Cipriani Gabriele, Di Fiorino Mario
Neurology Unit, Versilia Hospital, via Aurelia, 55043 Lido di Camaiore, Lucca (Lu), Italy; Psychiatry Unit, Versilia Hospital, via Aurelia, 55043 Lido di Camaiore, Lucca (Lu), Italy.
Psychiatry Unit, Versilia Hospital, via Aurelia, 55043 Lido di Camaiore, Lucca (Lu), Italy.
Leg Med (Tokyo). 2019 Sep;40:54-59. doi: 10.1016/j.legalmed.2019.07.007. Epub 2019 Jul 22.
Medicine aims to relieve patient suffering and cure illness. To relieve suffering is the heart of what doctors do. However, respect for individual autonomy and self-determination are fundamental principles in Western medical ethics and decision-making, often expressed as a desire for control over the timing and manner of death. Patients who become demented often formulate advance euthanasia and assisted suicide directives. Dealing with such request is quite complex because of the specific medical and conflicting ethical questions they raise. Some specific medical and ethical issues arise regarding these substantive requirements when evaluating the euthanasia request of a person suffering from dementia. In jurisdictions that allow euthanasia, the most fundamental prerequisite for a person to make autonomous decisions is capacity. Whether anyone with moderate or severe dementia, and even some with mild dementia, could be deemed to be competent by these criteria is debatable, but during the course of their disease people with dementia sooner or later lose their capacity to make self-determined decisions.
医学旨在减轻患者痛苦并治愈疾病。减轻痛苦是医生工作的核心。然而，尊重个人自主权和自决权是西方医学伦理和决策中的基本原则，这通常表现为对掌控死亡时间和方式的渴望。患痴呆症的患者常常会制定预先的安乐死和协助自杀指令。处理这类请求相当复杂，因为它们引发了特定的医学问题和相互冲突的伦理问题。在评估痴呆症患者的安乐死请求时，就这些实质性要求会出现一些特定的医学和伦理问题。在允许安乐死的司法管辖区，一个人做出自主决定的最基本前提是有行为能力。按照这些标准，是否任何患有中度或重度痴呆症的人，甚至一些轻度痴呆症患者都能被视为有行为能力是有争议的，但在患病过程中，痴呆症患者迟早会失去做出自主决定的能力。
