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在照顧之愛與病痛之苦間擺盪的生死倫理-論天主教有關植物人停止人工餵食餵水的觀點

The Ethics of Life and Death between the Love of Caring and the Suffering of Illness: On Catholic Perspectives Concerning the Withdrawal of ANH for Patients in PVS

摘要


天主教反對植物人人工餵食餵水(PVS-ANH)的停止或撤除,堅持為「最弱小的弟兄」爭取生存與被照顧的權利。本文仔細檢視其觀點,探討天主教的論證並提出本文的主張。本文雖認同天主教為弱勢生命發聲的理念,但難以認同其PVS-ANH觀點。天主教主張PVS-ANH在原則上是維護植物人生命的「普通且相稱」(ordinary and proportionate)手段,停止它就是消極安樂死,而安樂死則無論是消極或積極,都是絕對錯誤而必須加以反對者。本文認為這樣的觀點缺乏充分理據,過於絕對而有獨斷之嫌。首先,天主教似乎太過強調「第三人稱倫理觀」,忽略了「第一人稱倫理觀」,以致不夠同理PVS及其家庭之生命困境。其次,過於強調「支持生命」(pro-life),天主教似乎忽略了「支持選擇」(pro-choice)在捍衛人性尊嚴上也能有的價值。所謂「支持選擇」並非支持「只要我喜歡,就沒有什麼不可以」的那種任意抉擇,而是支持PVS在其健康時,經由慎思明辨的道德判斷過程,所做出的負責任的選擇,即使這樣的選擇包含了拒絕PVS-ANH。本文共分五節,第一節是前言,說明問題背景;第二節說明停止或撤除PVS-ANH的爭議脈絡,特別是相關問題涉及到怎樣的倫理學問題意識;第三節則從天主教的官方文件說明天主教反對停止或撤除PVS-ANH的理由;第四節則對這些理由進行分析討論並提出本文的看法,第五節為結論。本文主張:天主教反對植物人停止人工餵食餵水的觀點站不住腳,教會似乎應該思考其立場調整的可能性與必要性。

並列摘要


Advocating the rights of our "weakest brothers" to survival and care, the Roman Catholic Church resolutely objects to the withdrawal of assisted nutrition and hydration for patients in PVS. This article scrutinizes the relevant teachings of the Church, discusses the underlying arguments and then presents its own thesis. Although the advocacy of the Catholic Church for the most vulnerable is reasonable, her view on PVS-ANH as a whole cannot be accepted. She claims that ANH is an "ordinary and proportionate" means of maintaining the life of a PVS and as such its withdrawal is equivalent to passive euthanasia which, together with active euthanasia, is absolutely wrong and thus morally objectionable. However, I argue in this paper that this claim is overly dogmatic and lacking in sufficient rationale. Firstly, with her emphasis on "the third-person-ethicalperspective" the Church ignores "the first-person-ethical-perspective" almost completely and therefore does not show sufficient sympathy for the suffering PVS and their family. Secondly, a biased insistence on "prolife" ideology leads the Church to the point of overlooking the value of "pro-choice" in protecting human dignity. "Pro-choice" does not mean that anyone can arbitrarily do what he or she wants, but that the responsible choice that anyone makes through a process of moral discernment when she or he is competent should be respected even when it includes a refusal of PVS-ANH. This paper is divided into five parts. The first part is introductory. In the second the context of the controversy regarding withdrawal of ANH-PVS is explained, with special attention being paid to questions of ethical significance. Thirdly, the arguments given in the Catholic documents against withdrawing ANH-PVS are expounded in detail, so that they can be dealt with thoroughly and systematically in the fourth part. The last part is the conclusion drawn from the discussions: in objecting to the withdrawal of PVS-ANH the Catholic Church does not make her case and it seems appropriate for the Church to rethink her relevant teachings and even to consider the necessity for a revision.

參考文獻


孫效智 2012 〈安寧緩和醫療條例中的末期病患與病人自主權〉,《政治與社會哲學評論》,41期,頁45-91。
楊秀儀 2013 〈論病人之拒絕維生醫療權:法律理論與臨床實踐〉,《生命教育研究》,5卷1期,頁1-24。
CDF2007 2007 “Responses to Certain Questions of the United States Conference of Catholic Bishops Concerning Artificial Nutrition and Hydration.” Congregation for the Doctrine of the Faith. Available at http://www.vatican.va/roman_curia/congregations/cfaith/documents/rc_con_cfaith_doc_20070801_risposte-usa_en.html
JPII2004 2004 “Address to the Participants in the International Congress on Life-Sustaining Treatments and the Vegetative State: Scientific Advances and Ethical Dilemmas.” Pope John Paul II. Available at http://www.vatican.va/holy_father/john_paul_ii/speeches/2004/march/documents/hf_jp-ii_spe_20040320_congress-fiamc_en.html
Blandford, Janette 2011 "An Examination of the Revisionist Challenge to the Catholic Tradition on Providing Artificial Nutrition and Hydration to Patients in a Persistent Vegetative State," Christian Bioethics 17(2): 153-164. doi: 10.1093/cb/cbr013

被引用紀錄


凃均翰(2016)。佛教生命倫理學對臨終倫理議題之探究〔博士論文,國立臺灣大學〕。華藝線上圖書館。https://doi.org/10.6342%2fNTU201603441

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