Campbell C S
Department of Religious Studies, Oregon State University, Corvallis.
J Med Ethics. 1992 Sep;18(3):128-34. doi: 10.1136/jme.18.3.128.
In several US states, the legalisation of euthanasia has become a question for voters to decide in public referenda. This democratic approach in politics is consistent with notions of personal autonomy in medicine, but the right of choice does not mean all choices are morally equal. A presumption against the taking of human life is embedded in the formative moral traditions of society; human life does not have absolute value, but we do and should impose a strict burden of justification for exceptions to the presumption, as exemplified by the moral criteria invoked to justify self-defence, capital punishment, or just war. These criteria can illuminate whether another exception should be carved out for doctor-assisted suicide or active euthanasia. It does not seem, in the United States at any rate, that all possible alternatives to affirm the control and dignity of the dying patient and to relieve pain and suffering, short of taking life, have been exhausted. Moreover, the procedural safeguards built into many proposals for legalised euthanasia would likely be undone by the sorry state of the US health care system, with its lack of universal access to care, chronic cost-containment ills, a litigious climate, and socioeconomic barriers to care. There remains, however, common ground in the quest for humane care of the dying.
在美国的几个州，安乐死合法化已成为一个供选民在公民投票中决定的问题。政治上的这种民主方式与医学中个人自主的观念相一致，但选择权并不意味着所有选择在道德上都是平等的。反对剥夺人类生命的推定蕴含在社会的形成性道德传统之中；人类生命虽不具有绝对价值，但对于该推定的例外情况，我们确实且应该施加严格的正当理由负担，例如为自卫、死刑或正义战争辩护时所援引的道德标准。这些标准可以阐明是否应为医生协助自杀或主动安乐死另开一个例外。至少在美国，似乎尚未穷尽所有在不剥夺生命的情况下确认临终患者的控制权和尊严、减轻痛苦的可能替代方案。此外，许多安乐死合法化提案中设立的程序保障措施，很可能会因美国医疗保健系统糟糕的状况而失效，该系统存在缺乏普遍医疗服务、长期的成本控制问题、诉讼氛围以及医疗的社会经济障碍等。然而，在寻求对临终者的人道关怀方面仍存在共识。
