積分 27526
爵位二等廣武伯
榮銜從二品太子少保
官職正二品九門總兵
兼職從三品署理兵部右侍郎
身份博爾濟吉特嫡長主
旗籍蒙族正白旗
配偶赫舍里苕華
爵位二等廣武伯
榮銜從二品太子少保
官職正二品九門總兵
兼職從三品署理兵部右侍郎
身份博爾濟吉特嫡長主
旗籍蒙族正白旗
配偶赫舍里苕華
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摘要
1. 引言
2. 主動安樂死不得在香港合法化
3.實施安樂死的責任
3.1 誰應承擔實施非自願被動安樂死的責任
3.2 從病人和醫生的角度看實施自願被動安樂死的權利
4.臨終照護是安樂死的替代方案，對大多數需要安樂死的病例有用
5.結論
本文旨在提供安樂死的定義，解釋安樂死的各種類型，並概述安樂死在香港的現狀。目前，沒有足夠的證據支持安樂死在香港合法化。安樂死大致可分為兩大類：主動安樂死和被動安樂死，每一類又包括三個子類型：自願安樂死、非自願安樂死和不自主安樂死。雖然安樂死在香港合法化在某種程度上具有道德上的合理性，但考慮到安樂死的接受程度和實施安樂死的醫生資質，實施安樂死仍然是不切實際的。這一立場將透過三個步驟得到驗證。首先，由於積極安樂死的罪惡性質，應避免在香港將其合法化。其次是安樂死的責任分配問題，是由病人、醫生還是家屬來承擔？最後一步是介紹和解釋安寧療護，證明在考慮安樂死的大多數情況下，臨終照護是一種可行的替代方案。
1 引言
本文旨在闡述安樂死的定義、不同安樂死的類型及解釋，以及香港安樂死的現況。 Philippa Foot 認為，安樂死有三個組成部分：安靜和直接死亡的行動，以及促成這項行動的手段。 (Foot, 2002）
安樂死包括六種類型，而香港目前的情況並不支持安樂死合法化。安樂死可分為兩大類：主動安樂死和被動安樂死，每一大類又包括三個從屬類型：自願、非自願和非自願。主動安樂死是指透過直接介入結束臨終病人的生命，如注射致命劑量的止痛藥物（牛津大學出版社，2017年）。被動安樂死是指在明知當事人將會死亡的情況下，拒絕或撤銷維持其生命的治療。 (牛津大學出版社，2017年）自願安樂死是指當事人說出了對死亡的渴望。不自主安樂死是指當事人無法做出決定或無法表達自己的意願，而非自願安樂死則是指當事人希望活下去，但最終被殺死。 (英國廣播公司，2014年）
香港不允許安樂死。根據《守則》第34.2段，安樂死的定義是 "作為所提供的醫療服務的一部分，直接故意殺害某人"。 (香港特別行政區政府，2016 年）《守則》規定，安樂死是非法和不道德的。這種態度表明，地方政府認為，讓一個人有尊嚴地活著，而不是讓他死去，是合乎道德的。
下文将分三个步驟探討反對安樂死合法化的問題。首 先，主動 安樂死 不 應 在香港合 法 化 ， 因為這是 不 道 德 的 。其次是安樂死 的 責 任 問 題 ， 究 竟 應 由 病 人 、 醫生還 是 親 屬 負責？最后一步是介绍和阐明臨終照護的做法，说明臨終照護可以替代大多数需要安乐死的病例的理由。
2. 積極安樂死不得在香港合法化
醫生主動執行安樂死，是透過直接介入（如注射致命的止痛藥物）來結束臨終病人的生命。然而，由於希波克拉底倫理學由四個主要民族原則組成：自主、恩惠、非瀆職和公正，主動安樂死貶低了醫生的角色。 (Jeffery, 2006）在這些原則中，"非惡意 "是指不傷害病人。然而，積極安樂死無疑會透過注射有毒物質對病人造成傷害。基於此原則，香港絕不允許醫師違反救死扶傷使命的積極安樂死。
安樂死合法化亦可能造成紅燈區效應。(INVESTOPEDIA, 2017）由於主動安樂死可以在短時間內結束一個人的生命，其他人可能會違反規定，為其他目的而實施安樂死。 例如，患有精神疾病的人可能希望透過安樂死結束自己的生命。 如 果 香港容許主動 安樂死 的 話 ， 有 些 人 即 使不是 病入膏肓， 也 會 尋 求 死亡， 而不是 以其他方 法 解決問題。 一旦 本港社 會 接 受 主 動 安樂死 ， 市 民 便 會容許不 同 類 型 的安樂死 。 殺人犯可能會以此為藉口逃避法律制裁，例如日本就發生了兩起案件。 (劉建利，2013）因此，這將導致對人的生命的不尊重。
