Juth Niklas, Lindblad Anna, Lynöe Niels, Sjöstrand Manne, Helgesson Gert
Stockholm Centre for Healthcare Ethics, Karolinska Institutet, LIME, Stockholm, Sweden.
BMJ Support Palliat Care. 2013 Jun;3(2):203-6. doi: 10.1136/bmjspcare-2012-000431. Epub 2013 Mar 7.
In palliative care there is much debate about which end of life treatment strategies are legitimate and which are not. Some writers argue that there is an important moral dividing-line between palliative sedation and euthanasia, making the first acceptable and the latter not. We have questioned this. In a recent article, Lars Johan Materstvedt has argued that we are wrong on two accounts: first, that we fail to account properly for the moral difference between continuous deep palliative sedation at the end of life and euthanasia, and, second, that we fail to account properly for the difference between permanent loss of consciousness and death. Regarding the first objection, we argue that Materstvedt misses the point: we agree that there is a difference in terms of intentions between continuous deep palliative sedation and euthanasia, but we question whether this conceptual difference makes up for a moral difference. Materstvedt fails to show that it does. Regarding the second objection, we argue that if nothing else is at stake than the value of the patient's life, permanent unconsciousness and death are morally indifferent.
在姑息治疗中，关于哪些临终治疗策略是合理的，哪些是不合理的，存在很多争议。一些作者认为，姑息性镇静与安乐死之间存在重要的道德分界线，使得前者可接受而后者不可接受。我们对此提出了质疑。在最近的一篇文章中，拉尔斯·约翰·马特斯韦特认为我们在两个方面是错误的：第一，我们没有恰当地考虑临终时持续深度姑息性镇静与安乐死之间的道德差异；第二，我们没有恰当地考虑永久性意识丧失与死亡之间的差异。关于第一个反对意见，我们认为马特斯韦特没有抓住要点：我们同意持续深度姑息性镇静与安乐死在意图方面存在差异，但我们质疑这种概念上的差异是否构成道德上的差异。马特斯韦特未能表明它能构成这种差异。关于第二个反对意见，我们认为，如果除了患者生命的价值之外没有其他利害关系，那么永久性无意识状态和死亡在道德上是无差别的。
