Badarau Domnita O, De Clercq Eva, Elger Bernice S
University of Basel, Basel, Switzerland.
J Med Philos. 2019 Jan 14;44(1):50-70. doi: 10.1093/jmp/jhy033.
Debates on morally acceptable and lawful end-of-life (EOL) practices in pediatrics were reignited by the recent amendment in Belgian law to allow euthanasia for minors of any age who meet the criteria for capacity. Euthanasia and its legalization in pediatrics are often opposed based on the availability of aggressive palliative sedation. For terminally ill patients, this type of sedation is often identified as continuous and deep sedation until death (CDS). We demonstrate that this reasoning is based on flawed assumptions: (1) CDS is a morally preferable alternative to euthanasia; (2) CDS can meet the same patient needs as euthanasia; (3) children lack the capacity and experience to make EOL decisions; (4) unlike euthanasia, CDS does not raise capacity issues. Our aim is not to reject CDS as a valid option at the EOL, nor to offer a clear-cut defense of euthanasia for minors, but to emphasize the ethical issues with both practices.
比利时法律最近修订，允许符合行为能力标准的任何年龄的未成年人实施安乐死，这再次引发了关于儿科领域道德上可接受且合法的临终（EOL）做法的辩论。安乐死及其在儿科领域的合法化常常因积极姑息镇静的可行性而遭到反对。对于绝症患者，这种镇静方式通常被认定为持续深度镇静直至死亡（CDS）。我们证明，这种推理基于有缺陷的假设：（1）CDS在道德上比安乐死更可取；（2）CDS能满足与安乐死相同的患者需求；（3）儿童缺乏做出临终决定的能力和经验；（4）与安乐死不同，CDS不存在行为能力问题。我们的目的不是拒绝将CDS作为临终时的一种有效选择，也不是为未成年人安乐死提供明确的辩护，而是强调这两种做法所涉及的伦理问题。
