論醫療上病患「自主決定權」之憲法地位－－以宗教信仰為由拒絕輸血案判決為例

A Study of the Patients' Self-determination Rights in Medical Issues of Refusal of Blood Transfusion, Exampling the Japanese Judgments Related with Religional Reasons

在社會生活中存在著許多相互往來之機會，私人間因相互往來頻繁而可能產生之衝突也相對的增加，尤其病患自主決定權的主張造成病患與醫師間的緊張關係，在基於尊重信仰的自由，為救治病患醫師，是否該不該堅持對病患最好的治療方式以延續病患生命的議題，而使醫師及病患間呈現緊張的態勢，學者多認為因宗教信仰而有特殊之堅持時，私人亦應予以尊重，例如耶和華見證人之教義中，有拒絕接受輸血之說，醫師逢有類此個案，自應尊重其拒絕接受輸血之明示意願，而不可強為其輸血。但議題定性、界限與解決論理並未臻明確。本文嘗試再從前述病患醫療自主決定權議題中，藉由日本「耶和華見證人拒絕輸血」判決案例中，以憲法保障的角度來探討醫病之間的權利義務問題，先解釋醫師診療與病患所作決定間涉及基本權利關係，重新考慮並探討由基本權衝突之角度，評析本判決醫師處置與病患個人自主決定權所否涉及基本權之互動問題。並藉由宗教信仰為由拒絕輸血案判決為案例，來探討憲法層次病患生命權與病患之醫療「自主決定」權之衝突與解決。本文試著以利益衡量處理這個案件，以「誠懇宗教信仰」作為基本權衝突之解決與利益衝量之方法，並建議由立法者將利益衝量之方法要件明文於相關法條中，讓醫病雙方得以依據適從；若法條未為規定時，由法官自由心證衡量。

Since there are many conflictions existing in mutual exchanges in social life, the conflictions arising between people are relatively increasing, especially in doctors and patients advocating to selfdetermination rights, and cause tensions between them. Physicians are always confused in whether patients should or should not under the socalled on the best or suitable medical treatment for the patients by law, especially in the issues of life emergency. The purpose of this article is to discuss the constitutional issues on the patients' self-determination rights in medical issues and evaluates the balance between patients' self-determination rights and the national protective obligation of medical professionalism by exampling Japanese judicial cases of 'Jehovah's Witnesses Refuse blood transfusions,' since Jehova 's Witnesses believe that the Bible prohibits ingesting blood and that Christians should therefore not accept blood transfusions or donate or store their own blood for transfusion. Based on re-setting up to assess and review Fundamental Rights Confliction to doctors and patients ideal legal operation involving human right of freedom by continual physical limitations, this article confer the resolutional routes in constitutional issues related in the patients' self-determination rights of medical issues. In summary, this article tries to deal with the cases by patients' 'pious religious beliefs' as a solution and recommends the lawmakers to enact the aforementioned relevant elements in laws to leave doctors and patients to pursuant and appropriate situatuion in complex of these medical events, and meet their expectations.