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生命是受软硬法绝对保护的人格利益，现代医事价值产生的生命终结合法性论题挑战其法律地位。自杀成权和辅助死亡合法化无法以传统法学理论自洽解释，故依赖基本权利条款的司法适用独立构建。立法例显示医学辅助死亡权主要发生于绝症、失能疾病和痛苦，分歧源自立法价值平衡，但均开创功利主义生命评价先例，引发病患自主保护和实践效果问题。安宁疗护与传统法理冲突较少，且可保障医学辅助死亡权利自主行使，既作为制度配套，也是立法者的生命保护修辞。医事行业的治理范式结合当前医学辅助死亡权利主观化现象，导致医疗人员操作空间过大，加之医学辅助死亡权利的医事伦理冲击，造成行业治理失控，最终弱化医事法治。
Abstract：With modern medical values come the question of suicide's legality and the challenge against absolute legal protection of life. The Right to die finds limited ground from traditional legal theories and relies on jurisprudence about fundamental rights instead. Comparative analysis shows that Medically Assisted Death(MAD) is generally available to patients suffering from incurable disease, dis-capacitating illness and unbearable pain. Current legislations reflect axiological divergence across countries but a common precedent on utilitarian valuation of human life, leading to further debates about the protection of patient's autonomy and the consequences of legal practice. To former, apart from its rhetorical significance on legislation policy, palliative care has been a social prerequisite of MAD legalization because of its ethical value and its positive effects on patient's decision making. To latter, MAD legislations cause ethical disorder and weakened protections of vulnerable individuals in medical practice due to its authorization of a flagrant contrariety to medical ethics and its excessive empowerment of personnels governed by these ethics.
(1)Vide Rosa Maria de Andrade Nery,Tratado de Direito Privado.Parte Especial.Tomo VII.Direito de Personalidade.Direito de Família:Direito matrimonial (Existência e validade do casamento),Editora Revista dos Tribunais,2012,p.70-73.
(2)王利明:《人格权法(第四版)》,北京:中国人民大学出版社2022年版,第174-175页。
(3)Vide Diogo Costa Gon?alves,Li??es de Direitos de Personalidade,Princípia Editora,2022,p.509.
(4)World Medical Association,WWA Declaration of Geneva 2017,at https://www.wma.net/policies-post/wma-declaration-of-geneva (Last visited on February 26,2025).
(5)此概念(Distanasia/Distanásia/Δυσθανασι'α)见于西班牙法、葡萄牙法和巴西法相关讨论,文义为“不好/不幸的死亡”,与广义上的安乐死相对,在西班牙语中也称为“固执治疗”(Obstinación terapéutica)或更通俗的“残酷治疗”(Ensaňamiento terapéutico)。截至写作完成,作者无法在我国研究讨论中找到对应词汇,考虑价值背景和表述便利,在此暂作此称。
(6)Vide Diogo Costa Gon?alves,op.cit.,p.508-509.
(7)Comité de Bioética de Espaňa,Informe del Comité de Bioética de Espaňa sobre el final de la vida y la atención en el proceso de morir,en el marco del debate sobre la regulación de la eutanasia:propuestas para la reflexión y la deliberación,2020,p.13.
(8)Vide Diogo Costa Gon?alves,op.cit.,p.517-519.
(9)Digesta 40.12.37:Conventio privata neque servum quemquam neque libertum alicuius facere potest.
(10)此思路见于十世纪拜占庭法:“若法律之于市民如同家父之于子女般,教他们作有益之事,试问这样的法律又怎会使他们受约束于受疯病驱使、带来如此多不利和损害的行为呢?”Constitutio 59:Si enim quod pater filiis est,id idem leges civibus esse oportet,ut in hoc unum quod illis conducat ac salutare fit colliment:quomodo hanc legem,qu? tantum incommodum atque damnum incumbere iis qui per dementiam in id se coniecerunt,finit,legibus annumerari ?quum est?Henricus Agylaeus,Imp.Leonis Augusti Constitutiones novellae,aut correctoriae legum repurgationes,Latinae nunc primum ab Henrico Agylaeo factae.Imperatoris Justiniani Edicta.Imperatoris Justini Constitutiones aliquot.Imperatoris Tiberii Constitutio una.Imperatoris Zenonis Constitutio una,eodem interpret,1560,p.115-116.
(11)Vide Rosa Maria de Andrade Nery,op.cit.,p.67-69.
