病人自主權利法之倫理觀點與實務挑戰

The Ethical Perspectives and Practical Challenge of Patient Self Determination Act

本文探討病人自主權利法之倫理觀點與實務挑戰，介紹預立醫療照顧計畫及 預立醫療指示之觀念，以生命倫理四原則來闡述其倫理正當性，介紹世界各國相 關法規及英美專業醫學會相關倫理指引，評析病人自主權利法之特色並探討其施 行可能面臨之挑戰。作者指出，本法在於落實病人得於特定臨床條件時拒絕維生 醫療之消極權利，與主張積極權利之積極安樂死或協助自殺有所區別；本法實施 將有助於保障病患之醫療自主權與相關權益。

This paper investigates the ethical perspectives and practical challenges of the Patient SelfDetermination Act. The concepts of advanced care planning and advanced directive are introduced. The four principles of bioethics are adopted to justify the Act, and relevant legal regulations and professional guidelines in Western countries are introduced. Then the characteristics of the Act and the challenges could be encountered in its practice are analyzed. The authors point out that only negative right in refusing life sustaining treatment is protected in this Act, not the positive right in demanding active euthanasia and assisted suicide. The actualization of this Act can enhance the protection of patient autonomy and their medical welfare.