Euthanasia and Physician-assisted Suicide in the Netherlands : The Experiential, Logical, and Legal-historical Evidence of the "Slippery-slope"

Lee, Sang-Won Presbyterian General Assembly Theological Seminary 2006 CHONGSHIN THEOLOGICAL JOURNAL Vol.12 No.1

In this thesis I tried to show that the Slippery-slope progression had been realized in the Netherlands by examining the Dutch understanding of euthanasia, and concrete legal cases and the process of the decision of the Dutch court. The Remmelink committee's survey, which reflects the experience of the Dutch medical community, shows that the practice of euthanasia has gradually expanded beyond the standard Dutch definition of euthanasia: the practice began with the legalization of active and voluntary euthanasia, under certain conditions; then it became permissable as a treatment for non-physical pain; finally it was practiced without the request of a patient. The history of the Dutch Penal Law regarding euthanasia exemplifies the "slippery slope." The Dutch Criminal Law enacted in 1886 ruled euthanasia and physician-assisted suicide as criminal offence, but gradually exempted these two practices from punishment by adding various exceptions to the law. In 1973 the conditions which would be quoted in later legal decisions about euthanasia and physician-assisted suicide were formed. In 1981 the conditions for physician-assisted suicide upon which the appeal to necessity in emergent situations could be accepted was formed. In 1983 euthanasia was widely permitted, when the argument of necessity was accepted as a condition for legitimate euthanasia. In 1995 physician-assisted suicide not caused by diseases was permitted legally, and the discussion about the physician-assisted suicide for the normal people who were tired of monotonous life began. Finally in 2002 [The Law Proving the Act to Help to Terminate Life or Assist Suicide with Request] came into effect and the related Criminal Law article 293 and article 294 were revised. In conclusion, the medical and legal conditions for euthanasia and physician-assisted suicide in the Netherlands show vividly that the slipperyslope progression argument has been gradually realized, and proves that the strict definition of and the strict conditions for euthanasia and physicianassisted suicide cannot prevent the practice of euthanasia and physicianassisted suicide from growing. It is important to remember Jesus' teaching, "What good will it be for a man, if he gains the whole world, yet forfiets his soul? or what can a man give in exchange for his soul?" (Mt.l6:26) We must prohibit euthanasia and physician-assisted suicide ethically and morally in their initial stages. Then we will be able to protect human life from the merciless practice of euthanasia and physician-assisted suicide.

안락사에 대한 간호사의 인식 및 태도에 관한 연구

성미혜(Sung Mi Hae),전종철(Jeon Jong Cheol),모형중(Mo Hyung Joong) 대한종양간호학회 2007 Asian Oncology Nursing Vol.7 No.2

Purpose: The purpose of this study was to investigate nurses' perceptions and attitudes towards euthanasia. Method: The subject consisted of 345 nurses from the four general hospitals above 500 beds. Measurement tools were the Ryu's perceptions towards euthanasia, and Park's attitudes toward euthanasia. The data were analyzed using descriptive statistics, t-test, and ANOVA by using SPSS WIN 10.0 program. Results: The approval rate of passive euthanasia was 62.6%. Main reason of approval for the passive euthanasia was that euthanasia was “act of mercy”. On the other hand, main reason of opposition was that “life is invaluable”. 81.2% of subjects responded saying that they would ask for passive euthanasia. The approval rate of active euthanasia was 15.7%. 54.8% of subjects responded saying that they will not ask for active euthanasia. General characteristics significantly related to attitudes to euthanasia were the units, nursing degree, and meaning of euthanasia. The mean score for attitudes to euthanasia was 2.36 and it was negative attitudes. Conclusion: Man has the right to live within his life with dignity. What is most important here seems to be the legalization of euthanasia which still remains unresolved.

