About the doctor's assistance line-Assisted death (PAD)
In many jurisdictions in the United States, Canada and Europe, this remains a controversial issue.
PAD is a medical practice that occurs when a doctor gives a patient a prescription or takes a lethal drug.
As more and more jurisdictions build PAD for at least certain categories of patients, the proper scope of this practice becomes urgent.
This paper presents an argument to limit PAD to patients with terminal illness, a view that can be accepted by defenders and critics of terminal illness PAD.
This argument calls for fairness.
Social Significance of medical practice.
As explained in this paper, these two considerations interact in various ways.
The correct way to think about the social meaning of medical practice is related to a fair parental style, because it is related to PAD and vice versa.
The document argues that when it comes to proposals to extend the PAD to a non-PAD, these considerations have substantial effect
Terminal disease patients, but when the PAD for terminal disease patients, the force is much smaller.
The document attaches special importance
Terminal patient suffering from treatment
Resistance to depression as these patients present potentially strong reasons to extend PAD beyond terminal illness.
Distinguish between casesNon-
The terminal patient is a large and different group.
Therefore, it is necessary to distinguish different groups in the class.
We will discuss three groups in detail.
These groups have not exhausted all possibilities. There are non-
Not suitable for any patient with terminal illness.
Because it's not the highlight of each group.
Patients with terminal illness can be discussed in papers of this size, and our argument is that the legal choice of PAD should not be extended to non-terminal patients, which is based on the assumption that it is not feasible, that is, the argument we have put forward applies to non-absolute in the case of appropriate modification.
We don't discuss terminal patients.
Having noted this limitation of our argument, we would like to emphasize that the groups we are concerned with have raised fundamental questions about the range of PAD, two of them are the subject of debate in some jurisdictions to set up PAD for terminal patients.
Discussion of the third group
It seems that terminal patients with depression are being treated
The resistance and those who wish to end their lives as means to end their suffering are at the heart of this argument.
The group of patients presented the strongest cases that many believe extend PAD beyond terminal illness.
However, we started the analysis from the other two groups and the first group did not press because almost no one liked to extend the mat to them.
The first group consists of young adult patients who do not have any serious physical or mental illness but still want to end their lives with the help of a doctor. Consider a 22-year-
Physical condition is not an old patient of life-
Threats such as type 1 diabetes, she hopes to end her life due to a recent romantic breakup.
Even if she is currently experiencing a high degree of suffering, such a person will not suffer from serious illness.
There are very few such patients and we know that there is no legal jurisdiction to allow them access to the PAD.
However, while there is no dispute over the exclusion of these patients from PAD, the concern for the consideration to support such exclusion will prove instructive.
In fact, in seeking to determine where the line is drawn on the PAD, it should be considered first whether any line must be drawn.
First of all, it should be noted that if such young people need treatment
Injection of insulin, for example-
She can refuse this life in order to continue to live
Continuous treatment, provided that the patient is considered competent and makes a voluntary, autonomous decision.
In countries that recognize the general legal right to refuse unwanted medical care, she has the option to do so.
It can be said that she has the moral right to do so.
However, if one has the right to refuse to live --
Ongoing treatment, so why don't people help die by getting a lethal drug?
Rejection of life-
The decision to continue treatment and receive PAD may be the patient's autonomous decision to end his or her life.
Moreover, defenders of the PAD often boldly assert that autonomy takes precedence overbeing.
In the case of capable patients, it was declared "autonomy trumps everything"being’ (Steinbock,p34).
2. it is important for viIt to determine what is wrong with this argument.
There is a big difference between the legal right to refuse life
Maintaining Medical and legal rights.
These differences explain how the legal right to give young and healthy patients a refusal to live is consistent and reasonable --
Continue the treatment and deny that they claim to have a legal option.
One such difference is that PAD needs the help of a doctor.
Although all doctors must respect the patient's right to refuse medical treatment, no doctor is obliged to participate in the PAD.
The second difference is to refuse life.
The foundation of continuous treatment is the strong negative right to protect people from harm's physical health
A consistent invasion of their bodies.
Just as medical treatment is allowed only with informed consent for capable patients, so is refusal of life --
The ongoing treatment of capable patients must be respected.
