Golan Ofra G, Marcus Esther-Lee
The Gertner Institute for Epidemiology & Health Policy Research, Sheba Medical Center, Tel Hashomer, Israel; and.
Rambam Maimonides Med J. 2012 Jul 31;3(3):e0018. doi: 10.5041/RMMJ.10081. Print 2012 Jul.
A very troubling issue for health care systems today is that of life-sustaining treatment for patients who have permanently lost their cognitive capacities. These include patients in persistent vegetative state (PVS), or minimally conscious state (MCS), as well as a growing population of patients at the very end stage of dementia. These patients are totally dependent on life-sustaining treatments and are, actually, kept alive "artificially." This phenomenon raises doubts as to the ethics of sustaining the life of patients who have lost their consciousness and cognitive capacities, and whether there is a moral obligation to do so. The problem is that the main facts concerning the experiences and well-being of such patients and their wishes are unknown. Hence the framework of the four principles-beneficence, non-maleficence, autonomy, and justice-is not applicable in these cases; therefore we examined solidarity as another moral value to which we may resort in dealing with this dilemma. This article shows that the source of the dilemma is the social attitudes towards loss of cognitive capacities, and the perception of this state as loss of personhood. Consequently, it is suggested that the principle of solidarity-which both sets an obligation to care for the worst-off, and can be used to identify obligations that appeal to an ethos of behavior-can serve as a guiding principle for resolving the dilemma. The value of solidarity can lead society to care for these patients and not deny them basic care and life-sustaining treatment when appropriate.
当今医疗保健系统面临的一个非常棘手的问题是，如何为那些永久丧失认知能力的患者提供维持生命的治疗。这些患者包括处于持续性植物状态（PVS）或最低意识状态（MCS）的患者，以及越来越多处于痴呆症终末期的患者。这些患者完全依赖维持生命的治疗，实际上是被“人工”维持生命。这种现象引发了人们对维持失去意识和认知能力的患者生命的伦理问题的质疑，以及是否有道德义务这样做。问题在于，关于这些患者的经历、福祉及其意愿的主要事实尚不清楚。因此，四原则（即 beneficence、non-maleficence、autonomy 和 justice）框架不适用于这些情况；因此，我们研究了团结作为我们在处理这一困境时可以诉诸的另一道德价值。本文表明，困境的根源在于社会对认知能力丧失的态度，以及将这种状态视为人格丧失的观念。因此，有人建议，团结原则——既设定了照顾最弱势群体的义务，又可用于确定诉诸行为准则的义务——可作为解决这一困境的指导原则。团结的价值可引导社会照顾这些患者，在适当的时候不拒绝给予他们基本护理和维持生命的治疗。
