病人自主權利法於臺灣醫療法制中必要性探討

Explore of Impact to Medical Law of Patient Autonomy Act Implementation on Taiwan

病人自主權利法是臺灣第一部不限於末期病人為對象的法規，亦為亞洲第一部優先保障病患本人的權利及優先知情權之普通法。這個立法應該是以病人自主權為主軸，說它是私法體系應該是沒什麼問題，尤其本法很強調告知後的知情同意，如果未來產生醫療（糾紛）問題，勢必引發社會的討論，此行為到底是屬於侵權行為抑或是契約責任的違反。不過裡面夾雜免除醫療機構行政責任或醫師臨床裁量刑事責任的規定，故也帶有些許公法之色彩；又，國內亦有學者把告知後同意之概念整個套入刑法的體系進行討論。因此這樣的法律要區分是屬於什麼樣的體系，其實真的很困難。適用的醫療範圍及臨床疾病種類均較過去2013年修法的安寧緩和醫療條例限於疾病末期來的更廣。我國民法所定義之完全行為能力人，即可透過諮商，進而預立醫療指示；一旦面臨本法上開之五種臨床醫療情境之下即生效力；本法於2015年底通過，2016年總統公布，2019年1月正式施行；病人自主權利法之優點、設計上的道德風險和之後可能面臨到的臨床情境、醫療倫理等問題；藉由本文反思本法的設計，其原本所欲達到之初衷，和臨床醫療實務上之落差，達成病人享有真正的自主權，善終權得以獲得保障及實現，而臨床醫療團隊也有信心及意願協助病人和他的關係人（如：親屬、同居人、繼承人、醫療委任代理人等），共同處理疾病的不適症狀、面對疾病治療預後不如原先預期之情況，和臨終照護的方式，可以滿足病人價值觀之三贏局面。

Advance Care Planning (ACP) is a new term, which is provided in the Patients' Autonomy Right Act and could not be found in the Hospice Palliative Care Act (HPCA), to people in Taiwan. The Patients Right to Autonomy Act allows a patient to determine his own medication by himself before the end of his life, with assistance from medical specialists, when he faces unrecoverable and unbearable symptoms or illness of his disease. Under this Act, a patient can even refuse any medical treatment such as CPR (cardiopulmonary resuscitation). The Patient Right to Autonomy Act is the first legislation in Asia for one to have one's life ended appropriately under certain circumstances. Meanwhile, HPCA also permits a terminally ill patient to refuse life-sustaining treatment (LST) pursuant to his intent by advance directives (AD). Both acts have ultimate aim to realize a patient's autonomy of having his own life ended appropriately. It is an important human right issue for one to decide how to have his life ended when he suffers from serious symptoms of diseases. The core interest of patient's autonomy is about how to make ending life care appropriately, based on his own will, with physician-assisted ACP and AD for his incurable illness. When both of the aforementioned acts provide such autonomy, two new challenges have emerged: first, how to deal with the conflict of opinions between a physician who decide to continue medical treatment and a patient who choose to have his life end appropriately; second, do juveniles have such autonomy?