Holland is among one of the few countries that allows euthanasia.
According to the "Termination of Life on Request and Assisted Suicide Act", punishment is not followed after Euthanasia only if below requirements are met:
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Chapter II. Requirements of Due Care
Article 2
1. The requirements of due care, referred to in Article 293 second paragraph Penal Code mean that the physician:
- a. holds the conviction that the request by the patient was voluntary and well-considered,
- b. holds the conviction that the patient's suffering was lasting and unbearable,
- c. has informed the patient about the situation he was in and about his prospects,
- d. and the patient hold the conviction that there was no other reasonable solution for the situation he was in,
- e. e. has consulted at least one other, independent physician who has seen the patient and has given his written opinion on the requirements of due care, referred to in parts a - d, and
- f. has terminated a life or assisted in a suicide with due care.
2. If the patient aged sixteen years or older is no longer capable of expressing his will, but prior to reaching this condition was deemed to have a reasonable understanding of his interests and has made a written statement containing a request for termination of life, the physician may cant' out this request. The requirements of due care, referred to in the first paragraph, apply mutatis mutandis.
3. If the minor patient has attained an age between sixteen and eighteen years and may be deemed to have a reasonable understanding of his interests, the physician may cant' out the patient's request for termination of life or assisted suicide, after the parent or the parents exercising parental authority and/or his guardian have been involved in the decision process.
4. If the minor patient is aged between twelve and sixteen years and may be deemed to have a reasonable understanding of his interests, the physician may cant' out the patient's request, provided always that the parent or the parents exercising parental authority and/or his guardian agree with the termination of life or the assisted suicide. The second paragraph applies mutatis mutandis.
------------------------------The above requirements is basically describing a situation of voluntary euthanasia.
It appears that people generally found that voluntary euthanasia more defensible than involuntary euthanasia.
So does it imply that voluntary euthanasia is ethically more acceptable, or in other word, "less wrong" than involuntary euthanasia?
Does patient's consent make the act of termination of one's life different?
Termination of Life on Request and Assisted Suicide Act:
http://www.eutanasia.ws/documentos/Leyes/Internacional/Holanda%20Ley%202002.pdf
involuntary euthanasia is very much like murder. This involved the action against people's wish whereas voluntary euthanasia is align with people's wish
回覆刪除Involuntary euthanasia and voluntary euthanasia only differs in the wish of the patient, but both involve the act of killing. If we only consider the act of killing, shouldn't they be equally wrong morally?
刪除Also, if involuntary euthansia is morally acceptable, why should we condemn those who try to commit suicide as they are just doing what they wish to do.
1. Act of killing can be morally right or wrong, depends on situation. For e.g. it may be considered as not morally wrong under the situation of self-defense, or in war.
刪除2. Involuntary euthanasia is against the person's will, so it is often identified as a murder.
3. I think your last question refers to voluntary, not involuntary euthanasia. Euthanasia has other conditions to fulfill which makes it differs from suicide.
