Balint J A
The Albany Medical College Center For Medical Ethics, Education and Research, NY 12208, USA.
Croat Med J. 2000 Jun;41(2):144-9.
This paper presents a system for making decisions at the end of life. It emphasizes the role of patient autonomy and the importance of patient and family participation with the physician in decision-making. Definitions are presented for the terms: terminal illness, withholding and withdrawing life sustaining treatment, physician assisted suicide and euthanasia. Three cases are briefly described to illustrate the application of the decision-making system. A detailed discussion is then presented of the divergent views expressed by different authors about the moral differences or similarities between foregoing life sustaining treatment and physician assistance in dying. It is concluded that the view that these two actions are fundamentally different, as supported by the United States Supreme Court, in 1997, is the correct one. Physician assisted suicide (PAS) remains a controversial issue. Physicians and societies in individual countries must work out their own approaches to PAS. However, foregoing invasive or intensive life support in terminally ill patients consistent with their wishes is considered appropriate.
本文介绍了一种临终决策系统。它强调了患者自主权的作用以及患者和家属与医生共同参与决策的重要性。文中给出了以下术语的定义：晚期疾病、停止和撤销维持生命的治疗、医生协助自杀和安乐死。简要描述了三个案例以说明该决策系统的应用。接着详细讨论了不同作者对放弃维持生命的治疗和医生协助死亡之间道德差异或相似性所表达的不同观点。得出的结论是，正如美国最高法院在1997年所支持的那样，认为这两种行为本质上不同的观点是正确的。医生协助自杀（PAS）仍然是一个有争议的问题。各个国家的医生和社会必须制定出自己应对医生协助自杀的方法。然而，根据临终患者的意愿放弃侵入性或强化生命支持被认为是合适的。
