Euthanasia: What to do when changing hexagrams?

euthanasia: what to do when changing hexagrams halfway?

On November 9, 2018, a doctor who had euthanized a patient in The Hague, the Netherlands, was prosecuted and became the first lawsuit after the Dutch euthanasia law came into effect in April 2002, thus attracting worldwide attention.

The Netherlands is the first country to legalize euthanasia.According to the explanation of euthanasia by the official website of the Dutch government, euthanasia is when the patient's condition is hopeless to improve, and he hopes to end the unbearable pain.The act of life. According to Dutch "end-of-life request and assisted suicide" related laws, as long as it is performed in accordance with prescribed procedures, it is legal.

This time the lawsuit was triggered because it was considered to be inconsistent with the regulations. In sharp contrast to this, on November 1st, 2018, a person from Halifax, Canada called AustriaDelly Parker, a 57-year-old patient with advanced breast cancer, had to give up the idea of ​​Christmas because of strict adherence to euthanasia and was forced to accept euthanasia more than a month in advance.

Doctors, patients, law, ethics, the ultimate remedy around euthanasia, which is limited by scientific level and medical technology, is facing many difficulties and controversy when helping some people get rid of pain.

strict death conditions

According to limited information disclosed by Dutch prosecutors, this prosecution of euthanasia occurred in 2016. The executor was a 74-year-old woman with dementia, although she wrote the euthanasia 5 years ago.A letter of intent, but then expressing both wanting to die and not wanting to die, and when being euthanized, there was resistance, and the unnamed female doctor was chargedViolation of the euthanasia rule did not repeatedly confirm whether the patient still wanted to die.

According to Dutch regulations on euthanasia, the wishes of patients themselves are very critical, and must be made in person, not the opinions of relatives and friends, and doctors are clearly stressed that they should be cautious enough to understand the patient's medical history and determine the painOn the basis of unbearable and unimprovable conditions, euthanasia can be performed only after the procedures for reporting to the review board are fulfilled.

Similarly, in ensuring that the euthanasia decision is made by the patient himself, relevant Canadian laws require that patients write applications under the witness of two independent witnesses in addition to 10 days before death to ensure euthanasia applicationIn addition to being made without compulsion, two independent medical staff must confirm that the patient is indeed in a painful and irreparable medical condition. Based on this, the patient must repeatedly express his consent until the last moment before death.

It is also the last moment before death that this agreement is required to force Audrey Parker to choose to die early, because she has advanced cancer, cancer cells have spread to the brain and bones, and she is worried that she will lose her euthanasia by thenQualifications.

This Canadian law passed in 2016 and has just been implemented for three years. From the earliest legalized Netherlands to Canada, a reality is that in nearly 200 countries around the world, the only euthanasia is currently legal only in Belgium,Luxembourg, Germany, Switzerland, Colombia, South Korea, and a few other countries, and only a few states in the United States, such as Washington and Oregon, have passed relevant laws, and the legal situation of each country is different. Although legalization is becoming a trend, in general,It is a relatively small phenomenon, and it is related to the complexity of the problem of euthanasia. Whether the law can effectively reconcile the contradictions becomes the key to solving the problem.

How to weigh subjective will

For terminally ill, death seems to be predictable for a certain period of time, but it is only a matter of time. But when and how to face death can choose to face it. It can generate subjective will, because doctors and other people may have to intervene.During this death, the issue of assessing whether the subjective will is true has become the focus of legislation.

For diseases that are painful but not fatal, in addition to the assessment of subjective willingness, whether to choose to die itself has become a value problem, which has become a major challenge for the law when weighing the overall situation.

On November 1, 2018, when Audrey Parker was about to die, she publicly sued the Canadian euthanasia law to allow her to die earlier, saying that a mechanism such as dual consent did not protect but harmed her like her.She believes that as long as it goes through a strict consent process, it should be sufficient.

