高齢化が進み、ベビーブーム世代が高齢期を迎え始めている米国では、医師のほう助による安楽死は、既に5つの州で合法化され、公的課題としてしっかり位置づけられています。激しい議論が繰り広げられているこの問題が、すぐに解決することはないと考えられますが、本書はこの重要な議論において、読者が理性的かつ十分な情報に基づいた意見を形成するのに必要な、あらゆる情報を提供します。
まず、医師のほう助による安楽死を終末期医療という大きな枠組みの中に位置づけて、その合法化運動がなぜこれほどまでに国民の支持を得ているのかを説明し、この議論に不可欠な背景を説明します。1994年にオレゴン州で始まったこの運動の成功は、現在では3大陸にまたがる11の地域に広がります。安楽死は中絶と同様に倫理的な衝突や論議を呼びます。一方では、患者の自律性と苦痛の緩和を訴え、他方では、積極的に死期を早める措置をとることは生命の尊厳にもとるという主張です。合法化に賛成と反対の両方のケースを検討し、後者については、乱用のリスクと「滑り坂」の可能性（最初の一歩を踏み出せば、次々に巻き込まれ、悪しき結果に落ち込んでいくことが避けられなくなるとの考え方）に焦点を当てます。この文脈で、合法化に踏み切った地域の状況を注意深く検証し、そこからどのような教訓が引き出せるかを精査します。永久に意識のない患者や深刻な痴呆になった患者、重度の障害を持つ新生児に対する安楽死など、いつかは直面しなければならない問題も取り上げ、最後には、政治的、司法的な観点から、合法化へのさまざまな可能性を検討します。
The issue of physician-assisted death is now firmly on the American public agenda. Already legal in five states, it is the subject of intense public opinion battles across the country. Driven by an increasingly aging population, and a baby boom generation just starting to enter its senior years, the issue is not going to go away anytime soon. In Physician-Assited Death L.W. Sumner equips readers with everything they need to know to take a reasoned and informed position in this important debate.
The book provides needed context for the debate by situating physician-assisted death within the wider framework of end-of-life care and explaining why the movement to legalize it now enjoys such strong public support. It also reviews that movement's successes to date, beginning in Oregon in 1994 and now extending to eleven jurisdictions across three continents.
Like abortion, physician-assisted death is ethically controversial and the subject of passionately held opinions. The central chapters of the book review the main arguments utilized by both sides of the controversy: on the one hand, appeals to patient autonomy and the relief of suffering, on the other the claim that taking active steps to hasten death inevitably violates the sanctity of life.
The book then explores both the case in favor of legalization and the case against, focusing in the latter instance on the risk of abuse and the possibility of slippery slopes. In this context the experience of jurisdictions that have already taken the step of legalization is carefully reviewed to see what lessons might be extracted from it. It then identifies some further issues that lie beyond the boundaries of the current debate but will have to be faced sometime down the road: euthanasia for patients who are permanently unconscious or have become seriously demented and for severely compromised newborns.
The book concludes by considering the various possible routes to legalization, both political and judicial. Readers will then be prepared to decide for themselves just where they stand when they confront the issue both in their own jurisdiction and in their own lives.
Preface
1 How Should We Think about Death and Dying?
How do we tell when death has occurred?
What do we mean by death?
Why is it (usually) a bad thing to die?
How might death sometimes be a good thing?
How and where do we typically die?
2 What is End-of-life Care?
What is the end of life?
What end-of-life treatment options are currently available to patients?
Do patients have the right to refuse treatment?
Do patients have the right to refuse life-sustaining treatment?
What is pain management?
What is terminal sedation?
What is physician-assisted death?
3 What is the Ethical Case in Favor of Physician-Assisted Death?
What is the argument from well-being?
What is the argument from autonomy?
When is PAD justified?
Is there an ethical difference between the two forms of PAD?
4 What is the Ethical Case Against?
What is the right to life?
What is the sanctity of life?
What is the doctrine of double effect?
What is the doctrine of doing and allowing?
Is there an ethical difference between PAD and other end-of-life treatment options?
What role can be played in this issue by religious arguments?
5 What is the History of Legal Physician-Assisted Death?
Is it legal to refuse life-sustaining treatment?
Is it legal to administer pain medication that may hasten death?
Is terminal sedation legal?
Where did any form of PAD first become legal?
Where has PAE become legal?
What has been happening in the United States?
6 What are the Options for a Legal Regime?
Must the illness be terminal?
What kinds of suffering should be recognized?
What kinds of illnesses should be included?
What about people who are just How do we determine decisional capacity?
Adults only?
PAS , PAE, or both?
What procedures should be required?
What system of review and oversight would be appropriate?
What should be done about conscientious objection?
7 What is the Case in Favor of Legalization?
What is the relationship between ethics and law?
What is the argument from compassion?
What is the argument from respect?
What is the argument from freedom of conscience?
What is the argument from parity?
What is the argument from democracy?
8 What is the Case Against?
What is the slippery slope argument?
What is the abuse argument?
Is helping patients to die contrary to a doctor's professional duty?
Would helping patients to die undermine the physician-patient relationship?
Are doctors willing to assist the deaths of their patients?
Is helping patients to die consistent with the goals of palliative care?
Would legalizing PAD erode the delivery of other forms of palliative care?
Shouldn't we wait to legalize PAD until we can guarantee every dying patient
high-quality palliative care?
Why do patients need doctors to help them die? Can't they just do it themselves?
Why do patients need PAD, when they can die by refusing food and water?
9. What Might Lie Farther Down the Road?
What is nonvoluntary PAD?
Is it legal to withhold life-sustaining treatment from permanently unconscious patients?
What role should be played by advance directives?
Is there a case for euthanasia for permanently unconscious patients?
What about patients suffering from dementia?
What about infants?
10 How might legalization be achieved?
What kind of legal regime should advocates aim for?
What role might be played by legislatures?
What role might be played by courts?
What role might by played by prosecutors?
What role might be played by referenda?
Appendix
Oregon Death with Dignity Act
Notes
Bibliography
Index
"Sumner's volume is a splendid example of how ethical analysis, historical review, and pragmatic comparison of alternative policies can be brought together concisely in a handy book that conveys a great deal of what everyone really does need to know about PAD." -- Paul T. Menzel, Bioethics
"With his philosophy background and focus in medical ethics, Sumner is truly an expert and handles controversial topics in a thoughtful, impartial way. His audience here is not simply scholars of medical ethics but also general readers who may find themselves facing end-of-life challenges with a loved one. Reviewing the thorough notes and bibliography sections will be educational for all, but may be most interesting to scholars interested in further study." -- S. C. Grossman, CHOICE
ISBN : 9780190490171
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