反對者可能會強調，積極安樂死應該在某些情況下適用，尤其是對於那些遭受難以忍受的痛苦的臨終病人。 舉 例 來 說 ， 傑 克 因 患 上 癌 症 而 感 到 極 度 痛 苦 ， 須 靜 脈 註 射 嗎 啡 來 紓緩痛 楚 。 儘 管 如 此 ， 傑 克 仍 然 感 到 痛 苦 ， 他 的 哭 聲 也 越 來 越 頻 密 。 為了讓傑克擺脫痛苦，主動安樂死似乎是個合適的選擇。
但這是不道德的，因為醫生的職責是拯救生命，而不是消滅生命。 此外，主動安樂死的過程與死刑相似，是用來懲罰罪犯的刑法。 既 然 病 人 不 是 違 法，便 不應該被 主 動 安樂死 。 此 外 ， 即使安樂死 合 法 化 ， 尤 其 是主動 安樂死 ， 有 助 臨 終 病 人 止 痛 ， 但 在 公 共 政 策 層 面上， 卻 是 不 切 實 際 的 。 顯然，這與公共利益相悖，弱者在這種情況下無法受到保護。 (楊庭輝 & 郭文德, 2017)
3.實施安樂死的責任
3.1 誰應承擔實施非自願被動安樂死的責任
非自願安樂死是指病人無法計劃或無法表達自己的意願，因此，醫生或親屬在實施安樂死時將承擔更多的責任。患者無法做出決定有多種原因，例如患者可能是持續性植物人狀態（PVS）或患有晚期阿茲海默症。
在這種情況下，只有醫生或親屬才能做出決定。有些人可能會說，這是家屬的責任，因為他們有權為病人簽署法律文件，即知情同意書和 "不急救 "表格。然而，這是否表示他們有權放棄病人的生命？支持者認為，親屬簽署了要求安樂死的文件，因此他們需要承擔責任。這種說法一時聽起來很有道理，但深入調查後發現並非如此。事實上，親屬收到的所有文件都是由醫生提供的。如果醫生不提供這些文件，親屬就沒有機會為病人做決定。當他們收到需要安樂死許可的文件時，醫生對病人的決定就顯示出來了，病人在未來是無法康復的。雖然親屬在文件上簽了字，但他們只是同意或不同意醫生的決定。
3.2 從病人和醫生的角度看實施自願被動安樂死的權利
自主權是病人的權利之一，因此有人認為病人有死亡的權利。 但要先明確的是，病人有死亡的自由，但沒有死亡的權利。 (楊庭輝 & 郭文德，2017) 自由是指以自己的意願行事、說話或思考的權力，而權利是指擁有或做某事的道德或法律權利。 (牛津大學出版社，2017 年）由於安樂死只是病人的自由，因此它是醫生實施安樂死的充分條件，而不是必要條件。
有些人可能會說，病人應該對自己的生命有絕對的控制權，所以醫生應該按照病人的意願實施安樂死。這種說法是不成立的。病 人 希望安樂死，不代表他們必須安樂死。病人的自主權不應與醫生的自主權對立。由於希波克拉底誓言中的道德原則，大多數醫生反對實施安樂死。 (匿名，2012 年）除此之外，安樂死不僅與病人有關，醫生也參與其中。一旦醫生實施了安樂死，他們也需要承擔終止病人生命的責任。因此，醫生和患者在做出這項不可逆轉的決定時都應慎之又慎。
很難衡量病人的自主權是否得到了適當的利用。 病人要求安樂死的原因各有不同，例如照護不足或對家庭造成沉重的經濟負擔。 此 外 ， 有 些 病 人 可 能 是 受 到 社 會 壓 力 ， 被 迫 安樂死 的 。 有些人會認 為 長 期 患 有 嚴 重 疾 病 或 罕 有 疾 病 的 病 人，是浪 費 社 會 資 源 。 因 此 ， 病 人會感 到 壓 力而要 求 安樂死 ， 即 是 說 他們沒有相 應 的 自 主權。
經 典 的例子 說 明，只 有 醫生才 有 資 格 安樂死 ， 但 醫生卻 不應該 安樂死 。 劊子手有資格殺人，也有能力教別人殺人。 這些條件並不表示劊子手可以為了不道德的行為而殺人。 從這個例子來看，即使醫生可以實施安樂死，而且病人也接受安樂死，但由於安樂死是不道德的行為，醫生也不應該實施安樂死。
