Materstvedt L J, Kaasa S
Unit for Applied Clinical Research, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim N-7489, Norway.
Palliat Med. 2002 Jan;16(1):17-32. doi: 10.1191/0269216302pm470oa.
This article analyses and compares recent research on Scandinavian physicians' attitudes towards, as well as their practice of, euthanasia and physician-assisted suicide. The studies discussed are quite dissimilar in their design, resulting in considerable difficulties as far as comparability is concerned. Such difficulties are common in these fields of research. As an intended contribution to the amendment of future research, we suggest what we take to be detailed and precise definitions of the terms euthanasia and physician-assisted suicide for use internationally. Our definitions, or interpretations, basically draw on the Dutch experience and understanding of these terms. The Dutch approach implies that acts of abstention from life-prolonging treatment, i.e., withholding and withdrawing treatment, and pain and symptom treatment that theoretically could shorten life (including terminal sedation) are to be considered 'normal medical practice'. Furthermore, death is seen as having natural causes in all of these acts. That, however, is not the case with euthanasia and physician-assisted suicide. When a physician performs either of these acts, he or she is required to state 'unnatural death' in the patient's death certificate. Our conceptual suggestions do not address the ethical status of the various medical decisions that are made with regard to the death of patients; our aim is conceptual clarity only. As far as euthanasia and physician-assisted suicide in Scandinavia is concerned, even though comparisons prove difficult, we do think some observations may be made: physicians from Norway, Denmark and Sweden display differences in both attitude and practice concerning these phenomena. Norwegian physicians are most restrictive with regard to attitude. Danish and Swedish physicians display a more liberal attitude, the latter being the most liberal. These findings did not fit the physicians' practice. Danish physicians have performed euthanasia and physician-assisted suicide more often than Norwegian physicians. Swedish physicians, even though they are the most liberal when it comes to attitude, appear never to have performed euthanasia and very seldom physician-assisted suicide.
本文分析并比较了近期关于斯堪的纳维亚医生对安乐死和医生协助自杀的态度及其实践的研究。所讨论的研究在设计上差异很大，就可比性而言导致了相当大的困难。这些困难在这些研究领域很常见。作为对未来研究修正的一项预期贡献，我们提出了我们认为对安乐死和医生协助自杀这两个术语在国际上使用的详细而精确的定义。我们的定义或解释基本上借鉴了荷兰对这些术语的经验和理解。荷兰的方法意味着放弃延长生命的治疗行为，即 withholding 和 withdrawing 治疗，以及理论上可能缩短生命的疼痛和症状治疗（包括临终镇静）应被视为“正常医疗实践”。此外，在所有这些行为中，死亡被视为由自然原因导致。然而，安乐死和医生协助自杀并非如此。当医生实施这两种行为中的任何一种时，他或她需要在患者的死亡证明上注明“非自然死亡”。我们的概念性建议并未涉及就患者死亡所做出的各种医疗决定的伦理地位；我们的目标仅仅是概念清晰。就斯堪的纳维亚的安乐死和医生协助自杀而言，尽管比较困难，但我们确实认为可以得出一些观察结果：来自挪威、丹麦和瑞典的医生在对这些现象的态度和实践上存在差异。挪威医生在态度上最为严格。丹麦和瑞典医生表现出更自由的态度，瑞典医生最为自由。这些发现与医生的实践情况不符。丹麦医生实施安乐死和医生协助自杀的频率高于挪威医生。瑞典医生尽管在态度上最为自由，但似乎从未实施过安乐死，实施医生协助自杀的情况也非常罕见。