(12)Vide Diogo Costa Gon?alves,op.cit.,p.511-512.
(13)Ibid.,p.516-517;Rosa Maria de Andrade Nery,op.cit.,p.72.
(14)Vide Diogo Costa Gon?alves,op.cit.,p.516;Walter Claudius Rothenburg,Direito à vida e direito à integridade,Revista de Informa??o Legislativa Brasília,Vol.60,p.197-215 (2023).
(15)Diogo Costa Gon?alves,op.cit.,p.514-515.
(16)Diogo Costa Gon?alves,op.cit.,p.516;Walter Claudius Rothenburg,op.cit..
(17)Tribunal Constitucional,Sentencia 19/2023,de 22 de marzo de 2023,Recurso de inconstitucionalidad 4057-2021.Interpuesto por cincuenta diputados del Grupo parlamentario Vox en el Congreso de los Diputados en relación con la Ley Orgánica 3/2021,de 24 de marzo,de regulación de la eutanasia.Derecho a la vida y a la integridad física y moral:constitucionalidad de la regulación legal del derecho a la autodeterminación respecto de la propia muerte en contextos eutanásicos.Votos particulares.(ECLI:ES:TC:2023:19).
(18)此解读派生自《欧洲人权公约》第2条和第8条分别关于生命、隐私和私生活保护的规定,当事人主张医师拒绝处方致死药物侵犯了人选择死亡时间和方式的权利,因而违反前述公约第8条。ECHR,20 January 2011,Haas v.Switzerland,No.31322/07;Arend Cornelis Hendriks,End-of-life decisions.Recent jurisprudence of the European Court of Human Rights,ERA Forum,Vol.19,p.561-570 (2019).
(19)ECHR,29 April 2002,Pretty v.The United Kingdom,No.2346/02.
(20)ECHR,3 April 2001,Keenan v.The United Kingdom,No.27229/95;ECHR,20 January 2011,Haas v.Switzerland,No.31322/07;ECHR,31 January 2019,Fernandes de Oliveira v.Portugal,No.78103/14.
(21)La Corte Costituzionale,25 settembre 2019,Sentenza 242/2019 (ECLI:IT:COST:2019:242);La Corte Costituzionale,24 ottobre 2018,Ordinanza 207/2018 (ECLI:IT:COST:2018:207).
(22)BVerfG,Urteil des Zweiten Senats vom 26.Februar 2020-2 BvR 2347/15,2 BvR 2527/16,2 BvR 2354/16,2 BvR 1593/16,2 BvR 1261/16,2 BvR 651/16 (ECLI:DE:BVerfG:2020:rs20200226.2bvr234715),Rn.331-342.
(23)VfGH,11.12.2020,G 139/2019.
(24)西班牙3月24日第3/2021号基础性法律《规范安乐死》(Ley Orgánica 3/2021,de 24 de marzo,de regulación de la eutanasia.,下称“第3/2021号基础性法律”)序言第1部分第11自然段;《西班牙宪法》(Constitución Espaňola)第1.1、10、15、18.1条。
(25)Tribunal Constitucional,Sentencia 19/2023,de 22 de marzo de 2023 (ECLI:ES:TC:2023:19).
(26)Vide Rosa Maria de Andrade Nery,op.cit.,p.69.
(27)自杀的刑法评价,参见王钢:《自杀的认定及其相关行为的刑法评价》,载《法学研究》2012年第4期,第154-174页。
(28)西班牙第3/2021号基础性法律第3条c项,第5条第1款d项;葡萄牙5月25日第22/2023号法律《规范医学辅助死亡不予处罚之情况及修改刑法典》(Lei n.° 22/2023,de 25 de maio,Regula as condi??es em que a morte medicamente assistida n?o é punível e altera o Código Penal,下称“第22/2023号法律”)第2条d项、第3条第1款、第3款d项。葡萄牙立法史曾出现不必然要求疾病不可治愈的“严重或不可治愈的疾病”(Projeto de Lei n.°83/XV/1),以及要求不可治愈但程度不一样的“不可治愈且致死的疾病”(n.°4/XIV/1;n°195/XIV/1)、“严重、不可治愈且无合理好转期望的疾病”(n.°168/XIV/1)、“不可治愈的疾病”(n.°67/XIV/1)等。
(29)英国《成年绝症病患(结束生命)法案》(Terminally Ill Adults [End of Life] Bill)第2.1条。
(30)See National Academies of Sciences,Engineering,and Medicine,Physician-Assisted Death:Scanning the Landscape:Proceedings of a Workshop,The National Academies Press,2018,p.27,38.对比我国学者关于“安乐死”用词的现实问题和修辞作用的讨论,参见张迪:《不给予或撤除生命维持干预与安乐死、消极安乐死的概念辨析》,载《医学与哲学》2024 年第4期,第12-17页。
(31)Sílvia Marina,Inês Costa-Maia,Miguel Ricou,Defini??o do Conceito de Morte Antecipada em Português,Acta Médica Portuguesa,Vol.32,No.6,p.474。提前死亡(Antecipa??o da morte)也是葡萄牙其中一份立法草案(Projeto de Lei n.°4/XIV/1)采用的名称。
(32)Vide Pedro Vaz Patto,O veto presidencial da lei da eutanásia,Brotéria,Vol.194,No.1,p.13-17 (2022).