In contrast, the PAD involves patients asking for a fatal medical intervention instead of rejecting unwanted medical treatment.
Assuming positive medical rights, it is hard to say that its scope includes access to fatal medical interventions, especially for non-terminal patients.
It can be refuted that all patients who have decisions
If they have the ability to find a doctor who is willing to help them, they should have a legal option to participate in the PAD.
This is the position of some writers who strongly oppose the parental style.
But for young healthy patients, it is correct that almost all doctors refuse to do so.
They will refuse to do so because they will judge that PAD is not in the best interests of these patients.
PAD supporters sometimes doubt our ability to objectively judge whether PAD is in the best interests of patients seeking PAD.
As one writer said, "there is no objective standard, only a competent patient's judgment on whether it is no longer beneficial to continue living "(Brock,p11).
7, viii, but applicable to young non-
As described above, this statement is clearly wrong.
We can be sure that these patients are making mistakes because they are likely to have many years of healthy life.
Doctors will also refuse to participate in the PAD of such patients for another reason.
They will suspect that these patients will change their minds in many cases.
If we don't help them end their lives now, many of them will support us in refusing to do so when they feel better.
Things are different about terminal illness patients.
Due to their short life expectancy, it is more difficult for them for others to determine what their best interests are.
We also have no reason to think that if doctors refuse to help these patients now, they will change their minds later.
These points of view show the bold claim of autonomy overwhelming
And skeptical claims, we have to follow the patient's will, because there is no objective way to determine whether it is good for them to continue living, if it is true, only for some patients who may seek PAD.
These points also show that, with the help of others, there is no broad basic moral right to determine the time, environment and manner of a person's death.
These conclusions should be kept in mind, because we believe that these cases are more controversial than those of young people who have no life --
A disease that threatens or makes people weak.
We're now moving to the second group.
Patient with terminal illness
They are older, but they are not suffering from terminal illness or depression.
Nevertheless, they feel that "their life is complete" and it is not worth living on.
They are "tired of life", as sometimes said ".
Considering this group of patients is the natural next step in our discussion.
A key difference between young people and those who are tired of living is close to death.
Patients who are tired of life are not terminal diseases, but, unlike young people, they do not have a life prospect for the next few decades.
Patients who are tired of living want to end their lives, not because they have a potential physical or mental illness, but because they no longer feel that life is meaningful or worth living.
Often, these patients suffer from a variety of physical illnesses associated with getting older, but mainly their survival problems inspire their desire for death.
These existing problems may be quite serious and their importance should not be minimized.
Patients who are tired of life often feel lonely and lonely, worried about losing their independence and dignity, and fear of becoming a burden on their loved ones.
IxPAD, a patient tired of living, has become a problem in the Netherlands.
Most doctors in the Netherlands and elsewhere oppose the use of PAD for these patients, but more and more Dutch seem to prefer to give to older people without graves and lives --
Threatening medical conditions, but tired of the legal option to end your life.
10, when this group of patients is a contrast group compared to young people, it is obviously more controversial to limit PAD to terminal patients.
Older people live much less than young people in the future.
If they make a mistake at the end of their lives, then the mistake will not be as serious as a young man.
In addition, older patients are less likely to change their perception of the value of continuing their lives than younger patients.
Older people are more inclined to their preferences and values than young people.
Finally, what is more controversial is that when a person is old, people often think that life is not so valuable.
The deteriorating impact of ageing weakens the ability to enjoy life and make a valuable contribution to the world.
Many people who are tired of living compare their current situation with their past situation, and many condemn their ability to contribute to the lives of others for a decline.
The last point may reflect the problem of social attitudes towards aging and the elderly.
We will discuss this challenging issue later.
For the time being, we refer to an important consideration as to whether the legal option for PAD should be extended to patients who are tired of living.
This is related to the social significance of what we call the role of a doctor.
This social meaning includes both self and self.
Understanding of doctors and what the wider society thinks about them.
As expressed in a series of codes and documents, the role of physicians is to promote health, thereby protecting and improving human life.
The doctor's participation in PAD, both for young people and for the elderly who are tired of life, is directly inconsistent with this understanding of the doctor's role.