總 括 而言 ， 即 使 醫生有 資 格 實 施 安樂死 ， 也 不應該 實 施 ， 因為這是 不 道 德 的 行為， 而 醫生和 病 人的權利也 應該受到尊 重 。
4.臨終照護是安樂死的替代方案，對大多數需要安樂死的病例有用
由於安樂死在香港並不適合合法化，安寧療護成為照顧病人的實用方法。安寧療護是一種改善面臨危及生命疾病問題的患者及其家屬生活品質的方法，並提供疼痛和其他問題的治療，如身體、社會心理和精神問題。 (世衛組織，2017 年）此外，安寧療護也可以在臨終關懷機構中發展起來，作為對臨終關懷患者及其家屬關懷不足的回應。
一個典型案例可以揭示臨終照護的重要性。瑪麗是一名 40 歲的教師，丈夫本來是一名電腦程式設計師。他們有兩個孩子，喬和安娜。五年前，瑪麗罹患了乳癌，並接受了手術、放療和化學治療。不幸的是，瑪麗受到了這些療法的副作用的影響，健康狀況惡化。一家人向醫生、護士和心理醫生尋求幫助。最後，本和孩子們在瑪麗去世後再次見到了心理醫生，以獲得喪親支持。很明顯，臨終照護對這個家庭來說已經足夠了，因為護士和心理醫生可以緩解瑪麗的身體痛苦和心理焦慮。此外，其他家庭成員也可以向專家尋求協助，以應對悲傷問題。 (傑弗裡，2006 年）
在提供臨終照護時，所有專家都在實踐康德的 "道義論"。康德的道義論關注的是行為的性質，而不是行為的結果。如果行動是道德的，人們就應該去做，而不考慮其後果。 (沙基爾，2017）臨終照護也關注病人的感受，這與康德的道義論原則接近：人應該被當作手段，而不是目的。既然維持瑪莉有尊嚴的生命是合乎道德的，那麼所有的專家都會提供臨終照護，而不是實施安樂死。
臨終照護也符合醫生的道德標準。受益是《希波克拉底誓言》中的道德原則之一，（Berdine，2015）宗教倫理體系包括對自主、正義、非瀆職和受益的考慮，但服從神的命令優先於其他職責，因此醫生有必要理解瑪麗的受益。很顯然，護士給瑪麗服藥緩解症狀，幫助本照顧妻子幾個晚上，以減輕照顧瑪麗的壓力。心理學家能夠為兩個成年人提供心理支持。所有這些都與瑪麗的利益有關，專家可以解決這些問題，使她能夠安詳地離開人世。此外，這也得到了全世界醫生的廣泛支持。
5.結論
透過上述分析，我們可以看出，在大多數情況下，實施安樂死是不道德的。 安樂死合法化可能會導致許多問題，如紅燈區效應風險、違反希波克拉底倫理、不尊重人的生命等。 醫生是唯一有能力實施安樂死的群體，他們應該為此行為負起大部分責任。 然而，他們實施安樂死是不道德的。 雖 然 在 少 數情況下，安樂死 可以是 道 德 上 的 做 法，但 在現今 的 香港， 這 種 做 法 可 能並不可行。 有鑑於此，臨終照護比安樂死更合乎道德，因為臨終照護可以持續解決病人的需要和感受。
參考
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原文
Is there any sufficient ground for legalising euthanasia in Hong Kong
Abstract
1. Introduction
2. Active euthanasia must not be legalized in Hong Kong
3.Responsibility for the Implementation of Euthanasia
3.1 Who should be responsible for implementing involuntary passive euthanasia?
3.2 The right to perform voluntary passive euthanasia from the point of view of both the patient and the doctor.
4.Palliative care is the alternative to euthanasia that is useful in most cases requiring euthanasia.
