Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Manchester Metropolitan University, Manchester, UK.
J Med Ethics. 2019 Dec;45(12):832-834. doi: 10.1136/medethics-2019-105393. Epub 2019 Jul 18.
In developing their policy on paediatric medical assistance in dying (MAID), DeMichelis, Shaul and Rapoport decide to treat euthanasia and physician-assisted suicide as ethically and practically equivalent to other end-of-life interventions, particularly palliative sedation and withdrawal of care (WOC). We highlight several flaws in the authors' reasoning. Their argument depends on too cursory a dismissal of intention, which remains fundamental to medical ethics and law. Furthermore, they have not fairly presented the ethical analyses justifying other end-of-life decisions, analyses and decisions that were generally accepted long before MAID was legal or considered ethical. Forgetting or misunderstanding the analyses would naturally lead one to think MAID and other end-of-life decisions are morally equivalent. Yet as we recall these well-developed analyses, it becomes clear that approving of some forms of sedation and WOC does not commit one to MAID. Paediatric patients and their families can rationally and coherently reject MAID while choosing palliative care and WOC. Finally, the authors do not substantiate their claim that MAID is like palliative care in that it alleviates suffering. It is thus unreasonable to use this supposition as a warrant for their proposed policy.
在制定儿科医疗协助死亡（MAID）政策时，DeMichelis、Shaul 和 Rapoport 决定将安乐死和医师协助自杀视为与其他临终干预措施在伦理和实践上等同，特别是姑息镇静和停止治疗（WOC）。我们强调了作者推理中的几个缺陷。他们的论点取决于对意图的过于草率的驳斥，而意图仍然是医学伦理和法律的基础。此外，他们没有公正地呈现为其他临终决策提供依据的伦理分析，这些分析和决策在 MAID 合法化或被认为合乎道德之前很久就被普遍接受了。忘记或误解这些分析自然会让人认为 MAID 和其他临终决策在道德上是等同的。然而，当我们回忆起这些经过充分发展的分析时，就会清楚地认识到，批准某些形式的镇静和 WOC 并不意味着赞成 MAID。儿科患者及其家属可以在选择姑息治疗和 WOC 的同时理性和一致地拒绝 MAID。最后，作者没有证实他们的说法，即 MAID 与姑息治疗一样可以减轻痛苦。因此，将这种假设作为他们提议的政策的依据是不合理的。