In contrast with terminal patients, it may be compared with some patients who have received treatment
Patients in these groups are not victims of physical or mental illness because treatment has become futile.
It is certain that there is disagreement among clinicians as to whether it is necessary to take interventions to adequately treat pain or pain.
We do not stand on this controversial issue.
However, no matter how this problem is solved, the social significance of the physician's role helps explain why jurisdictions that recognize the pad rights almost always limit it to what is considered the last resort in dealing with incurable diseases.
It is certain that the social significance of the doctor's role may change, and those who wish to extend the PAD to those who are tired of life can argue that the social significance of this role should be adjusted, to reflect the changing attitude of new people.
However, this may affect all patients, not just those who wish to end their lives.
That's why we have made it in a social sense, not a more common formulation that emphasizes roles --
Basic duties of individual doctors.
Xi in considering whether changes in the social meaning of the doctor's role are desirable, people need to pay attention not only to the self
Understanding of individual clinicians and the wishes of patients.
One must also consider how this change will affect patients in general, as its effect on some patients may be different from that on others, so when they have a conflict, we must consider how to balance
This social dimension of the debate on the appropriate scope of the PAD is ignored by those who focus only on the rights of so-called adult patients to control the time and manner of death.
It is clear that this also links the social significance of the doctor's role to the fair parental argument that we will be putting forward soon.
The last group
The patients we want to consider, including those who are not terminal and have no life --
The threat of physical illness, but so far it has been shown to treat patients with depression who are resistant.
The severity of the depression suffered by these patients and their apparent resistance to treatment make this group of patients a potentially powerful reason to extend the legal option beyond terminal illness.
In the recent literature on PAD, this group of patients has been heavily discussed, more than patients suffering from other treatments --
It may be necessary for PAD to resist diseases such as mental division and bipolar disorder.
This explains why we are following them here.
Patients diagnosed as treatment in some legal jurisdictions
Legal options have been given to fight depression.
This option is limited to patients who experience pain that is considered "unknown" and must judge that assisted death is the only available means to solve this problem (
Schuklenk and van de Vathorst, p579).
Nevertheless, the public still supports the expansion of the PAD to patients receiving treatment
Depression is not strong (
Schuklenk and van de Vathorst, p577).
1, xii this may reflect the severity of the public's failure to fully understand the pain associated with major forms of depression (
Schuklenk and van de Vathorst, p578).
However, even with the severity of the associated pain given, the situation of extending the PAD to this group of patients is far from simple and clear.
Some writers claim that it is unfair discrimination to allow patients with terminal illness to use PAD if both groups of patients experience incurable and unbearable pain (
Schuklenk and van de Vathorst, p5771;
P3bock, p3 22).
However, this complaint is only powerful if there is no correlation difference between the two groups of patients.
Three important differences are highlighted. First, non-
Terminal patients with depression usually end their lives better than terminal patients.
This is not ideal, of course.
But it weakens the notion that without the PAD of these people, they would actually have no choice to get rid of the pain, and they would actually "be locked in a harsh prison ward,with]
There is no way to escape it. 11 (
When discussing the choice to voluntarily stop eating, we go back to this point below. )
Second, it is widely believed that depression poses a threat to decision-making.
To a non
No mental illness.
Third, identification and features of treatment
Depression is full of difficulties.
Many patients considered to be treating depression
In fact, resistance is "pseudo ". resistant’.
12 patients considered to be treated
For example, drug-resistant people may have taken inadequate anti-depression drugs, the main cause of their depression may be wrong, or they may not have followed the appropriate drug guidelines.
Uncertainty of treatment
Resistant depression, which is greater than the uncertainty associated with the assessment of patients with advanced stage, related to whether PAD should be the choice of a patient with depression, or appears to be treated
Nevertheless, there are probably still patients diagnosed correctly as treatment
They really want to end their lives as a way to fight their pain.
If such a patient is denied the PAD and a terminal patient is given the option, then concerns about discrimination will continue.
Some people will insist that if a patient has the ability to receive treatment
The choice of resistance to depression to be rejected from the mat, and then a serious injustice occurs (Steinbock, p36).
