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Public health, populations, and lethal ingestion

机译：公共卫生，人口和致命摄入

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Background: In 2008 the American Public Health Association endorsed lethal ingestion as a public health policy as part of "Patients' Rights to Self-Determination at the End of Life." Although rhetoric framing physician-assisted suicide (PAS) invokes individual autonomy, public health's focus is populations. Even regarding treatment refusal, its logic and coercive power (e.g., quarantine) subordinate autonomy to population interests. Research indicates health practitioners and disciplines that are closer to persons with terminal conditions oppose more PAS than those having little contact: specifically, public health associations are more willing to authorize life-ending means than disciplines directly caring for the dying. Why is that the case and with what consequences for populations and public health? Methods: Contextual analysis of semantics; policy submissions; standards; statutory and regulatory documents; related economic, equity, and demographic discourses is employed; and, finally, scenarios offered of the future. Results: Notwithstanding rhetoric invoking autonomy, public health's population orientation is reflected in population health measures (e.g., aggregated DALYs, QALYs) that intimate why public health might endorse availing life-ending means. Current associated statutes, regulations, terminology, and data practices compromise public health and semantic integrity (e.g., the falsification of death certificates) and inadequately address population vulnerabilities. In recent policy processes, evidence of patient and system vulnerabilities has not been given due weight while future-oriented scenarios suggest autonomy-based rationales will increasingly yield to population-driven rationales, increasing risk of private and public forms of domination and vulnerabilities at life's end. Conclusion: Public health should address institutionalized violations of data integrity and patient vulnerabilities, while rescinding policy supporting the institutionalization of lethal means.
机译：背景：2008年，美国公共卫生协会批准了致命摄入作为一项公共卫生政策，作为“患者生命终结时自决权的一部分”。尽管修辞框架的医生辅助自杀（PAS）引起了个人自治，但公共卫生的重点是人群。即使是拒绝治疗，其逻辑和强制力（例如检疫）也使自治权服从于人口利益。研究表明，与那些濒临绝症的人更接近的卫生从业者和学科反对的PAS比没有接触的人更多：特别是，公共卫生协会比直接关心死亡的学科更愿意授权使用挽救生命的手段。为什么会这样，对人口和公共健康有何后果？方法：语义的上下文分析;政策文件;标准;法定和监管文件;运用了相关的经济，平等和人口学话语;最后，提供了未来的方案。结果：尽管有口头上的自治权，但公共卫生的人口取向仍反映在人口卫生措施（例如汇总的DALY，QALY）中，这些措施密切说明了为什么公共卫生可能会认可终生手段。当前相关的法规，法规，术语和数据惯例损害了公共卫生和语义完整性（例如，伪造死亡证书），并没有充分解决人口脆弱性问题。在最近的政策流程中，没有适当考虑患者和系统漏洞的证据，而面向未来的情况表明，基于自治的理由将越来越多地以人口为驱动的理由，从而在生命的尽头增加私人和公共形式的支配和漏洞的风险。结论：公共卫生应解决对数据完整性和患者脆弱性的制度化侵犯，同时废除支持致命手段制度化的政策。

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