Union University Law School Belgrade, Belgrade, Goce Delceva 36, Serbia.
Bioethics. 2010 Mar;24(3):105-12. doi: 10.1111/j.1467-8519.2010.01806.x.
This article explores universal normative bases that could help to shape a workable legal construct that would facilitate a global use of advance directives. Although I believe that advance directives are of universal character, my primary aim in approaching this issue is to remain realistic. I will make three claims. First, I will argue that the principles of autonomy, dignity and informed consent, embodied in the Oviedo Convention and the UNESCO Declaration on Bioethics and Human Rights, could arguably be regarded as universal bases for the global use of advance directives. Second, I will demonstrate that, despite the apparent consensus of ethical authorities in support of their global use, it is unlikely, for the time being, that such consensus could lead to unqualified legal recognition of advance directives, because of different understandings of the nature of the international rules, meanings of autonomy and dignity which are context-specific and culture-specific, and existing imperfections that make advance directives either unworkable or hardly applicable in practice. The third claim suggests that the fact that the concept of the advance directive is not universally shared does not mean that it should not become so, but never as the only option in managing incompetent patients. A way to proceed is to prioritize work on developing higher standards in managing incompetent patients and on progressing towards the realization of universal human rights in the sphere of bioethics, by advocating a universal, legally binding international convention that would outlaw human rights violations in end-of-life decision-making.
本文探讨了普遍的规范基础，这些基础可以帮助构建一个可行的法律结构，促进全球范围内使用预先指示。尽管我认为预先指示具有普遍性，但我在处理这个问题时的主要目的是保持现实。我将提出三个主张。首先，我将论证，奥维耶多公约和教科文组织《生物伦理与人权宣言》中体现的自主性、尊严和知情同意原则，可以被视为全球范围内使用预先指示的普遍基础。其次，我将表明，尽管伦理权威显然支持全球使用预先指示，但目前不太可能导致无条件承认预先指示的法律认可，因为对国际规则性质、自主性和尊严的含义存在具体情境和文化特定的理解，以及现有不完善之处使得预先指示在实践中要么不可行，要么几乎无法适用。第三个主张表明，预先指示的概念并非普遍共享这一事实并不意味着它不应该如此，但在管理无行为能力患者时，它永远不应成为唯一选择。一种方法是优先努力制定管理无行为能力患者的更高标准，并通过倡导一项具有普遍约束力的国际公约，在生命终结决策领域取缔侵犯人权行为，从而在生物伦理领域推进普遍人权的实现。
