病人自主權──從善終論生命自主的困境與出路

Patient's Right of Autonomy: On the Problem of the Autonomy of Life and Its Solution from the Perspectvie of Good Death

當《病人自主權利法》訴諸法律宣稱為保障疾病中生命自主權，旨在保有生命尊嚴與最後的價值。這是病人生命終點的最後關注嗎？本文從生命價值面探討《病人自主權利法》的意義，追尋保障生命末期免除病痛之苦的歷程，再從臨床案例考察眾人生命末期之需求，發現生命即將結束時的需求，除了免除逃避病痛之外，還有承擔、愛與承諾，守護此生所愛最後之責。本文認為《病人自主權利法》立意良善，然而預立醫療決定僅表態未來的醫療與死亡方式，對於生命其他價值之完成實有不足。首先真正生命的困境是：在擺脫身體的病苦之外，面對即將到來的死亡，以及揮別家人的「道別」能力與勇氣；其次擔憂至親喪親之慟後如何生、死兩相安；儼然在心跳停止前的意識中，守護所愛才是生命的最終關注；最終《病人自主權利法》僅能提醒我們生命要有所準備才能自主，經由「生、死」的課程學習中「生命」「自主」的預約與實踐，擁有面對自己與至親死亡的勇氣與能力，透過醫護團隊提供照護諮商及實質的照護行動找到生命的出口。

The Patient Right Autonomy Act is a proclamation in the form of a law to protect the autonomy of the patient. Its aim is to retain the dignity of life and its last value. But is this the ultimate concern of the patient at the end of his or her life? This paper explores the meaning of the Act from the perspective of the value of life, analyses the process of protecting patients from suffering of life, and then examines the needs of a patient at the end of life from clinical cases. We found that besides the avoiding of suffering, there are burdens, love and commitments to the everlasting responsibility to those loved ones of this life. I believe that this Patient Right Autonomy Act is well-intended, but the advance medical decision only states the way of medical treatment and death, and it is not enough to fulfil other values of life that appeal to the terminal patient. First of all, the dilemma of real life is: in addition to getting rid of the physical suffering, facing the upcoming death, we need the capability and courage in saying goodbye to members of the family; secondly, worrying about how relatives could live peacefully with those survived and the dead after bereavement, it seems that in the consciousness of the patient before the heartbeat stops, guarding the love ones is the ultimate concern of his or her life. In the end, the Act only reminds us that we must be living prepared in order to have autonomy. It is through the preparation and practice of ''living'' and ''autonomy'' in the training of a course of in ''life and death'', that we have the courage and ability to face the death of ourselves and loved ones. Through the consultation of medical care and substantive care service provided by the medical team that we find the exit of living autonomously and a good death.