Tur Richard H S
Oriel College, Oxford, United Kingdom.
Mt Sinai J Med. 2002 Oct;69(5):317-28.
The paper takes as its point of departure a relatively recent case which attracted publicity in Britain, concerning a doctor charged with (but acquitted of) the murder of his terminally ill patient, and critically examines the criminal law of England and Wales relating to homicide in the context of medical practice. While similar issues obviously arise in many other countries, no comparative study is attempted in the paper. However, the arguments which have been presented are of more than local interest. From an analysis of this case and others, it appears that there is in common law something which can be called the doctor s defense. It holds that a doctor may, when caring for a patient who is suffering great pain, lawfully administer pain-killing drugs, despite the fact that, as the doctor well knows, one certain or highly probable consequence will be to shorten the patient s life. Current justifications for this defense are either incoherent or too weak. Some require that different conceptions of intention be deployed, depending on whether the agent is a doctor or not. Others rely on the philosophically controversial doctrine of double effect. Still others invoke an implausible notion of minimal causation. All these justifications apply readily enough to morally and factually easy cases, but fail in hard cases where the need for some justification is most pressing. These justifications seem incapable of providing adequate guidance to prosecutors or trial judges. Absent principled and transparent justification, the English criminal justice system exhibits different outcomes on what appear to be broadly similar facts. It is disturbing that the law is uncertain and incapable of giving adequate guidance. A doctor, compelled by conscience to intervene to end a person s life, should certainly be ready and willing to face rigorous legal scrutiny, but the law applied should not be arbitrary and random, nor should the outcome turn solely or chiefly on prosecutorial discretion or the predilections of the trial judge. The hope is to find a better rationale for the doctor s defense through an analysis of professional ethics and the concept of a recourse role.
本文以英国近期一起备受关注的案件为出发点，该案件涉及一名医生被控（但最终被宣判无罪）谋杀其身患绝症的病人，并在医疗实践背景下批判性地审视了英格兰和威尔士与杀人罪相关的刑法。虽然许多其他国家显然也出现了类似问题，但本文并未进行比较研究。然而，所提出的论点并非仅具有局部意义。通过对这起案件及其他案件的分析，似乎普通法中存在某种可称为医生辩护的东西。它认为，医生在照料遭受巨大痛苦的病人时，尽管深知这样做的一个必然或极有可能的后果是缩短病人的生命，但仍可合法地使用止痛药物。目前对这种辩护的正当理由要么前后矛盾，要么过于薄弱。有些理由要求根据行为主体是否为医生来采用不同的意图概念。另一些理由则依赖于哲学上有争议的双重效果学说。还有一些理由援引了一个难以置信的最小因果关系概念。所有这些理由在道德和事实层面简单的案件中都很容易适用，但在最需要某种正当理由的疑难案件中却失效了。这些理由似乎无法为检察官或初审法官提供充分指导。由于缺乏有原则且透明的正当理由，英国刑事司法系统在看似大致相似的事实上呈现出不同的结果。令人不安的是，法律不确定且无法提供充分指导。一名出于良知而干预以结束他人生命的医生，当然应该准备好并愿意面对严格的法律审查，但适用的法律不应是任意和随机的，结果也不应仅仅或主要取决于检察官的自由裁量权或初审法官的偏好。希望通过对职业道德和求助角色概念的分析，为医生的辩护找到更好的理论依据。
