豪・NZ緩和医療学会の安楽死・自殺幇助への反対声明
まずポジション・ペーパーの目的として、
以下の3点を明記。
以下の3点を明記。
Statementは以下。
（全訳する余裕がないので、論点のみを簡単にメモ）
（全訳する余裕がないので、論点のみを簡単にメモ）
1. The Palliative Medicine discipline does not include the practice of euthanasia or
assisted suicide. ANZSPM activities are limited to the Palliative Medicine discipline.
There is a clear distinction between good care for the dying and active interventions
instituted in order to deliberately end the life of a patient.
緩和ケアと意図的に患者の命を終わらせることの区別
2. Patients have the right to refuse life sustaining treatments including the provision of
medically assisted nutrition and/or hydration. Refusing such treatment does not
constitute euthanasia.
栄養と水分を含む生命維持を拒否する患者の権利
生命維持拒否は安楽死ではない
3. Good medical practice mandates that the ethical principles of beneficence and nonmaleficence should be followed at all times. The benefits and harms of any treatments (including the provision of medically assisted nutrition and/or hydration) should be considered before instituting such treatments. The benefits and harms of continuing treatments previously commenced should be regularly reviewed. Withholding or withdrawing treatments that are not benefitting the patient, is not euthanasia.
治療の利益と害の比較考量を繰り返すことの重要性
患者に利益のない治療の中止と差し控えは安楽死ではない
4. Treatment that is appropriately titrated to relieve symptoms and has a secondary and
unintended consequence of hastening death, is not euthanasia.
症状緩和のために適切に行われる治療が結果的に縮命となるのは安楽死ではない
5. Palliative sedation for the management of refractory symptoms is not euthanasia.
難しい症状を管理するためのセデーションは安楽死ではない
6. Requests for euthanasia or assisted suicide should be acknowledged with respect and be extensively explored in order to understand, appropriately address and if possible
remedy the underlying difficulties that gave rise to the request. Appropriate ongoing
care consistent with the goals of Palliative Medicine should continue to be offered.
安楽死や自殺幇助の要望は敬意を持って受け止めつつ、
緩和医療の目的に沿ったケアの続行により
そうした要望が起きてくる要因となっている困難に対応すべき
7 When requests for euthanasia or assisted suicide arise, particular attention should be
given to gaining good symptom control, especially of those symptoms that research has
highlighted may commonly be associated with a serious and sustained "desire for
death" (e.g. depressive disorders and poorly controlled pain). In such situations early
referral to an appropriate specialist should be considered.
安楽死や自殺幇助の要望があった際には
症状緩和をしっかり行うよう心がけること。
早期に適切な専門家に紹介することも必要
8. Despite the best that Palliative Care can offer to support patients in their suffering,
appropriate specialist Palliative Care to remedy physical, psychological and spiritual
difficulties may not relieve all suffering at all times.
緩和ケアの最善を尽くしても
常にすべての痛苦を緩和できるわけではない
9. ANZSPM acknowledges the significant deficits in the provision of palliative care in
Australia and New Zealand, especially for patients with non-malignant life limiting
illnesses, those who live in rural and remote areas, residents of Residential Aged Care
Facilities, the indigenous populations and those from culturally and linguistically
diverse backgrounds.
オーストラリアとNZの地方在住や施設入所、先住民など多様な背景の人々が
非悪性（非がん？）の生活を制約される病気になった際には
緩和ケアを受けにくい事態はANZSPMとしては了解している
10. ANZSPM advocates for health reform programs in Australia and New Zealand to
strengthen end of life care by remedying shortages in the palliative care workforce
(including in the specialist medical, nursing, and allied health fields), ensuring
improved access to appropriate facilities and emphasising the role of advance care
plans and directives.
ANSZPMは、緩和ケア労働力の不足を是正し終末期医療を強化するよう
事前の計画と事前指示書の重視を含め、両国の医療改革を訴える
11. ANZSPM advocates for increased carer support for respite care to decrease the sense of burden for many patients at the end of life.
ANSZPMは、多くの患者が終末期に家族の負担となっていると感じないよう
ケアラーへのレスパイト支援の増強を訴える
assisted suicide. ANZSPM activities are limited to the Palliative Medicine discipline.
