安乐死与医学目的

安乐死与医学目的徐萍医学的对象是人，是人的生命。医学的目的不仅在于维护和延长病人的生命，而且还注重生命存在的社会价值。当优生学被承认后，以安乐死为代表的优死学，来自人们生命末端的一系列生死攸关的伦理问题，又突出地摆在人们的面前。本文试就安乐死与医学目...     

实验动物非麻醉安乐死技术的伦理学探讨

对实验动物实施仁慈终点,是动物实验伦理的基本要求,除了被广为接受的麻醉法安乐死,非麻醉手段的使用也极为普遍。本文以动物实验伦理的“3R”原则和实验动物福利的“五项自由”为准则,系统探讨了断颈、颈椎脱臼两大非麻醉安乐死方法的伦理正当性,分析了空气栓塞法、液氮冰冻法、放血法、窒息法等作为安乐死方法存在的伦理问题及改进对策,并探讨了多种安乐死方法综合应用的可行性,为处于使用非麻醉安乐死方法伦理困境中的实验者提供借鉴和思路。     

我国安乐死立法探讨

十多年来 ,安乐死问题在我国日渐受到人们的关注 ,并引起激烈讨论。其结果主要存在两种观点 :一种观点认为 ,安乐死明显违背社会主义人道主义原则 ,从法学角度看 ,它不符合我国立法精神 ;同时也违反社会主义医德 ,在社会主义中国是绝对行不通的。另一种观点则认为 ,安乐死减轻了患者的痛苦 ,减轻了家庭和社会的负担 ,符合社会主义人道主义原则 ,不具备社会危害性 ,在我国法律中应当立法确认。本文拟从安乐死的概念 ,实施安乐死行为是否构成故意杀人罪 ,是否符合伦理道德和人道主义原则 ,国外安乐死立法状况以及在我国实施安乐死的立法设想五…     

关于安乐死现实可行性的几点讨论

目前,安乐死已成为被世界关注的一大问题.对于安乐死的可行性以及其对医学、对社会、对人类道德伦理的影响,有持肯定态度,也有持否定态度.本文拟从伦理学、社会学、经济学、医学等四个方面来讨论安乐死的可行性.1安乐死遵循了生命伦理学的原则     

安乐死的发展与实践

英国哲学家人道主义倡导者培根曾主张用实验方法来控制人的生命过程 ,达到延长生命和无痛苦的目的[1] 。进入本世纪 ,人类对于生与死的认识进入了一个新的层次。随着医学的进步和生活的提高 ,人们不仅强调生命的神圣 ,同时也提出了生命的“质量论”和“价值论” ,除了关注优生外 ,人们开始关注“优死”—安乐死。围绕安乐死这一焦点 ,许多国家的医学界、法学界、伦理学界一直在争论。1　安乐死的性质安乐死是 70年代以来国内外医学界、哲学界和伦理学界讨论最为热烈的问题之一 ,是一种无痛苦、幸福的死亡。它包括两层含义 ,一是无痛苦的死亡…     

肿瘤放射治疗中若干伦理问题的思考

从肿瘤放射治疗的不确定性、患者知情权与"善意的谎言"之间的伦理悖论和终末期肿瘤病人临终关怀与"安乐死"的选择三个方面讨论了肿瘤放射治疗中的伦理问题,旨在引发医务人员对放射治疗相关伦理问题的深入思考,通过不断提高肿瘤放射治疗的疗效、减少放射治疗并发症;医疗机构及其医务人员认真负责的履行告知义务;制定出台相关的法律条款,实现对安乐死等医学伦理问题的法律规范,以更好保障肿瘤患者的生命权和生命尊严。     

儒家生命伦理视阈下的安乐死

安乐死的研究者往往强调死得"安乐",但是安乐死首先面对的问题仍然是"生"与"死"的问题,本文从儒家世界观,人生观,价值观方面来探讨安乐死问题,儒家世界观认为"天人一体",在死亡面前,应该坦然接受死亡,这为安乐死研究提供了一个逻辑起点。儒家人生观认为,并非存在持续性的痛苦的患者都可以申请安乐死,只有疾病已阻止到了对人格理想的追求时才可以申请安乐死,并且痛苦不包含精神上的痛苦。生命权的地位问题是安乐死的一个热点问题,儒家价值观认为,生命权并不是绝对神圣的,还对安乐死所附带的功利主义效果予以肯定,虽然这种功利主义效果不能作为实行安乐死的理由。     

我国健康服务业发展的生命伦理学研究

随着生活水平的提高,广大群众对健康服务的需求持续增长,健康服务业已成为我国经济发展新的增长点和保障、改善民生的重大举措.健康服务业的产生基于维护公民生命＂健康权＂这一基本人权,与生命伦理具有内在关联性,其后天的发展中同样展现了生命伦理的性状和特质.健康服务业发展的生命伦理原则包括：公益原则、人道原则、互惠原则.     

安乐死质疑

安乐死(Eufhanasia)是目前在国内外讨论最为热烈的医学伦理学问题之一。不少西方学者都积极主张对处于垂危、十分痛苦而又缺乏有效抢救措施的病人实施安乐死;国内也有不少人提出相似看法。我国是社会主义国家。如何运用马克思主义的理论来指导我们正确地评价安乐死,不仅对于创建具有中国特色的社会主义的医学伦理学有较为重要的意义,而且对发展危重急症抢救的理论和实践亦有较大的影响。主张提倡安乐死的学者所提出的主要理由是:“安乐死在道德上的可容许性是符合病人本身的利益”,“符合人道主义原则”。为了弄清楚这一问题,我们有必要研究一下什么是马克思主义的道德观。根据马列主义经典作家们的论述,道德乃是一种特定的意识形态,是属于社会上层建筑的现象。道德和法律一样,都是一定社会的经济、政治、文化的发展所要求于人们的行为规范。但道德规范和法律不同,它不     

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.     

