死的认识.对安乐死不赞同的主要原因是安乐死的标准是否可行以及会不会因为某些利益关系导致患者被安乐死.结论 学生对安乐死的认可度较低,且我国安乐死的立法需要更完善.     

Care of the dying: a Catholic perspective. Part IV: Theological, moral, and pastoral response--the transformation of suffering. Catholic Health Association

People struggle to find meaning in suffering and death. In a culture that cannot depend on religious insights into suffering to address the deeper questions (e.g., Why me?), all kinds of interventions, even euthanasia and assisted suicide, may seem inevitable. Catholic healthcare providers can respond by offering patients, families, and care givers a vision of how suffering can be understood. Based on the power of divine love to transform suffering and death from absolute evils to personal triumphs, the moral principles the Catholic Church upholds can provide a hopeful perspective for healthcare professionals who care for the dying. Three principles support Roman Catholic teaching on conserving health and life: sanctity of life, God's dominion and human stewardship, and the prohibition against killing. These principles by themselves are insufficient as a moral or pastoral response to the care of the suffering and dying. Action is also required. Moral virtues must be reflected in ethical behavior and in pastoral practice so that we may enact our Christian vision in the face of suffering and death. Attention to our character as providers and our ethical practices is of grave importance in these days when euthanasia and assisted suicide are being promoted so aggressively. To carry on Jesus' healing mission by responding to human suffering and death, healing communities must embody virtues that bear convincing witness in both a personal and a corporate manner regarding the care of the dying. Three characteristics of a virtuous community stand out: interdependence, care, and hospitality. By being a virtuous community, we may be able to address many of the concerns that motivate people to consider euthanasia.(ABSTRACT TRUNCATED AT 250 WORDS)     

Issues at the end of life. The revised Ethical and Religious Directives discuss suicide, euthanasia, and end-of-life procedures

Part 5 of the Ethical and Religious Directives for Catholic Health Care Services reminds us that death is necessary for the transition to eternal life. Thus, although Christians have a duty to preserve worldly life, a gift from God, that duty is not absolute. Suicide and euthanasia are never morally acceptable. On the other hand, life-prolonging therapy need not be used if it provides insufficient benefit or imposes an excessive burden. Directive 55 describes the comfort and care that should be given to dying patients. Directives 56 through 59 discuss the ethical norms for either using or forgoing procedures designed to prolong life. Directive 60 repeats the Church's teaching in regard to euthanasia and physician-assisted suicide (PAS)--that is, whatever the intentions of those who employ them, euthanasia and PAS remain forms of murder. Directive 62 considers the methods used to determine that death has occurred. Directive 66 encourages patients to donate their organs and bodily tissue after death. However, the directive says, Catholic healthcare facilities should not make use of tissue obtained by direct abortions.     

Dying cancer patients talk about euthanasia

Within developed nations, there is increasing public debate about and apparent endorsement of the appropriateness of euthanasia as an autonomous choice to die in the face of intolerable suffering. Surveys report socio-demographic differences in rates of acceptance of euthanasia, but there is little in-depth analysis of how euthanasia is understood and positioned within the social and moral lives of individuals, particularly those who might be considered suitable candidates-for example, terminally-ill cancer patients. During discussions with 28 such patients in Australia regarding medical decisions at the end of life, euthanasia was raised by 13 patients, with the others specifically asked about it. Twenty-four patients spoke positively of euthanasia, 19 of these voicing some concerns. None identified euthanasia as a currently favoured option. Four were completely against it. Endorsement for euthanasia was in the context of a hypothetical future or for a hypothetical other person, or temporally associated with acute pain. Arguments supporting euthanasia framed the issue as a matter of freedom of choice, as preserving dignity in death, and as curbing intolerable pain and suffering, both of the patient and of those around them. A common analogy featured was that of euthanising a dog. These arguments were typically presented as self-evident justification for euthanasia, construed as an appropriate choice to die, with opposers positioned as morally inferior or ignorant. The difficulties of ensuring 'choice' and the moral connotations of 'choosing to die,' however, worked to problematise the appropriateness of euthanising specific individuals. We recommend further empirical investigation of the moral and social meanings associated with euthanasia.     