The "Canadian Dies with Dignity" website records these, and a month ago, they discussed the difficult choices they faced with Audrey Parker.

She hopes that the law can be changed so that dying patients can leave less painfully.

However, after receiving this proposal, Canadian MP and Health Minister Ginette expressed regret. Although she wants to help her, the law is for all Canadians. To protect vulnerable groups, these need to be studied and discussed., Including whether people with mental illness and minors are eligible for euthanasia, an expert report on this topic is expected to be launched in December 2018.

The reason why the current regulations are reset is because of the fear that vulnerable groups such as those with mental illness cannot choose euthanasia according to their true wishes. This is universal.

Although only a few states in the United States have passed euthanasia laws, the Americans with Disabilities Commission issued a document as early as 1997 to express the position of disabled people on euthanasia assisted suicide. While recognizing that disabled people should have this right, they alsoIt is emphasized that the assessment of quality of life should be based on an independent, equal-opportunity, optimal environment, rather than being forced to make a choice because of discrimination or inadequate treatment.

The author of the document, Professor Robert Bogdorf, has proposed 9 standard recommendations for this purpose. In addition to the general regulations such as "it must be unbearable pain" and "have sufficient time to consider", it also includes the need not to cause unnecessaryPain and more.

At the time, when discussing the legalization of euthanasia in some states in the United States, he mentioned "should have the opportunity to discuss with mental health professionals" and "fully understand the possibilities and resources that can be used to improve the quality of life", heI think this is not enough for people with disabilities, so I specifically mentioned more than 20 things that need to be ensured, such as the patient's diagnosis must be completely accurate, the patient is about to die, etc.

But is it completely accurate? Compared to the two recent incidents, Dutch doctors have been accused of failing to fully respect the real-time wishes of elderly people with dementia in the face of the law. The elderly have frequently changed according to their mental state and physical state.Attitude towards life and death. On the other hand, Audrey Parker hopes to further expand the scope of euthanasia in Canada to include the expectation of people who are unconscious at the end of life, and it is also based on no one can tell when her cancer is progressing.It will make her brain unconscious. Those who are cared for by law, mentally ill patients and minors who are terminally ill, and the disadvantaged position makes it more difficult for this accurate information transmission from doctors to patients, which has become a legal requirement.A pair of contradictions struggling to weigh.

More complicated is that the special connotation of death at the social level makes the problem of euthanasia often difficult to become a personal matter. Who chooses euthanasia? Why choose euthanasia? These issues usually contain deeper social information.

euthanasia by multidimensional interpretation

In January 2018, a Dutch girl who was only 29 years old and did not have terminal terminal illness applied for euthanasia on the grounds of her intolerable mental illness. Eventually, she had to take poison with the help of a doctor after twists and turns, which caused people's special attention.. Like the skepticism raised by euthanasia ads on the screen of a waiting room in a Canadian hospital after the death of Audrey Parker, some are fighting for more rights to death, while others are worried about whether euthanasia is being encouraged and whether it will beabuse.

Palliative care and hospice are generally considered as an important alternative to euthanasia. Palliative care is proposed for patients who are difficult to cure, especially facing life threats at the same time, in order to improve the quality of life for them and their families, hospice care isEspecially for the medical care of dying patients, as early as 1990, the World Health Organization in an expert report on cancer pain relief and palliative care proposed that modern palliative care can be an alternative to euthanasia, and countries should consider relieving cancer painTreatment.

In February 2018, the World Health Organization introduced in a note on the status of palliative care. At present, only 14% of people in need of palliative care worldwide have actually been treated. It is estimated that 40 million people need palliative care each year.78% of people live in low- and middle-income countries. Inadequate awareness, lack of professionals, and excessive restrictions on related drugs are considered obstacles to palliative care.

