好英语网荷兰推动人死亡的权利
AMSTERDAM — It was 1989, and Dr. Petra de Jong, a Dutch pulmonologist, was asked for help by a terminally ill patient, a man in great pain with a large cancerous tumor in his trachea. He wanted to end his life.
那是在1989年，荷兰胸肺科医生佩特拉·德容（Petra de Jong）收到一位晚期病人的求助。这位男性病人的气管内长了一个巨大的恶性肿瘤，遭受着极大的痛苦。他想结束自己的生命。
She gave the man pentobarbital, a powerful barbiturate — but not enough. It took him nine hours to die.
她给这位病人使用了戊巴比妥（一种强效巴比妥酸盐），但并没给足剂量。9个小时后，病人才死去。
德容领导着安乐死倡导组织“荷兰死亡权利”。
“I realize now that I did things wrong,” Dr. de Jong, 58, said in an interview in her office here. “Today you can Google it, but we didn’t know.”
58岁的德容在她的办公室里接受采访时说：“我现在知道自己做错了。今天你可以用Google在网上进行搜索，但那时候我们不知道。”
Her warm and sincere manner belies, or perhaps attests to, her calling. The man was the first of 16 patients whom Dr. de Jong, now the head of the euthanasia advocacy group Right to Die-NL, has helped to achieve what she calls “a dignified death.”
她温和而真诚的举止似乎与她的职业不符，又或者，恰恰证明了她的职业。德容现在是安乐死倡议组织“荷兰死亡权利”（Right to Die-NL）的领头人。她曾帮助过16位病人实现了安乐死，她称之为“有尊严地死去”。那位男性病人是其中的第一位。
Founded in 1973, Right to Die-NL has been at the forefront of the movement to make euthanasia widely available in the Netherlands, even as the practice remains highly controversial elsewhere. Polls find that an overwhelming majority of the Dutch believe euthanasia should be available to suffering patients who want it, and thousands formally request euthanasia every year.
“荷兰死亡权利”自1973年创建以来，一直走在让安乐死在荷兰广泛实现的运动的最前沿，尽管这种做法在其他国家依然倍受争议。民意调查显示，绝大多数荷兰人认为应该为遭受痛苦的病人实施自愿安乐死，并且，每年都有几千名荷兰人正式要求安乐死。
Right to Die-NL, which claims 124,000 members, made worldwide headlines in early March with the news that it was creating mobile euthanasia teams to help patients die at home. The organization has also courted controversy with its call for legislation to make euthanasia available to anyone over age 70, sick or not.
今年3月初，宣称拥有12.4万名会员的“荷兰死亡权利”成立了帮助病人在家中安乐死的流动小组，成为世界性的头条新闻。该组织还呼吁立法允许任何70岁以上的老人，无论是否患有疾病，都可以安乐死。这也引发了争议。
Dr. de Jong said more than 100 requests have been made for the mobile service. Several of them are being evaluated, and euthanasia has been performed in one case.
德容表示，流动服务现在已经接到了100多份申请。其中一些正在接受评估，并且已经实施了一例安乐死。
Advocates and critics of assisted suicide are watching the organization’s efforts closely. Rick Santorum, the Republican presidential candidate from Pennsylvania, created something of a stir in February when he asserted — wrongly — that euthanasia accounted for 5 percent of all deaths in the Netherlands, and that many elderly Dutch wore wristbands that said “Do not euthanize me.” Dutch officials quickly countered the claims.
协助自杀的支持者和批评者都在密切关注这一组织的行动。今年2月份，来自宾夕法尼亚州的共和党总统候选人瑞克·桑特罗姆（Rick Santorum）就引发了一次不小的轰动，他当时误称，安乐死占了荷兰所有死亡人数的5%，并且很多年迈的荷兰人佩戴着写有“不要让我安乐死”的腕带。荷兰官方很快就驳斥了这一说法。
“Internationally, the Dutch have pushed the conversation on both the wisdom of allowing people to choose how and when they die when they’re in great suffering, and on the nature of compassion in dying,” said Paul Root Wolpe, director of the Center for Ethics at Emory University in Atlanta.
位于亚特兰大市的埃默里大学（Emory University）伦理中心负责人保罗·鲁特·沃尔普（Paul Root Wolpe）说：“荷兰人已经推动了国际间的谈话，探讨允许人们在遭受极大痛苦时选择如何以及何时结束自己的生命的观念，以及人类怜悯濒死之人的天性。”
Under the Netherlands’ 2002 Termination of Life on Request and Assisted Suicide Act, doctors may grant patients’ requests to die without fear of prosecution as long as they observe certain guidelines. The request must be made voluntarily by an informed patient who is undergoing suffering that is both lasting and unbearable. Doctors must also obtain the written affirmation of a second, independent physician that the case meets the requirements and report all such deaths to the authorities for review.
