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Katedra Filozofie Filozofie Euthanasie, Problém Praktické Etiky Masarykova univerzita Filozofická fakulta Katedra filozofie Filozofie Petra Šmidmayerová Euthanasie, problém praktické etiky Magisterská diplomová práce Vedoucí práce: doc. PhDr. Radim Brázda, Dr. 2009 Prohlášení Prohlašuji, ţe jsem předkládanou práci zpracovala samostatně a pouţila jen uvedené prameny a literaturu. Současně dávám svolení k tomu, aby tato diplomová práce byla umístěna v Ústřední knihovně FF MU ke studijním účelům. Brno, 11. květen 2009 Petra Šmidmayerová ……………………………………………. Poděkování Na tomto místě bych chtěla poděkovat vedoucímu mé diplomové práce doc. PhDr. Radimovi Brázdovi, Dr. za cenné rady a pokyny při psaní zadaného diplomového úkolu. OBSAH ÚVOD............................................................................................................................. 1 1. PRINCIP DVOJÍHO EFEKTU .................................................................................. 4 1.1 Definice principu dvojího efektu .......................................................................... 4 1.2 Rozlišení záměru lékaře ....................................................................................... 5 1.3 Argumenty pro akceptovatelnost principu dvojího efektu ................................... 6 1.4 Argumenty proti akceptovatelnosti principu dvojího efektu ................................ 8 1.5 Závěrečné stanovisko k přípustnosti principu dvojího efektu .............................. 9 2. AKTIVNÍ A PASIVNÍ EUTHANASIE .................................................................. 11 2.1 Definice aktivní a pasivní euthanasie ................................................................. 11 2.2 Srovnání aktivní a pasivní euthanasie ................................................................ 13 2.3 Přípustnost pasivní euthanasie ............................................................................ 15 2.4 Přípustnost aktivní euthanasie ............................................................................ 16 2.5 Teze o ekvivalenci .............................................................................................. 19 2.6 Závěrečné stanovisko k přípustnosti aktivní a pasivní euthanasie ..................... 20 3. DOBROVOLNÁ EUTHANASIE A ASISTOVANÁ SEBEVRAŢDA .................. 22 3.1 Ţadatelé .............................................................................................................. 23 3.2 Argumenty pro přípustnost dobrovolné euthanasie a asistované sebevraţdy .... 25 3.2.1 Práva a povinnosti lékaře ............................................................................. 27 3.2.2 Práva výběrová a práva závazná .................................................................. 31 3.2.3 Práva pacientů ............................................................................................. 32 3.2.4 Pravidla pro legalizaci ................................................................................. 38 3.3 Argumenty proti přípustnosti dobrovolné euthanasie a asistované sebevraţdy . 40 3.3.1 Právo na ţivot .............................................................................................. 41 3.3.2 Argument kluzkého svahu ........................................................................... 43 3.3.3 Paliativní péče ............................................................................................. 45 3.3.4 Pokrok v medicíně ....................................................................................... 46 3.4 Závěrečné stanovisko k přípustnosti dobrovolné euthanasie a asistované sebevraţdy ............................................................................................................................ 47 4. NEDOBROVOLNÁ EUTHANASIE ...................................................................... 49 4.1 Skupiny pacientů ................................................................................................ 50 4.2 Argumenty pro přípustnost nedobrovolné euthanasie ........................................ 52 4.2.1 Ztráta práva na ţivot .................................................................................... 52 4.2.2 Postupové směrnice ..................................................................................... 55 4.2.3 Teorie nahraditelnosti .................................................................................. 58 4.3 Argumenty proti přípustnosti nedobrovolné euthanasie ..................................... 62 4.3.1 Právo na ţivot .............................................................................................. 62 4.3.2 Nedůvěra v lékaře ........................................................................................ 63 4.3.3 Nikdo nemá právo rozhodovat za druhé ...................................................... 