We think this is a mistake.
A key question in determining the appropriate scope of the PAD legal choice is, under what circumstances, if any, individuals have the basic right to obtain medical assistance in determining the time and circumstances of death.
We argue above that the comprehensive view of pad rights based on personal autonomy is unreasonable, as this will allow healthy adults to end their lives with the help of doctors.
People who have been treated
Does resistance to depression have a strong demand for the legal rights of the pad?
We oppose the recognition of this right by invoking the concept of fairness. based (legitimate)paternalism.
We will focus on patients who are treated.
But if this argument works for them, then it may also apply to patients who are tired of living.
Parental interventions are designed to protect people from flawed decisions.
Parents' style is a bad name in contemporary medical ethics.
Modern emphasis on respect for patient autonomy is rightly seen as a significant step forward for physicians to make treatment decisions without soliciting the will of patients.
However, the form of a parent-style is getting better and better, and the kind of parent-style we defend here involves any acceptable PAD policy that must consider fairness.
How should we understand a fair parental style for PAD?
We believe that the parent-style restrictions on PAD are justified on the grounds of preventing two errors.
When any of them (1)
When patients lack decision-making, they participate in the PAD-
The ability to do so, and/or (2)
It is not in their best medical interest for patients to engage in PAD in doing so.
These errors can be avoided when a patient makes a decision
Improve the ability to participate in the PAD and do so further, or at least not hinder their interests.
Claiming that patients should not have a choice pad if they don't decide --
There is no dispute over manufacturing capacity.
In all jurisdictions that allow the PAD, this is the legal requirement of the PAD.
Restrictions on the PAD are designed to ensure that decisions are wrong
The formation of the ability to avoid can be described as soft parenting.
The legitimacy of soft parenting is even widely recognized by those who oppose it.
Claiming that if patients do this is not in their best medical interest, the PAD should not be chosen even if they have a decision --
However, the ability and autonomy to make choices is controversial.
To prevent this error, restrictions on the PAD can be described as a strict parental style.
15. the legitimacy of the hard-parent style is often denied.
Shouldn't a patient have a choice?
Even if they make decisions that run counter to their interests, decide on the choice of such an important thing?
However, PAD is not only a patient who committed suicide, but a doctor. aided suicide.
In order to determine the legitimacy of the restricted PAD, we need to consider how different regulatory plans affect the interests of different patients.
The scope of the PAD is a public policy issue as this approach involves prescribing or managing lethal interventions by state-licensed professionals to serve the best interests of vulnerable patients.
Whether individual patients should have legal pad rights depends on whether or not
A well-thought-out policy will empower them. Well-
The policy under consideration must be in the interest of all affected parties and in the significant practical uncertainty of determining their interests.
We will return to this in a moment.
But first we emphasize a point of support.
Earlier, we claimed that the role of the doctor was of social significance, and we can now add, fair --Based on dimensions.
In the current social sense, it is the doctor's responsibility not to hurt the patient.
As we acknowledge, this social significance may change.
As long as their patient agrees, the doctor can be allowed to do harm to their patient.
We believe that this dramatic change in the role of doctors will expose countless vulnerable patients to unfair harm imposed on them.
If we are correct at this point, then it is fair to retain the current social significance of medicine, which supports policy --
Based on the parents' style of work, it is believed that the reasonable example of PAD must meet the maximum benefit conditions and decision-making --
Create capacity conditions.
Some would object that, for any particular patient, if all the relevant conditions were met, it would be unreasonable to exclude the parent-type intervention of the legal choice prepared for that patient.
This is an inference that we want to challenge.
In the literature on PAD, it is a mistake to pay too much attention to the ideal situation, and it is also a common mistake. in the ideal case, no mistakes will occur, and all uncertainties have been solved.
Because if the ideal case does not represent the type of case affected by the policy, then it does not tell us whether the policy is fully considered.
For this reason, parental restrictions on PAD must be collective
Focusing on the realistic assessment of the situation.
They must aim to prevent errors between a representative group of patients because they do not have enough confidence to know which individual members of the group will make mistakes or tend to make mistakes.
