Lemiengre Joke, Dierckx de Casterlé Bernadette, Schotsmans Paul, Gastmans Chris
Ethos, Expertise Centre of Ethics and Care, Catholic University College Limburg, Oude Luikerbaan 79, 3500, Hasselt, Limburg, Belgium,
Med Health Care Philos. 2014 May;17(2):215-28. doi: 10.1007/s11019-013-9524-y.
As euthanasia has become a widely debated issue in many Western countries, hospitals and nursing homes especially are increasingly being confronted with this ethically sensitive societal issue. The focus of this paper is how healthcare institutions can deal with euthanasia requests on an organizational level by means of a written institutional ethics policy. The general aim is to make a critical analysis whether these policies can be considered as organizational-ethical instruments that support healthcare institutions to take their institutional responsibility for dealing with euthanasia requests. By means of an interpretative analysis, we conducted a process of reinterpretation of results of former Belgian empirical studies on written institutional ethics policies on euthanasia in dialogue with the existing international literature. The study findings revealed that legal regulations, ethical and care-oriented aspects strongly affected the development, the content, and the impact of written institutional ethics policies on euthanasia. Hence, these three cornerstones-law, care and ethics-constituted the basis for the empirical-based organizational-ethical framework for written institutional ethics policies on euthanasia that is presented in this paper. However, having a euthanasia policy does not automatically lead to more legal transparency, or to a more professional and ethical care practice. The study findings suggest that the development and implementation of an ethics policy on euthanasia as an organizational-ethical instrument should be considered as a dynamic process. Administrators and ethics committees must take responsibility to actively create an ethical climate supporting care providers who have to deal with ethical dilemmas in their practice.
由于安乐死在许多西方国家已成为一个广受争议的问题，尤其是医院和养老院越来越多地面临这一具有伦理敏感性的社会问题。本文的重点是医疗机构如何通过书面的机构伦理政策在组织层面处理安乐死请求。总体目标是批判性地分析这些政策是否可被视为支持医疗机构履行处理安乐死请求的机构责任的组织伦理工具。通过解释性分析，我们在与现有国际文献的对话中，对比利时以前关于安乐死书面机构伦理政策的实证研究结果进行了重新解读。研究结果表明，法律法规、伦理和以护理为导向的方面强烈影响了安乐死书面机构伦理政策的制定、内容和影响。因此，这三个基石——法律、护理和伦理——构成了本文所提出的基于实证的安乐死书面机构伦理政策的组织伦理框架的基础。然而，制定安乐死政策并不会自动带来更高的法律透明度，也不会导致更专业和符合伦理的护理实践。研究结果表明，将安乐死伦理政策作为一种组织伦理工具的制定和实施应被视为一个动态过程。管理人员和伦理委员会必须承担责任，积极营造一种伦理氛围，以支持在实践中必须应对伦理困境的护理人员。