간호 학생의 안락사에 대한 태도 연구

이종화;김희영;김수강 중앙대학교 의과대학 간호학과 간호과학연구소 2004 중앙간호논문집 Vol.8 No.1

The present study is a descriptive survey on nursing students’ attitude toward euthanasia. The subjects of this study were students in 4-year nursing colleges in Seoul, Chtmgcheong-do and Jolla-do and a total of 151 questionnaires were used in analysis. The research tool used was the scale of attitude toward euthanasia developed by Kim Ae-gyeong(2001), and SPSS 11.0 was used in statistical proessing. The results of this stuφ are as follows. 1. The subjects’ scores of attitude toward euthanasia were within the range between 23 and 73 points and the average score was 54.89 points, which suggests that the subjects advocate euthanasia 2. Statistically significatn difference was observed in the subjects’ quality of life according to their general characteristics including school year, religion, the legality of euthanasia, decision on euthanasia, willingness to execute euthanasia on themselves and willingness to execute euthanasia on their families. 3. Statistically significant difference was obseπed in the subjects' respect for life according to their general characteristics including school year, religion,experience in witnessing the painful last of life, the legality of euthanasia, decision on euthanasia, willingness to execute euthanasia on themselves and willingness to execute euthanasia on their families. 4. Statistically significant difference was obseπed in the subjects’ medical morality according to their general characteristics including religion, experience in witnessing the painful last of life, the legality of euthanasia, decision on euthanasia, willingness to exeαlte euthanasia on themselves and wi1lingness to execute euthanasia on their families. 5. Statistically significant difference was observed in the subjects’ right according to their general characteristics including religion, the legality of euthanasia, decision on euthanasia, willingness to execute euthanasia on themselves and willingness to execute euthanasia on their families. There should be repeated researches on various population groups. Moreover, it is considered necessarγ to carrγ out factor -related theoretical researches on several variables related to euthanasia through multilateral literature review.

안락사 : 정의, 분류 그리고 윤리적 정당화

김상득(KIM Sangdeug),손명세(SOHN Myong-sei) 한국생명윤리학회 2000 생명윤리 Vol.1 No.1

Nowadays, the most important question arising in the medical situation is not whether euthanasia is ethically acceptable, but what are the acceptable guidelines for euthanasia. In order to determine this acceptable guidelines, we reviewed the definition and classification of euthanasia in the ethical context. After defining the broad of euthanasia in the ethical context, we classified and discussed on different types of euthanasia according to patient's consent, types of practice, and causal relation between practice and death. This study did not apply the idea of action/non-action from previous ethics studies into euthanasia, but rather we discussed on and analysed euthanasia according to types of practice and cause of death. As a result, we developed the acceptable guideline of euthanasia: (1) there must be the patient's own voluntary consent, (2) advanced directives or agreement of euthanasia ethics committee can be considered as patient's voluntary consent, (3) physician-assisted suicide is a kind of euthanasia and must be treated case by case, (4) distinguishing active/passive euthanasia is not meaningful in the ethical context, (5) indirect euthanasia, whether active or passive, it is acceptable ethically, and (6) except for special cases, direct euthanasia is not acceptable.