For the above reasons, when the group of patients considered is those diagnosed with a treatment disease,
Anti-depression, high probability of making mistakes.
Since this is important to our argument, we now add some further consideration to support this.
Although quite a few patients with severe depressive disorder are classified as treatment-resistant (
Some estimate this figure as high as 30%)
There is no clinical consensus on the criteria for this diagnosis.
Determine what is [correctly [treatment-
Consensus needs to be reached on the criteria for treatment response (
Dose, duration and compliance)
Sufficient trials are required before the patient is determined to be unresponsive.
But there is no such consensus.
Patients with depression diagnosed as treatment
Some standard resistance will not be diagnosed by other standards.
An attractive response to this problem is to set a set of clinical criteria for determining treatment
But the standard needs to be defended.
If there is no expert consensus on these criteria, why should these criteria be assumed instead of others when considering whether PAD should be extended to such patients?
In addition, specify "treatment-
This can be misleading.
For many, this will indicate that the patient cannot be helped by treatment.
However, for clinicians who study and treat depression, the name does not mean treatment
Proper treatment does not help drug-resistant patients.
In fact, once a patient with depression is diagnosed as a treatment
An important clinical problem has emerged.
Which treatment is the best for her?
Given these difficulties, one may try to introduce a new class of treating patients --
These are patients who were correctly diagnosed as treatment.
Resistance, the possibility of little response to any further treatment.
The obvious advantage of this approach is to pick out patients who intuitively claim to have the most legitimate choice.
This new patient category will be smaller than the patient category correctly diagnosed as treatmentresistant (
Any major statements regarding the relevant criteria for this diagnosis)
But the number of these patients may still be large.
The disadvantage of this approach is that it makes the effort to correctly identify the group of patients involved more complex.
Not only does the diagnosis have to correctly identify those who are treating depression --
It must also correctly identify those who are ineffective for further treatment.
At present, further decisions cannot be made by clinicians.
Related difficulties in diagnosis and treatment --
Drug-resistant depression does not suggest that a correct diagnosis cannot be made.
But they do bring a very large potential error to any such diagnosis.
Since the relevant error would violate the maximum benefit condition on the PAD acceptable instance, this type of error
Consideration restrictions on PAD should be designed to prevent.
Similar concerns can be raised about the decision.
Create capacity conditions.
Patients with severe depression are not necessarily disqualified from suicide.
But even acknowledging this, there are still huge challenges in determining when depression will disrupt decision-making --
Depression is an emotional disorder that affects decision-making, and severe depression can seriously affect people's ability to make decisions based on lasting values.
This reality helps explain why many people with depression show an unstable preference for their treatment.
14 assessment of decisions
Developing capacity for patients with severe depression is a challenge and often with considerable uncertainty.
In this case, one should expect to make mistakes, even if serious efforts are made to avoid them.
We have been drawing attention to these errors, as well as the possibility that they occur, which relate to whether PAD should be a legal option for those diagnosed with treatment --
These errors can be characterized as false positive errors related to patients who are not suitable for PAD due to impaired decision making
The possibility of enabling capacity or effective interventions that can restore the patient's willingness to live.
There is no systematic study of the prevalence of these errors in jurisdictions that allow these patient pads.
But scholars are concerned about this.
As one expert recently explained, "I believe that in Belgium people have died, there are still treatment options there, and there is still a chance for years or even decades (quality)life’.
16 policies are general in nature, but they can be developed so that there is a great deal of discretion for individuals applying them.
Some people may support the PAD policy for treating patients.
Anti-depression, establish a personalized approval process with strict guarantees.
But given the difficulties of diagnosis and treatment-
Drug-resistant depression, lack of clear professional consensus on the criteria for this diagnosis, and challenges in determining whether patients with severe depression have decisions --
Ability to make, there is little reason to think that a personalized approval process is a reliable guarantee to prevent false positive errors.
A little further explanation is needed.
Even if one believes that an ideal approval process can reduce the risk of false positive errors in an acceptable way, one still needs to consider the current approval process in the country concerned, and these procedures may be significantly improved in the near future.
One needs to take seriously the possibility that the required approval process is not feasible.
