行将就木，向死而在 | 经济学人社论
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思维导图：
Summer，女，QE在职，梦想能仗走天涯翻译/音乐/健康
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英文部分选自经济学人20240413社论版块
Leaders | The sense of an ending
经济学人社论 | 行将就木，向死而在
The rights and wrongs of assisted dying
安乐死的是与非
Britain’s next great social reform is coming. Here’s how it should work
英国下一项重大社会改革即将到来。以下是它应如何实施。
Britain has become a much more liberal country in recent decades.In 1981 only 12% of Britons thought that homosexuality was justifiable, according to the World Values Survey; in 2022 the figure was 66%. Over the same period the proportion of people who were accepting of divorce rose from 18% to 64%. Where the public has led, politicians have followed: same-sex marriages were legalised in 2013; no-fault divorces became possible in 2022. That pattern may well be about to repeat itself with assisted dying.
近几十年来，英国的自由开放程度越来越深。据世界价值观调查（World Values Survey）数据显示，在1981年，仅有12%的英国民众接受同性恋；而到了2022年，这一比例升至66%。同期，接受离婚的比例也从18%上升至64%。民之所向，政之所从：英国在2013年实现了同性婚姻合法化，到了2022年，无过错离婚制度也得以推行。这样的趋势很可能在安乐死议题上再次出现。
Over two-thirds of Britons support changing the law to let someone help in the suicide of a person with a terminal illness. Assisted dying has a good chance of getting on the statute book in the near future. Bills are already in progress on the Isle of Man, in Jersey and in Scotland. Sir Keir Starmer, the Labour leader, is sympathetic and has promised a free vote among MPs if his party wins the next general election.
超过三分之二的英国民众支持法律改革，认为应当允许协助绝症患者结束生命。安乐死有望在不久的将来被写入法律。目前，马恩岛、泽西岛和苏格兰已经在推进相关法案。工党党魁基尔·斯塔默（Keir Starmer）对此深表支持，并承诺如果工党在下届大选中获胜，他将允许国会议员自由投票。
If The Economist had a vote, it would be unequivocally in favour.The case for assisted dying is, at its core, one of individual freedom. Britons have the right to marry whom they want. They have the right to roam. Through an obscure medieval law, some even have the right to drive sheep across London Bridge. They should have the right to choose the manner and timing of their death. The more complex question is what form an assisted-dying regime should take. That is not just to ensure safeguards against abuses, though it must undoubtedly do that. It is also to make sure that the law is not drawn too tightly.
如果《经济学人》拥有投票权，无疑会全力支持。支持安乐死的根本原因在于维护个人自由。英国民众有权自由选择结婚对象，享有四处漫游的权利。根据一项鲜为人知的中世纪古老法律，一些人甚至有权在伦敦桥上赶羊。同样，他们也应当有权选择自己生命的终结方式和时间节点。更复杂的问题在于，应设立何种安乐死机制。这不仅需要确保有足够的措施防止滥用，还要确保法律条文不会过于严苛。
注释：
right to roam: 漫游自由允许人们在私人住宅和庭院的一定距离外行走、滑雪、骑自行车、露营、生火（除了有火灾风险时公告禁止）、采集莓果、蕈类和花（除了保育物种）、划船和游泳，但钓鱼和打猎是地主的权利。如其他北欧国家，漫游自由也同时附带有不破坏环境的义务。
Britain is in many ways late to the issue (as are countries like Ireland and France; a bill was presented to the French cabinet this week). Belgium, the Netherlands, Oregon and Switzerland have had assisted-dying laws for decades. Seventeen jurisdictions have passed laws since we argued in favour of legalisation in 2015. Although opponents of assisted dying have deeply held beliefs, and raise legitimate concerns, the actual experience of these many jurisdictions strengthens the arguments in its favour.
