Cuman Giulia, Gastmans Chris
, 35141, Padova, Italy.
Centre for Biomedical Ethics and Law, Faculty of Medicine, Catholic University of Leuven, Kapucijnenvoer 35, 3000, Leuven, Belgium.
Eur J Pediatr. 2017 Jul;176(7):837-847. doi: 10.1007/s00431-017-2934-8. Epub 2017 Jun 1.
Euthanasia was first legalised in the Netherlands in 2002, followed by similar legislation in Belgium the same year. Since the beginning, however, only the Netherlands included the possibility for minors older than 12 years to request euthanasia. In 2014, the Belgian Act legalising euthanasia was amended to include requests by minors who possess the capacity of discernment. This amendment sparked great debate, and raised difficult ethical questions about when and how a minor can be deemed competent. We conducted a systematic review of argument-based literature on euthanasia in minors. The search process followed PRISMA guidelines. Thirteen publications were included. The four-principle approach of medical ethics was used to organise the ethical arguments underlying this debate. The justification for allowing euthanasia in minors is buttressed mostly by the principles of beneficence and respect for autonomy. Somewhat paradoxically, both principles are also used in the literature to argue against the extension of legislation to minors. Opponents of euthanasia generally rely on the principle of non-maleficence.
The present analysis reveals that the debate surrounding euthanasia in minors is at an early stage. In order to allow a more in-depth ethical discussion, we suggest enriching the four-principle approach by including a care-ethics approach. What is Known: • The Netherlands and Belgium are the only two countries in the world with euthanasia legislation making it possible for minors to receive euthanasia. • This legislation provoked great debate globally, with ethical arguments for and against this legislation. What is New: • A systematic description of the ethical concepts and arguments grounding the debate on euthanasia in minors, as reported in the argument-based ethics literature. • A need has been identified to enrich the debate with a care-ethics approach to avoid oversimplifying the ethical decision-making process.
安乐死于2002年在荷兰首次合法化，同年比利时也出台了类似立法。然而，从一开始，只有荷兰规定12岁以上的未成年人可以请求安乐死。2014年，比利时使安乐死合法化的法案进行了修订，将有辨别能力的未成年人的请求纳入其中。这一修订引发了激烈辩论，并提出了关于未成年人何时以及如何被视为有行为能力的棘手伦理问题。我们对基于论证的关于未成年人安乐死的文献进行了系统综述。检索过程遵循PRISMA指南。纳入了13篇出版物。医学伦理学的四原则方法被用于组织这场辩论背后的伦理论证。允许未成年人安乐死的理由主要基于行善原则和尊重自主权原则。有点自相矛盾的是，这两个原则在文献中也被用来反对将立法范围扩大到未成年人。安乐死的反对者通常依赖不伤害原则。
目前的分析表明，围绕未成年人安乐死的辩论尚处于早期阶段。为了进行更深入的伦理讨论，我们建议通过纳入关怀伦理学方法来丰富四原则方法。已知信息：• 荷兰和比利时是世界上仅有的两个有安乐死立法且使未成年人能够接受安乐死的国家。• 这项立法在全球引发了激烈辩论，有支持和反对该立法的伦理论证。新内容：• 对基于论证的伦理学文献中关于未成年人安乐死辩论的伦理概念和论证进行了系统描述。• 已确定需要用关怀伦理学方法丰富辩论，以避免过度简化伦理决策过程。