(33)See National Academies of Sciences,Engineering,and Medicine,supra note 30,20-23.
(34)西班牙第3/2021号基础性法律第3条b项、第5条第1款d项。
(35)葡萄牙第22/2023号法律第2条e项;第3条第1款、第3款d项。
(36)See Council of Canadian Academies,The State of Knowledge on Advance Requests for Medical Assistance in Dying,Council of Canadian Academies,2018,p.18-19,28,146,173.
(37)爱尔兰《自愿辅助死亡法案2024》(An Bille um Bás Cuidithe Saorálach,2024;Voluntary Assisted Dying Bill 2024)第6(a)(ii)、7(e)条。
(38)葡萄牙第22/2023号法律第2条f项;第3条第1款。
(39)西班牙第3/2021号基础性法律《规范安乐死》第3条b、c项。
(40)See National Academies of Sciences,Engineering,and Medicine,supra note 30,18-19,23,25-26;Comité de Bioética de Espaňa,op.cit.,p.26;Tribunal Constitucional,Sentencia 19/2023,de 22 de marzo de 2023 (ECLI:ES:TC:2023:19).
(41)ECHR,20 January 2011,Haas v.Switzerland,No.31322/07.
(42)Tribunal Constitucional,Sentencia 19/2023,de 22 de marzo de 2023 (ECLI:ES:TC:2023:19).
(43)See National Academies of Sciences,Engineering,and Medicine,supra note 30,20-26;Austrian Bishops oppose legalization of assisted suicide,at vaticannews.va/en/church/news/2021-11/austrian-bishops-oppose-legalization-of-assisted-suicide.html (Last visited on February 26,2025).
(44)See Nathan E.Goldstein et al.,Prevalence of Formal Accusations of Murder and Euthanasia against Physicians,Journal of Palliative Medicine,Vol.15,No.3,p.334-339 (2012);Lars Johan Materstvedt,Georg Bosshard,Deep and continuous palliative sedation (terminal sedation):clinical-ethical and philosophical aspects,The Lancet Oncology,Vol.10,No.6,p.622-627 (2009).
(45)张迪、毕可嘉、徐士婷:《安宁疗护中的伦理学问题》,载《协和医学杂志》2024年第1期,第24-31页。
(46)See Sheri Mila Gerson et al.,The Relationship of Palliative Care With Assisted Dying Where Assisted Dying is Lawful:A Systematic Scoping Review of the Literature,Journal of Pain and Symptom Management,Vol.59,No.6,p.1287-1303 (2020).
(47)Vide Diogo Costa Gon?alves,op.cit.,p.517-519.
(48)持此立场的群体或组织如天主教会,奥地利主教团在立法进程中一直支持宣告有关法律违宪,同时尝试推动增加安宁疗护的财政资源。Austrian Bishops oppose legalization of assisted suicide,at vaticannews.va/en/church/news/2021-11/austrian-bishops-oppose-legalization-of-assisted-suicide.html (Last visited on February 26,2025).
(49)See Matthew Doré,Alan McPherson,The Regional Palliative Medicine (RPMG) Assisted Dying Survey 2024,The Ulster Medical Journal,Vol.93,No.3,p.105-110 (2024);Sheri Mila Gerson et al.,supra note 46.
(50)Diogo Costa Gon?alves,op.cit.,p.517.
