Metamedica, Department of Health Sciences, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, The Netherlands.
Health Policy. 2010 Oct;97(2-3):166-72. doi: 10.1016/j.healthpol.2010.04.007. Epub 2010 May 21.
'Unbearable suffering' is a pivotal criterion for lawful euthanasia in the Netherlands. The due-care criterion is not defined in the law and could refer to conditions varying from physical pain to psychological forms of suffering. It is unknown, however, what doctors consider 'unbearable suffering' and for what kind of suffering they are willing to grant a euthanasia request. We conducted a vignette-study among Dutch general practitioners (n=115, response 38%). We found high concordance between the classification of a patient's suffering as 'unbearable' and the willingness to grant a euthanasia request. Most doctors are only inclined to classify a patient's suffering as 'unbearable' when suffering is directly related to untreatable and actual pain or physical symptoms. Doctors' judgment of suffering varied strongly in cases in which physical symptoms are absent and a patient suffers from a combination of irreversible functional loss and 'existential' kinds of suffering. Although some doctors (17%) stick to the idea that physical symptoms are a necessary condition for 'unbearable suffering', a majority is willing to occasionally make an exception. When and for which case an individual doctor will make such an exception, is highly unpredictable. Various explanations for the findings are discussed.
“无法忍受的痛苦”是荷兰合法安乐死的关键标准。适当照顾标准在法律中未予界定，可能涉及从身体疼痛到心理痛苦等各种形式的痛苦。然而，医生如何定义“无法忍受的痛苦”，以及他们愿意为哪种痛苦批准安乐死请求，尚不清楚。我们在荷兰全科医生中进行了病例研究（n=115，应答率 38%）。我们发现，患者痛苦被归类为“无法忍受”与医生愿意批准安乐死请求之间存在高度一致性。大多数医生只有在患者的痛苦直接与无法治疗和实际疼痛或身体症状相关时，才倾向于将患者的痛苦归类为“无法忍受”。在没有身体症状且患者患有不可逆转的功能丧失和“存在”类痛苦的情况下，医生对痛苦的判断差异很大。尽管一些医生（17%）坚持认为身体症状是“无法忍受的痛苦”的必要条件，但大多数医生愿意偶尔破例。个别医生何时以及为何种情况会破例，极难预测。对这些发现的各种解释进行了讨论。
