Franke Irina, Urwyler Thierry, Prüter-Schwarte Christian
Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany.
Psychiatric Services of Grisons, Chur, Switzerland.
Front Psychiatry. 2022 Jul 29;13:909096. doi: 10.3389/fpsyt.2022.909096. eCollection 2022.
The principle of equivalence of care states that prisoners must have access to the same standard of health care as the general population. If, as recent court decisions suggest, assisted dying is not limited to people with a terminal physical illness or irremediable suffering, it might also be requested by people with severe mental illness in detention. Some of the countries with legal regulations on assisted dying also have recommendations on how to handle requests from prisoners. However, detention itself can lead to psychological distress and suicidality, so we must consider whether and how people in such settings can make autonomous decisions. Ethical conflicts arise with regard to an individual's free will, right to life, and physical and personal integrity and to the right of a state to inflict punishment. Furthermore, people in prison often receive insufficient mental health care. In this review, we compare different practices for dealing with requests for assisted dying from people in prison and forensic psychiatric facilities and discuss the current ethical and psychiatric issues concerning assisted dying in such settings.
医疗平等原则规定，囚犯必须能够获得与普通民众相同标准的医疗保健服务。如果正如近期法庭判决所显示的那样，协助死亡不限于身患晚期身体疾病或遭受无法缓解痛苦的人，那么被拘留的严重精神疾病患者也可能会提出协助死亡的请求。一些对协助死亡有法律规定的国家也有关于如何处理囚犯请求的建议。然而，拘留本身会导致心理困扰和自杀倾向，所以我们必须考虑处于这种环境中的人能否以及如何做出自主决定。在个人自由意志、生命权、身体和人格完整性以及国家实施惩罚的权利方面会出现伦理冲突。此外，监狱中的人往往得不到足够的心理健康护理。在本综述中，我们比较了处理来自监狱和法医精神病设施中的人提出的协助死亡请求的不同做法，并讨论了在此类环境中与协助死亡相关的当前伦理和精神病学问题。
