紐約時報:荷蘭「安樂死」第一案

Doctor Acquitted in Euthanasia of Patient Who May Have Changed Her MindBy PALKO KARASZ，New York Times, Sep.12

A court in the Netherlands on Wednesday acquitted a doctor who had been accused of unlawful euthanasia for administering a lethal injection to patient with dementia, a case that raised questions about the clarity of the country’s law in such circumstances.荷蘭一家法院周三宣布，一名醫生無罪釋放。此前，這名醫生被控向痴呆症患者注射致命藥物，對患者實施非法安樂死。在這種情況下，這起案件引發對該國法律的明確性提出質疑。The patient, 74, who has not been publicly identified, had asked in writing for doctors to end her life if she had to be admitted to a nursing home, and if she thought the time was right. But, when she entered the home, incapacitated, she appeared to have changed her mind, giving 「mixed signals,」 about her intentions, prosecutors said.這位74歲的患者沒有公開身份，她曾以書面請求醫生：如果她必須住進養老院並且認為時機合適的話，請醫生結束她的生命。但是，檢察官說，當她住進養老院時，已經失去了行動能力，她似乎改變了主意，對自己自殺的意圖發出了「複雜的信號」。A doctor at the home, now retired and also unidentified, decided to go through with the euthanasia, in close consultation with the family, in the spring of 2016.該養老院的一名醫生現已退休，身份不明，他決定在2016年春天與患者家人密切協商後，對其實施安樂死。

A paper in the London-based Journal of Medical Ethics that reviewed the case said the doctor had put a sedative in the patient’s coffee and that the patient’s relatives had helped to hold her down as she struggled against the injection.倫敦《醫學倫理學雜誌》(Journal of Medical Ethics)上的一篇論文對這一案例進行了研究，文章稱，醫生在患者的咖啡裡放了鎮靜劑，在實施注射時，患者的親屬也幫助按住了她。The review, published in 2018, said the case demonstrated the 「myriad ethical concerns」 raised by advance euthanasia directives.這份發表於2018年的報告稱，這起案件顯示出安樂死事前指令引發的「無數倫理問題」。Prosecutors said that the doctor did not act with due care, as required by the law. They said she should have cleared any doubt about the patient’s wish to die before going ahead with the procedure. Although prosecutors had pushed for a guilty verdict, they also made clear that they had brought the criminal case to try to resolve ambiguities of the euthanasia law, rather than to punish the doctor, whose motives they said were blameless.檢察官說，這名醫生沒有按照法律規定的應有的謹慎行事。他們說，在進行安樂死手術之前，醫生她應該確認消除任何關於病人是否願意死的疑問，再執行安樂死程序。儘管檢察官們要求法院做出有罪判決，但他們也明確表示，他們提起這起刑事案件是為了解決安樂死法律的模糊性，而不是懲罰醫生，他們說醫生的動機是無可指責的。

The court cleared the doctor of any wrongdoing.

「The patient was heavily demented and deemed completely mentally incompetent,」 the court said in an online statement. Medical records, heard during the proceedings, said the patient could not recognize her own reflection.

法院在網上的一份聲明中說:「這名患者嚴重精神錯亂，故法院認為其完全沒有行為能力。」在審訊過程中聽到的醫療記錄顯示，該患者甚至無法認出自己的倒影。Taking into account the patient’s state, the court ruled that the doctor did not have to verify her wishes at the time of administering euthanasia.考慮到患者的狀況，法院裁定醫生在實施安樂死時不必核實她的意願。

Franz Zonneveld, a spokesman for the Public Prosecution Service of The Hague, said on Wednesday that the aim of the case had been to resolve the limits of the law.海牙公訴機構發言人弗朗茨·佐內維爾德(Franz Zonneveld)周三表示，此案的目的是解決法律對「安樂死」的限制。「The court has given a clear ruling but on one point they have a very different view,」 he said by phone, referring to the prosecutors』 belief that the doctor should have made greater efforts to confirm that the patient still wished to proceed with euthanasia.「法院雖然給出了明確的裁決，但在某一點上，他們有非常不同的看法，」他在電話中說。檢察官認為醫生應該做出更大的努力來證實病人仍然希望進行安樂死。「Even though she was suffering from dementia, you should check that as the physician, with the patient, and you should be 100 percent sure,」 Mr. Zonneveld said.佐內維爾德說，「即使她患有痴呆症，作為醫生，你也應該檢查患者，你應該百分之百確定患者的死亡意願。」

