■大多数允许安乐死和辅助自杀(AS)的司法管辖区通过医学界对其进行监管。然而,医学应如何参与的程度和性质存在争议。瑞士AS的做法是不寻常的,因为它是由外行AS组织管理的,这些组织依赖于一项法律,该法律允许AS出于非自私的原因而进行。法律中没有提到医生,但通常要求医生开出致命药物并进行能力评估。
■我们分析了包括伦理学家在内的23位瑞士AS专家的深入访谈,律师,医生,以及AS组织的高级官员对AS的看法。
■尽管在某些问题上达成了共识(例如,需要更好的临终关怀),受访者首选的AS模型,以及首选医疗参与的性质,变化,我们将其分为五种类型:优先考虑AS组织之前的AS实践;优先考虑当前的非专业模型;优先考虑修改的非专业模型,以增加自主性保护,同时限制医疗AS规范化;优先考虑各种类型的更加医疗化的AS模型;以及,对任何特定的医疗参与模式的矛盾。每种类型的模型给出的基本原理反映了关于医学作用可能如何影响AS实践的不同观点,并展示了专家对这些影响的态度。
■瑞士AS政权内部的动态,正如瑞士AS专家的不同观点所反映的那样,阐明了医疗范围和AS参与所固有的困境,这可能会对其他司法管辖区的辩论产生影响。
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.
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 medicine\'s role would likely impact AS practice and demonstrated the experts\' attitudes toward those impacts.
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.