武汉市江岸区居民安乐死实践的调查研究

调查发现，该区1993年死亡病例中主动安乐死发生概率为1．0％（0～2．1％），病人其他生命本期医学决策为：不治疗11．6％，减痛治疗9．9％，“情感”治疗182％，积极抢救573％；21％病人临终前有求死欲望，其中56．7％有过自杀行为，近一半的人自杀成功；摆脱疾病所致难以忍受的痛苦是其求死的主要目的。本研究揭示，在安乐死尚未合法化的我国大城市中，安乐死正以1．0％左右的发生概率在悄然进行着。     

Debbie's dying: mercy killing and the good death

Vaux, a consultant in medical ethics, reflects on the issue of physician-administered euthanasia raised in JAMA's controversial article, "It's over, Debbie" (1988 Jan 8; 259(2): 272). He asks if the death of the young terminal cancer patient was really a case of morally acceptable double-effect euthanasia, resulting from the anonymous resident's use of morphine primarily to relieve her pain with death as an unfortunate side effect. Vaux argues that, while the cardinal purpose of medicine is "to save and sustain life and never intentionally to harm or kill," and while euthanasia must be proscribed in principle, "in exceptional cases it may be abided in deed."     

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.     

北京地区安乐死社会心态的调查分析

通过对北京地区部分医院的医务人员、患者和医学院在校学生以及社区人群等进行问卷调查,旨在从一个侧面反映社会对安乐死及相关问题的态度。从调查中发现,社会对安乐死的认知程度较高,并且人群对安乐死的不同态度与其文化程度和职业背景具有相关性。另外,通过对人们谈论死亡时的心态进行分析发现拥有健康生死观的人更倾向于赞同积极安乐死。     

中国安乐死实施的不可行性分析

目前，国内外关于安乐死立法的呼声日益高涨。但是，从我国的国情、立法环境和文化风俗来看，安乐死尚不具备实施的可行性。从社会宏观角度看，由于受传统伦理道德和价值观念的束缚，民众观念需要转变。同时，由于对生命权也未作规定。政治经济等各方面原因，医疗科研水平存在局限，我国对安乐死基本问题和判断标准无法达成一致。从微观角度来看，安乐死行为涉及患者、医务人员、患者家属和医疗机构四方利益，实施安乐死存在安全隐患。本丈将从这两个方面分析我国实施安乐死的现实可行性，论证目前在我国实施安乐死的条件和时机还不成熟。     

医学生对安乐死的认知和态度调查

目的:调查医学生对安乐死的认知和态度,并分析可能的影响因素,为医学伦理教育提供参考依据.方法:采用自行设计的问卷对某医学院校526名本科生进行关于安乐死认知和态度方面的调查.结果:526名被调查者中,安乐死知晓率为63.9%,被调查者表示对安乐死有所了解,但了解的内容和范围有限,94.3%的被调查者认为生命权属于个人,但对于个人是否有权利决定自己生死则表现得较为矛盾.被调查者均承认安乐死属于跨学科、跨领域的争议性问题,63.9%赞成安乐死,63.5%表示安乐死在我国立法是非常必要的.58.7%表示在本人面临是否选择安乐死时要视具体情况而定,64.6%的被调查者在面对亲人选择安乐死时表示不会主动建议,但会支持其决定.结论:多数调查者对安乐死有一定的了解,但是受我国传统思想观念的影响,医学生对于死亡和安乐死的认识有限,被调查者对实施安乐死态度较为严谨,应加强医学生伦理教育和死亡教育,正确引导医学生认识死亡,正确看待安乐死.     

Passive euthanasia

The idea of passive euthanasia has recently been attacked in a particularly clear and explicit way by an "Ethics Task Force" established by the European Association of Palliative Care (EAPC) in February 2001. It claims that the expression "passive euthanasia" is a contradiction in terms and hence that there can be no such thing. This paper critically assesses the main arguments for the Task Force's view. Three arguments are considered. Firstly, an argument based on the (supposed) wrongness of euthanasia and the (supposed) permissibility of what is often called passive euthanasia. Secondly, the claim that passive euthanasia (so-called) cannot really be euthanasia because it does not cause death. And finally, a consequence based argument which appeals to the (alleged) bad consequences of accepting the category of passive euthanasia.We conclude that although healthcare professionals' nervousness about the concept of passive euthanasia is understandable, there is really no reason to abandon the category provided that it is properly and narrowly understand and provided that "euthanasia reasons" for withdrawing or withholding life-prolonging treatment are carefully distinguished from other reasons.     

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.     

我国安乐死与临终关怀现状的伦理审视

由于我国社会老龄化步伐的加快,使得安乐死和临终关怀成为社会日益关注的焦点。作为死亡控制的核心内容,二者皆有非凡之处。通过对我国安乐死与临终关怀现状的伦理审视,有针对性地提出：积极开展安乐死在我国的多学科研究,高度重视并积极推进我国的临终关怀建设,促进二者和谐统一是推动我国老龄化社会和谐发展的得力之举。