IT IS easy to forget that adultery was a
crime in Spain until 1978; or that in America, where gay marriage is allowed by
37 states and may soon be extended to all others by the Supreme Court, the last
anti-sodomy law was struck down only in 2003. Yet, although most Western
governments no longer try to dictate how consenting adults have sex, the state
still stands in the way of their choices about death. An increasing number of
people—and this newspaper—believe that is wrong.
忘记通奸直到
1978
年前在西班牙还是一项罪名是容易的,忘记在同性婚姻已经在
38
个州得到允许且不久可能被联邦最高法院扩展至其他所有州的美国,最后的反鸡奸法直到
2003
年才被废除也是容易的。然而,在西方,尽管大多数政府已经不再试图指导成年同性恋者如何发生性关系。但是,国家仍是人们有关死亡选择的障碍。越来越多的人以及本报相信,这是错误的。
The argument is over the right to die with
a doctor's help at the time and in the manner of your own choosing. As yet only
a handful of European countries, Colombia and five American states allow some
form of doctor-assisted dying. But draft bills, ballot initiatives and court
cases are progressing in 20 more states and several other countries. In Canada
the Supreme Court recently struck down a ban on helping patients to die; its
ruling will take effect next year. In the coming months bills will go before
parliaments in Britain and Germany.
争论的核心是在医生的帮助下,以自己选择的时间和方式死亡的权力。时至今日,只有少数几个欧洲国家,以及哥伦比亚和美国的
5
个州允许某种形式的协助性自杀。但是,各种草案、公投议案和法庭案件正在美国的另外
20
个州和多个国家中取得进展。在加拿大,最高法院刚刚驳回了一项协助病人死亡的禁令;判决将在明年生效。在今后几个月中,将有多项提案将被提交至英国和德国议会。
The idea fills its critics with dismay. For
some, the argument is moral and absolute. Deliberately ending a human life is
wrong, because life is sacred and the endurance of suffering confers its own
dignity. For others, the legalisation of doctor-assisted dying is the first
step on a slippery slope where the vulnerable are threatened and where
premature death becomes a cheap alternative to palliative care.
这种观点让批评者大失所望。在某些人看来,争论所涉及内容属于道德范畴,是绝对的。有意结束一个人的生命是错误的。因为,生命是神圣的,对于痛苦的忍耐授予生命以尊严。对于另外一些人来说,协助性自杀合法化是道德滑坡的第一步。这个滑坡会让弱者受到威胁,会让提前死亡成为姑息治疗的廉价替代品。
These views are deeply held and deserve to
be taken seriously. But liberty and autonomy are sources of human dignity, too.
Both add to the value of a life. In a secular society, it is odd to buttress
the sanctity of life in the abstract by subjecting a lot of particular lives to
unbearable pain, misery and suffering. And evidence from places that have allowed
assisted dying suggests that there is no slippery slope towards widespread
euthanasia. In fact, the evidence leads to the conclusion that most of the
schemes for assisted dying should be bolder.
这些看法根深蒂固,值得认真对待。但是,自由和自主也是人类尊严之源,两者皆增加了生命的价值。在世俗社会中,通过让大量的个体生命被迫承受无法承受的身体和精神痛苦的方式,来支撑抽象意义上的生命尊严的做法是奇怪的。来自已经允许了协助性自杀之地的证据表明,不存在通向大范围安乐死的滑坡。实际上,这些证据所指向的结论是:大多数支持协助性自杀的计划都应当更大胆。
The popular desire for assisted dying is
beyond question. The Economist asked Ipsos MORI to survey people in 15
countries on whether doctors should be allowed to help patients to die, and if
so, how and when. Russia and Poland are against, but we find strong support
across America and western Europe for allowing doctors to prescribe lethal
drugs to patients with terminal diseases. In 11 out of the 15 countries we
surveyed, most people favoured extending doctor-assisted dying to patients who
are in great physical suffering but not close to death.
民众对于协助性自杀的渴望是毫无疑问的。本报曾委托
Ipsos MORI
,就医生是否应当被允许协助病人死亡,以及如何与何时协助病人死亡,在
15
个国家做了一次民调。俄罗斯和波兰持反对态度。但是,我们却在美国和西欧各国发现了对于允许医生给身患绝症的病人开具致命药物的做法的强烈支持。在我们调查的
15
个国家中的
11
个,大多数人都支持将协助性自杀扩展到正在经受巨大身体痛苦但还没有接近死亡的病人。
No wonder that, just as adultery existed in
Spain before 1978, so too many doctors help their patients die even if the law
bans them from doing so. Usually this is by withdrawing treatment or
administering pain-relief in lethal doses. Often doctors act after talking to
patients and their relatives. Occasionally, when doctors overstep the mark,
they are investigated, though rarely charged. Some people welcome this fudge
because it establishes limits to doctor-assisted dying without the need to
articulate the difficult moral choices this involves.
