Oehmichen Manfred, Meissner Christoph
Institute of Forensic Medicine, University Hospital of Kiel, Arnold-Heller-Strasse 12, D-24105 Kiel, Germany.
Leg Med (Tokyo). 2003 Mar;5 Suppl 1:S20-8. doi: 10.1016/s1344-6223(02)00091-3.
The debate on legalization of active euthanasia in the Netherlands and Belgium and the refused legal right to choose the circumstances of Diana Pretty's own death are the last actual reasons for reconsidering the situation in Germany. Around the world heated debates have broken out on the topic of active euthanasia. Specialists in the field of 'forensic medicine' have taken full part in these discussions. The present survey from the point of view of forensic medicine begins with a look at current terminology and at the laws pertaining to euthanasia in Germany. These laws are then contrasted with actual practice, including a description of the increasing acceptance of active euthanasia by the German population. The main argument against legalization of active euthanasia is that its formal acceptance in law would cause the dam of restraint to burst, culminating in widespread misuse, as already seen in recent serial killings by nurses in hospitals and homes for the elderly around the world. Contrasted with this are the arguments for taking active steps at the end of life, including emotional considerations such as the revulsion against mechanized medicine and the fear of pain and rational arguments such as the necessity to end a 'life unworthy of life', to save medical costs, and obtaining prior consent in 'living wills'. Such considerations have put in jeopardy the moral integrity of the medical profession - and thus the layperson's trust in physicians--around the world. In Germany especially the history of mass killing during the Nazi era constitutes a fundamental argument against active euthanasia. As a consequence, in Germany active euthanasia will not receive legal sanction, although recommendations on rendering dying more bearable are permitted.
荷兰和比利时关于积极安乐死合法化的辩论，以及戴安娜·普雷蒂被拒绝选择自己死亡情形的合法权利，是重新审视德国现状的最后现实原因。在全球范围内，围绕积极安乐死这一话题爆发了激烈辩论。“法医学”领域的专家充分参与了这些讨论。本次从法医学角度进行的调查，首先审视了当前的术语以及德国与安乐死相关的法律。然后将这些法律与实际做法进行对比，包括描述德国民众对积极安乐死的接受程度日益提高的情况。反对积极安乐死合法化的主要论点是，其在法律上的正式认可会导致约束的堤坝决堤，最终导致广泛滥用，正如最近在世界各地医院和养老院发生的护士连环杀人事件中所看到的那样。与此形成对比的是，支持在生命末期采取积极措施的论点，包括诸如对机械化医疗的反感以及对疼痛的恐惧等情感因素，以及诸如结束“无价值生命”的必要性、节省医疗成本以及在“生前遗嘱”中获得事先同意等理性论据。这些考量危及了世界各地医疗行业的道德完整性——进而危及了外行对医生的信任。尤其是在德国，纳粹时代的大屠杀历史构成了反对积极安乐死的根本论据。因此，在德国，积极安乐死不会得到法律制裁，尽管允许提出让死亡更可忍受的建议。