There is a clear distinction between good care for the dying and active interventions
instituted in order to deliberately end the life of a patient.
緩和ケアと意図的に患者の命を終わらせることの区別
2. Patients have the right to refuse life sustaining treatments including the provision of
medically assisted nutrition and/or hydration. Refusing such treatment does not
constitute euthanasia.
栄養と水分を含む生命維持を拒否する患者の権利
生命維持拒否は安楽死ではない
3. Good medical practice mandates that the ethical principles of beneficence and nonmaleficence should be followed at all times. The benefits and harms of any treatments (including the provision of medically assisted nutrition and/or hydration) should be considered before instituting such treatments. The benefits and harms of continuing treatments previously commenced should be regularly reviewed. Withholding or withdrawing treatments that are not benefitting the patient, is not euthanasia.
治療の利益と害の比較考量を繰り返すことの重要性
患者に利益のない治療の中止と差し控えは安楽死ではない
4. Treatment that is appropriately titrated to relieve symptoms and has a secondary and
unintended consequence of hastening death, is not euthanasia.
症状緩和のために適切に行われる治療が結果的に縮命となるのは安楽死ではない
5. Palliative sedation for the management of refractory symptoms is not euthanasia.
難しい症状を管理するためのセデーションは安楽死ではない
6. Requests for euthanasia or assisted suicide should be acknowledged with respect and be extensively explored in order to understand, appropriately address and if possible
remedy the underlying difficulties that gave rise to the request. Appropriate ongoing
care consistent with the goals of Palliative Medicine should continue to be offered.
安楽死や自殺幇助の要望は敬意を持って受け止めつつ、
緩和医療の目的に沿ったケアの続行により
そうした要望が起きてくる要因となっている困難に対応すべき
7 When requests for euthanasia or assisted suicide arise, particular attention should be
given to gaining good symptom control, especially of those symptoms that research has
highlighted may commonly be associated with a serious and sustained "desire for
death" (e.g. depressive disorders and poorly controlled pain). In such situations early
referral to an appropriate specialist should be considered.
安楽死や自殺幇助の要望があった際には
症状緩和をしっかり行うよう心がけること。
早期に適切な専門家に紹介することも必要
8. Despite the best that Palliative Care can offer to support patients in their suffering,
appropriate specialist Palliative Care to remedy physical, psychological and spiritual
difficulties may not relieve all suffering at all times.
緩和ケアの最善を尽くしても
常にすべての痛苦を緩和できるわけではない
9. ANZSPM acknowledges the significant deficits in the provision of palliative care in
Australia and New Zealand, especially for patients with non-malignant life limiting
illnesses, those who live in rural and remote areas, residents of Residential Aged Care
Facilities, the indigenous populations and those from culturally and linguistically
diverse backgrounds.
オーストラリアとNZの地方在住や施設入所、先住民など多様な背景の人々が
非悪性（非がん？）の生活を制約される病気になった際には
緩和ケアを受けにくい事態はANZSPMとしては了解している
10. ANZSPM advocates for health reform programs in Australia and New Zealand to
strengthen end of life care by remedying shortages in the palliative care workforce
(including in the specialist medical, nursing, and allied health fields), ensuring
improved access to appropriate facilities and emphasising the role of advance care
plans and directives.
ANSZPMは、緩和ケア労働力の不足を是正し終末期医療を強化するよう
事前の計画と事前指示書の重視を含め、両国の医療改革を訴える
11. ANZSPM advocates for increased carer support for respite care to decrease the sense of burden for many patients at the end of life.
ANSZPMは、多くの患者が終末期に家族の負担となっていると感じないよう
ケアラーへのレスパイト支援の増強を訴える
全身麻痺になった翌日に「自己決定」で人工呼吸器とり外して死亡（米）(2013/11/17)
「死の自己決定権」議論の一方で、
「無益な治療」論が対象者をどんどん拡大させていくにつれて、
「重症障害者は治療に値しない」という価値意識が広がっていくならば、
「無益な治療」論が対象者をどんどん拡大させていくにつれて、
「重症障害者は治療に値しない」という価値意識が広がっていくならば、
それでも自己決定権による延命治療の拒否は安楽死ではない、と言っていていいんだろうか。