5.Conclusion
This paper aims to present an objective overview of euthanasia, including its definition, various types and their explanations, and the current situation in Hong Kong. Euthanasia encompasses two primary types: active and passive. Each type is further divided into three subtypes: voluntary, involuntary, and non-voluntary. However, there is currently no compelling evidence to support the legalization of euthanasia in Hong Kong. Although legalizing euthanasia in Hong Kong may have some moral justification based on the acceptance of euthanasia and the qualifications of physicians to perform it, it remains impractical to implement. To establish the validity of this stance, three steps will be discussed. Firstly, active euthanasia should not be legalized in Hong Kong due to its sinful nature. The following step concerns determining who bears responsibility for implementing euthanasia - patients, physicians, or relatives. The final step involves introducing and explaining palliative care, which can serve as an alternative for the majority of cases that call for euthanasia.
This brief article aims to provide a definition of euthanasia, an explanation of the various types of euthanasia, and an overview of its current status in Hong Kong. At present, there is insufficient evidence to support the legalisation of euthanasia in Hong Kong. Euthanasia can be broadly categorised into two major types: active and passive euthanasia, each of which comprises three subtypes: voluntary, involuntary, and non-voluntary euthanasia. Although legalising euthanasia in Hong Kong may be morally justifiable to some extent, given the acceptance of euthanasia and the qualification of physicians to perform it, it remains impractical to implement. This stance will be validated through three steps. Firstly, legalising active euthanasia in Hong Kong should be avoided due to its sinful nature. The next stage concerns the allocation of responsibility for implementing euthanasia - should it rest with the patient, medical practitioners or family members? The final step is to introduce and explain palliative care, demonstrating that it could be a viable alternative in the majority of cases where euthanasia is being considered.
1.
Introduction
This paper aims to provide a definition of euthanasia, explain the different types of euthanasia, and examine the current situation of euthanasia in Hong Kong. According to Philippa Foot (2002), euthanasia comprises three components: the action and nature of a peaceful and pain-free death, along with the means of achieving it.
Euthanasia encompasses six types, but currently, the legalisation of euthanasia is not supported in Hong Kong. Euthanasia can be divided into two main categories: active and passive euthanasia. These categories encompass three subtypes each, namely voluntary, involuntary, and non-voluntary euthanasia. Active euthanasia involves directly intervening in the life of a terminally ill individual, typically through the administration of lethal painkilling drugs. On the other hand, passive euthanasia refers to the withholding or withdrawal of life-sustaining medical treatment when it is known that the person will not survive. Additionally, voluntary euthanasia specifically pertains to the expressed wish for death by the person in question. These definitions are according to the Oxford University Press (2017). Non-voluntary euthanasia refers to situations where a person is unable to make a decision or communicate their wishes, while involuntary euthanasia involves the killing of an individual who wishes to live. (BBC, 2014)
Euthanasia is prohibited in Hong Kong, as stated in paragraph 34.2 of the Code, which defines it as "direct intentional killing of a person as part of the medical care being offered". (The government of HKSAR, 2016) The Code expressly prohibits euthanasia, deeming it both illegal and unethical. This perspective implies that the local government considers it ethical to maintain an individual's life with respect, instead of permitting death.
The ensuing sections will argue against the legalisation of euthanasia in three stages. Firstly, it is essential that active euthanasia remains illegal in Hong Kong, as it is unethical. The subsequent stage is concerned with determining who should shoulder the responsibility of implementing euthanasia, whether it should be the patient, physicians, or relatives. The final step involves introducing and clarifying the practice of palliative care to provide reasons for its suitability as an alternative to euthanasia in most cases.
2. The legalisation of active euthanasia in Hong Kong is not recommended.
Active euthanasia, where physicians directly intervene to end a terminally ill person's life, such as administering a lethal dose of painkilling drugs, is considered inappropriate according to the Hippocratic ethics.
