Bioethics. 2021 Feb;35(2):214-220. doi: 10.1111/bioe.12810. Epub 2020 Sep 18.
Disconnecting a patient from artificial life support, on their request, is often if not always a matter of letting them die, not killing them-and sometimes, permissibly doing so. Stopping a patient's heart on request, by contrast, is a kind of killing, and rarely if ever a permissible one. The difference seems to be that procedures of the first kind remove an unwanted external support for bodily functioning, rather than intervening in the body itself. What should we say, however, about cases at the boundary-procedures involving items that seem bodily in some respects, but not others? When, for instance, does deactivating an implanted device like a pacemaker count as killing, and when as letting die? Contra existing proposals, I argue that the boundaries of the body for this purpose are not drawn at the boundaries of the self, or (if this is different) the human organism. Nor should we determine when we are killing and when we are letting die by deferring to existing practices for distinguishing ongoing from completed treatment. Rather, I argue that whether something (organic or inorganic) counts as body part for purposes of this distinction depends on the results of a normative analysis of the particular character of our rights in it-particularly, whether and in what way these rights ought to be alienable. I conclude by arguing that there are likely good reasons to recognize distinctively "bodily" rights and restrictions in at least some implantable devices.
应患者要求断开与人工生命支持的连接，通常（如果不是总是）是让他们死亡，而不是杀死他们——有时，这样做是可以允许的。相比之下，应患者要求停止心脏跳动是一种杀戮，很少是可以允许的。这种区别似乎在于，第一种程序去除了身体功能不需要的外部支持，而不是干预身体本身。然而，对于处于边界的情况，我们应该怎么说呢？涉及到某些看起来在某些方面是身体的，但在其他方面不是身体的物品的程序呢？例如，当停用像起搏器这样的植入设备时，算作是杀人还是让死亡？与现有建议相反，我认为，为了这个目的，身体的界限不是划在自我的界限上，或者（如果这是不同的）人类有机体的界限上。我们也不应该通过推迟到现有的区分正在进行的治疗和已完成的治疗的实践来决定我们何时在杀人，何时在让死亡。相反，我认为，对于这种区别，某物（有机的或无机的）是否算作身体部分取决于对我们在其中的权利的特殊性质的规范性分析的结果——特别是，这些权利是否以及在何种程度上应该可转让。最后，我认为，至少在某些可植入设备中，承认独特的“身体”权利和限制可能有很好的理由。
