從臨終死亡的概念與儒家親子關係反省病人自主權利法之意涵

An Examination of the Implications of Patient Autonomy Right Act from the Concepts of Death in Bioethics and the Perspective of Confucian Family Relationship

本文以生命倫理學的幾種處理臨終病亡的概念和儒家的親子關係的角度，檢討2019年1月6開始上路的《病人自主權利法》的內容和實踐的問題。本文首先確定此法所容許的病人的自主權只限於放棄無效醫療所涵蓋的停止營養與水分，只屬於「自然死」的方法，其他「醫助自殺」、「安樂死」都不能用。此法雖然擴大了原來《安寧療護條例》的範圍，仍然不足以涵蓋所有需要行使自主權利以解除臨終時不可減輕的痛苦。同時此法在表示自主放棄無效醫療需要先通過醫院安排的諮商，實產生巨大的障礙而使有需要的病人達不到自主放棄無效治療的要求。此法的「自主權利」也局限在「個人自主自律的權利」之內，顯然與本土和儒家傳統文化價值中重視家庭關係有差距。本文認為應增強家庭參與病人的臨終的自主決定。本文進一步說明在儒家之孝道之下，真正的「善終」是在「養生送死無憾」之下才真能達成，而這需要依循儒家親子關係中「孝道」的了解。本文的分析表明儒家的孝道並不反對親人在末期臨終而又有巨大痛苦的情況下，可以採取「自然死」。而且，在沒有其他不能減輕病人的巨大病痛之下，儒家可以接受病人採取「醫助自殺」和「安樂死」的方法，結束生命。本文認為最能使「生死兩相安」的善終是採取「終極鎮靜」的醫療手段，讓病人在無痛的昏迷狀態中離去。

This paper examine from the various concepts of death in bioethics and the perspective of Confucian family relationship on the content and practice of the ''Patient Autonomy Right Act'', which becomes law in effect on January 6, 2019. I first identify the right of autonomy of the patient in this Act is limited to natural death with the right to refuse water and nutrition. Other methods using acceleration of death, such as physician assisted suicide, and euthanasia are not allowed. It does expand the diseases covered by the law of palliative treatment, but still far from covering all those patients who need to employ the right to be released from the terrible pain of the disease at the end of their life. Another blocking of patient's right of autonomy decision is the requirement of medical consultation before this Act could be employ according to the will of the patient to withdraw from medical treatment. Furthermore, the concept is limited to the individualistic autonomy, which is different from the Confucian traditional value of emphasis on family importance. I propose that the participation of family in patient's autonomy decision should be enhanced.I argue that, under the ideal of filial piety of Confucianism within family relation, ''good death'' could be achieved only when people achieve the ideal of ''without remorse in nurturing the alive and saying good bye to the deceased''.It means that we have to understand the family relationship under basic concept of filial piety. In this paper, we argue that Confucianism would not reject natural death when the patient is under terrible pain which could not be diminished. When there is no other way to release the great pain of the patient, Confucianism would support the use of physician assisted suicide and even euthanasia. However, the best alternative is the employment of the medical treatment of terminal sedation with the patient died in painless coma.