失智症患者的安樂死：一項義務還是權利

Euthanasia for Dementia Patients: An Obligation or a Right

Abstract

LANGUAGE NOTE | Document text in Chinese; abstract also in English.

本研究探討失智症患者是否有義務或權利接受安樂死，並 對美國學者庫利（Dennis Cooley）和羅德斯（Rosamond Rhodes）基於康德哲學與公正原則所提出的“患者有義務接受安樂死”論點進行批判。文章首先指出，在康德道德框架中並不存 在保全自身道德能力的義務；即便承認此種義務，亦無法推出 失智症患者應接受安樂死的結論。此外，從公正原則主張失智 症患者有義務接受安樂死，也存在因果推定與資源分配的邏輯 缺陷。之後，文章轉向行善（beneficence）原則中的利他主義， 論證失智症患者擁有請求安樂死的“權利”而非“義務”。最 後，文章強調實踐層面的困難：失智症導致患者認知功能受 損，如何在保障自主決策的前提下實施安樂死，尚需進一步的 社會支持與制度設計。總體而言，失智症患者行使安樂死的權 利在道德上可被允許，但應謹慎處理以避免外在壓力或強制要求，對患者的真實意願予以最大程度的尊重。

This paper examines whether patients with dementia have an obligation or a right to undergo euthanasia through critical analysis of arguments made by the American scholars Dennis Cooley and Rosamond Rhodes. Based on Kantian philosophy and the principle of justice, both scholars assert that these patients have a duty to accept euthanasia. The paper first observes that the Kantian moral framework contains no obligation to preserve one’s own moral agency, and even if such an obligation were acknowledged, it would not require patients with dementia to accept euthanasia. The paper further observes that using the principle of justice to impose such an obligation on patients with dementia is logically flawed in terms of inference and resource distribution. The discussion then shifts to altruism in the principle of beneficence, arguing that dementia patients possess the “right”, rather than the “duty”, to request euthanasia. Finally, the paper highlights practical challenges. Specifically, as dementia impairs patients’ cognitive functions, additional social support and institutional structures are necessary to ensure that their decisions about euthanasia remain truly autonomous. While it may be ethically permissible for patients with dementia to exercise their right to euthanasia, this option should be pursued cautiously to avoid external pressures or coercion and to uphold the patient’s genuine wishes.