With this in mind, one can accept our argument during this period because it believes that PAD should not be extended to patients receiving treatment --
Anti-depression before establishing approval procedures that are strict enough and adequately resourced.
18. a better objection to our proposal is that, in highlighting the risk of false positive errors, we ignore another error of the same or more importance.
This error occurs when the patient is refused when he wants to end his life and when both decisions are rejected
Meet the conditions of capacity and best interests.
This error, the objection will continue to exist, and it will certainly happen under the parent-style policy that we have been proposing.
This objection once again demonstrates the key features of the policy situation that we are dealing.
Any policy on treating patient PAD
Whether it's parental or tolerant, resistance depression can benefit some patients and hurt others.
Under the loose policy, some patients will take responsibility for the false positive mistakes we have always emphasized.
In contrast, under a parent-teacher policy, when acceptable conditions are met, some patients will be prevented from participating in the PAD, resulting in potential false negative errors.
While we acknowledge that some people with depression may be hindered by the benefits of our recommended policies, the number of such patients may be small.
In addition, it is important to have a clearer understanding of the costs involved.
Extending the legal options of the PAD to defenders who treat patients --
Resistance to Depression claims that these patients will not be able to get rid of the pain without this option.
But, as we have pointed out above, this statement is correct only if these patients have no other option to end their lives.
There is such a choice.
Without the help of a doctor, patients can and do end their lives.
Some people have no impression of this observation.
The patient is not interested in anyone (have to)
Resort to starving themselves, jumping off a building or taking any number of more or less terrible means to cause their death.
We agree that it is desirable to avoid terrible means, but the option to stop eating and drinking can be a tolerable option for the PAD, in most jurisdictions of our concern, this is an option protected by law.
Voluntary cessation of diet (VSED)
Important ethical questions are raised for doctors we cannot accept.
But, most fundamentally, it can be seen as a product of moral and legal rights to reject unnecessary medical interventions.
21. There are many advantages to the VSED option, which is understandable.
First, a firm determination is needed to implement this decision.
Those who are ambivalent about ending their lives are unlikely to succeed in this way.
Second, it can take a couple of weeks to give patients a considerable amount of time to change their mind.
This is especially important for depression patients who often change their suicidal thoughts.
Third, almost all patients with depression can choose from, including those with severe physical damage, such as those with paralysis of the limbs.
Fourth, it doesn't need to be particularly uncomfortable for those involved.
When properly managed, the process of VSED is often described as calm, characterized by gradual weakness and decreased alertness, and in a few days to weeks it is gradually declining
23 fifth, doctors do not need to participate in the initial decision of the patient to participate in VSED.
In a recent study of VSED in the Netherlands, the researchers found that only one of the two family doctors was informed in advance of their patient's decision to choose VSED, one out of every three people did not participate in the decision at all.
The last point shows that it is not possible to simply treat VSED as a different form of PAD.
It is true that doctors often provide supportive care for patients who choose VSED.
But the doctor against PAD
Terminal patients can provide them with supportive care as a means to alleviate their physical pain, not as a means to end their lives.
The problem here is subtle.
There is an urgent need for better care and treatment for people with severe mental illness, including those with depression who have so far proved resistant to standard treatment.
For the reasons we have outlined, in determining whether the patient receiving the treatment is
Resistance to depression really goes beyond the help of treatment, so there may be considerable uncertainty as to whether VSED is in the best interests of the patient in any given case.
This is one of the reasons why doctors, even those who receive PAD permission from patients with advanced stage, do not want to recommend this option to patients who receive treatment --
The second reason is that it is difficult to determine that people with depression are capable of rejecting food and fluids.
If the patient does not decide
She was then unable to participate in VSED and we have reviewed the challenges in identifying patients with severe depression to meet decision-making --
Create capacity conditions.
However, for patients receiving treatment, VSED
For these patients, resistance to depression is less prone to error than PAD, because when they have the ability to exercise their legal right to refuse food and liquid, their doctors must respect this refusal, even if the doctor is still not sure if it is in the best interests of the patient to do so.
Despite the difficulties, VSED remains an option to treat patients and is legally protected in many jurisdictions
Although some patients think this option is not as good as the PAD, its availability reduces the cost of their rejection of the latter option.
