從佛教的觀點談病人自主權

Buddhist's Perspestive of Patient's Right of Autonomy

安寧緩和醫療條例自從民國89公告實施已接近二十年，另一部亦是標榜病維護病人自主與善終的「病人自主權利法」，適用的對象不只限末期病患，而是同時涵蓋處於不可逆轉之昏迷狀況、永久植物人狀態、極重度失智、其他經中央主管機關公告之病人疾病狀況或痛苦難以忍受、疾病無法治癒且依當時醫療水準無其他合適解決方法之情形。且病患可以自主拒絕的醫療已從無效醫療擴大至部分可有效維持生命的治療，拒絕的考量點主要是以所處的疾病狀態之生命質素。這樣的改變所帶來的衝擊，對醫療人員不可謂不大。我國近年來社會上有一股力量希望能將病人的自主權再擴大，希望能有請求安樂死與醫助自殺的權利。就法律的權利來說，此乃從安寧緩和醫療條例與病人自主權利法的特殊拒絕權希望擴充到能有特殊請求權。在這不斷擴充的病人自主權的滑坡中，佛法是如何看待呢？又會在哪裡訂出止滑點？佛教的生命觀平等的看待生命中由生、老、病、死串起的每一個階段，並認為生命的維持，是為了可以修道。當一個人生命質素不佳，已到無法用功修道的狀態，就可以不勉強維持，但前提是不可以外力提早結束生命，因為這樣已是殺生的行為。是以，就佛法觀點安寧緩和醫療例乃至病人自主權利法所賦予病患的特殊拒絕權並不包含以外力提早結束生命的權利，僅不以醫療或外力維持生命質素不佳的生命。安樂死與醫助自殺所需求特殊請求權，乃企圖擴充權利至可以要求以外力提早結束生命質素不佳的生命，這樣的特殊請求權已經逾越佛法的倫理要求。

The law of palliative treatment has been put forward since Year 2000, and now another law for the protection of the autonomy and good death of the patient, Autonomy Patient Right Act, expands the application of patients beyond those terminal patients and includes irreversible vegetative, permanent vegetative, seriously retarded patients and other patients that the central medical institute announces as patients with unbearable pain, incurable and according to the present medical technology could not be treated with other methods. Patient could autonomous reject not only ineffective treatment but also life sustaining water and nuitritions. The point of consideration is the quality of life of the patient. This change brings serious impact to the medical professionals. There is a stream of power that wants to expand the autonomy of the patient in order to let patient have the right to euthanasia and physician assisted suicide. It is an expansion of the legal right from special right of rejection to a right of special request. In such a slipperly development of patient's right of autonomy, what would Buddhism respond and how to set the line for stopping point? Buddhism sees equality of life and life is a series of stages running through birth, getting old and die. The maintaining of life is for practice. When one;s quality of life is no good, and when it comes to the stage of could not do any more practice, we should not try to maintain life, but the premise is not to accelerate death. For such acts are acts of killing. Hence, for Buddhism the acceptance of refuse of living on in the law of palliative treatment and the Act of Patient Autonomy Right does not include the use of external force in ending life. Euthanasia and physician assisted suicide is an attempt to expand the request of employing external force to end the life of those with a low quality of life, but this has trespassing the ethical line of Buddhism.