The case was the first of its kind to prompt a criminal investigation since 2002, when the Netherlands became the first country to legalize euthanasia.自2002年荷蘭成為第一個將安樂死合法化的國家以來，這是第一起引發刑事調查的此類案件。Questions are often raised about the parameters for those wishing to end their lives and about who should be allowed to take that step, and lessons from the Dutch system often reverberate internationally. The debate can be particularly complex when dementia patients are involved, and opinion is often divided almost on a case-by-case basis.對於那些希望結束生命的人，以及應該允許誰採取這一步驟，人們常常會提出一些問題，荷蘭制度的教訓往往在國際上產生反響。當涉及到痴呆症患者時，爭論可能會特別複雜，而且意見往往幾乎是在個案基礎上產生分歧。

In 2017, after reports of an increase in euthanasia among dementia patients in the Netherlands, and of a growth in the practice of administering sedatives before lethal injections, a group of more than 200 doctors signed a letter urging against euthanasia based on advance directives from patients. The doctors argued that they were reluctant to end the life of people who could not confirm that they still wanted to die.2017年，有報導稱荷蘭老年痴呆症患者使用安樂死的人數有所增加，注射死刑前使用鎮靜劑的做法也有所增加，之後，200多名醫生籤署了一封公開信，敦促醫生們不要根據患者之前的醫院，隨意使用安樂死。醫生們爭辯說，他們不願意結束那些不能確認自己仍然想死的人的生命。Dr. Scott Y.H. Kim, a psychiatrist and bioethicist at the National Institutes of Health in the United States, wrote in an email that, 「When a human being is resisting — regardless of how 『meaningless』 the action is in terms of intentions and understanding — and what she is resisting is an act to end her life,」 then it could be 「pretty difficult to take in.」美國國立衛生研究院生物倫理學家、精神病學家斯科特Y.H.金博士（Dr. Scott Y.H. Kim）在一封電子郵件中寫道,「當一個人正在抵制（死亡）——就意圖和理解上來說，無論她的行為多麼的『毫無意義』——她拒絕的是一個結束她的生命的行為，那麼接下來（醫生還繼續實施安樂死）可能是『相當難以接受』的。」

The Dutch law on euthanasia contains strict rules, known as due care criteria, that must be met in every case.荷蘭關於安樂死的法律有嚴格的規定，即適當的護理標準在任何情況下都必須滿足。Among other conditions, the decision to request euthanasia has to be voluntary and carefully considered, and the patient must be facing a future of unbearable suffering with no reasonable alternative. The physician has to consult at least one other independent professional, and the procedure to end the patient’s life should be administered in a medically appropriate way.在其他情況下，要求安樂死的決定必須是自願的和仔細考慮的，患者必須面對一個無法忍受的痛苦的未來，且沒有其他合理的選擇。醫生必須至少諮詢另一名獨立的專業人士，結束患者生命的程序應該以醫學上適當的方式進行。

The court ruling on Wednesday underlined the legal position that a doctor can carry out euthanasia on patients at least 16 years old who have made written requests to die but are no longer able to express that will, as long as the due care criteria have been fulfilled.

法院周三的裁決強調了這樣一個法律立場:醫生可以對16歲以上的患者實施安樂死，這些患者曾書面提出死亡要求，但只要符合適當的護理標準，且無法繼續再表達自己的意願。

The Dutch Public Prosecution Service said in a statement that the patient’s advance directive in this case was clear but that a conversation should have continued about the patient’s wishes.荷蘭公訴人在一份聲明中表示，在這起案件中，儘管患者的事先指示是明確的，但醫生應該繼續就患者後續的意願進行談話。

「As long as that conversation gave cause for doubt,」 the prosecution service said, 「the nursing home doctor should have refrained from euthanasia.」

「只要那次談話引起懷疑，」檢察機關說，「養老院的醫生就應該避免為其實施安樂死。」

允許轉載，轉載可聯繫後臺，需標明出處及作者、翻譯、校閱。