Emeritus of Philosophy, Pacific Lutheran University, Tacoma WA, USA.
J Law Med Ethics. 2013 Summer;41(2):484-500. doi: 10.1111/jlme.12057.
Physician-assisted suicide laws in Oregon and Washington require the person's current competency and a prognosis of terminal illness. In The Netherlands voluntariness and unbearable suffering are required for euthanasia. Many people are more concerned about the loss of autonomy and independence in years of severe dementia than about pain and suffering in their last months. To address this concern, people could write advance directives for physician-assisted death in dementia. Should such directives be implemented even though, at the time, the person is no longer competent and would not be either terminally ill or suffering unbearably? We argue that in many cases they should be, and that a sliding scale which considers both autonomy and the capacity for enjoyment provides the best justification for determining when: when written by a previously well-informed and competent person, such a directive gains in authority as the later person's capacities to generate new critical interests and to enjoy life decrease. Such an extension of legalized death assistance is grounded in the same central value of voluntariness that undergirds the current more limited legalization.
俄勒冈州和华盛顿州的医生协助自杀法律要求患者目前具有行为能力和绝症的预后。在荷兰，安乐死需要自愿和无法忍受的痛苦。许多人更担心在严重痴呆症的数年中失去自主性和独立性，而不是在最后几个月遭受痛苦和苦难。为了解决这个问题，人们可以为痴呆症患者的医生协助死亡写预嘱。即使在当时，这个人不再有行为能力，也不会处于绝症或无法忍受的痛苦之中，是否应该执行这些指令？我们认为，在许多情况下，应该执行这些指令，并且考虑到自主性和享受能力的滑动尺度为确定何时执行提供了最佳理由：当由以前知情和有能力的人撰写时，随着后来的人产生新的关键利益和享受生活的能力下降，这样的指令会获得更多的权威。这种对合法化死亡援助的扩展基于自愿性这一核心价值观，这种价值观是当前更有限的合法化的基础。
