Rizzo R F
Canisius College, Williamsville, Buffalo, New York 14221-5128, USA.
Theor Med Bioeth. 2000;21(3):291-304. doi: 10.1023/a:1009947732023.
In the United States, judicial rulings that unrealistically addressed the complexity of cases and demonstrated limited understanding of principles, helped to create a legal quagmire which legislatures had to confront. Moreover, the legislative response was often slow and inadequate in terms of both the scope and clarity of the laws. However, since the 1970s, progress has been made on many fronts, particularly in regard to advance directives dealing with end-of-life decisions. The debate over physician-assisted suicide has spawned a repetition of moral and legal arguments. Those against legalization have failed to make a realistic appraisal of the dilemmas facing patients and their families in an age of technological medicine delivered in the context of the marketplace. The underlying problem is a system in dire need of reform that will no longer treat health care as a commodity of the marketplace and provide universal health care. Terminal care as an integral part of health care will substantially benefit from such reforms because a major obstacle to comprehensive palliative care is the condition of the present system.
在美国，那些不切实际地处理案件复杂性且对相关原则理解有限的司法裁决，导致了一个立法机构不得不面对的法律困境。此外，立法回应在法律的范围和清晰度方面往往既缓慢又不足。然而，自20世纪70年代以来，在许多方面都取得了进展，特别是在涉及临终决定的预先指示方面。关于医生协助自杀的辩论引发了道德和法律争论的反复。那些反对合法化的人未能对在市场背景下提供技术医学的时代患者及其家人所面临的困境做出现实评估。根本问题在于一个急需改革的体系，该体系不应再将医疗保健视为市场商品，而应提供全民医疗保健。作为医疗保健不可或缺一部分的临终关怀将从这些改革中大幅受益，因为当前体系的状况是全面姑息治疗的一个主要障碍。