These ethics are based on four dominant principles: autonomy, beneficence, non-maleficence, and justice. The practice of active euthanasia undermines the role of physicians. (Jeffery, 2006) Non-maleficence, amongst these principles, entails avoiding harming a patient. Nevertheless, administering toxic substances unquestionably causes harm to the patient, which contradicts the physician's duty in Hong Kong to preserve life. Nevertheless, administering toxic substances unquestionably causes harm to the patient, which contradicts the physician's duty in Hong Kong to preserve life. Therefore, active euthanasia should not be permitted.
The legalisation of euthanasia poses a significant risk of spillover effects. (INVESTOPEDIA, 2017) Active euthanasia can quickly end a person's life, which may lead to rule violations and use for non-terminal conditions. For instance, individuals experiencing mental distress could seek to end their lives via euthanasia. If allowed in Hong Kong, active euthanasia could become a means of problem-solving for some, even if they are not terminally ill. Once active euthanasia is accepted within society, there is a risk that other forms of euthanasia may also be allowed. This could provide an excuse for murderers to evade legal punishment, as seen in two cases in Japan. (刘建利, 2013) Additionally, it could lead to a lack of respect for human life.
Opponents argue that active euthanasia may be appropriate in certain circumstances, particularly for terminally ill patients experiencing unbearable pain. For instance, Jack experienced intense pain due to his cancer, requiring an intravenous injection of morphine to alleviate the discomfort. Despite this, Jack continued to suffer and his crying grew more frequent. Active euthanasia appears to be a viable option for relieving Jack's pain.
However, the act is immoral as a doctor's duty is to preserve life, not to end it. Furthermore, active euthanasia is comparable to the death penalty used to punish criminal offenders. As patients are not criminals, active euthanasia should not be considered an appropriate solution. Additionally, while the legalisation of euthanasia, including active euthanasia, may be beneficial in relieving the suffering of a terminally ill patient, it is not a practical approach for public policy. This would be contrary to the public interest, as vulnerable individuals may not be adequately protected. (楊庭輝 & 郭文德, 2017)
3. Responsibility for implementing euthanasia
3.1 Who should bear the responsibility of implementing non-voluntary passive euthanasia?
Non-voluntary euthanasia occurs when patients are unable to express their wishes, either because they cannot plan for the future or because they are unable to communicate their wishes.
Responsibility for implementing euthanasia
3.1 Who should bear the responsibility of implementing non-voluntary passive euthanasia?
Non-voluntary euthanasia occurs when patients are unable to express their wishes, either because they cannot plan for the future or because they are unable to communicate their wishes.
Responsibility for implementing euthanasia
3.1 Who should bear the responsibility of implementing non-voluntary passive euthanasia?
Non-voluntary euthanasia occurs when patients are unable to express their wishes, either because they cannot plan for the future or because they are unable to communicate their wishes. In such cases, either physicians or relatives will bear greater responsibility for the use of euthanasia. There are several reasons why patients may be unable to make decisions, such as being in a persistent vegetative state (PVS) or suffering from advanced Alzheimer’s disease.
In this situation, only physicians or relatives are authorized to make decisions. While some argue that it is the responsibility of families to decide because they have the right to sign legal documents on behalf of the patient, such as informed consent and "Do Not Resuscitate" forms, does this imply that they have the right to choose to end the patient's life? Supporters of euthanasia argue that the responsibility lies with the relatives who sign the document requesting it. The stated argument appears plausible, yet subsequent investigation reveals otherwise. The fact is that physicians provide all the documents received by the patient's relatives. Without these documents, the relatives would be unable to make decisions regarding the patient's care. Upon receiving the document detailing the permission for euthanasia, the physician's prognosis that the patient would not recover was made clear to the family. Upon receiving the document detailing the permission for euthanasia, the physician's prognosis that the patient would not recover was made clear to the family. Although the relatives signed the document, they merely assented or dissented to the physician's verdict.
3.2 The Right to Voluntarily Passive Euthanasia from Both Patient and Physician Perspectives
Autonomy is considered a fundamental patient right, leading some to believe that patients have the right to die. However, it is important to clarify that patients have the freedom to die, but not a legal entitlement to do so. (楊庭輝 & 郭文德, 2017) Freedom refers to the power to act, speak, or think as one wishes, whereas rights refer to moral or legal entitlements to have or do something. (Oxford University Press, 2017) Euthanasia represents patient freedom and is sufficient rather than necessary for physician intervention.
