臺灣「病人自主權利法」施行前夕──論病人自主之實踐與挑戰

The Eve of Executing the “Patient Right to Autonomy Act＂ in Taiwan–A Research of Patient Autonomy's Practices and Challenges

本文宗旨在於探討臺灣時值「病人自主權利法」施行前夕，病人自主之實踐與挑戰。「病人自主權利法」施行前，受制於「安寧緩和醫療條例」在範圍、樣態與表達方面之限制，而「病人自主權利法」施行後，醫事人員、醫療機構、病人、親屬與政府機關等皆須面對雙軌併行，所衍生之同一末期病人、同一醫療委任代理人與同一張全民健康保險憑證同時適用不同法源之衝擊。有鑑於此挑戰，本文主張因應之道為熟悉預立醫療照護諮商此一新機制、掌握5類臨床條件之新操作與駕馭「病人自主權利法」與「安寧緩和醫療條例」併行之雙軌道。無論世界醫師會或美國律師協會，觀察「日內瓦宣言」與「預立指示：律師輔導指引」，皆顯示國際趨勢對於病人自主之重視與落實。臺灣「病人自主權利法」作為亞洲第一部病人自主法律，其施行後對於臺灣社會面對死亡與處理醫病關係皆為重要的分水嶺。 The theme of this article is to discuss patient autonomy's practices and challenges during the eve of executing the “Patient Right to Autonomy Act＂ in Taiwan. Before executing the “Patient Right to Autonomy Act＂, the “Hospice Palliative Care Act＂ subjects to restrictions on scope, sort, and expression. After the “Patient Right to Autonomy Act＂ is executed, medical personnel, medical care institutions, patients, relatives, and government agencies etc. all should face the impact of applying different legal sources called double tracks parallel derived from the same terminal illness patient, the same health care agent, and the same national health insurance certificate. Due to the above challenges, this article advocates that the way to respond is to be familiar with the new advance care planning mechanism, to master new operation of the 5 clinical conditions, and control the double tracks parallel called the “Patient Right to Autonomy Act＂ and the “Hospice Palliative Care Act＂. No matter the World Medical Association or the American Bar Association, observing the “Declaration of Geneva＂ and the “Advance Directives: Counseling Guide for Lawyers＂, all show the international trend related to emphasizing and implementing patient autonomy. Being the Asian's first patient autonomy law, after executing the “Patient Right to Autonomy Act＂, it will be an important watershed regarding how the society faces death and how to manage patient-doctor relationship in Taiwan.