論積極安樂死之臨床實務問題：以安樂死合法化國家為中心之系統性文獻回顧（二）【全球瞭望】 試閱
Identifying Practical Clinical Problems in Active Euthanasia: A Systematic Literature Review of the Findings in Countries Where Euthanasia Is Legal (II)
目標：全球目前只有七個國家通過積極安樂死合法化，這些國家在執行上遭遇一些困境，本研究主要針對文獻中有關臨床實務積極安樂死進行彙總。方法：以系統性文獻回顧之方法，針對140份文件，包含130篇文章（文章來源為PubMed以及EthxWeb）以及10個安樂死法規進行分析。結果：經過文獻分析各國與安樂死有關的具體問題回報後，可以得出五個問題點，分別為：存在許多有待解釋之模糊空間、對於自願性選擇的保證不足、如何回應因精神疾病而請求安樂死之情形、出於道德良心而反對，以及醫療人員不遵從行為。結果之重要性：存在許多有待解釋之模糊情況可能導致「滑坡效應」發生；對於自願性的保證不足違反了尊重自主原則，此原則為安樂死之根本基礎；因內心煎熬而進行安樂死的案例下，很重要的一件事情是需要區分：因單純因精神疾病導致內心痛苦而想選擇死亡，或者是因為身體疾病煎熬產生心理症狀而想選擇死亡；由於執行安樂死的醫生需要承受相當大的壓力，所以出於道德良心而反對執行安樂死仍應作為一個選項供醫生選擇；醫療人員因為對於安樂死規定缺乏認知或者不同意而產生的不遵從行為是與程序正義相違背的。
Objectives. Currently, active euthanasia is legalized in only 7 countries worldwide. These countries have encountered problems in its implementation. The study aims to summarize the practical clinical problems in the literature on active euthanasia. Methods. A systematic literature review was conducted using 140 works consisting of 130 articles from PubMed and EthxWeb and data from 10 euthanasia laws. Results. After reviewing the specific problems reported to be associated with euthanasia in each country, 5 problems were extracted: many ambiguous conditions with room for interpretation, insufficient assurance of voluntariness, response to requests for euthanasia due to psychological distress, conscientious objection, and noncompliance by medical professionals. Significance of results. Multiple ambiguous conditions that are open to interpretation can result in a “slippery slope phenomenon.” An insufficient guarantee of voluntariness violates the principle of respect for autonomy, which is the underlying justification for euthanasia. In cases of euthanasia due to mental anguish, a distinction between a desire for death caused by psychological pain alone prompted by mental illness and a desire for death caused by mental symptoms prompted by physical illness is essential. Conscientious objection should remain an option because of the heavy burden placed on doctors who perform euthanasia. Noncompliance by medical professionals due to ignorance and conflicts regarding euthanasia is contrary to procedural justice.
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