我不想去瑞士，我不想嘗試自殺
2018年2月7日，英國醫學會《英國醫學雜誌》在線發表一位乳腺癌患者的述評：我不想去瑞士，我不想嘗試自殺。
我叫莎拉·傑西曼，51歲，來自英格蘭的拉格比鎮（現代英式橄欖球運動發源地）。我樂觀積極，正在努力與晚期癌症共同生活。我想解釋一下，為什麼我認為醫生應該支持英國的協助死亡合法化運動。這也許聽起來很奇怪，居然出自我這個準備忍受各種艱苦治療以繼續生存者。
我想選擇協助死亡的原因很簡單，並且許多類似處境的患者也有同感。我恐怕我可能不得不面對的那種死亡。如果，當我無法繼續忍受我的疾病時，我可以說「夠了」，我將得到巨大安慰，那樣我就可以在家裡、在我最愛的人支持下走完人生。我不想去瑞士（全球首個自願安樂死合法化國家），而且我也不想嘗試自殺。我現在坦坦蕩蕩地活著，為什麼我將來不能同樣坦坦蕩蕩地死去？
每天，醫生都在幫助像我這樣的晚期患者，盡他們最大的努力讓我們活著並且儘可能擺脫痛苦。不過，他們還無法提供最後的、對我而言終極的同情行動——那就是，當真正可怕的死亡即將來臨時，使我們能夠結束我們的生命。我為什麼要忍受死亡的折磨？難道為了讓人們在我死時對我丈夫和我爸爸說：至少莎拉不再繼續受苦了？我寧願他們說：莎拉死在受苦之前。
45歲時，我發現一個乳房腫塊，很快被診斷為3期乳腺癌。這真是晴天霹靂，因為我沒有癌症家族史，並且有健康的生活方式。經過九個月的艱苦治療後，我獲得了「完全緩解」，並以新的活力繼續生活。當我正在準備慶祝50歲生日並且感謝所有支持者時，可怕的背部疼痛突如其來：腫瘤轉移到脊椎了！癌症不請自來，也不打算離開。不過，這並未妨礙我們舉辦一場絕妙的聚會。
我的生活現在少了很多，但是仍然彌足珍貴。一些小事，比如遛狗、會友喝茶、計劃旅行等，對我而言意義都很重大，但是我確實日夜承受著晚期癌症的重壓。如果我知道，當癌症最後發威時，我可以選擇協助死亡，那麼我的負擔就會輕許多。請幫助我和許多像我這樣的患者，減輕我們對死亡的擔憂。我並不沮喪，我沒有沮喪，而且我得到了全科醫生、腫瘤專科醫生、專科護士、麥克米倫（英國最大的癌症慈善機構之一）護士、本地臨終關懷醫院以及我丈夫、親友的支持。我絕對不是孤身一人與晚期癌症鬥爭，但是我仍然覺得很有必要幫助「死亡尊嚴」運動（原名：自願安樂死合法化協會，成立於1935年）。我希望你也一樣。
莎拉·傑西曼（左一）購買英國乳腺癌慈善周彩贏得100英鎊之後，決定請三位乳腺癌友喝下午茶
莎拉·傑西曼（左二）與她的三位乳腺癌友
編者按：安樂死為無痛苦的死亡，可分為主動安樂死和被動安樂死兩種。主動安樂死是指醫務人員或其他人採取直接行為提前結束患者的生命；被動安樂死則是指在確定治療不再有效的情況下，中止使用延續患者生命的器械或維持患者生命的治療措施，任由患者自行死亡。瑞士為全球首個可以合法實施被動安樂死的國家，瑞士法律對於醫生協助患者死亡最為寬容，前提為該患者已被確診無望治癒且自殺行為由患者自己實施，而協助者並不因此直接獲利。1937年，瑞士通過刑法第115條並於1942年生效，明確規定協助自殺僅在動機為自身利益的條件下，方才被認定為犯罪，對出自利己的動機而唆使或幫助他人自殺或者試圖唆使或幫助他人自殺者，處以最高5年的徒刑或監禁。1941年，瑞士通過安樂死相關法案，合法化協助自殺；協助方式局限於為被動（例如除去患者的維持生命系統或讓患者停止服藥）而非主動（例如對患者注射致命藥物），限定須由醫師以外人士執行。所有主動安樂死在瑞士仍受禁止，瑞士刑法第114條規定，任何人不得主動結束患者的生命，即使安樂死的請求由患者自己提出。瑞士立法只允許為接受者提供藥物或器具，且不得涉及利益。瑞士還有專門為患者提供安樂死服務的機構。目前瑞士已成為理想的安樂死樂園。由於瑞士被動安樂死制度接受者不限於瑞士公民，前往瑞士尋求被動安樂死的外國人數逐年增加，瑞士也因此蒙上「自殺觀光業」的陰影。根據瑞士聯邦統計局資料顯示，1998年有43人在協助自殺下過世，2009年則近300人；而單在蘇黎世，每年有約200人尋求被動安樂死協助，其中很大比例為外國人。生不易，死不易，且行且珍惜。
BMJ. 2018 Feb 7;360:k542.
Patient Commentary: "I don"t want to go to Switzerland, and I don"t want to attempt suicide".
Sarah Jessiman.
Rugby, UK.
My name is Sarah Jessiman, and I"m a positive person doing my best to live well with terminal cancer at 51 years of age. I want to explain why I think doctors should support the campaign to legalise assisted dying in the UK. Perhaps this seems odd, coming from someone prepared to endure all kinds of arduous treatments to stay alive.
My reasons for wanting the choice of an assisted death are simple and shared by many patients in similar situations. I"m terrified of the sort of death I may have to face. I would draw huge comfort from knowing that I could say "enough" when I can no longer endure my illness, so I can die at home, supported by the people I love most. I don"t want to go to Switzerland, and I don"t want to attempt suicide. Why can"t I die as I live—in an open and honest way?
Every day doctors support terminally ill people like me and do their best to keep us going and as free from pain as possible. However, they cannot yet offer the last and, to me, ultimate act of compassion—that is, to enable us to end our lives when a truly awful death is close. Why should I have to endure a death that will cause people to say to my husband, Eddie, and my Dad, "At least Sarah"s no longer suffering?" I"d rather they said, "Sarah died at just the right time."
Aged 45, I found a lump on my breast that was soon diagnosed as stage 3 breast cancer. It was a real bolt from the blue because I have no family history of cancer and have had a healthy lifestyle. After nine months of gruelling treatment I was given the "all clear" and got on with life with renewed vigour. Preparations to celebrate my 50th birthday, and to thank all the people who had supported me so well, were rudely interrupted with the news that hideous back pain was a tumour in my spine. Cancer was the uninvited guest who was not going to leave. It didn"t prevent us from having a jolly good party, though.
My life is so much smaller now but still very precious. The little things like walking my dog, meeting friends for tea, and planning travels mean so much, but I do drag around the weight of this terminal illness, day and night. My load would be so much lighter if I knew assisted dying was a choice for me when the illness dictates.
Please help me and the many patients like me by easing our worry about death. I"m not depressed and am well supported by my GP, oncologist, specialist nurse, Macmillan nurse, and local hospice as well as by my husband, family, and friends. I"m definitely not someone alone struggling with a terminal illness but still I feel a great need to help the campaign for Dignity in Dying. I hope you will too.
DOI: 10.1136/bmj.k542
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