안락사에서 제기되는 윤리적 문제에 대한 세계평화통일가정연합의 견해

강명호 통일사상학회 2022 통일사상연구 Vol.22 No.-

유병장수의 시대를 맞아 안락사에 대한 담론이 팽배하는 가운데 그에 따른 윤리 적 문제 또한 부각되었다. 이러한 시점에 세계평화통일가정연합에서는 안락사에 대 해 어떻게 바라보는지, 안락사에서 제기되는 윤리적 문제에 대해 어떻게 판단하는지 를 연구했다. 안락사는 일반적으로 ‘심각한 정신적・육체적 고통을 겪고 있는 환자를 자연적 수명이 다하기 전에 끊어주거나 일찍 죽도록 적극적 치료를 중단하여 죽음 에 이르게 하는 것’으로 정의한다. 죽음을 야기하는 행위의 양상에 따라 적극적 안락 사와 소극적 안락사로 나뉜다. 죽임을 당하는 사람의 의사 표명에 따라 자발적 안락 사와 비자발적 안락사, 또는 반자발적 안락사로 나뉜다. 안락사에서 제기되는 윤리 적 쟁점은 첫째, 인간은 스스로 ‘죽을 권리’가 있는가 하는 문제이다. 자발적 안락사 나 조력자살이 이 윤리적 쟁점에 놓여있다. 두 번째로 안락사에서 제기되는 윤리적 쟁점은 인간은 타인을 ‘죽일 권리’가 있는가 하는 문제이다. 안락사에 대한 기본적 판단근거는 인간관이다. 인간관에 따라서 윤리적 문제를 달리 해석한다. 인간이면 누구나 인간 생명에 대한 존엄성을 가진 인격체라고 보는 인격주의 인간관과 인간 과 인격체를 분리해서 인간의 가치를 심리・사회적 특징을 지닌 자와 지니지 못한 자를 구별하여 판단하는 자유주의 인간관으로 대별된다. 가정연합의 인간관은 인격 주의 인간관이다. 인간은 하나님으로부터 생명을 부여받은 신래적(神來的) 존재로서 결과적 존재이다. 인간은 하나님의 자녀로서 신격(神格)의 가치를 지닌 존엄한 존재이다. 인간은 육신과 영혼이 통일된 존재로서 영혼을 사랑의 완성체로 성장시키 기 위해 주어진 생명을 잘 지켜야 할 존재이다. 인간 생명의 주권은 하나님이 갖고 있기 때문에 인간은 스스로 죽을 수 있는 권리를 갖지 못하고, 타인을 죽일 수 있는 권리도 갖지 못한다. 따라서 가정연합에서 볼 때, 자발적 안락사나 적극적이든 소극 적이든 안락사는 반윤리적인 것이라 할 수 있다. 다만 비자발적 안락사에 있어서 뇌 사 상태에 준하거나 말기환자가 연명치료 중에 있는 경우에 가족들의 합의와 교회 의 동의 속에 연명의료를 중단하거나 유보하는 것은 자의적이든 비자의적이든 윤리 적으로 어긋나지 않는다고 본다. Amid the widespread discourse on euthanasia in the era of longevity accompanied by disease, ethical issues have also emerged. On this point, the Family Federation studied how to view euthanasia and how to judge ethical issues raised in euthanasia. Euthanasia is generally defined as ‘the act of killing a patient who has significant mental or physical pain before their natural life expectancy or letting the patient die through stopping aggressive treatment of the patient’. It is divided into active euthanasia and passive euthanasia according to the pattern of death-causing behavior. It is also divided into voluntary euthanasia, involuntary euthanasia, or nonvoluntary euthanasia according to the expression of intention of the person being killed. The ethical issue raised in euthanasia is first, whether humans have the right to die on their own. Voluntary euthanasia or assisted suicide is included in this ethical issue. The second ethical issue raised in euthanasia is whether humans have the right to kill others. The basis for the basic judgment on euthanasia involves the perspective on human beings. Ethical issues are interpreted differently depending on the view of human beings. It is roughly divided into a personalism view of human beings that any human being is seen as a person with dignity to human life and the non-personalism view of human beings that separates human values from those with psychological and social characteristics and those who do not. The perspective on human beings of the FFWPU is a personalism's view of human beings. Humans are the resultant beings, that is divine beings who have been given life by God. As a child of God, man is a dignified being with the value of God. Humans are beings in which the physical self and the spirit self are unified and must protect the life given to grow the spirit self into a completion of love. Since God has the sovereignty of human life, humans do not have the right to die on their own, nor do they have the right to kill others. Therefore, from the FFWPU perspective, voluntary euthanasia, active or passive, can be said to be anti-ethical. However, in involuntary euthanasia, if a brain-dead patient or a terminally ill patient is undergoing life-sustaining treatment, then suspending life-sustaining treatment according the agreement of the family and the consent of the church, it is not considered to be unethical.