Although some may argue that patients should have absolute control over their lives, physicians should not necessarily practice euthanasia according to patients’ wishes, as it does not necessarily follow that all patients who desire euthanasia truly require it. Patient autonomy should not conflict with that of physicians. Abbreviations such as "UK" and "NHS" should be explained upon first use. Many physicians oppose carrying out euthanasia due to moral principles outlined in the Hippocratic Oath (Anonymous, 2012). Furthermore, euthanasia involves not only patients but also physicians. When physicians perform euthanasia, they must accept the responsibility of ending their patients' lives. Hence, it is crucial for medical professionals and individuals to exercise caution while engaging in this irreversible decision.
Evaluating whether patient autonomy was effectively employed can prove challenging. There exists a multitude of reasons why patients may seek euthanasia, ranging from inadequate care to imposing financial strain on family members. There exists a multitude of reasons why patients may seek euthanasia, ranging from inadequate care to imposing financial strain on family members. There exists a multitude of reasons why patients may seek euthanasia, ranging from inadequate care to imposing financial strain on family members. Furthermore, external pressures from society might coerce some patients into considering euthanasia. Some argue that patients with severe chronic illnesses or rare diseases consume disproportionate social resources. This perception may lead to pressure on patients to request euthanasia, which compromises their autonomy.
While it is true that only physicians possess the qualifications to perform euthanasia, they should not exercise this power. It is akin to how an executioner is qualified to kill someone but should not do so and teach others how to do it. These conditions do not suggest that the executioner may execute anyone due to unethical behaviour. Despite the fact that physicians are permitted to practice euthanasia and it is acknowledged by the patient, physicians must refrain from doing so due to its immorality.
In conclusion, while physicians are permitted to practice euthanasia, it is unethical, and the rights of both physicians and patients must be respected.
References
[1] Anonymous. Physician fights right-to-die law; palliative care doctor opposed to assisted
suicide. Kamloops Daily News 2012 Mar 16;News Sect A:5.
[2] BBC. (2014). Voluntary and involuntary euthanasia. Retrieved from http://www.bbc.co.uk/ethics/euthanasia/overview/volinvol.shtml
[3] Berdine, G. (2015). The Hippocratic Oath and Principles of Medical Ethics. The Southwest Respiratory and Critical Care Chronicles, pp. 28-32.
[4] Foot, P. (2002). Euthanasia.
[5] INVESTOPEDIA. (2017). Spillover Effect. Retrieved from https://www.investopedia.com/terms/s/spillover-effect.asp
[6] Jeffery, D. (2006). Patient-centred Ethics and Communication at the End of Life. CRC Press.
[7] OXFORD. (2017). Definition of right in English:. Retrieved from https://en.oxforddictionaries.com/definition/right
[8] Oxford University Press. (2017). freedom. Retrieved from
https://en.oxforddictionaries.com/definition/freedom
[9] Oxford University Press. (2017). active euthanasia. Retrieved from https://en.oxforddictionaries.com/definition/active_euthanasia
[10] Oxford University Press. (2017). passive euthanasia. Retrieved from https://en.oxforddictionaries.com/definition/passive_euthanasia
[11] Shakil, A. (2017). Kantian Duty Based (Deontological) Ethics. Retrieved from http://sevenpillarsinstitute.org ... eontological-ethics
[12] The government of HKSAR. (2016, December 14). LCQ4: Euthanasia. Retrieved from http://www.info.gov.hk/gia/gener ... 0657.htm?fontSize=1
[13] WHO. (2017). WHO Definition of Palliative Care. Retrieved from http://www.who.int/cancer/palliative/definition/en/
[14] 楊庭輝, & 郭文德. (2017, September 7). 【01沙龍】安樂死：哲學和倫理學多角度探討. Retrieved from https://www.hk01.com/%E6%96%B0%E ... 6%E6%8E%A2%E8%A8%8E
[15] 孫效智. （2012）安寧緩和醫療條例中的末期病患與病人自主權 pp1-28
[16]刘建利. (2013). 死亡的自我决定权与社会决定权——中日安乐死问题的比较研究. 法律科学(西北政法大学学报), pp. 62-71.
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