根据荷兰2002年的《应要求终止生命和协助自杀法案》，医生只要遵循一定的准则就可以批准病人要求死亡的请求而不必担心被起诉。死亡请求必须由知情的病人自愿提出，并且该病人正经受着持久而不堪忍受的痛苦。医生还必须获得另一名独立医生证明该病例符合要求的书面确认，并向官方报告所有此类死亡以供审查。
Dr. de Jong said Dutch physicians typically euthanize patients by injecting a barbiturate to induce sleep, followed by a powerful muscle relaxant like curare. For assisted suicide, the doctor prescribes a drug to prevent vomiting, followed by a lethal dose of barbiturates.
德容表示，荷兰医生通常会先注射一种巴比妥酸盐使病人陷入沉睡，然后注射一种强效肌肉松弛剂（如箭毒）来实施安乐死。对于协助自杀，医生会先为病人开一种防止呕吐的药物，然后再注射致命剂量的巴比妥酸盐。
Almost 80 percent of all such deaths take place in patients’ homes, according to the Royal Dutch Medical Association. In 2010, the latest year for which data are available, doctors reported 3,136 notifications cases of “termination of life on request.” Serious illnesses — late-stage cancer, typically — lie behind a vast majority.
荷兰皇家医学协会表示，所有这类死亡中有几乎80%发生在病人的家中。在2010年——可获得这类数据的最新年份——医生们共报告了3136件“应要求终结生命”的通知案例。绝大多数原因都是严重疾病，通常是晚期癌症。
Euthanasia is responsible for about 2 percent of all deaths annually in the Netherlands, according to Eric van Wijlick, a policy adviser for the association.
该协会的政策顾问埃里克·凡·威力克（Eric van Wijlick）表示，在荷兰，安乐死占每年死亡人数的2%左右。
Euthanasia is typically carried out by the general practitioners who serve as the backbone of the country’s universal health care system, doctors who often have enjoyed long relationships with their patients and know their feelings well. Mr. van Wijlick said the euthanasia law was possible because of “the moderate and open climate we have in the Netherlands, with respect for other points of view,” and acknowledged that it would be difficult to carry out elsewhere, because everyone in the Netherlands has access to health care, an income and housing.
安乐死通常由那些在一个国家的全民医疗系统中起骨干作用的全科医生来实施，这些医生通常与病人保持着长期关系并且非常了解他们的感受。凡·威力克表示，安乐死法令之所以成为可能，是因为“我们荷兰具有温和而开放的氛围尊重其他的观点”，他承认这在其他国家难以执行，因为荷兰的每个人都有医疗保健、收入以及住房。
“There are no economic reasons to ask for euthanasia,” he said, something that might not be true in the United States, with its for-profit health care system.
他说：“荷兰人不会因为经济原因而寻求安乐死。”在美国可能就不会这样，因为美国的医疗系统是要赢利的。
The mobile teams were needed, Dr. de Jong said, because many general practitioners, either for moral reasons or perhaps because of uncertainty about the law, refused to help suffering patients to die after it had become too late to find another doctor. The mobile teams will work to help them do so, she said.
德容表示，流动小组是有必要的，因为很多全科医生或者出于道德原因，或者因为法律的不确定，在病人已经病入膏肓而无法找到另外一个医生对其进行救助时，拒绝帮助遭受痛苦的病人死去。流动小组会来帮助病人实现安乐死。
Say a hypothetical 82-year-old man with metastasizing prostate cancer and poor prospects is told by his doctor that does not qualify for euthanasia. The man could contact the Right to Die-NL’s new “life-ending clinic,” and if he appeared to meet the criteria, a doctor and a nurse would go to his home to make an assessment. If all the conditions were met, he would be euthanized, ideally with his family beside him.
比如，假设有一位82岁的老人患有转移性前列腺癌，救治无望，而医生说他没有资格接受安乐死，那么这位老人就可以联系“荷兰死亡权利”新设的“生命终结诊所”。若他看上去满足条件，将有一名医生和一名护士去他的家里做一次评估。如果所有条件都满足，他将会被实施安乐死，理想情况是在他家人的陪伴下。
Dr. de Jong emphasized that a patient could never be euthanized on the initial visit, because the law requires that a second physician be consulted.
