Appelbaum Paul S
Dr. Appelbaum, who is editor of this column, is the Elizabeth K. Dollard Professor of Psychiatry, Medicine and Law, Department of Psychiatry, Columbia University, New York City (e-mail:
Psychiatr Serv. 2017 Apr 1;68(4):315-317. doi: 10.1176/appi.ps.201700013. Epub 2017 Feb 15.
Laws permitting physician-assisted death in the United States currently are limited to terminal conditions. Canada is considering whether to extend the practice to encompass intractable suffering caused by mental disorders, and the question inevitably will arise in the United States. Among the problems seen in countries that have legalized assisted death for mental disorders are difficulties in assessing the disorder's intractability and the patient's decisional competence, and the disproportionate involvement of patients with social isolation and personality disorders. Legitimate concern exists that assisted death could serve as a substitute for creating adequate systems of mental health treatment and social support.
美国目前允许医生协助死亡的法律仅限于晚期病症。加拿大正在考虑是否将这种做法扩大到涵盖由精神障碍引起的顽固性痛苦，而美国不可避免地也会出现这个问题。在已将精神障碍协助死亡合法化的国家所出现的问题中，包括难以评估病症的顽固性和患者的决策能力，以及患有社会隔离和人格障碍的患者过度参与其中。人们有合理的担忧，即协助死亡可能会成为建立完善的心理健康治疗和社会支持系统的替代品。
