Baker Justice
J Med Ethics. 2017 Jul;43(7):427-434. doi: 10.1136/medethics-2017-104256. Epub 2017 Jun 23.
Cases concerning the withdrawal or withholding of artificial nutrition and hydration from patients in a vegetative or minimally conscious state raise difficult medical, legal and ethical questions including the diagnosis and classification of disorders of consciousness, the legal processes to be followed, and the legal and ethical principles to be applied when making decisions. There is also an issue as to whether it is necessary or appropriate for such decisions to be taken by judges. This article, based on a lecture given in Oxford in October 2016, considers a number of these issues and concludes that any consideration of the question from the patient's point of view must include an objective analysis of what is in his or her best interests, as well as subjective expressions of wishes and feelings. Whilst noting that it has been suggested that applications to the court should be confined to those cases where there is a dispute as to whether withdrawal of artificial nutrition and hydration (ANH) would be in the patient's best interests, the author proposes that, until such time as we have greater clarity and understanding about the disorders of consciousness, and about the legal and ethical principles to be applied, there remains a need for independent oversight and that applications to the court should continue to be obligatory in all cases where the withdrawal of ANH is proposed, at least for the time being.
关于对处于植物人状态或最低意识状态的患者停止或 withholding 人工营养和水分补充的案例引发了诸多棘手的医学、法律和伦理问题，其中包括意识障碍的诊断和分类、应遵循的法律程序，以及在做决策时应适用的法律和伦理原则。对于此类决策是否应由法官做出，也存在一个问题。本文基于2016年10月在牛津的一次讲座，探讨了其中一些问题，并得出结论：从患者角度对该问题的任何考量都必须包括对其最佳利益的客观分析，以及愿望和感受的主观表达。虽然有人建议向法院提出申请应仅限于那些对停止人工营养和水分补充（ANH）是否符合患者最佳利益存在争议的案例，但作者提议，在我们对意识障碍以及应适用的法律和伦理原则有更清晰的认识和理解之前，仍需要独立监督，并且在所有提议停止ANH的案例中，向法院提出申请应继续是强制性的，至少目前如此。 （注：原文中“withholding”未准确翻译，结合语境推测可能是“停止提供”之类的意思，这里整体译文根据大概意思进行了完善。）