This is helpful to our argument.
By reducing the costs of those who will fail under our proposed parent-teacher policy, it becomes more fair for them to bear those costs, given the alternative policy of extending PAD to patients receiving treatment --
Resistance to depression imposes the cost of false positive errors on others we have highlighted, and considering that the incidence of these errors may be higher than that of false negative errors. A group-
Focus on fairness
Parent-based policy, excluding PAD for treating patients
Thus, resisting the depression is a convincing (if imperfect) response to the conflict of interest among the affected parties.
Extend argument our argument can be applied to non-
Our respected terminal patient.
The likelihood and severity of false positive errors that extend the PAD to young healthy patients is indeed very high, and the cost of rejecting their choice is not high.
For patients who are "tired of life", the problem is not very clear --cut.
These patients are unlikely to misjudge what is their best interest, at least as we have described, and they have no mental illness.
Then there may be a large number of such patients to satisfy this decision --
Create the most favorable conditions.
In contrast, however, these patients do not have physical or mental illness that is not to be treated.
Given the current social significance of medicine, which makes it seriously problematic for doctors to participate in PAD, we think it is fair --
Based on the reasons for saving.
In addition, these patients have the option to end their lives with VSED without worrying about whether they will make a decision or not
Improved ability compared to patients receiving treatment
We feel like a well.
The considered policy on the PAD will not extend this option to patients who are "tired of living.
The error cost here is sufficient to justify the potential cost to those who have been rejected, especially given that they can choose VSED to end their lives.
But there is a more subtle point to come up with for patients who are "tired of life.
A fair parental style applies to regulatory programs that manage the PAD, as well as to society and self-
Understanding of people involved in practice.
Suggestions to modify or retain the social significance of medicine, or to interpret the advice of medicine in one way rather than another, involving greater problems with fair treatment for different categories of patients.
Moreover, these proposals were not made in a cultural vacuum.
Responsible advice to revise the social significance of medicine must recognize the danger of strengthening or contributing to bad social attitudes.
Patients who are tired of living often worry that their lives are no longer valuable, that they have become a burden on others, that their bodies are deformed, or that they have no significant contribution to society.
We are not saying that such concerns are invalid.
We do believe that they reflect and are influenced by the perception of older persons in the wider society.
There is a trend, at least among those who urge the expansion of legal options to a growing population, to consider the patient's decision to participate in the PAD as an isolated assessment of the value of one's own life.
These assessments and their motivational decisions are neither affected by the broader society's perception of older persons nor contributed to these attitudes in any significant way.
Such individualism is not credible.
People's attitudes and decisions are deeply influenced by the social environment, which should not be denied by anyone.
Responsible consideration of the PAD policy must take into account all the risks involved --
Direct and indirect, long term and short term.
One risk of extending the PAD to patients who are tired of living is that doing so will help the elderly to depreciate their society.
We point out here a potential danger, not an attempt to determine its existence or measure its severity.
This requires your own investigation.
Nevertheless, if we are right about the real concerns that exist here, then caution may be required.
Rather than making it easier for elderly patients to end their lives when they feel they no longer have anything to live, a society of one Tao, and medical practice as an integral part of it, may better combat the social attitudes and social conditions that lead to the self
The first is to belittle attitude.
It is true that this action may not comfort those who are tired of life because they are deprived of the legal option of the PAD.
They may feel that their interests have been sacrificed for the greater social interest.
However, we believe that there is no basic pad right, and the proper scope of the pad right is a policy issue.
And, considering that this is a policy issue, it is appropriate to consider all relevant risks.
Conclusion our argument supports a conditional policy stance: If PAD is a legal option, it should be limited to terminal patients.
We pay special attention to patients with treatment-
And those with old depression who are tired of life.
There are other groups of patients who are not suffering from terminal illness, and some may think this is a strong or stronger statement to extend PAD beyond terminal illness.
We acknowledge that our argument that the legal choice of PAD should not be extended to non-terminal patients is based on an unfeasible assumption, that is, the argument we put forward can be applied by appropriate modification to non-group
There is no discussion about terminal illness here.
The consideration of the social significance of fair parenting and medicine is not so powerful when targeting the PAD of the terminal patient.