正如通奸行为在
1978
年之前还在西班牙存在一样,现在有如此多的医生纵然是在法律禁止他们的情况下,依旧帮助自己的病人死亡,这丝毫不令人感到奇怪。协助性自杀通常是通过撤回治疗或者是给予致死剂量的止痛药来实现。医生经常是在同病人和他们的亲属进行过交谈后才采取行动。医生偶尔会越过这个界限,这时,他们会被调查,但很少被指控。有的人对此持欢迎的态度,是因为这种模棱两可可以在不需要讲明其所涉及的艰难道德选择的情况下,为协助性自杀设定界限。
But this approach is unethical and
unworkable. It is unethical because an explicit choice that should lie with the
patient is wholly in the hands of a doctor. It is hypocritical because society
is pretending to shun doctor-assisted dying while tacitly condoning it without
safeguards. What may turn out to be more important, this system is also
becoming impractical. Most deaths now take place in hospital, under teams of
doctors who are working with closer legal and professional oversight. Death by
nods and winks is no good.
但是,这种做法是不道德的,也是不可行的。不道德,是因为理应取决于病人的明确选择完全掌握在医生手中;伪善,是因为社会在假装回避协助性自杀的同时,又心照不宣在没有保障的情况下纵容它。更为重要的是,这个体系也在变得不切实际。如今,大多数死亡都是在医院中,在工作在更加严密的法律和职业监督的医生团队下发生的。在医生忙碌下的死亡毫无意义。
Better is to face the arguments. One fear
is that assisted dying will be foisted on vulnerable patients, bullied by rogue
doctors, grasping relatives, miserly insurers or a cash-strapped state.
Experience in Oregon, which has had a law since 1997, suggests otherwise. Those
who choose assisted suicide are in fact well-educated, insured and receiving
palliative care. They are motivated by pain, as well as the desire to preserve
their own dignity, autonomy and pleasure in life.
最好是直面争论。一个担心是,协助性自杀会被强加给弱势的病人,而弱势的病人又会被流氓医生、贪婪的亲属、吝啬的保险公司所欺凌,或是因为自己囊中羞涩而被迫选择死亡。但是,自
1997
年以来就有了一项这方面法律的俄勒冈州的经历却表明了另一种情况。实际上,选择了协助性自杀的人都受过良好教育、享受保险,并且正在接受临终关怀。他们选择死亡,既是被病痛所驱使,也是被保存自己的尊严、自主和生命中的乐趣的渴望所驱使。
Another fear is that assisted dying will
downgrade care. But Belgium and Holland have some of the best palliative care
in Europe. Surveys show that doctors are as trusted in countries with assisted
dying as they are in those without. And there are scant signs of a slippery
slope. In Oregon only 1,327 people have received lethal medicine—and just
two-thirds of those have used it to take their lives. Assisted dying now
accounts for about 3% of deaths in the Netherlands—a large number—but this is
less a rush to assisted dying than the coming to light of an unspoken tradition
in which doctors quietly brought their patients' lives to an end.
另一个担心是,协助性自杀会使照料水平降低。但是,比利时和荷兰有着欧洲最好的一些姑息治疗。调查显示,医生在有协助性自杀国家所享受的信任同没有的国家是一样的。而且,这些地方几乎没有滑坡的迹象。在俄勒冈州,至今仅有
1327
人接受了致死药物,但是使用这些药物来结束自己的生命的人只有三分之二。如今,在荷兰,协助性自杀占死亡总数的
3
%左右——这是一个很大的数字。但是,相比医生可以安静地将其病人的生命带至终点的不言而喻的传统,并没有出现大量的安乐死。
How, then, should assisted dying work? For
many the model is Oregon's Death with Dignity Act. It allows (but does not
oblige) doctors to prescribe lethal drugs to patients with less than six months
to live who ask for them, if a second doctor agrees. There is a cooling-off
period of 15 days.
那么,协助性自杀应当如何进行呢?对许多国家来说,俄勒冈州的《尊严死亡法案》是一个模板。这项法律允许医生(但是医生没有义务)在第二名医生同意的情况下,给生命剩余时间不到
6
个月且向他们提出要求的病人开出致死药物。这其间有一段
15
天的冷静期。
We would go further. Oregon insists that
the lethal dose is self-administered, to avoid voluntary euthanasia. To the
patient the moral distinction between taking a pill and asking for an injection
is slight. But the practical consequence of this stricture is to prevent those
who are incapacitated from being granted help to die. Not surprisingly, some of
the fiercest campaigners for doctor-assisted dying suffer from ailments such as
motor neurone disease, which causes progressive paralysis. They want to know
that when they are incapacitated, they will be granted help to die, if that is
their wish. Allowing doctors to administer the drugs would ensure this.
我们会走得更远一些。俄勒冈州法律坚持,致死剂量由病人自己开出,以回避自愿安乐死。对于病人来说,吃药和要求注射之间的道德差别微乎其微。但是,这种严格要求的实际后果却是让丧失行动能力的人想安乐死的时候得不到别人的帮助。一些最激烈地为协助性自杀造势的人承受的是诸如引发渐进性麻痹的运动神经元病这类病痛的折磨,这不令人惊讶。他们想知道的是,当自己丧失行动能力时,是否会如愿以偿地获准协助性自杀。允许医生控制药物能够保证这一点。
Oregon's law covers only conditions that
are terminal. Again, that is too rigid. The criterion for assisting dying
should be a patient's assessment of his suffering, not the nature of his
illness. Some activists for the rights of the disabled regard the idea that
death could be better than a chronic condition as tantamount to declaring
disabled people to be of lesser worth. We regard it as an expression of their
autonomy. So do many disabled people. Stephen Hawking has described keeping
someone alive against his wishes as the “ultimate indignity”.