Currently New Zealand's euthanasia bill, known as the End of Life option, is in the process of preparing a report by a special committee. In 2017, it passed a preliminary review by members of Parliament. It is expected that it will be discussed and voted in the House of Representatives in 2019. Although data show that most people support legalization,But there are objections that New Zealand's palliative care and hospice services are excellent worldwide, and there is no need to pass this.

In the past 30 years, New Zealand has held parliamentary votes on the euthanasia bill for many times. Although the consent rate is getting higher and higher, they have never passed, and there are not a few countries with similar experience.

As the earliest country to legalize euthanasia, the Netherlands began discussing euthanasia in the 1970s, and in the 1980s it focused on the issue of active and voluntary euthanasia, so it is often studied as a reference case.

1988, "Journal of the American Medical Association" JAMA 's attention to euthanasia issues including California's legislative initiative, Dutch policy, etc., sparked discussions in academia. Also during this year, during the seventh session of the National People's Congress of China, representatives of the National People's Congress, Yan Renying, an expert in obstetrics and gynecology and women's health, and others have mentioned the euthanasia bill. In fact, since the 1990s, many countries around the world have conducted discussions on euthanasia legislation.

At the time, a study by the Australian Parliament's Law and Public Management Group concluded that the successful implementation of euthanasia in the Netherlands was closely related to its sociocultural ecology, such as the willingness of society to openly discuss issues such as prostitution, abortion, and homosexuality.Issues, as well as a tolerant philosophy of life, respect for the autonomy of others, public trust and respect for the medical profession, universal medical insurance, high standards of health care and old-age care, and active government funding for research on this issue.

Fears about inadequate medical conditions represent the thinking of some people at the time. In 1990, Peter Singer and others at the University of Toronto published an article in the New England Medical Journal NEJM on pain relief, personal rights, and public policy risksAfter critical analysis of euthanasia, they believe that rising medical costs will increase the pressure to legalize euthanasia, and doctors must pay more attention to the ideas of patients who want euthanasia, provide better pain management and compassionate hospice care.

How to reduce potential risks

These worries are still of great significance today, especially in low- and middle-income countries. If euthanasia is legalized, will it be used indirectly as a killing tool by some people, or will they actively give up treatment if it can be cured? This social systemThe problem is the focus of legislation, that is, how to effectively make euthanasia take its original meaning and wipe out the pain and euthanasia in the last short period of time when a person goes to death.

Scientifically assessing whether you really face death right away is one of the red lines that can be controlled. Some countries that have legalized euthanasia quantify life and death to minimize potential risks.

Oregon, the United States, which was the earliest state to legalize euthanasia, has a specific time limit for applying euthanasia to related terminally ill patients in its Dignity Death Act DWDA.Died within 6 months. And if the doctor believes that the patient's euthanasia decision was affected by a mental illness or psychological problem, the patient must be referred to a mental examination to ensure objective and subjective accuracy. In addition, the doctor, pharmacyNeither teachers nor the health care system are obliged to participate in euthanasia, reducing institutional interference from outside sources.

The intervention of law changed all this. When the law faced this type of death, it faced the problem of co-ordinating and considering the meaning of the death. Pain patients, concerned family members, doctors and human consciences,Witness, they were asked to reach a consensus on life, and if they conflicted, they would be in trouble.

Even so, discussions to solve the dilemma continue around the world. In Australia, following Victoria, Western Australia is expected to pass the Euthanasia Act in Parliament in the near future, and Queensland may launch related legislative issues. From the end of October 2018Initially, discussions on euthanasia started in the Singapore media. Proposals to amend the law triggered by the death of Audrey Parker have also received attention from all walks of life in Canada.

Today's population aging phenomenon is prominent, including palliative care and euthanasia, the management and care of the unbearable pain caused by terminal terminal illness should be the concern of the whole society.

Because life is only one time, how to face death is an inevitable problem that runs across everyone's life.

Jinquan recommended from "Southern Weekend"

Author: WANG Jiang-tao

Source: "East, West, South, North"

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