Tulsky J A, Ciampa R, Rosen E J
Health Services Research, Durham Veterans Affairs Medical Center, North Carolina 27705, USA.
Ann Intern Med. 2000 Mar 21;132(6):494-9. doi: 10.7326/0003-4819-132-6-200003210-00012.
In 1998, 15 terminally ill Oregon residents ended their lives with overdoses of medications supplied legally by their physicians. Many more people consider this possibility. This paper examines the ways in which the physician's response to requests for assisted suicide may change in an era of legalization, articulates some of the resulting conceptual challenges, and provides practical advice to physicians facing such requests. In areas where it is legal, assisted dying becomes one of the many options that can be freely considered for terminally ill patients with extreme suffering. Some patients even view assisted death as a right that can be expected on demand. We consider the ethical implications of disclosing assisted dying to patients as an option of last resort and suggest that physicians working in environments where assisted dying is legal are obliged to do so. However, we conclude that physicians should not encourage patients to hasten death even when practicing in jurisdictions that allow assisted dying. Furthermore, without abandoning the model, we suggest that strict informed consent does not fully address patients' needs at this time. Physicians must also focus on patients' broader biopsychosocial concerns and help them identify solutions through empathic listening and emotional support. We provide a framework and vocabulary for physicians to use when responding to requests for assisted suicide. Physicians should clarify the request, explore and address the patient's concerns, achieve a shared understanding of the goals of treatment, search for less harmful alternatives, express to the patient what they are willing to do, discuss the relevant legal issues, and share their decision making with colleagues.
1998年，15名身患绝症的俄勒冈州居民过量服用医生合法提供的药物结束了生命。更多的人考虑过这种可能性。本文探讨了在合法化时代医生对协助自杀请求的回应方式可能发生的变化，阐明了由此产生的一些概念性挑战，并为面临此类请求的医生提供了实用建议。在合法的地区，协助死亡成为身患绝症且极度痛苦的患者可以自由考虑的众多选择之一。一些患者甚至将协助死亡视为一种可以按需期待的权利。我们考虑了将协助死亡作为最后手段告知患者的伦理意义，并建议在协助死亡合法的环境中工作的医生有义务这样做。然而，我们得出的结论是，即使在允许协助死亡的司法管辖区执业，医生也不应鼓励患者加速死亡。此外，在不摒弃该模式的情况下，我们认为严格的知情同意目前并未完全满足患者的需求。医生还必须关注患者更广泛的生物心理社会问题，并通过共情倾听和情感支持帮助他们找到解决方案。我们为医生在回应协助自杀请求时提供了一个框架和词汇表。医生应澄清请求，探索并解决患者的担忧，就治疗目标达成共同理解，寻找危害较小的替代方案，向患者表明他们愿意做什么，讨论相关法律问题，并与同事分享他们的决策过程。
