美國五個州承認安樂死合法

‘Aid in Dying’ Movement Takes Hold in Some States

美國五個州承認安樂死合法

DENVER — Helping the terminally ill end their lives, condemned for decades as immoral, is gaining traction. Banned everywhere but Oregon until 2008, it is now legal in five states. Its advocates, who have learned to shun the term “assisted suicide,” believe that as baby boomers watch frail parents suffer, support for what they call the “aid in dying” movement will grow further.

丹佛——幾十年來，幫助病危患者終結(jié)他們的生命一直被譴責(zé)是不道德的，而如今卻在獲得更多的支持。在2008年以前，俄勒岡州以外的所有地方都禁止為病?；颊呓K結(jié)生命，但如今這種做法已經(jīng)在五個州取得合法地位。它的倡導(dǎo)者們知道，要避免使用“協(xié)助自殺”一詞，他們相信，當(dāng)嬰兒潮一代眼看自己年老體弱的父母飽受病痛折磨時，被他們稱為“死亡援助”的運動就會得到更大的支持。

In January, the New Mexico Supreme Court authorized doctors to provide lethal prescriptions and declared a constitutional right for “a competent, terminally ill patient to choose aid in dying.” Last May, the Vermont Legislature passed a law permitting it, joining Montana, Oregon and Washington. This spring, advocates are strongly promoting “death with dignity” bills in Connecticut and other states.

1月，新墨西哥州最高法院(New Mexico Supreme Court)授權(quán)醫(yī)生開具致命性的處方藥物，并宣布“一位具有行為能力的病?；颊哌x擇死亡援助”是憲法賦予的權(quán)力。去年5月，佛蒙特州議會通過了一項法律準許此種做法，由此加入了蒙大拿州、俄勒岡州和華盛頓州的行列。這個春天，倡導(dǎo)者們正在康涅狄格等州大力推廣“尊嚴死”法案。

Public support for assisted dying has grown in the past half-century but depends in part on terminology. In a Gallup Poll conducted in May, for example, 70 percent of respondents agreed that when patients and their families wanted it, doctors should be allowed to “end the patient’s life by some painless means.” In 1948, that share was 37 percent, and it rose steadily for four decades but has remained roughly stable since the mid-1990s.

在過去50年，公眾對死亡援助的支持已有所增加，但這從一定程度上也取決于所用的術(shù)語。例如，在去年5月份進行的一次蓋洛普民意調(diào)查(Gallup Poll)中，70%的受訪者同意，如果患者和他們的家人希望得到幫助，醫(yī)生應(yīng)該有權(quán)力“以一些無痛的方式來終結(jié)患者的生命”。1948年，這一比例是37%，它在40年里穩(wěn)定增長，但從20世紀90年代中期開始就大體維持在一個穩(wěn)定的水平。

Yet in the same 2013 poll, only 51 percent supported allowing doctors to help a dying patient “commit suicide.”

然而就在同一個2013年民調(diào)中，只有51%的受訪者支持允許醫(yī)生幫助垂死病人“實施自殺”。

About 3,000 patients a year, from every state, contact the advocacy group Compassion & Choices for advice on legal ways to reduce end-of-life suffering and perhaps hasten their deaths.

每年，來自各州的大約3000名患者會聯(lián)系倡導(dǎo)組織“慈悲與選擇”(Compassion & Choices)，以尋求建議，希望以合法途徑減少臨終痛苦，或許加速死亡。

Giving a fading patient the opportunity for a peaceful and dignified death is not suicide, the group says, which it defines as an act by people with severe depression or other mental problems.

該組織表示，讓一位垂死病人有機會以平和、有尊嚴的方式死去，并不是自殺。他們認為，自殺是有著嚴重抑郁癥或其他精神問題的人實施的行為。

But overt assistance to bring on death, by whatever name, remains illegal in most of the country. And so for Robert Mitton of Denver, 58 and with a failing heart, the news from New Mexico last month was bittersweet.

但是在美國大多數(shù)地區(qū)，不論以何種名義，公開提供幫助，以帶來死亡，都仍是違法的。因此，對患有嚴重心臟病的58歲的丹佛人羅伯特·米頓(Robert Mitton)來說，上個月來自新墨西哥的那個消息令他又喜又悲。

“I am facing my imminent death,” he said, asking why people in Montana and New Mexico “are able to die with dignity and I am not.”

“我即將死去，”他說，他不明白為什么蒙大拿和新墨西哥的人“能夠有尊嚴的死去，而我不能”。

“This should be a basic human right.”

“這應(yīng)該是一個基本的人權(quán)。”

Husky and garrulous, with a graying ponytail, Mr. Mitton does not look like a dying man. But his doctors say that he must undergo extensive open-heart surgery in the coming months or face a nearly certain and painful end.

米頓身材魁梧、十分健談，灰白的頭發(fā)扎成一個馬尾，他看上去怎么都不像垂死之人。但是他的醫(yī)生說，他必須在未來幾個月接受一次大面積的開胸手術(shù)，否則的話，他幾乎必然會面臨痛苦的死亡。

A previous operation to replace his aortic valve was so brutal, he says, that now, with his prior implant failing, he will not endure the surgery again. He wants a doctor’s help to end his life before he becomes too helpless to act.

他說，此前進行的一次心瓣置換術(shù)非常之殘酷，而如今，移植的器官正在衰竭，他不愿再忍受這樣的手術(shù)。他希望在自己變得無法自理、不能采取任何行動之前，由醫(yī)生來幫助他終結(jié)生命。

Mr. Mitton’s frustrated quest draws attention to the limited choices facing patients in the large majority of states that bar the practice.

