Health Law Research Program, Faculty of Law, Queensland University of Technology, Brisbane, Queensland, Australia.
Intern Med J. 2011 Jun;41(6):485-92. doi: 10.1111/j.1445-5994.2011.02511.x.
Care and decision-making at the end of life that promotes comfort and dignity is widely endorsed by public policy and the law. In ethical analysis of palliative care interventions that are argued potentially to hasten death, these may be deemed to be ethically permissible by the application of the doctrine of double effect, if the doctor's intention is to relieve pain and not cause death. In part because of the significance of ethics in the development of law in the medical sphere, this doctrine is also likely to be recognized as part of Australia's common law, although hitherto there have been no cases concerning palliative care brought before a court in Australia to test this. Three Australian States have, nonetheless, created legislative defences that are different from the common law with the intent of clarifying the law, promoting palliative care, and distinguishing it from euthanasia. However, these defences have the potential to provide less protection for doctors administering palliative care. In addition to requiring a doctor to have an appropriate intent, the defences insist on adherence to particular medical practice standards and perhaps require patient consent. Doctors providing end-of-life care in these States need to be aware of these legislative changes. Acting in accordance with the common law doctrine of double effect may not provide legal protection. Similar changes are likely to occur in other States and Territories as there is a trend towards enacting legislative defences that deal with the provision of palliative care.
在生命末期提供关怀和决策，以促进舒适和尊严，这得到了公共政策和法律的广泛支持。在对可能加速死亡的姑息治疗干预措施进行伦理分析时，如果医生的意图是缓解疼痛而不是导致死亡，那么根据双重效应原则，这些干预措施可能被认为在伦理上是允许的。部分由于伦理在医学领域法律发展中的重要性，这一原则也可能被视为澳大利亚普通法的一部分，尽管迄今为止，澳大利亚法院还没有受理任何涉及姑息治疗的案件来检验这一原则。尽管如此，澳大利亚的三个州还是制定了与普通法不同的立法辩护，旨在澄清法律，促进姑息治疗，并将其与安乐死区分开来。然而，这些辩护可能为实施姑息治疗的医生提供较少的保护。除了要求医生有适当的意图外，这些辩护还坚持遵守特定的医疗实践标准，并可能要求患者同意。在这些州提供临终关怀的医生需要了解这些立法上的变化。按照普通法的双重效应原则行事可能无法提供法律保护。随着立法辩护的出台，以处理姑息治疗的提供问题，其他州和地区也可能发生类似的变化。