(51)参见联合国人权理事会第四十三届会议第A/HRC/43/41号报告。
(52)Oregon Health Authority,Oregon Death with Dignity Act 2023 Data Summary,2024,p.14.
(53)Id.,12,14.
(54)See National Academies of Sciences,Engineering,and Medicine,supra note 30,32.
(55)张迪:《安宁疗护与安乐死:差异或协同》,载《医学与哲学》2021年第10期,第6-12页。
(56)Lars Johan Materstvedt,Palliative care on the ‘slippery slope’ towards euthanasia?,Palliative Medicine,Vol.17,p.387-392 (2003).
(57)Tribunal Constitucional,Sentencia 19/2023,de 22 de marzo de 2023 (ECLI:ES:TC:2023:19).
(58)西班牙第3/2021号基础性法律第5条第1款b项。
(59)葡萄牙第22/2023号法律第4条第6款、第5条第1款。
(60)英国《成年绝症病患(结束生命)法案》第4(4)条。
(61)爱尔兰《自愿辅助死亡法案2024》第6(a)(ii)、7(e)条。
(62)Vide Diogo Costa Gon?alves,op.cit.,p.508-509.
(63)Ibid.,p.515-516;António Menezes Cordeiro,Tratado de Direito Civil,IV (Parte Geral-Pessoas),5a edi??o,Almedina,2019,p.172.
(64)Tribunal Constitucional de Portugal,15 de mar?o de 2021,Acórd?o N.°123/2021.
(65)就实定法,葡萄牙第22/2023号法律第2条d-f项。就相对的批评,vide Conselho Nacional de ética para as Ciências da Vida,Parecer sobre os projetos de lei n.°5/XV/1° (BE),n.°74/XV/1° (PS) e n.°83/XV/1° (PAN),que regulam as condi??es em que a morte medicamente assistida n?o é punível e alteram o Código Penal,2022,p.8;Ordem dos Médicos,Parecer sobre os projetos de lei n.°5/XV/1° (BE),que regulam as condi??es em que a morte medicamente assistida n?o é punível e alteram o Código Penal,2022,p.4.
(66)如英国《成年绝症病患(结束生命)法案》第2(1)(b)条。
(67)See National Academies of Sciences,Engineering,and Medicine,supra note 30,9-10,22-23.
(68)Vide Ordem dos Advogados,Parecer da Ordem dos Advogados (Ofício n.°55/1.a-CACDLG/2020),2022,p.4.
(69)参见周少华:《法律中的语言游戏与权力分配》,社会科学文献出版社2022年版,第46-49,189-190页。
(70)Tribunal Constitucional de Portugal,15 de mar?o de 2021,Acórd?o N.°123/2021.
(71)Vide Ordem dos Médicos,op.cit.,p.4-6.就同样修辞批评,see National Academies of Sciences,Engineering,and Medicine,supra note 30,38.
(72)Ordem dos Advogados,op.cit.,p.5.
(73)See Sheri Mila Gerson et al.,supra note 46.
(74)See National Academies of Sciences,Engineering,and Medicine,supra note 30,23.
(75)Id.,21,24-26;David Gibbes Miller,Scott Y H Kim,Euthanasia and physician-assisted suicide not meeting due care criteria in the Netherlands:a qualitative review of review committee judgements,BMJ Open,Vol.7,No.10,e017628 (2017).
(76)See National Academies of Sciences,Engineering,and Medicine,supra note 30,24-25,32-33.
(77)Vide Ordem dos Advogados,op.cit.,p.4.
(78)See Belgian Advisory Committee on Bioethics,Opinion no.1 of 12 May 1997 concerning the advisability of a legal regulation on euthanasia,1997,p.1.
(79)Vide Conselho Nacional de ética para as Ciências da Vida,op.cit.,p.9-10.
(80)See National Academies of Sciences,Engineering,and Medicine,supra note 30,28-29.
(81)Digesta 1.5.2:Hominum causa omne ius constitutum sit.
基本信息:
DOI：10.19752/j.cnki.2097-5058.2025.06.001
中图分类号:D912.1
引用信息:
[1]甄富坤,石佳友.医学辅助死亡的立法争议：以比较法为视角[J].卫生法学,2025,33(06):1-13.DOI:10.19752/j.cnki.2097-5058.2025.06.001.
基金信息:
国家社科基金重大课题“民法典与国家治理现代化研究”（24&ZD126）