米頓無法實現(xiàn)的愿望讓人們認識到，在禁止此種操作的絕大多數(shù)州里，患者所面臨的選擇多么有限。

Opponents say that actively ending a life, no matter how frail a person is, is a moral violation and that patients might be pushed to die early for the convenience of others.

而反對者表示，不論一個人的身體多么衰弱，主動終結(jié)生命都是違反道德的，而一些患者也可能因為其他人的便利，而被迫早死。

“The church teaches that life is sacred from conception through to natural death,” Archbishop Michael J. Sheehan of Santa Fe, N.M., told legislators at a recent breakfast as he criticized the court decision there.

新墨西哥州圣菲的大主教邁克爾·J·希恩(Archbishop Michael J. Sheehan)批評了新墨西哥州最高法院的決定，他在最近的一次早餐會上對議員們說，“基督教告訴我們，生命從孕育到自然死亡，都是無比神圣的。”

“This assisted-suicide thing concerns me,” Archbishop Sheehan added, according to The New Mexican. “I foresee dangerous consequences.”

據(jù)《新墨西哥報》(The New Mexican)報道，希恩大主教又補充說道，“這個叫做協(xié)助自殺的東西讓我很不安。我能預(yù)見到危險的后果。”

Mr. Mitton’s predicament illustrates a seldom-discussed side of the debate: the anguish experienced, and the sometimes desperate measures taken, by some patients in states where doctors who knowingly prescribe lethal drugs, or relatives who help a patient obtain them, can be subject to felony charges of “assisted suicide.”

米頓面臨的尷尬境地清楚地描繪了這場辯論中很少涉及的一面。經(jīng)歷了極度的痛苦折磨后，病人有時會采取絕望的措施，因為在他們所在的州，醫(yī)生有意開具致命藥物，或是親屬幫助病人獲取這種藥物，都可能會觸犯法律，構(gòu)成“協(xié)助自殺”的重罪。

There is a quiet, constant demand all over the country for a right to die on one’s own terms, said Barbara Coombs Lee, president of Compassion & Choices, and that demand is likely to grow, she said, as the baby boomers age.

“慈悲與選擇”的主席芭芭拉·庫姆斯·李(Barbara Coombs Lee)表示，在全國上下，都不斷有人小聲地要求擁有按照自己的意志去死亡的權(quán)利。她說，而隨著嬰兒潮一代的老去，這種要求可能會增加。

Her group counsels people who call for advice, Ms. Lee said, describing options but not encouraging them to end their lives or providing direct help.

李表示，她的組織會為那些打電話尋求意見的人提供咨詢，會描述各種可能的選擇，但并不鼓勵他們終結(jié)生命，或給予直接幫助。

Callers who seem to be mentally disturbed and suicidal, she said, are referred to a suicide hotline. If they are facing imminent suffering and death and seek some control, the group urges them first to arrange for palliative or hospice care as they consider their next steps.

她說，如果打電話的人看上去精神狀態(tài)不穩(wěn)定、有自殺傾向，他們就會被建議撥打一個自殺熱線。如果他們即將遭受巨大的痛苦和死亡，尋求對此加以控制，這一組織就會要他們在考慮下一步措施的同時，首先安排姑息治療或臨終關(guān)懷。

“People should get the best care, but also have a choice to accelerate the time of death if the very best care cannot make their remaining days acceptable,” she said.

“人們應(yīng)該獲得最好的治療，但如果即使接受了最好的治療，他們余下的日子依然難以忍受，那么他們也應(yīng)該可以選擇加速死亡，”她說。

One method for some is to simply halt vital treatments, such as dialysis or insulin. Another is to turn off a pacemaker or, like Mr. Mitton, refuse an unwanted new treatment. An increasingly popular choice, she said — “for patients who are truly, emotionally and spiritually ready to die” — is to stop eating and drinking.

對一些人來說，一條途徑就是停止透析、胰島素注射等必需的治療。另一條途徑就是關(guān)閉心臟起搏器，或者像米頓那樣，拒絕他所厭惡的新治療手段。她說，“對一些真正地、從情感和精神上都做好了死亡準備的人來說”，一個日益普遍的做法則是停止進食和飲水。

Others try to accumulate medications that would bring a peaceful death.

其他人則會存下一些藥物，幫助他們平靜地死去。

But it makes a tremendous difference, Ms. Lee said, to live where the law permits assisted dying. Too often people seek alternatives in shame and secrecy, sometimes making frantic international trips for lethal drugs or using more violent means to kill themselves.

李說，住在法律允許援助性死亡的地方，結(jié)果會十分不同。通常，人們羞愧地、偷偷摸摸地尋找其他途徑，有時會不顧一切地出國尋求致命藥物，或者以更暴力的手段自殺。

Research in Oregon indicates that for many patients, just knowing the option is there has proved a great comfort, she noted. Of the 122 patients who obtained lethal drugs in 2013, only 71 used them, the rest dying naturally with the pills in a drawer.

她指出，俄勒岡州所做的調(diào)查表明，對許多患者來說，僅僅知道有這樣一個選擇就是一個極大的安慰。在2013年，在122名取得致命藥物的患者中，僅有71人使用了這些藥物，其他人都是自然地死去，而這些藥片則靜靜地躺在抽屜里。