sharing...this book could be rather disturbing...
刪除"Final Exit" by Derek Humphry
http://www.learnoutloud.com/Catalog/Self-Development/Healing/Final-Exit/2387
"Some people want to cling to every precious moment of life - no matter how painful - but others believe there should be a way to choose death and put an end to suffering. Author Derek Humphry, national executive director of the Hemlock Society and a past president and board member of the World Federation of Right to Die Societies, frankly examines the option of rational suicide for the terminally ill - if and when suffering becomes unbearable. Humphry outlines the ways doctors and nurses may need to handle a patient's request for euthanasia, and gives guidance to people who may be supportive of the option."
安樂死「求死還是求助訊號？」 勞永樂
回覆刪除死亡，人生無可迴避的事實。即使醫學科技發展如何超卓，仍然存在局限，不治之症，還是無法倖免。但疾病總有一個發展過程，如何令臨終病人有尊嚴地走人生最後一程，一直在世界各國引起極大的關注和討論。
繼去年十一月荷蘭下議院通過安樂死條例，今年四月亦獲上議院正式通過，令荷蘭正式成為全球首個可進行合法安樂死的國家。這項破天荒的舉動，隨即又引起新一輪討論。
社會人士一般對臨終決策的種類和定義眾說紛紜，存有許多混淆，因此，筆者希望先清楚解釋何謂「安樂死」，以及經常跟安樂死混淆的兩個觀念。
停止無效的治療
首先，根據大部分國家，其中包括剛立法的荷蘭，以及香港醫務委員會，皆同意以下對「安樂死」（Euthanasia）的定義：就是：「直接蓄意殺死病人，作為治療的一部分。」"Direct intentional killing of a person as part of the medical care being offered."但是，根據香港法例第212章《侵害人身罪條例》"Offences against the person"的規定，「安樂死」是絕對不容許的。
最容易跟「安樂死」混為一談的，就是「終止無效治療」（forgo futile treatment）。其實這純粹是一項醫療決定，在考慮一些治療未能達致醫療上的效果或目的，而採取放棄或終止該項治療。在這情況下，病人的死亡原因是由於不能逆轉的病情，而不是由「停止治療」所導致，所以不應視為「被動安樂死」。
另一個同樣容易被混淆的觀念是「病人拒絕治療」（patient refusal of treatment）。當病人在神智清醒下了解病情及治療建議後，使用其個人自決權利，及考慮其個人因素，拒絕治療，這包括有效或無效的治療。這亦不算是安樂死。根據香港現行法例，上述兩項臨終決策，即是「終止無效治療」及「病人拒絕治療」，皆是合法的。
為安樂死合法化開創先河的荷蘭，雖然獲得皇家荷蘭醫學會支持，學會相信此舉有助那些無望及難以抵受病苦的病人找尋出路。但最後能否達致整體社會的好處，相信有待觀察具體執行情況，才有定論。
其實，「真正」是全球第一個推行安樂死合法化的地區，並非荷蘭，而是北澳洲，法例於96年七月起生效，不過，實施九個月後，於97年3月撤回。這段期間，共有七名癌症病人依法申請，其中四人在法律容許下成功進行安樂死。事後整合七宗個案，發表報告，並刊登在權威性的醫學期刊上。
根據有關法例規定，要求安樂死的臨終病人須獲兩名醫生同意，證明在不使用額外方法的正常治療程序下，將死亡。但報告質疑，末期癌症病人的潛在生存期限是難以準確預測。事實上，醫學界對「臨終」（terminal）二字的詮釋意見不一，不同專家對不同疾病有相異的「期限」預測。即使美國最高法院及不同州份，對「臨終」亦有不同的演繹。例如威斯康辛州以三十日為限；維珍尼亞州法院則可以長達數月；亞利桑那州則包括永久植物人及無可逆轉的昏迷。再者，醫療科技日新月異，隨時可以延長病人的死亡過程，即使醫學界，也難有一致的看法。
此外，根據北澳洲的安樂死法例，要求安樂死的病人須事先經精神科醫生核實沒有患上可治療的臨床抑鬱病。但報告卻指出，七名申請人中有四人出現抑鬱徵狀，如情緒低落、反應遲緩、有自殺傾向等。但由於申請者已有「求死」意向，可以佯裝，令精神科醫生難以作出準確的評估。面對落實執行安樂死時存在很多灰色地帶，北澳洲備受爭議下，最後撤銷有關法例。
要加強生死教育
作為醫學界代表，當然跟醫務委員會對「臨終病人的照顧」立場一致，反對施行安樂死，因為這是不合法和不道德的。醫生的天職是救治病人，並有責任使臨終病人帶著尊嚴、以及盡量在少受痛苦的情況下離世。所以，醫生應竭盡所能，紓緩臨終病人身體、情緒和精神上的問題和痛苦，絕非協助病人求死。
病人發出安樂死的訴求，多是由於病人在身、心所受的痛苦難以控制。所以，安樂死往往是病人求救的訊號。因此，我們應針對臨終病人求死的消極情緒，加強善終服務，幫助臨終病人面對死亡及離世的痛苦，紓緩疾病痛楚，提高生命的素質，讓他們有尊嚴及安然離世，以減少對安樂死的訴求。除此以外，亦要加強「生死教育」，為病者及家屬提供身心的全人照顧，以減輕分離的苦痛。由此可見，照顧臨終病人不僅是醫護界的責任，也是家人、社群的整體責任。
醫學界在反對安樂死之餘，卻認為在適當情況下，這包括「治療無效」及「病者意願」，可以慎重考慮「終止無效治療」。事實上，在臨終病人身上使用過多高科技，不僅未能產生療效，甚至可能引起更多不必要的痛楚，令臨終病人未能安然離世。因此，「停止無效治療」在世界各地的醫療界已廣泛實施。
積極摸索出路
面對臨終抉擇，若病人及其家屬的意願不同時，應該優先考慮病人自決的權利。然而，當病人不能表達其個人意願時，醫生的決定應以確保病人最大利益為依歸。在決定過程中，醫生應尋求家屬的意向。一旦出現任何爭議，可交由醫院的倫理委員會，甚至由法庭來裁決。
因此，為了保障及尊重病人的意願，當局可以考慮立法制定臨終前的「預前意願」（advance directive），讓臨終者在獲得足夠相關資訊的情況下，預先表達其治療意願。面對臨終病情，病人可在神智清醒之下，清楚表達其個人意願，及制定具法律約束力的「預前意願」，這不僅道出臨終病人的心聲，更讓家人及醫生了解病者的意願，相信會較容易作出符合病人最大利益的決定。新加坡政府已於1996年5月通過有關法例，筆者建議政府應該慎重考慮。
我們必須理解，荷蘭通過安樂死合法化，相信具有她獨特的歷史、個人、社會文化價值觀及醫療體制的背景。作為醫者，雖然理解臨終病人在面對不治之症所帶來的極大痛苦，但絕不贊成以安樂死來解決。透過今次立法會動議辯論，會否令我們更加關注臨終病人發出安樂死的訴求，其實是尋求紓緩痛楚的求救訊號？除此以外，臨終病人的意願能否及早獲得充分照顧，同樣值得我們關注。那，現在考慮立法制定「預前意願」是否是適當的時候呢？
上述問題，絕非醫學界可以單方面作決定，盼望我們能夠透過更多公開討論，摸索一條積極面對死亡的出路。
involuntary euthanasia seems not quite respect of the human life. the patient may not want to terminate the life. Because the resources allocated issue, doctor has the power to determine who is worth to life. It will be getting danger for the society. The voluntary euthanasia is more acceptable. It is because it based on the view of patient who would like to terminate the life.
回覆刪除