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第 67  期

論壇專文
Invited Papers

  (74)
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
Confucian Perspective on the Limitation of the Patient Right to Autonomy Act in the Case of Permanent Vegetative State Patients
作者 黃漢忠
Author Hon-Chung Wong
關鍵詞 病人自主權利法永久性植物人狀態預立醫療決定維生醫療
Keywords Patient Right to Autonomy Act, Permanent Vegetative State, Advanced Decision, Life-sustaining Treatment
摘要 醫療科技的不斷進展,為許多病人帶來治癒的希望,但也產生了各種過往沒有出現過的倫理難題。例如,各種維生醫療的使用,固然讓危急的病人存有一線生機,但當病人已沒有任何治癒的希望,這些醫療處置可能只是延長其瀕死過程,甚至只是增加他們的痛苦。雖然民國89 年制定的安寧緩和醫療條例,已可讓末期病人透過簽署意願書,選擇安寧緩和醫療或作維生醫療抉擇,但對於罹患其他嚴重疾病、且亦沒有治癒希望、但尚未是末期的病人,例如處於永久性植物人狀態的病人,安寧緩和醫療條例仍未能讓他們從其所處的困境中解脫。因此,民國105 年制定、並於今年(108 年)開始施行的病人自主權利法,為此類飽受疾病煎熬的病人提供了一條出路。病人自主權利法除申明了病人的知情權、選擇權和決定權外,同時規定當病人處於該法所列的五種臨床條件,包括永久性植物人狀態時,可透過預立醫療決定,選擇終止、撤除或不施行維持生命治療或人工營養及流體餵養。雖然相比於安寧緩和醫療條例,病人自主的確擴大了病人的自主權,為末期病人外的其他某些特定類型的重症病人提供更多的選擇,但事實上是否能充分解決他們以及其家人所面對的難題,仍有待商榷。本文的目的,即在於藉由國內一宗相當著名的植物人案例-王曉民的遭遇,反思病人自主權利法的限制,並從儒家的觀點和參考國外相關案例,提出修訂建議。
Abstract The continuous advancement of medical technology has brought hope for their cure for many patients, but it has also produced various ethical problems that have not appeared in the past. For instance, the use of various life-sustaining treatments may give a chance to keep alive to critically ill patients, but may also prolong their dying process or may even increase their suffering if they have no hope of healing. Although the Hospice Palliative Care Act enacted in 2000 in Taiwan have enabled terminally ill patients to choose palliative care and to decide not to receive or withdraw from life-sustaining treatments by signing a letter of intent, patients who are not yet in the final stage but may be irreversible, such as patients in a permanent vegetative state, have not been able to free themselves from their predicament through this Act. Hence, the Patient Right to Autonomy Act enacted in 2016 and begins to implement this year, provides a way out for such patients suffering from their disease. In addition to affirming patient’s right to know, choice and decision, the Act also stipulates that patient may choose to terminate, withdraw or not receive life-sustaining treatment or artificial nutrition and hydration through advanced decision when the patient is in the five clinical conditions listed in the Act, including permanent vegetative state. Although the Patient Right to Autonomy Act,compared to the Hospice Palliative Care Act, does expand patient autonomy and provide more choices for certain types of critically ill patients other than terminal patients, whether it is able to adequately address the problems encountered by them and their families is still open to question. This paper aims at reviewing the limitations of the Patient Right to Autonomy Act through a reflection on the case of Wang Xiao-Min, a well-known medical vegetative state patient in Taiwan, and proposing some revisions of the Act from the Confucian point of view and reference to other relevant foreign medical cases.
《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
論台灣病人自主法: 家庭干涉如何刺激病人自律
/ 許文鳳    BunRong Kouy
187
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