在处理安乐死议题上，英国在很多方面的步伐相对迟缓（爱尔兰和法国等国家亦然；法国内阁本周刚提出了一项法案）。安乐死法律已在比利时、荷兰、美国俄勒冈州和瑞士等国家与地区实行了数十载。自从2015年英国为支持合法化展开辩论以来，已有17个司法管辖区通过了相关法律。尽管反对人士持有坚定信念并提出了合理担忧，但这些司法管辖地区的实践经验进一步为安乐死的正当性提供了有力支持。
注释：
2015年2月6日，英国议会上院激烈辩论“安乐死法案”。2015年9月，英国下议院曾以118票赞成、330票反对否决了安乐死合法化议案。英国议会此后多次就安乐死进行讨论。
Take concerns about coercion. Critics argue that no regime could ever fully protect the vulnerable from relatives looking to claim an inheritance, or indeed from a state seeking to cut health-care costs. Yet the evidence suggests that cases of coercion are extremely rare. The state should do its best to help people live well, whether through social support or palliative care, but if it cannot, those who truly wish to die should not be obliged to suffer. In places where an assisted death remains illegal, only those with money have the option to take matters into their own hands—on average one Briton a week travels to Switzerland to end their life there. The rights of hypothetically vulnerable patients are taking precedence over the rights of those who are actually in anguish.
下面谈谈胁迫问题引发的担忧。批评人士认为，任何制度都无法完全保护弱势群体免受胁迫，或是患者亲属索要遗产，或是国家想要削减医疗开支。然而证据表明，胁迫的情况极为罕见。无论是通过社会支持还是姑息治疗，国家应该竭尽所能让患者活得体面。但如果做不到这一点，那些真正希望结束生命的人不应被迫承受痛苦。在安乐死仍然非法的地区，只有经济条件允许的人才能掌控自己的命运。平均每周都有一位英国人前往瑞士结束自己的生命。为了保护“弱势群体”的权利，使他们免遭可能的胁迫，却牺牲了那些真正处于痛苦中的患者的权利。
Some critics say that assisted dying is a “slippery slope”. If this is the fundamental reason for your opposition, you are pretty much conceding the principle that there are indeed instances when it would be right to help someone die—it’s the scope that is the problem. In any case experience suggests that no such slope exists. Although eligibility criteria for an assisted death have expanded in Belgium and the Netherlands, they have never done so in jurisdictions whose initial laws were restricted to terminally ill adults. Canada’s decision to postpone the extension of assisted-dying laws to the mentally ill until 2027 shows that it is possible to press “pause”. True, the numbers of people seeking assisted deaths is increasing: they now make up 4% of all deaths in Canada and 5% in the Netherlands. Yet if those higher figures are an expression of people’s desire to make use of a new freedom, as is overwhelmingly likely, they are a reason to pass laws, not to block them.
一些批评人士认为，安乐死是一个“滑坡谬误”。如果这是你持反对立场的根本原因，那么你相当于承认了在某些情况下，帮助他人死亡是正确的，问题就在于适用范围的界定。经验表明，无论如何都不存在这样的“斜坡”。虽然比利时和荷兰已经扩大了实行安乐死的资格标准，但对于那些最初法律仅限于晚期患者的司法管辖区，这些标准从未变化。加拿大决定将安乐死法律的范围扩大到精神疾病患者，但该项法律推迟到2027年实施，表明可能会对这种范围的扩大按下“暂停”键。诚然，寻求安乐死的人数日益增长。在加拿大和荷兰，安乐死的人数分别占死亡总人数的4%和5%。然而，如果这些数字升高反映了人们对新自由的渴望（极大可能如此），那么这恰恰是应该通过法律的理由，而非阻碍它的原因。
注释：
滑坡谬误（Slippery slope）是一种逻辑谬论，即不合理地使用连串的因果关系，将“可能性”转化为“必然性”，以达到某种意欲之结论。但其实每个的推断还有很多不同的可能性，却武断地将某个可能性引伸成为必然性，然后串联这些不合理的因果关系，推断成一件毫无关联的结果，这就是滑坡谬误。滑坡谬误的典型形式为“如果发生A，接着就会发生B，接着就会发生C，接着就会发生D，……，接着就会发生Z”，而后通常会明示或暗示地推论“Z不应该发生，因此我们不应允许A发生”。A至B、B至C、C至D、……等因果关系好似一个个“坡”，从A推论至Z的过程就像一个滑坡。滑坡谬误的问题在于，每个“坡”的因果强度不一，有些因果关系只是可能、而非必然，有些因果关系相当微弱，有些因果关系甚至是未知或缺乏证据的，因而即使A发生，也无法一路滑到Z，Z并非必然（或极可能）发生。相对地，若有充足证据显示每个“坡”都有合理、强烈的因果连结，即不构成滑坡谬误。
Whether out of conviction or caution, politicians tend to respond to such concerns by writing laws that are based on Oregon’s model, which requires a person to be terminally ill with less than six months to live to be eligible for an assisted death. This is the approach being followed in Ireland. France’s assisted-dying bill is also limited to the terminally ill, even though a citizens’ assembly convened by President Emmanuel Macron supported a broader law for those suffering unbearably from an incurable illness. The Oregon template is also likely to be the one mps in Westminster will eventually end up debating, if previous bills are a guide. It is too restrictive.