New research on the practice, reporting and reviewing of euthanasia and other medical end-of-life decisions, 2001/2002

In the second half of 2001, an extensive study will start which will evaluate the review procedure for euthanasia in the Netherlands. Since the end of 1998, euthanasia has to be reviewed by regional review committees, which include a physician and an ethicist, in addition to a legal expert. The aim of this study is to examine whether the reporting procedure meets the aim and whether there are any points which require improvement. This study follows on from those carried out in 1990/1991 and 1995/1996, which investigated euthanasia and other medical end-of-life decisions (assisted suicide, termination of life without the patient's explicit request, treatment of pain and symptoms with a possible life-shortening effect, and forgoing potentially life-prolonging treatment). The study consists of an analysis of cases of death (in which the numbers and nature of various medical end-of-life decisions will be established), physician interviews (to gain insight into the context in which medical end-of-life decisions are made), a study of reported cases (to give an overview of doctors' experiences with the review committees), and a study carried out amongst the general public (around 1,500 Dutch adults will be given a written questionnaire about their opinions concerning medical end-of-life decisions and the reporting procedure). In addition to this Dutch study, a European study subsidized by the European Commission is being carried out which will examine attitudes and experiences regarding medical end-of-life decisions in six European countries (Belgium, Denmark, Italy, the Netherlands, Sweden and Switzerland). This will, for the first time, enable a true comparison to be made between the Netherlands and other countries in terms of euthanasia and other medical end-of-life decisions.     

How accurately is euthanasia reported on death certificates in a country with legal euthanasia: a population-based study

Background

Death certificates are the main source of information on the incidence of the direct and underlying causes of death, but may be unsuitable for monitoring the practice of medical assistance in dying, e.g. euthanasia, due to possible underreporting. This study examines the accuracy of certification of euthanasia.

Methods

Mortality follow-back survey using a random sample of death certificates (N?=?6871). For all cases identified as euthanasia we checked whether euthanasia was reported as a cause of death on the death certificate. We used multivariable logistic regression analysis to evaluate whether reporting varied according to patient and decision-making characteristics.

Results

Through the death certificates, 0.7% of all deaths were identified as euthanasia, compared with 4.6% through the mortality follow-back survey. Only 16.2% of the cases identified from the survey were reported on the death certificate. Euthanasia was more likely to be reported on the death certificate where death was from cancer (14% covered), neurological diseases (22%) and stroke (28%) than from cardiovascular disease (7%). Even when the recommended drugs were used or the physician self-labelled the end-of-life decision as euthanasia, euthanasia was only reported on the death certificate in 24% of cases.

Conclusions

Death certificates substantially underestimate the frequency of euthanasia as a cause of death in Belgium. Mortality follow-back studies are essential complementary instruments to examine and monitor the practice of euthanasia more accurately. Death certificate forms may need to be modified and clear guidelines provided to physicians about recording euthanasia to ensure more accurate certification.

     

Euthanasia,assisted suicide,and cessation of life support: Japan's policy,law, and an analysis of whistle blowing in two recent mercy killing cases

Issues pertaining to euthanasia, assisted suicide, and cessation of life support continue to be a subject of worldwide interest. Euthanasia- particularly "active" euthanasia- is not considered legally or socially acceptable in most countries. In Japan, the first judgment of a case involving euthanasia took place in 1949. Since then there have been another five cases that reached the point of sentencing in 1990. All six cases were examples of so called "active euthanasia", in which the termination of life was performed by family members. However, the focus of discussion has been changed dramatically in recent years, owing to two prominent cases of mercy killing in 1995 (Yokohama) and 1996 (Kyoto), respectively. Medical doctors were involved in both of these cases, and euthanasia moved from being a theoretical problem to a practical dilemma. These cases also drew attention to the fact that assisted suicide could be distinguished from euthanasia. The first part of this paper will summarize the current status of euthanasia and the cessation of life support in Japan, focusing on its historical background and policy. The second part will briefly sketch the characteristics of Japanese law and then will examine the two recent cases of mercy killing mentioned above to try and determine the roles of whistle blowing in the medical practice arena, with particular reference to Japanese culture. This analysis is a challenge to elucidate how ethics and the law interact, and influence medical practice in a specific cultural context.     