False positive errors in these patients are not serious, because these patients will soon die regardless of medical intervention.
Similarly, when PAD is confined to terminal illness, the threat to the social significance of medicine is not so clear.
In contrast, the policy of tolerance for PAD may open the door to a large number of morally intolerable false positive errors, which will harm vulnerable patients and the professional ethics of doctors.
While drawing the PAD's line during terminal illness prevents some patients from accepting the PAD, it may be a morally permissible option, and the VSED option greatly reduces the severity of this error.
Fair parental style and the social significance of medicine make it reasonable to limit PAD to patients with terminal illness, so as to draw a clear line on PAD's legal choice.
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There is also a big difference between 6307OpenUrlFootnotes Zaii (
The latter (
But these differences are not important to our discussion.
In Canada, for example, the PAD was legalized in 2016 and applied to patients with "severe illness" and "natural death has become reasonably foreseeable (see Li et al27).
This apparently includes some non-terminal patients.
Advocates in Oregon are working to extend the standard beyond terminal illness to include patients with various degenerative diseases (see Kuznia28).
The expectations of our arguments can be found in Pickering Francis 29, Kim and Lemens, 15 although none of these discussions form a general normative framework to attract groups
Based on a fair parental style.
Who maintains that human rights in health care include the rejection
Medical treatment agreed by both partiessee www. who. int/news-room/fact-
European Court of Human Rights (
Haas v. Switzerland, 2014)
The patient has the right to decide the time and manner of death.
This does not mean that they are entitled to the help of others at the end of their lives. ↵v See Brock.
7. see also Van Berg.
See, for example, Van Berg.
30. effective criticism of Van Berg's strong anti-parental stance, in itself, invites readers to consider the case of suicide among young people, see Arnesen.
31 The Interpretation of rwviii is beneficial, and the statement here is not whether it is in the best interests of the patient to continue living, but rather an objective method of determining the facts.
The root cause of suffering should be distinguished from its nature and severity.
From the fact that the patient's suffering is not caused by a serious physical or mental illness, it does not mean that it is not serious.
Niux other Onwuteaka-Felison and others.
For a statement of the latter view, see Pellegrino.
33 ↵ xii but see the Third Assessment Report of the death rate act, where public support for PAD in patients with severe depression is reported to be 58%.
Xiii and others.
34. an important general statement of justice for Vivo xiv --
See Arnesen based on a parent-style.
35. for the application of this argument in clinical studies, see Jansen and Wall.
To be more precise, the hard-parent doctrine in the question is classified by Van Berg as indirect hard-parent because it involves two parties (
Doctors and patients)
Impose restrictions on one party (the physician)
To protect the other party (the patient).
See feynberg Pp9-10.
For example, 30 Pax xvi, can specify that "when treating two different categories of products in a row, the patient is considered to be resistant to treatment and used in sufficient doses for a long enough time, failed to introduce an acceptable effect.
The European Commission on proprietary drugs, a drug evaluation agency.
Description of the drug clinical investigation guidelines for the treatment of depression. Availableat (
Please note that there is still ambiguity or uncertainty in regulations like this, because clinicians may have different opinions on what is an acceptable dose for a long enough time, what is an acceptable effect. )(
Sourey et al, treatment
In addition, in order to qualify for clinical studies, this standard may be effective in defining "therapeutic resistance" but does not appear appropriate
Suitable for defining life qualification-
End practice of PAD.
Such patients also have illegal options, such as obtaining e-obarbital or other lethal drugs through the Internet.
See Bernat et al, 37 Jansen, 21 McGee and Miller, 25 and Quill et al for various views of VSED.
The 38 contributors LAJ, SW and FGM were all involved in the drafting of this manuscript, making a significant contribution to the writing, editing and revision of the manuscript.
All authors have also made significant contributions to the design and conception of the manuscript and have finally approved the completed manuscript.
All authors are held accountable for all aspects of their work.
Funding authors have not announced specific funding for this study from any public, commercial or non-commercial funding agency --for-profit sectors.
No one declared a competitive interest.
Patient consent is not required.
Uncommissioned source and peer review;
External peer review.