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第 57  期

Special Issue

Reflections on Family and Medical Decision Making from Perspective of Hardwig’s Conception of a “Duty to Die”
作者 林雅萍
Author Ya-Ping Lin
關鍵詞 死亡義務家庭自主醫療決策醫學倫理
Keywords Duty to Die, Autonomy, Family, Medical Decision Making, Medical Ethics
摘要 John Hardwig 在1997年所發表的文章"Is there a duty to die?"中主張,當病人的生病狀態已經對其家人或重要關係人造成沉重的生理、心理,社會與經濟負擔時,病人或許有死亡義務以免除家人的負擔,成全其福祉。其論證核心建立在「關係自主」(relational autonomy) 與「以家庭為中心」(family-centered) 的醫療決策模式之上。Hardwig 主張一個心智健全的成年病人在進行醫療決定時,必須為他所置身的關係負責,顧及其決定對於家人或重要關係人的
Abstract John Hardwig claims in his controversial essay "Is There a Duty to Die" (1997) that one may have a duty to die when her or his illness imposes overly heavy physical, emotional and financial burdens on family members or loved ones. The core of his argument is based on the notion of relational autonomy and family-centered medical decision making model. According to Hardwig, a competent adult patient’s autonomy is profoundly connected to moral responsibility to family and loved ones, and the traditional focus on patient-centered medical ethics, in which patient interests have priority, should be shifted to family-centered medical ethics. In this paper, I shall first delineate Hardwig's conception of a duty to die. Second, I shall critically examine the plausibility of his understanding of family ethics and values with reference to medical decision making. Finally, I suggest some possible contributions of Hardwig's idea of a duty to die to the controversies surrounding end-of-life care, refusal of life-sustaining medical treatment, euthanasia and physician-assisted suicide in the rapidly aging society in Taiwan.
/ 王心運    Shin-Yun Wang
/ 林慧如    Hui-Ju Lin
/ 蕭玉霜    Yu-Shuang Hsiao
/ 蕭宏恩    Hung-En Hsiao
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