캐나다에 있어 안락사 논의의 현재와 미래

홍태석 원광대학교 법학연구소 2019 의생명과학과 법 Vol.21 No.-

안락사(安樂死, euthanasia)란 불치의 중병에 걸린 등의 이유로 치료 및 생명 유지가 무의미하다고 판단되는 사람에 대하여 직·간접적 방법으로 고통없이 죽 음에 이르게 만드는 행위를 말하며, 존엄사(尊嚴死, death with dignity)라고도 한다. 이러한 안락사는 적극적 안락사와 소극적 안락사로 나뉜다. 특히 적극적 안락사는 종교계나 의학계에서도 허용되지 않거니와 법률적인 부분에서도 허용되지 않고 있다. 이는 환자에게 고통제거의 수단으로 행하였다 하여도 살인행위로 볼 수 있어 위법의 소지가 있으며 이러한 이유로 적극적 안락사는 살인행위로 평가되고 있다. 캐나다에서는 1990년대초 근위축성측색경화증(筋萎縮性側索硬化症, Amyotrophic Lateral Sclerosis)을 앓고 있는 여성이 안락사에 대한 요청이 있었고, 이에 자 살방조규정의 합헌성을 심리하는 재판이 진행되었다. 캐나다 연방대법원은 5대 4의 근소한 차이로 이 여성의 주장을 배척하였고, 이 재판은 미국의 여러 주 (州)에 자살방조규정의 합헌성을 심리하는 재판과 자살방조 및 안락사의 합헌성 을 둘러싼 운동에 까지 큰 영향을 주었고 이후 세계 각지에서 일어난 자살방조 및 안락사 합법화의 운동전개에 많은 영향을 주었다. 안락사는 인간의 생명을 인위적으로 앞당기는 것이므로 그 허용범위와 허용 성 자체에 이론(異論)이 있는 것도 사실이다. 이에 본 논문에서는 캐나다에서 논의되고 있는 안락사 대상자의 요건, 안락사 남용의 위험성에 따른 안전대책 등에 대하여 검토함으로서 향후 우리나라의 안락사 논의에 조금이나마 도움이 되고자 하였다. Euthanasia is the act of causing death without pain in a direct and indirect way for those who are judged to have no meaning in treatment or life maintenance, such as an incurable disease, and so on. Such euthanasia is divided into positive euthanasia and passive euthanasia. Active euthanasia is not allowed in religious and medical circles, but it is not allowed in legal terms. Even if this is done as a means of relieving pain in patients, it is illegal, and for this reason positive euthanasia is considered a murder. In Canada in the early 1990s, women suffering from amyotrophic lateral sclerosis were requested to die in euthanasia and trials were carried out to determine the constitutionality of the suicides and assistance provisions. The Canadian Supreme Court rejected the woman's claim by a margin of 5 to 4. The trial had a major impact on several states in the United States, including the trial of the constitutionality of the suicidal assistance provision and the movement for the constitutionality of suicidal assistance and euthanasia. In this paper, the requirements of the euthanasia subject being discussed in Canada, safety measures due to the risk of euthanasia abuse, etc. were reviewed, which was intended to be helpful for the future discussion of euthanasia in Korea.

中国生命权的宪法上保护问题

林宗浩(Lin, Zong-Hao),程金池(Cheng, Jin-Chi) 충북대학교 법학연구소 2012 과학기술과 법 Vol.3 No.1

In China, since 80 years of reform and opening up have its first case of euthanasia has never stopped for the discussion of euthanasia. The people in favor of euthanasia think that people have the right to choose euthanasia, the era of the rule of law, people not only have the right to life, also has the right to make independent decisions on the death , the state and society must respect this right. The people who against euthanasia believe that life is the most valuable asset, people's life should be respected by others, no one has the right to deprive others of life. when patients suffer from the disease should be timely and full treatment. Every lives should receive equal treatment and protection, We must prohibit any early termination of life and give up to help the patient's behavior. Although many people called for the legalization of euthanasia, but from the current situation, the legalization of euthanasia in China, there are also many problems must to be solved. For example, in the ethical it need to develop a clear consensus in the community; still the lack of legitimacy of the basis in law; difficult to eliminate the conflict between the value of personal autonomy and social community in the implementation of euthanasia; possible abuses of the social evaluation of the euthanasia rights will lead to social shaken the value of life. Only in solving the above problems, in order to further carry out the relevant legislation on euthanasia.