64 4.4 Závěrečné stanovisko k přípustnosti nedobrovolné euthanasie .......................... 65 5. NEVYŢÁDANÁ EUTHANASIE ............................................................................ 67 5.1 Skupiny pacientů ................................................................................................ 67 5.2 Argumenty pro přípustnost nevyţádané euthanasie ........................................... 68 5.2.1 Povinnost lékaře .......................................................................................... 68 5.3 Argumenty proti přípustnosti nevyţádané euthanasii ........................................ 70 5.3.1 Právo svobodně se rozhodovat .................................................................... 70 5.4 Závěrečné stanovisko k přípustnosti nevyţádané euthanasie ............................. 71 ZÁVĚR ......................................................................................................................... 72 RESUMÉ ...................................................................................................................... 74 SUMMARY ................................................................................................................. 76 POUŢITÁ LITERATURA ........................................................................................... 78 Primární literatura ..................................................................................................... 78 Sekundární literatura ................................................................................................ 81 Internetové zdroje ..................................................................................................... 82 PŘÍLOHY ..................................................................................................................... 85 ÚVOD Tématem magisterské diplomové práce je euthanasie jako problém praktické etiky. Praktická etika je spjata s otázkami, které se týkají počátku a konce lidského ţivota. Problematika umírání a smrti je jednou ze základních existenciálních aspektů lidského ţivota. Je nezpochybnitelné, ţe kaţdý člověk jednoho dne zemře. Je velmi pravděpodobné, ţe během svého ţivota se setká i se smrtí blízkého člověka. Nikdo však neví, jaký průběh bude mít jeho konec ţivota. Jistě by si kaţdý člověk přál, aby jeho smrt byla rychlá a co nejméně bolestivá. Existuje i moţnost, ţe člověk onemocní takovou nemocí, kterou současná medicína není schopna vyléčit. Díky rozvoji medicíny je moţné udrţovat při ţivotě i takové jedince, kteří by dříve v důsledku svého zdravotního stavu zemřeli. V této souvislosti vyvstává otázka týkající se přípustnosti euthanasie. Cílem práce je provést kritickou analýzu argumentačních výpovědí pro přípustnost a proti přípustnosti euthanasie v textech soudobých autorů. Samotná euthanasie není monolitickým problémem. Při podrobnější zpracování tématu zjistíme, ţe na otázku přípustnosti euthanasie nelze striktně odpovědět ano nebo ne. Argumentační výpovědi se liší v souvislosti s dílčími druhy euthanasie. Výklad započnu principem dvojího efektu, který bývá označován jako divoká euthanasie. Poté se budu věnovat konkrétním druhům euthanasie. Jednotlivé druhy dělím do dvou základních skupin, a to v souvislosti se způsobem ukončení ţivota jedince (aktivní euthanasie a pasivní euthanasie) a v souvislosti s moţností jedince vnímat faktické okolnosti své existence a jeho moţnou schopností se vědomě rozhodovat (dobrovolná euthanasie, asistovaná sebevraţda, nedobrovolná euthanasie, nevyţádaná euthanasie). Abych eliminovala případná nebezpečí příklonu k jednotlivým argumentům, v kaţdé kapitole nejprve definuji konkrétní druh euthanasie a následně předloţím argumenty týkající se přípustnosti tohoto druhu euthanasie. Kaţdému argumentu je věnována podkapitola, v níţ se zabývám jeho analýzou. V závěru kapitoly porovnám a zhodnotím argumentační výpovědi. Na základě srovnání předloţím závěrečné stanovisko k přípustnosti konkrétního druhu euthanasie. Při analýze argumentů jsem čerpala především z děl představitelů praktické etiky a filosofie, konkrétně z děl P. Singera, H. Kuhse, J. Rachelse, T. Nagela, F. M. Kamma, P. Foot, J. J. Thomson, M. Tooleye aj. Ve filosofických studiích chybí text, který by se zabýval problematikou euthanasie komplexně. Autoři, kteří se problematikou euthanasie 1 zabývají, se vţdy specializují na určitou část této problematiky, nevěnují pozornost všem druhům euthanasie. Mým záměrem je srovnat, rozlišit a zhodnotit argumentační výpovědi, stanoviska a spory v otázce přípustnosti těch druhů euthanasie, které jsou v současné době diskutovány. První kapitola je věnována principu dvojího efektu, který bývá označován jako divoká euthanasie. V této kapitole definuji princip dvojího efektu, jeho moţnou spojitost
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