病人自主權利法－－善終的抉擇

Patient Autonomy Act-Choice of Good Death

每個人都要死亡，只是不知道何時死亡，將以何種方式死亡。死亡降臨的那一刻不可預測，但通常是發生不可治的大病或意外，使得醫療只能成為延緩死亡的過程，醫療因此成為沒有意義。為了更加尊重病人的自主決定權，必須讓人在最壞的時刻發生前，就預立意願書，決定自己在生命盡頭的處理方式。台灣《病人自主權利法》（以下稱本法）堪稱亞洲第一個善終權的立法。換言之，病人善終自主權是病人在特定情況下能夠依據自己真實意願，在醫師協助下自然而無痛苦或較小痛苦地走向生命終點的權利。不過，病人善終權不能遭到濫用。依照本法，可以預立善終權的人，必須二十歲以上的完全行為能力人，心智正常，沒有受到監護宣告。預立的意願，必須得到公證，而且還要經過醫療照護上的評估，並且正式記載在健保卡上。預立意願書之後，如果發生了特定的情況時，醫療機構即能依照病人的意願放棄醫療，但仍需提供必要的照護措施，以減緩病人的痛苦。本法對於醫護人員必有衝擊。傳統的觀念，醫護人員的職責是盡力救人，而不是協助死亡。本法尊重善終權，等於要求醫護人員依照病人的自願而協助死亡。所以，醫護人員的工作倫理將有一番調整，醫療機構也必須有相關的配套措施以資因應。本法制訂前，台灣已經有《安寧緩和醫療條例》，也有病人自主權利或善終權的相關規定。只是本法的規定更為全面，更為積極，更為細緻。本法正式公布後，至正式施行預留有三年的時間。施行前，還有若干規範內容及相關配套，留待討論與改進。這是法界與醫界所要共同努力的課題。

Everyone dies, and we just don't know when or how the death comes. Though the death is unpredictable, it usually makes medical treatment ineffective just as a procedure to postponing dying process while the death causes from an incurable illness or an accident. Having more respect for the patient's autonomy right, we should allow people to prewrite the letter of intent for deciding the way of how their lives end before the worst moment comes. ＂Patient Autonomy Act＂ in Taiwan is the first legislation about the right of good death in Asia. The autonomy right to choose good death means: under certain circumstances, the patient have the right to choose dying naturally and painlessly (or less painfully) according to his/her own true will with assistance from the doctor. However, the patient's autonomy right to choose good death must not be misused. According to the Act, the Advance Directive shall be made by a person who is with age of 20 years or above and have the legal capacity without being subject to the order of commencement of guardianship. Moreover, the intent of Advance Directive must be notarized, and registered on the National Health Insurance Card after it being assessed under medical healthcare profession. When the certain circumstance occurred, medical institution may be permitted to abandon medical treatment as the patient wishes while still providing necessary medical care to relieve his/her painfulness. The Act must have impact on healthcare professionals when their conventional obligation is to save people's lives instead of assisting people's deaths. Having respect for the patient's autonomy right to choose good death, the Act ask healthcare professionals to assist the patient's deaths according to his/her own will. Therefore, ethical issues of healthcare profession are supposed to be adjusted a lot, and relevant complementary measures would need to be provided from healthcare institutions as well. There is an act called ＂Hospice Palliative Care Act＂ enforced in Taiwan before this Act been made; however, this Act regulates more comprehensively, actively, and subtly. This Act will take effect in three years after its promulgation. Before then, several contents and relevant complementary measures about the Act are still necessary to be discussed and improved, which is an important task that needs to work on between the law and medicine fields.