안락사 개념의 새로운 정립과 비범죄화에 관한 연구

김낙현(Nakhyun Kim),나광주(Kwangjoo Na) 성균관대학교 법학연구소 2013 성균관법학 Vol.25 No.4

Current concept of euthanasia is confusing enough to interpret the same word in a different way. So, it is necessary to organize the term, 'Euthanasia'. When it comes to enter the area of Criminal law, the principle of "nulla poena sine lege, a need to define of euthanasia more clearly is self-evident. Upon conceptualize euthanasia neoterically, the starting point is just "life". It can be seen that human lives toward death from the birth, can also be viewed as dying. In other words, because humans ought to exist under the flow of a common time, the "life and death", it is needed that premise of the right of self-determination, the pursuit of happiness and the dignity of human includes not only the 'life' but also 'death'. Accordingly, "the right to die with dignity", select the life to the death, must be guaranteed by the right of self-determination. In Korea, it is seen as not consistent with the standards concept of euthanasia. Furthermore, the discussion on permission of euthanasia is intertwined complicatedly due to this reason. By paying attention to such points, this study is conducted as the overall discussion of the existing associated with euthanasia and the trial to define of the standardized concept of euthanasia on the basis of the right of die with dignity guaranteed by Constitution. In light of the concept which is newly defined, it is performed to demonstrate to classify euthanasia into small groups and justify euthanasia. After these demonstrations, it can be said that the purpose of this paper is examining the legal system of the country, which is already the legislation, and considering appropriate legislation example to us about euthanasia.

독일의 안락사 논의와 입법 및 판례의 동향

홍석한 가천대학교 법학연구소 2010 가천법학 Vol.3 No.3

우리나라에서도 어느 때보다 안락사 법제화에 관한 논의가 뜨겁게 일고 있는 시점에서 해외 각국의 논의와 관련 법제 및 판례를 검토하고 그 시사점을 찾아보는 것은 중요한 의의를 갖는다고 할 것이다. 특히, 독일의 경우 나치정권에 의해 안락사라는 명분하에 자행된 학살행위의 경험 때문에 안락사는 인간의 존엄에 상응하기 보다는 인간의 존엄을 침해하는 것이라는 부정적 사고를 가지게 되었다. 하지만 1980년대 이후부터 주로 소극적 안락사를 긍정하는 연방대법원의 결정들을 계기로 안락사의 의미와 그 허용범위에 대한 논의가 본격적으로 이루어지기 시작했다. 이에 안락사를 법제화하기 위한 각계의 노력도 오랜 기간에 걸쳐 진행되었으며, 2009년 6월에는 연방의회에서 사전지시서에 관한 법률(Gesetz zur Patientenverfgung)이 통과되어 동년 9월 1일부터 시행되고 있다. 이처럼 안락사에 대해 매우 부정적인 인식을 가졌던 독일에서의 논의와 최근 판례 및 입법의 경향은 우리에게도 참고할 만한 중요한 자료가 될 것이다.헌법상 안락사는 죽음에 대한 자기결정권을 기본권으로 인정할 수 있는가, 인정할 경우 국가는 어느 범위까지 이를 제한할 수 있는가, 국가의 기본권보호의무와의 관계에서 생명의 침해에 대해 국가는 어떠한 보호조치를 취해야 하는가의 문제로 귀결된다. 생명의 처분에 관한 자기결정권을 헌법상 기본권으로 인정한다고 하더라도 이는 인간의 생명에 관한 중요한 문제이며 또한 현실적으로 남용 내지 악용될 위험이 크기 때문에 그 조건 및 한계와 제한에 대해서는 신중한 접근이 요구되며, 관련된 이익을 엄격하게 형량하여 결정해야 한다. 따라서 상이한 조건 하에 매우 다양한 형태로 이루어지는 안락사에 대해 헌법적으로 상세하고 명확한 결론을 내리는 것은 한계가 있으며, 안락사와 관련된 분쟁은 일차적으로 법원에서 다루어지게 되는 만큼 자기결정권의 내용을 구체적으로 확정하는 것 역시 법원의 몫이 될 것이다. 그러나 안락사의 문제는 기본권에 대한 중대한 사항이 될 뿐만 아니라 공개된 토론과 타협을 거쳐 사회적 합의에 의해 확정되는 것이 요구되는 사항이다. 따라서 구체적인 분쟁의 해결이 법원에서 이루어지더라도 기본적인 사항을 법률로 정함으로써 법적 안정성을 기하고 남용 내지 악용의 위험을 사전에 차단하는 것이 필요하며, 이러한 입법의 틀은 물론 헌법적 관점에서 설정되어야 한다. There are a lot of topics to evoke the sharp contrast for a long time at the boundaries of law and morality or religion. Among them, the death penalty, abortion, euthanasia and the issues surrounding human life, as even more extreme is the subject of controversy. In particular, from the use of the term euthanasia opposing viewpoints are expressed. Because, euthanasia can be made into various forms, the pros on this discussion takes on a very complex pattern. Currently, the whole world to legalize euthanasia or tendencies are tolerated.In Germany, the Nazi regime committed genocide under the name of human dignity. Because of the experience, German had negative perceptions about euthanasia a violation of human dignity, rather than increase human dignity. Since the 1980s, however, the decisions of the Supreme Court that recognize largely passive euthanasia inspired to discuss about the meaning and the permissible range of euthanasia. So, in various areas the efforts to legalize euthanasia has been progressing over a long period, in June of 2009 the Federal Parliament 'Gesetz zur Patientenverfgung' was passed and has been in force since September 1. This paper related to the euthanasia debate in Germany is going to look at the trend of legislation and court precedents, is looking at the implications for our discussion at the constitutional perspective.Constitutionally, the euthanasia all boils down to discussions in the end; self-determination to death can be recognized as a fundamental right, admit it, the country that may limit the extent, the relationship between the duty to protect the fundamental rights, for the violation of life, the country should take what protection measures. Even if the right of self-determination to death is recognized it is very important issue on human life and also there are realistic risks of abuse or exploitation. So, it is required to carefully approach with the conditions, the size limits and restrictions, the benefits associated should be strictly determined. The problem of euthanasia to be crucial for the fundamental rights, as well as through public debate and compromise, to be determined by social consensus is a requirement. Therefore, even if the resolution of specific disputes made in court, it is necessary to set by law the fundamentals of euthanasia to secure legal stability and prevent the risk of abuse or exploitation. Above all, this legislative framework should be set in terms of constitutional.

