Twycross R G
Pallative Medicine, Oxford University, England.
J R Soc Med. 1996 Feb;89(2):61-3.
My experience in 25 years as a hospice doctor have reinforced my belief that when everything is taken into account--physical, psychological, social and spiritual--euthanasia is not the answer. This belief is enhanced by what I see happening in the Netherlands. However, lest it be thought that I have become hardened and indifferent to suffering let me add that, although firmly opposed to euthanasia, I consider that: (i) a doctor who has never been tempted to kill a patient probably has had limited clinical experience or is not able to empathize with those who suffer (ii) a doctor who leaves a patient to suffer intolerably is morally more reprehensible than the doctor who performs euthanasia A doctor has twin obligations to preserve life and to relieve suffering. Preserving life is increasingly meaningless when a terminally ill patient is close to death, and the emphasis on relieving suffering becomes paramount. Even here, however, the doctor is obliged to achieve his objective with minimum risk to the patient's life. This means that treatment to relieve pain and suffering which coincidentally might bring forward the moment of death by a few hours or days is acceptable (the principle of double effect), but administering a drug such as potassium or curare, with the primary intention of causing death, is not.
我作为临终关怀医生25年的经历强化了我的信念，即综合考虑身体、心理、社会和精神等各方面因素后，安乐死并非答案。我在荷兰所见到的情况进一步增强了这一信念。然而，以免有人认为我变得冷酷无情、对痛苦麻木不仁，我补充说明一下，尽管我坚决反对安乐死，但我认为：（i）从未有过杀死病人念头的医生，可能临床经验有限，或者无法对受苦的人感同身受；（ii）任由病人遭受无法忍受的痛苦的医生，在道德上比实施安乐死的医生更应受谴责。医生有双重义务，即挽救生命和减轻痛苦。当绝症患者濒临死亡时，挽救生命变得越来越没有意义，减轻痛苦的重点就变得至关重要。然而，即便如此，医生也有义务以对患者生命造成最小风险的方式来实现这一目标。这意味着，为减轻疼痛和痛苦而进行的治疗，即使可能会使死亡时间提前几个小时或几天，也是可以接受的（双重效应原则），但以导致死亡为主要目的使用诸如钾或箭毒之类的药物则不行。
