Maung Hane Htut
Department of Politics Philosophy and Religion, Lancaster University, Lancaster, UK
J Med Ethics. 2025 Feb 21;51(3):199-200. doi: 10.1136/jme-2024-110100.
In a recent paper, I argued that an externalist understanding of mental disorder from the philosophy of psychiatry presents an ethical challenge to the practice of medical assistance in dying (MAiD) for psychiatric illness, because it highlights the ways in which the suffering associated with psychiatric illness is sustained by features of the external environment wherein the person is embedded, including social barriers and injustices. In a response to my paper, Harry Hudson argues that addressing social inequality lacks relevance to the immediate permissibility of psychiatric MAiD and that the issue of psychiatric MAiD should be informed by 'pragmatic politics' rather than by 'obfuscatory philosophy'. Herein, I contend that Hudson's response misconstrues my position and ascribes to me views I neither express nor endorse. My paper does not claim that psychiatric MAiD should be denied to people who are presently in intolerable distress. Rather, it suggests that the provision of psychiatric MAiD comes along with social responsibilities of the state to attend to the barriers and injustices that sustain and exacerbate psychiatric illness, as well as ethical responsibilities of clinicians to consider a wider range of presently available psychological and social interventions which may have been neglected under a traditional internalist approach.
在最近的一篇论文中，我认为，从精神病学哲学角度对精神障碍的外在主义理解对为精神疾病实施医疗协助死亡（MAiD）的做法提出了伦理挑战，因为它凸显了与精神疾病相关的痛苦是如何由患者所处的外部环境特征所维系的，这些特征包括社会障碍和不公正现象。在对我的论文的回应中，哈里·哈德森认为，解决社会不平等与精神疾病医疗协助死亡的直接可允许性无关，并且精神疾病医疗协助死亡问题应由“务实政治”而非“晦涩哲学”来指导。在此，我认为哈德森的回应误解了我的立场，并将我并未表达也未认同的观点归于我名下。我的论文并未主张应拒绝为目前处于无法忍受的痛苦中的人提供精神疾病医疗协助死亡。相反，它表明，提供精神疾病医疗协助死亡伴随着国家的社会责任，即处理维系和加剧精神疾病的障碍和不公正现象，以及临床医生的伦理责任，即考虑更广泛的目前可用的心理和社会干预措施，而这些措施在传统的内在主义方法下可能被忽视了。
