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| 從臨終死亡的概念與儒家親子關係反省 病人自主權利法之意涵1 |
| An Examination of the Implications of Patient Autonomy Right Act from the Concepts of Death in Bioethics and the Perspective of Confucian Family Relationship |
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| 作者 |
李瑞全 |
| Author |
Shui-Chuen Lee |
| 關鍵詞 |
：《病人自主權利法》、
臨終病人死亡、
自主權利、
儒家、
善終、
孝道、
親子關係
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| Keywords |
Patient Autonomy Right Act,
terminal patient death,
right of autonomy,
Confucianism,
good death,
filial piety,
family relation
|
| 摘要 |
本文以生命倫理學的幾種處理臨終病亡的概念和儒家的親子
關係的角度，檢討 2019 年 1 月 6 開始上路的《病人自主權利法》
的內容和實踐的問題。本文首先確定此法所容許的病人的自主權
只限於放棄無效醫療所涵蓋的停止營養與水分，只屬於「自然
死」的方法，其他「醫助自殺」、「安樂死」都不能用。此法雖然
擴大了原來《安寧療護條例》的範圍，仍然不足以涵蓋所有需要
行使自主權利以解除臨終時不可減輕的痛苦。同時此法在表示自
主放棄無效醫療需要先通過醫院安排的諮商，實產生巨大的障礙
而使有需要的病人達不到自主放棄無效治療的要求。此法的「自
主權利」也局限在「個人自主自律的權利」之內，顯然與本土和儒家傳統文化價值中重視家庭關係有差距。本文認為應增強家庭
參與病人的臨終的自主決定。
本文進一步說明在儒家之孝道之下，真正的「善終」是在
「養生送死無憾」之下才真能達成，而這需要依循儒家親子關係
中「孝道」的了解。本文的分析表明儒家的孝道並不反對親人在
末期臨終而又有巨大痛苦的情況下，可以採取「自然死」。而且，
在沒有其他不能減輕病人的巨大病痛之下，儒家可以接受病人採
取「醫助自殺」和「安樂死」的方法，結束生命。本文認為最能
使「生死兩相安」的善終是採取「終極鎮靜」的醫療手段，讓病
人在無痛的昏迷狀態中離去。 |
| Abstract |
This paper examine from the various concepts of death in bioethics and the
perspective of Confucian family relationship on the content and practice of the
“Patient Autonomy Right Act”, which becomes law in effect on January 6, 2019.
I first identify the right of autonomy of the patient in this Act is limited to
natural death with the right to refuse water and nutrition. Other methods using
acceleration of death, such as physician assisted suicide, and euthanasia are not
allowed. It does expand the diseases covered by the law of palliative
treatment, but still far from covering all those patients who need to employ the
right to be released from the terrible pain of the disease at the end of their life.
Another blocking of patient’s right of autonomy decision is the requirement of
medical consultation before this Act could be employ according to the will of
the patient to withdraw from medical treatment. Furthermore, the concept is
limited to the individualistic autonomy, which is different from the Confucian
traditional value of emphasis on family importance. I propose that the
participation of family in patient’s autonomy decision should be enhanced.
I argue that, under the ideal of filial piety of Confucianism within family
relation, “good death” could be achieved only when people achieve the ideal of
“without remorse in nurturing the alive and saying good bye to the deceased”.
It means that we have to understand the family relationship under basic concept
of filial piety. In this paper, we argue that Confucianism would not reject natural
death when the patient is under terrible pain which could not be diminished.
When there is no other way to release the great pain of the patient,
Confucianism would support the use of physician assisted suicide and even
euthanasia. However, the best alternative is the employment of the medical
treatment of terminal sedation with the patient died in painless coma.
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