德容强调，病人绝不会在流动小组首次到访时就被实施安乐死，因为法律还要求有接受第二位医生的咨询。
Even in the Netherlands, some think Right to Die-NL may now be going too far. In addition to the mobile teams, the organization is among those pushing to give all people 70 years old and over the right to assisted death, even when they are not suffering from terminal illness. (The conservative government of Prime Minister Mark Rutte has said there will be no changes to the law under its tenure.)
即使在荷兰，也有人认为“荷兰死亡权利”如今可能做得过头了。除流动小组之外，该组织还参与推动政府给所有70岁以上的老人接受协助死亡的权利，即便他们没有遭受晚期疾病之苦。（荷兰总理马克·吕特（Mark Rutte）执政下的保守党政府已表示，在其任期内不会对安乐死法案做出修改。）
“We think old people can suffer from life,” Dr. de Jong said. “Medical technology is so advanced that people live longer and longer, and sometimes they say ‘enough is enough.’ ”
德容说：“我们觉得老年人可能会遭受生活的不幸。医疗技术这么先进，人们活得越来越长久。有时候，他们会说：‘真是活够了。’”
Mr. Wijlick said the Royal Dutch Medical Association was “uneasy” with the mobile teams because “the question of euthanasia can’t be taken out of isolation of the care of the patient,” which should be in the hands of the primary caregiver, the general practitioner.
威力克表示，荷兰皇家医学协会对流动小组感到“不安”，因为“安乐死的问题不能和对病人的照料隔离开”，而对病人的照料应该掌握在全科医生这样的主要护理人手里。
Most of the time, he added, there is a good reason that a doctor refuses euthanasia. Often, it is because the doctor believes the patient’s case does not meet the criteria set out by law.
他还表示，大多数时候，医生拒绝实施安乐死是有着充分理由的。通常是因为医生认为病人的情况并不满足法律所设定的标准。
The association also opposes euthanasia for those “suffering from life.” “There must always be a medical condition,” Mr. van Wijlick said. Still, in such cases a doctor could explain to patients how to deny themselves food and drink, he noted, and could assist with any suffering that entailed.
该协会还反对为那些“遭受生活不幸”的人实施安乐死。凡·威力克说道：“必须有某种健康状况才可以。”在那种情况下，医生仍可以向病人解释如何给自己断绝饮食，并帮助他们缓解因此而来的任何痛苦。
The Dutch patients’ organization N.P.V., a Christian group with 66,000 members, strongly criticizes the current application of the law, saying the practice of euthanasia has been extended to encompass patients with dementia and other conditions who may not by definition be competent to request help in dying.
拥有6.6万名会员的基督教组织——荷兰病人团体N.P.V.对当前的安乐死法令提出了强烈批评，他们说，安乐死的实施已经扩展到了包括那些患有痴呆症和其他明显没有能力请求死亡帮助的病人。
Elise van Hoek-Burgerhart, a spokeswoman for the N.P.V., said in an e-mail that the idea of mobile euthanasia teams was “absurd,” and that there was no way the mobile-team doctors could get to know a patient in just a few days. Moreover, she added, research shows that 10 percent of requests for euthanasia from the elderly would disappear if palliative care were better.
N.P.V.组织的女发言人伊利斯·凡·霍克-博格哈特（Elise van Hoek-Burgerhart）在一封电子邮件中表示，安乐死流动小组这个想法是“荒谬”的，流动小组的医生不可能在几天之内就了解一个病人。不仅如此，她还说，调查显示，如果临终关怀较好，来自老年人的安乐死申请会减少10%。
She also noted that the law requires review committees to sign off on every reported case of euthanasia, but that 469 cases from 2010 had still not been reviewed, meaning it was not clear how well doctors were adhering to the official guidelines.
她还表示，法律要求各审查委员会对每一个安乐死报告案例进行签署确认，但2010年有469个案例仍未进行审核。这意味着医生在多大程度上遵守了官方的准则尚不清楚。
Dr. Wolpe, the Emory University bioethicist, said he was “generally supportive” of people’s right to choose their own death, but that he was troubled by some trends in the Netherlands, including the extension of euthanasia to people who were not suffering physically.
埃默里大学生物伦理学家沃尔普表示，他“一般情况下支持”人们选择自己死亡的权利，但他对荷兰的一些趋势感到不安，包括把安乐死扩展到那些身体上并未遭受病痛的人身上。
“When you switch from purely physiological criteria to a set of psychological criteria, you are opening the door to abuse and error,” he said.
他说：“当你从纯生理标准转到一系列心理标准时，你就打开了一扇滥用和失误的大门。”