美国五个州承认安乐死合法
美国五个州承认安乐死合法
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——几十年来，帮助病危患者终结他们的生命一直被谴责是不道德的，而如今却在获得更多的支持。在2008年以前，俄勒冈州以外的所有地方都禁止为病危患者终结生命，但如今这种做法已经在五个州取得合法地位。它的倡导者们知道，要避免使用“协助自杀”一词，他们相信，当婴儿潮一代眼看自己年老体弱的父母饱受病痛折磨时，被他们称为“死亡援助”的运动就会得到更大的支持。
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)授权医生开具致命性的处方药物，并宣布“一位具有行为能力的病危患者选择死亡援助”是宪法赋予的权力。去年5月，佛蒙特州议会通过了一项法律准许此种做法，由此加入了蒙大拿州、俄勒冈州和华盛顿州的行列。这个春天，倡导者们正在康涅狄格等州大力推广“尊严死”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.
在过去50年，公众对死亡援助的支持已有所增加，但这从一定程度上也取决于所用的术语。例如，在去年5月份进行的一次盖洛普民意调查(Gallup Poll)中，70%的受访者同意，如果患者和他们的家人希望得到帮助，医生应该有权力“以一些无痛的方式来终结患者的生命”。1948年，这一比例是37%，它在40年里稳定增长，但从20世纪90年代中期开始就大体维持在一个稳定的水平。
Yet in the same 2013 poll, only 51 percent supported allowing doctors to help a dying patient “commit suicide.”
然而就在同一个2013年民调中，只有51%的受访者支持允许医生帮助垂死病人“实施自杀”。
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，来自各州的大约3000名患者会联系倡导组织“慈悲与选择”(Compassion & Choices)，以寻求建议，希望以合法途径减少临终痛苦，或许加速死亡。
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.
该组织表示，让一位垂死病人有机会以平和、有尊严的方式死去，并不是自杀。他们认为，自杀是有着严重抑郁症或其他精神问题的人实施的行为。
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.
但是在美国大多数地区，不论以何种名义，公开提供帮助，以带来死亡，都仍是违法的。因此，对患有严重心脏病的58岁的丹佛人罗伯特·米顿(Robert Mitton)来说，上个月来自新墨西哥的那个消息令他又喜又悲。
“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.”
“我即将死去，”他说，他不明白为什么蒙大拿和新墨西哥的人“能够有尊严的死去，而我不能”。
“This should be a basic human right.”
“这应该是一个基本的人权。”
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.
米顿身材魁梧、十分健谈，灰白的头发扎成一个马尾，他看上去怎么都不像垂死之人。但是他的医生说，他必须在未来几个月接受一次大面积的开胸手术，否则的话，他几乎必然会面临痛苦的死亡。
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.
他说，此前进行的一次心瓣置换术非常之残酷，而如今，移植的器官正在衰竭，他不愿再忍受这样的手术。他希望在自己变得无法自理、不能采取任何行动之前，由医生来帮助他终结生命。
Mr. Mitton’s frustrated quest draws attention to the limited choices facing patients in the large majority of states that bar the practice.
米顿无法实现的愿望让人们认识到，在禁止此种操作的绝大多数州里，患者所面临的选择多么有限。
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.
而反对者表示，不论一个人的身体多么衰弱，主动终结生命都是违反道德的，而一些患者也可能因为其他人的便利，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迈克尔·J·希恩(Archbishop Michael J. Sheehan)批评了新墨西哥州最高法院的决定，他在最近的一次早餐会上对议员们说，“基督教告诉我们，生命从孕育到自然死亡，都是无比神圣的。”
“This assisted-suicide thing concerns me,” Archbishop Sheehan added, according to The New Mexican. “I foresee dangerous consequences.”
据《新墨西哥报》(The New Mexican)报道，希恩大主教又补充说道，“这个叫做协助自杀的东西让我很不安。我能预见到危险的后果。”
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.”
米顿面临的尴尬境地清楚地描绘了这场辩论中很少涉及的一面。经历了极度的痛苦折磨后，病人有时会采取绝望的措施，因为在他们所在的州，医生有意开具致命药物，或是亲属帮助病人获取这种药物，都可能会触犯法律，构成“协助自杀”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.
“慈悲与选择”的主席芭芭拉·库姆斯·李(Barbara Coombs Lee)表示，在全国上下，都不断有人小声地要求拥有按照自己的意志去死亡的权利。她说，而随着婴儿潮一代的老去，这种要求可能会增加。
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，她的组织会为那些打电话寻求意见的人提供咨询，会描述各种可能的选择，但并不鼓励他们终结生命，或给予直接帮助。
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.
她说，如果打电话的人看上去精神状态不稳定、有自杀倾向，他们就会被建议拨打一个自杀热线。如果他们即将遭受巨大的痛苦和死亡，寻求对此加以控制，这一组织就会要他们在考虑下一步措施的同时，首先安排姑息治疗或临终关怀。
“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.
“人们应该获得最好的治疗，但如果即使接受了最好的治疗，他们余下的日子依然难以忍受，那么他们也应该可以选择加速死亡，”她说。
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.
对一些人来说，一条途径就是停止透析、胰岛素注射等必需的治疗。另一条途径就是关闭心脏起搏器，或者像米顿那样，拒绝他所厌恶的新治疗手段。她说，“对一些真正地、从情感和精神上都做好了死亡准备的人来说”，一个日益普遍的做法则是停止进食和饮水。
Others try to accumulate medications that would bring a peaceful death.
其他人则会存下一些药物，帮助他们平静地死去。
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.
李说，住在法律允许援助性死亡的地方，结果会十分不同。通常，人们羞愧地、偷偷摸摸地寻找其他途径，有时会不顾一切地出国寻求致命药物，或者以更暴力的手段自杀。
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，俄勒冈州所做的调查表明，对许多患者来说，仅仅知道有这样一个选择就是一个极大的安慰。在2013年，在122名取得致命药物的患者中，仅有71人使用了这些药物，其他人都是自然地死去，而这些药片则静静地躺在抽屉里。
