End of life decision-making, euthanasia, and physician assisted suicide in persons with neuropsychiatric conditions

神经精神疾病患者的临终决策、安乐死和医生协助自杀

基本信息

批准号：
10917895
负责人：
Scott Kim
金额：
--
依托单位：
CLINICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
资助国家：
美国
起止时间：
至
项目状态：
未结题

项目摘要

In the past year, we have conducted the following projects. 1. Most jurisdictions that allow euthanasia and assisted suicide (AS) regulate it through the medical profession. However, the extent and nature of how medicine should be involved are debated. Swiss AS practice is unusual in that it is managed by lay AS organizations that rely on a law that permits AS when done for nonselfish reasons. Physicians are not mentioned in the law but are usually called upon to prescribe the lethal medications and perform capacity evaluations. We analyzed in-depth interviews of 23 Swiss AS experts including ethicists, lawyers, medical practitioners, and senior officials of AS organizations for their views on AS. We found that although there was agreement on some issues (e.g., need for better end-of-life care), the interviewees preferred model for AS, and the nature of preferred medical involvement, varied, which we categorized into five types: preference for AS practice as it occurred prior to lay AS organizations; preference for the current lay model; preference for a modified lay model to increase autonomy protections while limiting medical AS normalization; preference for various types of more medicalized models of AS; and, ambivalence about any specific model of medical involvement. The rationales given for each type of model reflected varying opinions on how medicines role would likely impact AS practice and demonstrated the experts attitudes toward those impacts. We conclude that the dynamics within the Swiss AS regime, as reflected in the varying views of Swiss AS experts, shed light on the dilemmas inherent to medical scope and involvement in AS, which may have implications for debates in other jurisdictions. 2. There have been prominent media reports of persons in Canada seeking and receiving medical assistance in dying (MAID; usually provided as euthanasia, i.e., termination of life by injection upon patient request) as a second resort because they were unable to access adequate care. This occurs in Canada due to their MAID law permitting it without being a last resort option (at it is in the Netherlands, for example). We are currently examining the normative issues around such laws, whether it conflicts with established norms of medical practice as well as principles of human rights. In addition, we are conducting a survey of the Canadian public regarding their knowledge and attitudes toward such practices. 3. Normative, philosophical analysis of the principle of equality as it applies to the assisted dying debate. Equality arguments are ubiquitous in the assisted dying literature but their full implications have not been drawn out. This project attempts to sketch out the implications.

在过去的一年中，我们进行了以下项目。 1。大多数允许安乐死和协助自杀（AS）的司法管辖区通过医学界进行了规范。但是，辩论应该如何参与医学的程度和性质。瑞士人作为实践是不寻常的，因为它是由依靠法律的组织来管理的，该法律是出于非官方原因而允许这样做的法律。法律没有提及医师，而是通常要求开处方致命的药物并进行能力评估。我们分析了23个瑞士的深入访谈作为专家，包括伦理学家，律师，医生和AS AS组织的高级官员的观点。我们发现，尽管在某些问题上达成了共识（例如，需要更好的寿命护理），但受访者首选的模型和首选的医疗参与的性质各不相同，我们将其分为五种类型：偏爱作为实践，因为它是在作为组织之前发生之前发生的；偏爱当前的LIE模型；偏爱修改的外行模型，以增加自治保护，同时将医学限制为归一化；偏爱AS的各种类型的更医学的模型；并且，对任何特定的医学参与模型的矛盾情绪。每种类型的模型的理由反映了关于药物角色如何影响实践的不同意见，并证明了专家对这些影响的态度。我们得出的结论是，瑞士人内部的动态，反映在瑞士人作为专家的不同观点中，阐明了医疗范围固有的困境和参与AS的困境，这可能对其他司法管辖区的辩论产生影响。 2。有媒体报道在加拿大寻求和接受垂死的医疗援助（通常为安乐死，即因患者要求终止生命而终止生命），因为他们无法获得足够的护理，因为他们是由患者要求终止的）。由于女仆的法律允许它成为最后的手段选择（例如，在荷兰），这发生在加拿大。我们目前正在研究有关此类法律的规范问题，它是否与已建立的医学实践规范以及人权原则冲突。此外，我们正在对加拿大公众进行有关他们对这种做法的知识和态度的调查。 3。对平等原则的规范性，哲学分析，适用于辅助垂死的辩论。在辅助垂死的文献中，平等论点无处不在，但尚未提出其全部含义。该项目试图勾勒出含义。