University of Utah.
Am J Bioeth. 2019 Oct;19(10):29-39. doi: 10.1080/15265161.2019.1653397.
Involuntary psychiatric commitment for suicide prevention and physician aid-in-dying (PAD) in terminal illness combine to create a moral dilemma. If PAD in terminal illness is permissible, it should also be permissible for some who suffer from nonterminal psychiatric illness: suffering provides much of the justification for PAD, and the suffering in mental illness can be as severe as in physical illness. But involuntary psychiatric commitment to prevent suicide suggests that the suffering of persons with mental illness does not justify ending their own lives, ruling out PAD. Since both practices have compelling underlying justifications, the most reasonable accommodation might seem to be to allow PAD for persons with mental illness whose suffering is severe enough to justify self-killing, but prohibit PAD for persons whose suffering is less severe. This compromise, however, would require the articulation of standards by which persons' mental as well as physical suffering could be evaluated. Doing so would present a serious philosophical challenge.
出于预防自杀的目的而对精神疾病患者进行非自愿住院治疗，以及在绝症患者中实施医生协助自杀（Physician Assisted Dying，简称 PAD），这两者结合在一起引发了一个道德困境。如果绝症患者实施 PAD 是可以接受的，那么对于患有非绝症的精神疾病患者，这种做法也应该是可以接受的：身患绝症为实施 PAD 提供了主要的正当性理由，精神疾病患者所遭受的痛苦与身体疾病患者所遭受的痛苦一样严重。但是，为了预防自杀而对精神疾病患者进行非自愿住院治疗，这表明精神疾病患者的痛苦并不能成为他们结束自己生命的正当理由，从而排除了 PAD 的适用。由于这两种做法都有强有力的潜在正当性理由，最合理的解决办法似乎是允许患有精神疾病且其痛苦足以证明其自我伤害是正当的患者实施 PAD，但禁止那些痛苦程度较轻的患者实施 PAD。然而，这种妥协需要制定标准，以评估患者的精神和身体痛苦。这样做将带来一个严重的哲学挑战。
