对生前预嘱相关问题的探讨

生前预嘱是指人在意识清楚时签署一份文书来事先表达出自己在生命末期的医疗意愿。本文针对生前预嘱的理解和适用中存在的相关问题作出探讨。本文以尊严死在我国的提出以及生前预嘱在我国的推广现状为基础,从法律的视角分析了生前预嘱的合法性和必要要件,并阐明了在目前的法律框架下生前预嘱还不是生效的法律文件,生前预嘱的落实还需要亲属的同意。本文借鉴其他国家和地区对生前预嘱的立法状况并结合我国的实际,提出了对于放弃治疗和尊严死的理解,以及针对医疗实践中放弃治疗的困惑提出了对放弃治疗应该严格遵循的原则。     

生命预嘱制度建构初探简

生命预嘱（Living Will）是人们事先也就是在健康或意识清楚时签署的,说明在不可治愈的伤病末期或临终时要或不要哪种医疗护理的指示文件。生命预嘱尊重患者的医疗自主权,强调了医护人员和患者及家属之间在医疗工作中的合作关系,是医学领域中必要的创新。事实上,由于种种原因,在中国临终放弃治疗已经相当普遍,但对临终患者是否可以预立生命预嘱,告诉医护人员他是否想要手术,插管进食或使用呼吸机来维持生命,我国法律尚无此类规定。由于缺少相关法律制度对医师的行为进行有效的保护和约束,临床实践中医师对临终患者的处理做出决策相当困难。就死亡过程而言,社会提出了明确要求,法律就应当认真对待。本文通过介绍国内外的生命预嘱立法及其实践情况,了解实践中生命预嘱在我国的存在空间,探讨我国未来生命预嘱的立法思路,为我国未来生命预嘱的主要制度的构建略尽绵薄之力。     

The legal basis for ethical withholding and withdrawing of life-sustaining medical treatment in children

Withholding and withdrawing life-sustaining medical treatment are common in paediatric practice, especially in intensive care units. However, not all clinicians apparently adhere to principles in ethical guidelines or to the principles which are to be found in judgments from common law cases arising when doctors and parents dispute treatment. This article examines selected ethical guidelines and compares them to judgments in leading cases. The rationale to forgo treatment is usually the child's "best interests" in both clinical practice guidelines and legal cases but in the former "best interests" may remain ill defined. Although "best interests" must essentially pertain to the individual child, the interests of others are not irrelevant. In legal cases "best interests" of the child are defined in terms such as "burden versus benefit", "futility", "indignity", "intolerability", "prolonging death rather than saving life" and "quality of life". These or like terms should form the basis of ethical decisions in discussions with parents when contemplating withholding or withdrawing life-sustaining treatment.     

Value of fetal autopsy after medical termination of pregnancy

We carried out a retrospective study of 352 medical terminations of pregnancy (MTP) carried out in a large French administrative region over two consecutive years. We analysed the indications for MTP and then compared the prenatal ultrasound diagnosis with fetal autopsy findings in order to demonstrate the value of pathological examination of the fetus in prenatal diagnosis and genetic counselling as well as the need to check by autopsy the quality of ultrasound screening. Preliminary analysis of the indication for these MTP showed that in 69.9% ultrasound screening had been carried out, revealing mainly brain abnormalities (22.2%) and heart defects generally associated with chromosomal abnormalities (32.1%). Prenatal findings were in agreement with autopsy results, showing no false-positive prenatal diagnoses. However, in 7.9% of cases in which brain abnormalities were detected, confirmation was not possible at autopsy because of tissue autolysis, showing the need for optimal conditions of expulsion. In 35.8% of cases, confirmation of the diagnosis by autopsy was not useful for management but still added to medical knowledge and demonstrated to the mother the reality of the defects. In 50.9%, the autopsy findings were decisive for genetic counselling.     

Cops and drivers: Police discretion and the enforcement of Maine's 1981 OUI law

This study examined police discretionary behavior in stopping and arresting drivers suspected of drunken driving in the state of Maine (U.S.A.). A sample of 186 officers was questioned at the beginning and end of a one-year period with respect to their attitudes toward OUI (Operating Under the Influence of Alcohol) law enforcement and their discretionary behavior in regard to OUI.Significant minorities of police officers reported that they made decisions either not to apprehend (thirty-three percent) or not to arrest (forty-one percent) OUI suspects in the study year. Officers who reported discretionary decisions not to apprehend or arrest generally did so infrequently—i.e. five percent of possible apprehensions and ten percent of possible arrests.Type of police department was significantly associated with decisions not to stop OUI suspects: officers in large departments ( ≥ 20 officers) reported more discretion. Officers with longer service careers, administration responsibilities, high personal priorities on OUI enforcement, and favorable opinions of the climate of OUI enforcement were less likely not to arrest OUI suspects.