Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Level 4, 207 Bouverie St, Melbourne, VIC, 3010, Australia.
BMC Med Ethics. 2020 May 13;21(1):38. doi: 10.1186/s12910-020-00483-5.
In June 2019, the Australian state of Victoria joined the growing number of jurisdictions around the world to have legalised some form of voluntary assisted dying. A discourse of safety was prominent during the implementation of the Victorian legislation.
In this paper, we analyse the ethical relationship between legislative "safeguards" and equal access. Drawing primarily on Ruger's model of equal access to health care services, we analyse the Victorian approach to voluntary assisted dying in terms of four dimensions: horizontal equity, patient agency, high quality care, and supportive social norms. We argue that some provisions framed as safeguards in the legislation create significant barriers to equal access for eligible patients.
While safety is undoubtedly ethically important, we caution against an overemphasis on safeguarding in voluntary assisted dying legislation given the implications for equal access.
2019 年 6 月，澳大利亚维多利亚州加入了全球越来越多的司法管辖区的行列，将某种形式的自愿协助死亡合法化。在维多利亚州立法的实施过程中，安全问题是一个突出的话题。
在本文中，我们分析了立法“保障”与平等准入之间的伦理关系。主要借鉴鲁格的卫生保健服务平等准入模式，我们从四个方面分析了维多利亚州自愿协助死亡的做法：横向公平、患者代理、高质量护理和支持性社会规范。我们认为，立法中作为保障措施的一些规定，为符合条件的患者平等准入制造了重大障碍。
虽然安全无疑在伦理上很重要，但我们警告说，在自愿协助死亡立法中，过于强调保障措施可能会对平等准入产生影响。
