從死亡保險觀點論拒絕醫療權

Right to Refuse Medical Treatment in Taiwan: Focusing on Life Insurance Contract against Death

二○一九年臺灣正式施行了亞洲第一部病人自主權利法，使非末期病人得拒絕血液製品、抗生素與「人工營養及流體餵養」等任何有可能延長病人生命之必要醫療措施，不但可能提早數年死亡，且其死因非疾病自然進程所導致。此情形於死亡保險，雖不一定要將其認定為故意自殺，但因可能為足以影響保險人危險估計及保費精算之重要事實，建議可將被保險人預立特定醫療決定，列為要、被保險人於保險契約訂立時，據實說明義務所應行告知之書面詢問事項，及保險契約訂立後危險增加之通知義務，使保險人有評估危險之機會，以防免道德危險，維護對價平衡原則。

Taiwan's Patient Right to Autonomy Act (hereinafter P.R.A.A.), as a pioneer in the field of patient autonomy in Asia, came into effect on January 2019, which enables non-terminal patients to refuse blood products, antibiotics, artificial nutrition and hydration, and other medical measures that may prolong the lives of patients. It may expedite death, as is not caused by the natural process of disease. In the scenario, though the cause of death would not be likely identified as suicide, the medical measures under P.R.A.A. may be considered a significant fact affecting the insurer's risk evaluation and premium actuarial calculations. The article argues that applicants should disclose advance medical decisions while making representations in response to the written inquiries of the insurer ex ante entering into insurance contracts, and notify insurers of the decisions made ex post insurance contracts as alteration of risk. In doing so, insurers are provided with opportunities of assessing the insured risk, which can prevent moral hazard and maintain the principle of equivalence.