Extending’ euthanasia to those ‘tired of living’ in the Netherlands could jeopardize a well-functioning practice of physicians’ assessment of a patient's request for death

The Dutch Euthanasia Act (EA) took effect in 2002 and regulates the ending of one’s life by a physician at the request of a patient who is suffering unbearably. According to the Dutch Supreme Court, unbearable suffering is a state for which the presence of a medical condition is a strict prerequisite. As a consequence, the Dutch EA has attributed the assessment of unbearable suffering to physicians who evaluate the presence of a medical classifiable disorder. Currently, a debate within the Netherlands questions whether older people, without a medical condition, who value their life as completed, should be granted euthanasia. To concede the autonomy of such a person, the Dutch government intends to create a separate legal framework that regulates this tired of living euthanasia request. This debate is crucial for policy-makers and an international audience because it discusses if a self-directed death of older people, should be implemented in (the current Dutch) euthanasia practice. However, this article argues that the current legal proposal that regulates the tired of living euthanasia request ignores crucial jurisprudence on physicians’ application of the unbearable suffering criterion in practice. Furthermore it points out that this proposal neglects physicians role in guaranteeing a euthanasia practice of due care and that its use of an ethic of absolute autonomy could jeopardize this well-established practice.     

Why we should not legalize euthanasia. The foundational ethical principle obliging us to protect life must be translated into a concrete norm

The euthanasia debate is really the backdrop for a discussion within our society about the very nature of human life and meaning. Because the origin of life is in God, human beings do not have dominion over life but are stewards of life. The powerful combination of sanctity and stewardship is expressed in the foundational ethical principle. This principle says that no person has the right to directly take innocent human life and in fact there is a positive obligation to nurture and protect life. In our secular society there is a need to develop a "natural" metaphysic of sacredness. Such a metaphysic can serve as bedrock from which a foundational principle can be developed and then applied in concrete moral norms. It can show that life contributes to the full dignity of the human person. For this perspective to be effective in countering the movement to legalize euthanasia, this sense of integral wholeness of human personhood must be demonstrated in a convincing manner. It can be because a dualistic philosophical bias has been found wanting by Western culture. We must arrive at what ethicists would call concrete norms that guide individual choices. At issue is how we translate our foundational principle--Do not directly attack innocent human life--into a concrete norm when confronted with the possibility of death. Some persons question whether the concrete norm opposing euthanasia should be a matter of public morality. To answer this question, we must turn to our foundational principle.(ABSTRACT TRUNCATED AT 250 WORDS)     

Attitudes, sociodemographic characteristics, and actual end-of-life decisions of physicians in Flanders, Belgium.

AIM: To study the effect of sociodemographic and attitudinal determinants of physicians making end-of-life decisions (ELDs). METHODS: The physicians having signed 489 consecutive death certificates in the city of Hasselt (Belgium) were sent an anonymous questionnaire regarding their ELDs and another on their attitudes toward voluntary euthanasia (EUTH) and physician-assisted suicide (PAS). RESULTS: 55% response rate. Nontreatment decisions occurred in 16.7% of all death cases; in 16%, there was potentially life-shortening use of drugs to alleviate pain and symptoms; in 4.8% of cases, death was deliberately induced by lethal drugs, including EUTH, PAS, and life termination without explicit request by the patient. In their attitudes toward EUTH and PAS, the 92 responding physicians clustered into 3 groups: positive and rule oriented, positive rule-adverse, and opposed. Cluster group membership, commitment to life stance, years of professional experience, and gender were each associated with specific ELD-making patterns.