Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Flanders, Belgium
Centre for Biomedical Ethics and Law, Department of Public Health and Primary Care, KU Leuven, Leuven, Flanders, Belgium.
J Med Ethics. 2022 Nov;48(11):907-914. doi: 10.1136/medethics-2021-107308. Epub 2021 May 20.
In current Western societies, increasing numbers of people express their desire to choose when to die. Allowing people to choose the moment of their death is an ethical issue that should be embedded in sound clinical and legal frameworks. In the case of persons with dementia, it raises further ethical questions such as: Does the person have the capacity to make the choice? Is the person being coerced? Who should be involved in the decision? Is the person's suffering untreatable? The use of Advance Euthanasia Directives (AED) is suggested as a way to deal with end-of-life wishes of persons with dementia. However, in the Netherlands-the only country in which this practice is legal-the experiences of patients, doctors, and relatives have been far from satisfactory.Our paper analyses this complex ethical challenge from a Dignity-Enhancing Care approach, starting from the Dutch experiences with AED as a case. We first consider the lived experiences of the different stakeholders, seeking out a dialogical-interpretative understanding of care. We aim to promote human dignity as a normative standard for end-of-life care practices. Three concrete proposals are then presented in which this approach can be operationalised in order to deal respectfully with the end-of-life choices of persons with dementia.
在当前的西方社会，越来越多的人表示希望能够选择自己的死亡时间。允许人们选择自己死亡的时刻是一个伦理问题，应该嵌入健全的临床和法律框架中。在痴呆症患者的情况下，这引发了进一步的伦理问题，例如：这个人是否有能力做出选择？这个人是否受到胁迫？应该涉及哪些人参与决策？这个人的痛苦是否无法治疗？建议使用 Advance Euthanasia Directives (AED) 来处理痴呆症患者的临终愿望。然而，在荷兰——唯一一个这种做法合法的国家——患者、医生和家属的体验远不尽如人意。我们的论文从荷兰的 AED 经验出发，从尊严增强护理方法的角度分析了这一复杂的伦理挑战。我们首先考虑不同利益相关者的生活体验，寻求对护理的对话式解释理解。我们旨在将人的尊严作为临终关怀实践的规范标准来加以促进。然后提出了三个具体建议，以便以尊重的方式处理痴呆症患者的临终选择。
