Department of Politics Philosophy and Religion, Lancaster University, Lancaster, UK
J Med Ethics. 2023 Aug;49(8):553-557. doi: 10.1136/jme-2022-108431. Epub 2022 Sep 29.
Medical assistance in dying, which includes voluntary euthanasia and assisted suicide, is legally permissible in a number of jurisdictions, including the Netherlands, Belgium, Switzerland and Canada. Although medical assistance in dying is most commonly provided for suffering associated with terminal somatic illness, some jurisdictions have also offered it for severe and irremediable psychiatric illness. Meanwhile, recent work in the philosophy of psychiatry has led to a renewed understanding of psychiatric illness that emphasises the role of the relation between the person and the external environment in the constitution of mental disorder. In this paper, I argue that this externalist approach to mental disorder highlights an ethical challenge to the practice of medical assistance in dying for psychiatric illness. At the level of the clinical assessment, externalism draws attention to potential social and environmental interventions that might have otherwise been overlooked by the standard approach to mental disorder, which may confound the judgement that there is no further reasonable alternative that could alleviate the person's suffering. At the level of the wider society, externalism underscores how social prejudices and structural barriers that contribute to psychiatric illness constrain the affordances available to people and result in them seeking medical assistance in dying when they otherwise might not have had under better social conditions.
安乐死，包括自愿安乐死和协助自杀，在一些司法管辖区是合法的，包括荷兰、比利时、瑞士和加拿大。尽管安乐死最常用于治疗与绝症相关的痛苦，但一些司法管辖区也为严重和无法治愈的精神疾病提供安乐死。与此同时，最近精神病学哲学的研究工作导致人们对精神疾病有了新的理解，强调了人与外部环境之间的关系在精神障碍构成中的作用。在本文中，我认为这种对精神障碍的外在主义方法凸显了医疗协助自杀在治疗精神疾病方面所面临的伦理挑战。在临床评估层面，外在主义引起了人们对潜在的社会和环境干预措施的关注，这些干预措施可能会被标准的精神障碍方法所忽视，从而使判断变得复杂，即是否没有其他可以减轻患者痛苦的合理选择。在更广泛的社会层面上，外在主义强调了导致精神疾病的社会偏见和结构性障碍如何限制人们的机会，并导致他们在社会条件更好的情况下可能不会寻求医疗协助自杀。
