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第 67  期

專題論文
Special Issue

  (65)
論台灣病人自主法: 家庭干涉如何刺激病人自律
On Taiwan Patient Right to Autonomy Act: How Family Stimulates Autonomy
作者 許文鳳
Author BunRong Kouy
關鍵詞 自主法案自主原則台灣美國個人自主家庭自主
摘要 2015 年 12 月 18 日,台灣立法院通過了病人自主法案《病主法》。三年後,該法在 2019 年 1 月 6 日正式施行。根據衛生福利部,《病主法》是全亞洲第一部完整保障病人自主權利的專法,意味著病人自主的里程碑。然而,儘管《病主法》的倫理價值在於提供病人在醫療決定上擁有決定權,該法自身的設計會依照不同情境脈絡和文化而有所差異。在美國,《病主法》的三個目的即是透過教育保障病人擁有接受或拒絕醫療的權利、提倡預立醫囑在個人喪失行為能力時的更大表述以及減低生命末期的治療費用。有別於美國,台灣的《病主法》設計源自於三個目的:尊重病人在醫療決定上的自主性、保障善終權益以及促進醫病關係和諧。儘管西方生命倫理學原則傾向於視自主原則為基於自我或個人自主原則,東方視角明顯採用基於家庭的徑路。因此,本文旨在探討在不同社會和文化脈絡下,自主是如何被激發的?具體來說,透過探討《病主法》,家庭之間的親密關係可能如何影響個人自主行為。本文將採用東西方比較法進行探討。
Abstract On December 18, 2015, the Legislative Yuan of Taiwan has passed the Patient Right to Autonomy Act (PRAA). Three years later on January 6, 2019, the act is officially implemented. According to Ministry of Health and Welfare, Taiwan Patient Right to Autonomy Act is the first of its kind among Asian nations, signifying the milestone of patient autonomy of the country. Nonetheless, although the ethical value of PRAA is to offer patient Right to decide on medical decision, how PRAA is designed matters contextually and culturally. In the United States, the three main goals of Patient Self Determination Act (PSDA) are providing education regarding individual’s Right to accept or refuse treatment, promoting greater formulation of advanced directives (ADs) if one becomes incapacitated, and reducing end-of life treatment cost. Unlike the States, Taiwan designed its PRAA for three main objectives: respecting patient autonomy in medical decision, ensuring the Right to good death and improving physician-patient relationship. While western bioethical principles tend to regard principle of autonomy as self-based or individualistic autonomy, the Asian perspective distinctly adopts a family-based approach. This paper thus aims to explore how autonomy stimulates within different social and cultural context, specifically how intimate relationship of the family might affect the behavior of individual autonomy through examining PRAA and its comparison with PSDA. An east-west comparison is sought.
《病人自主權利法》之倫理、法律、社會與政策意涵:引言
/ 李瑞全    Shui-Chuen Lee
1
「趨生畏死」與「趨樂避苦」之兩難 抉擇──「自主意願」:流動且幽微的 心靈答案
/ 釋昭慧    Chao-hwei Shih
5
自主與善終
/ 尉遲淦    Chi-Kan Ywi
29
從儒家的觀點省察病人自主權利法的限制:以永久性植物人為例
/ 黃漢忠    Hon-Chung Wong
43
從一位醫師的角度來看病人自主權利法
/ 陳秀丹    Shew-Dan Chen
65
病人自主決定權與「涉艾信息」告知規則的建構
/ 胡曉翔    Xiaoxiang Hu
77
從北京首例冷凍胚胎案看患者自主權
/ 田文鳳、張新慶、張群芝、杜華英    Tian Wen-Feng, Zhang Xinqing, Zhang Jing-Zhi, Du Hua Ying
91
佛教生死觀在預立醫療照護諮商的應用
/ 李明書    Ming-Shu, Lee
107
突然「不想死」錯了嗎?──從尊重自主原則到尊重自主死亡權利的道德疑慮
/ 周琬琳    Wanling Chou
125
臺灣《病人自主權利法》的倫理分析
/ 林孟蒨    Meng-Chien Lin
141
由「病人自主權利法」立法歷程論生命自主權之限制
/ 陳俊志    Chun-Chih Chen
157
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