不论是出于信念还是谨慎，政治家在回应这种担忧时，往往会基于俄勒冈州的模式来制定法律。该模式要求必须是寿命不足六个月的绝症患者才有资格申请安乐死。爱尔兰也采用了这种方式。尽管埃马纽埃尔·马克龙总统召集的公民大会支持扩大法案适用范围，涵盖那些痛苦不堪的绝症患者，法国的安乐死法案也仅限于身患绝症之人。如果以前的法案可以作为参考，俄勒冈州的模板也很可能是英国议员们最终要辩论的内容。（但）这种模式的限制性太强。
注释：
1994年，俄勒冈州公民投票通过《尊严死亡法》，开创了医生协助晚期病人安乐死合法化的先河，将美国安乐死之争推向巅峰。
Strict time constraints mean that people often die before they can receive the lethal medication. And many people suffer terribly with a disease that is not terminal. Canada’s model, which allows someone to determine for themselves whether their suffering is unbearable, is fairer. A person there must be suffering from a serious and incurable medical condition and must wait 90 days to reflect on their decision. Arguments that this broader scope devalues disabled lives are well-meaning but paternalistic. Three-quarters of Canadians with disabilities support the existing law.
时间限制如此严格，这意味着患者通常还未能获得致死药物就已经离世。而且让许多人饱受痛苦的疾病，并非是不治之症。加拿大的模式相对更公平，患者可自行判断是否已经无法忍受病痛的折磨。在加拿大，申请人必须患有无法治愈的重疾，还必须等待90天来深思自己的决定。有人认为这种更广泛的适用范围轻贱了残疾人的生命，这种说法也是出于好心，但颇具家长作风。其实四分之三的加拿大残疾人都支持现行法律。
The thorniest issues arise when it is hard to determine whether people are of sound mind. Canada’s decision to postpone the extension of assisted-dying laws to people with mental-health disorders is sensible for this reason. Mental suffering is as real as physical suffering, yet society’s understanding of it is still inadequate.Doctors must be able to tell between a considered, rational wish to die and a suicidal impulse, a distinction many clinicians feel unable to make.
当难以判定某人是否心智健全时，问题变得最为棘手。鉴于此，加拿大推迟将安乐死的法律适用范围扩大到精神疾病患者，这一决定实乃明智之举。身体遭受的痛苦是切实存在的，精神折磨亦如是，但社会对此仍然认知不足。到底是经过深思熟虑的、理性的死亡愿望，还是自杀冲动，医生必须能够对此做出鉴别，而许多临床医生自觉无力分辨。
Dementia, which already afflicts one in 11 Britons over 65, is also a difficult area. It is possible for someone in the early stages of dementia to make a request in advance for an assisted death, but their wishes when the time comes should prevail. When in doubt, the best rule of thumb is not to proceed.
安乐死如何应用于痴呆症也是一个难题。在65岁以上的英国人中，每11人里就有1人患有痴呆症。早期痴呆症患者有可能提前请求安乐死，届时还是应以他们的意愿为准。如果有拿不准的地方，最好的经验法则就是不要执行。
The right balance
正确的平衡
There is no guarantee that politicians in Britain will vote in favour of assisted dying. But when they do debate the issue, they should not default to the narrowest definition of what is a basic human right. All adults of sound mind who are enduring unbearable suffering with no prospect of recovery should be able to choose the way they die.
我们不敢说英国政客一定会投票支持安乐死。但当他们就此展开辩论时，不应该将基本人权的定义局限得太狭隘。所有心智健全的成年人，如果正在遭受无法忍受的痛苦且没有康复希望，都应该有权自行选择死亡方式。
翻译组：
Yo，女，种下过流星，立志不做大鸵鸟
Trista，女，暴富不是梦想，是未来的现实
Humi，在躺平、侧卧和睡梦中寻找诗和远方
校对组：
Charlie，剃刀边缘无比锋利
Hannah，女，做个废柴，保持愉快
Lucian，医学翻译，灵魂在杰作中冒险
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