Schicktanz Silke, Raz Aviad, Shalev Carmel
Department of Medical Ethics and History of Medicine, University Medical Center Göttingen, Göttingen, Germany.
Med Health Care Philos. 2010 Nov;13(4):363-9. doi: 10.1007/s11019-010-9262-3.
The moral discourse surrounding end-of-life (EoL) decisions is highly complex, and a comparison of Germany and Israel can highlight the impact of cultural factors. The comparison shows interesting differences in how patient's autonomy and doctor's duties are morally and legally related to each other with respect to the withholding and withdrawing of medical treatment in EoL situations. Taking the statements of two national expert ethics committees on EoL in Israel and Germany (and their legal outcome) as an example of this discourse, we describe the similarity of their recommendations and then focus on the differences, including the balancing of ethical principles, what is identified as a problem, what social role professionals play, and the influence of history and religion. The comparison seems to show that Israel is more restrictive in relation to Germany, in contrast with previous bioethical studies in the context of the moral and legal discourse regarding the beginning of life, in which Germany was characterized as far more restrictive. We reflect on the ambivalence of the cultural reasons for this difference and its expression in various dissenting views on passive euthanasia and advance directives, and conclude with a comment on the difficulty in classifying either stance as more or less restrictive.
围绕临终（EoL）决策的道德论述极为复杂，对德国和以色列进行比较能够凸显文化因素的影响。这种比较展现出在临终情形下，就医疗治疗的 withhold（停止提供）和 withdraw（撤除）而言，患者自主权与医生职责在道德和法律层面相互关联方式上的有趣差异。以以色列和德国两个国家的临终问题专家伦理委员会的声明（及其法律结果）作为这一论述的示例，我们阐述它们建议的相似之处，接着聚焦于差异，包括伦理原则的权衡、被认定为问题的方面、专业人员所扮演的社会角色，以及历史和宗教的影响。这种比较似乎表明，与以往在生命起始的道德和法律论述背景下的生物伦理研究相反（在那些研究中德国被描述为限制得多），以色列相对于德国限制更多。我们思考造成这种差异的文化原因的矛盾性及其在关于被动安乐死和预立医疗指示的各种不同观点中的体现，并以对将任何一种立场归类为更具或更不具限制性之困难的评论作为结论。
