Emeritus Clinical Reader in Palliative Medicine, Oxford University, Oxford, UK.
Sir Michael Sobell House, Churchill Hospital, Old Rd, Headington, Oxford, OX3 7LE, UK.
BMC Palliat Care. 2024 Apr 13;23(1):99. doi: 10.1186/s12904-024-01422-6.
It seems probable that some form of medically-assisted dying will become legal in England and Wales in the foreseeable future. Assisted dying Bills are at various stages of preparation in surrounding jurisdictions (Scotland, Republic of Ireland, Isle of Man, Jersey), and activists campaign unceasingly for a change in the law in England and Wales. There is generally uncritical supportive media coverage, and individual autonomy is seen as the unassailable trump card: 'my life, my death'.However, devising a law which is 'fit for purpose' is not an easy matter. The challenge is to achieve an appropriate balance between compassion and patient autonomy on the one hand, and respect for human life generally and medical autonomy on the other. More people should benefit from a change in the law than be harmed. In relation to medically-assisted dying, this may not be possible. Protecting the vulnerable is a key issue. Likewise, not impacting negatively on societal attitudes towards the disabled and frail elderly, particularly those with dementia.This paper compares three existing models of physician-assisted suicide: Switzerland, Oregon (USA), and Victoria (Australia). Vulnerability and autonomy are discussed, and concern expressed about the biased nature of much of the advocacy for assisted dying, tantamount to disinformation. A 'hidden' danger of assisted dying is noted, namely, increased suffering as more patients decline referral to palliative-hospice care because they fear they will be 'drugged to death'.Finally, suggestions are made for a possible 'least worse' way forward. One solution would seem to be for physician-assisted suicide to be the responsibility of a stand-alone Department for Assisted Dying overseen by lawyers or judges and operated by technicians. Doctors would be required only to confirm a patient's medical eligibility. Palliative-hospice care should definitely not be involved, and healthcare professionals must have an inviolable right to opt out of involvement. There is also an urgent need to improve the provision of care for all terminally ill patients.
在可预见的未来，在英格兰和威尔士，某种形式的医疗协助自杀可能会合法化。协助自杀法案正在周边司法管辖区（苏格兰、爱尔兰共和国、马恩岛、泽西岛）的不同阶段进行准备，活动家也在不断地争取改变英格兰和威尔士的法律。通常，媒体对这一问题的报道都是不加批判的支持，而个人自主被视为不可动摇的王牌：“我的生命，我的死亡”。
然而，制定一项“合适”的法律并非易事。挑战在于在一方面，在同情和患者自主权与普遍尊重生命和医疗自主权之间取得适当的平衡。更多的人应该从法律的改变中受益，而不是受到伤害。在医疗协助自杀方面，这可能是不可能的。保护弱势群体是一个关键问题。同样，不要对残疾人和体弱老年人的社会态度产生负面影响，尤其是那些患有痴呆症的人。
本文比较了瑞士、俄勒冈州（美国）和维多利亚州（澳大利亚）现有的三种医生协助自杀模式。讨论了脆弱性和自主性问题，并对协助自杀的大部分宣传存在偏见表示关注，这相当于虚假信息。还注意到协助自杀的一个“隐藏”危险，即由于更多的患者拒绝转介姑息治疗/临终关怀，因为他们担心自己会“被药物致死”，因此会增加痛苦。
最后，对可能的“最不坏”前进方向提出了建议。一种解决方案似乎是将医生协助自杀的责任交给一个独立的协助死亡部门，由律师或法官监督，并由技术人员操作。医生只需确认患者的医疗资格。姑息治疗/临终关怀绝对不应参与，医疗保健专业人员必须拥有不可侵犯的不参与的权利。还迫切需要改善所有绝症患者的护理服务。
