Script 閱讀文本
For over two decades, Belgium and the Netherlands have allowed euthanasia for individuals with terminal or non-terminal illnesses, including those with mental disorders, who are experiencing unbearable suffering. Despite a continuous increase in euthanasia cases over the years, the proportion of euthanasia cases involving patients with mental disorders has remained stable (approximately between 1% to 2%). Both Belgium and the Netherlands have similar care standards in their euthanasia regulations, including requirements such as the decision being made by a competent adult after careful consideration, repeated requests, voluntary consent, no improvement in the patient’s condition, existence of unbearable and unrelievable suffering, consultation with two independent physicians including a psychiatrist, post-assessment, and control.
This article discusses a case of a 64-year-old female psychiatric patient in Belgium who applied for euthanasia. The patient had long suffered from chronic depression and personality disorders with ineffective treatment over the years. In September 2011, she applied for euthanasia with Professor D, and after confirmation of her competency and the unrelievable nature of her suffering by three psychiatrists, euthanasia was carried out by Professor D in April 2012. Subsequently, the case was reviewed by the Federal Control and Evaluation Committee (FCECE) and found to comply with regulations.
The patient’s son, upon learning of his mother’s euthanasia, repeatedly requested access to her medical records without success. In 2014, he filed a complaint against Professor D with the Belgian Medical Commission, but it was rejected due to insufficient evidence. Upon retrial in 2019, the case was again found not to be in violation. Subsequently, the son filed a lawsuit against the European Court of Human Rights (ECtHR), alleging violations of Articles 2 and 8 of the European Convention on Human Rights. The ECtHR found that Belgium’s regulations on euthanasia for psychiatric patients met four criteria, namely: clearly defining the right to medical assistance in dying, voluntary request, protection of vulnerable groups, and clear assessment decision-making processes, and did not violate Article 2. Furthermore, the court stated that the patients right to self-determination should take precedence over family involvement, and the case did not violate Article 8.
The court also pointed out that there were independence issues in the anonymous review process of the FCECE, with Professor D serving as co-chair, which could potentially influence the review outcome. According to the judgment, Belgian legislative bodies need to revise the post-control process in euthanasia regulations to ensure the independence of the FCECE. The FCECE recommended removing the anonymity of application documents to enhance the transparency and compliance of the control mechanism. Belgium could consider the control mechanisms in the Netherlands, where euthanasia application documents are not anonymous, and participating physicians must identify themselves, and committee members involved in the case must withdraw from the review.
In conclusion, the ECtHR’s judgment confirms the legality of euthanasia for psychiatric patients and calls for improvements in the control process in Belgian euthanasia regulations to better protect human rights.
Translation 中文翻譯
20 多年以來，比利時及荷蘭對於末期疾病或者非末期疾病，包含精神疾病患者，在處於難以忍受的痛苦的情況下，得以進行安樂死，儘管多年來安樂死案例不斷增加，但是精神疾病患者進行安樂死的案例仍維持穩定的比例（大約 1% 至 2% 之間），就此類案例，比利時以及荷蘭的安樂死法規中均有相類似的照護標準進行規範，包含：是否出於成年具有完全行為能力之人的深思熟慮、反覆以及自願的請求、治療狀況並未見好轉、存在無法緩解且持續難以忍受的痛苦、諮詢兩位獨立醫生，包含精神科醫生、事後評估以及控制。
本文討論了一名 64 歲女性精神病患者在比利時申請安樂死的案例。該患者長期患有慢性憂鬱症和人格障礙，多年來的治療無效。2011 年 9 月，她向 D 教授申請安樂死，並經三名精神科醫生確認其具備行為能力，且痛苦難以緩解。2012 年 4 月，D 教授為其執行安樂死。事後，該案被聯邦監督和評估委員會 (FCECE) 審查並認定符合規範。
患者的兒子在得知母親安樂死後，多次要求索取病歷未果，並於 2014 年向比利時醫療委員會控訴 D 教授，但因證據不足被駁回。2019 年，案件重新審理後仍認定無違規。隨後，兒子向歐洲人權法院 (ECtHR) 起訴，聲稱該安樂死違反歐洲人權公約第 2 條和第 8 條。ECtHR 認為，比利時在精神疾病患者安樂死的相關規範符合四項要件，即：清楚定義醫療協助死亡的權利、自願請求、保護弱勢群體、及明確評估決策流程，並未違反第 2 條。此外，法院指出患者的生命自主權應優先於家庭參與權，且該案未違反第 8 條。
法院也指出，FCECE 的匿名審核流程存在獨立性問題，D 教授作為委員會共同主席，有可能影響審核結果。根據判決，比利時立法機關需修訂安樂死法規中的事後管控流程，以確保 FCECE 的獨立性。FCECE 建議刪除申請文件的匿名性，以提升管控機制的透明度和符合性。比利時可參考荷蘭的管控機制，荷蘭安樂死申請文件不匿名，參與醫生需標明身份，審查委員會中若有委員涉及該案，需退出審查。
總結來說，ECtHR 的判決確認了精神疾病患者安樂死的合法性，並要求改進比利時安樂死法規中的管控流程，以更好地保障人權。
CHECK THIS OUT 學習知識點
Look at this sentence: ‘For over two decades, Belgium and the Netherlands have allowed euthanasia.’ We use the present perfect verb tense here because of ‘for’ and ‘two decades’. The time of the decades includes now. Remember that the present perfect is used to describe present time and time leading up to it.
請看這個句子：「二十多年來，比利時和荷蘭都允許安樂死。」基於『因為』和『二十年』這兩個用詞，這裡使用動詞現在完成時態。這幾十年的時間包括現在。請記住，現在完成式用於描述現在的時間和導致該時間的時間。
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