적극적/소극적 안락사 구분 논변에 대한 비판적 고찰

장동익 ( Chang Dong Ik ) 성균관대학교 인문학연구원 2023 人文科學 Vol.- No.89

이 논문에서는 적극적/소극적 안락사 구분이 안락사에 대한 윤리적 논의에서 큰 의의가 없다는 것을 해명하려고 하였다. 이를 위하여 먼저 적극적/소극적 안락사를 구분해 준다고 주장되는 근거들을 살펴보았다. ‘행위’와 ‘무행위’, 그리고 ‘죽이려는 의도’가 적극적/소극적 안락사를 구분할 수 있는 근거가 될 수 없다는 것을 해명하였다. 그리고 적극적/소극적 안락사 구분에 실패한다면, 적극적 안락사는 금지하고, 소극적 안락사는 허용하려는 입장은 성공적이지 못하다는 것을 해명하였다. 또한 행위와 무행위에 의해, 적극적/소극적 안락사를 구분할 수 있지만, 이렇게 구분된 적극적 안락사와 소극적 안락사에 도덕적 차이가 없다는 이유로, 적극적 안락사도 허용되어야 한다는 레이첼스의 견해에 논리적인 문제점이 있다는 것도 지적하였다. In this paper, I tried to explain that the classification of active and passive euthanasia is not of great significance in the ethical discussion of euthanasia. For this purpose, the grounds for distinguishing between active and passive euthanasia were examined. It was clarified that “action,” “omission,” and “an intention to kill” cannot be the basis for distinguishing active and passive euthanasia. This study also proved that if the distinction between active and passive euthanasia fails, the position of banning active euthanasia and allowing passive euthanasia is not successful. In addition, this paper found a logical problem in Rachels' view, according to which active and passive euthanasia can be distinguished by action and omission but active euthanasia should be allowed because no moral difference exists between active and passive euthanasia.