臺灣施行病人自主權利法的美麗與哀愁

Advantages and disadvantages of executing the Patient Right to Autonomy Act in Taiwan

目的：臺灣《病人自主權利法》（簡稱病主法）於2019年 1月6日正式施行，與「安寧緩和醫療條例」（簡稱安寧條例）雙軌併行，學者專家對政策看法有支持見解，亦有質疑聲浪，本文評估施行病主法的優缺。

材料與方法：針對國內病人自主文獻進行回顧，搜尋華藝線上圖書館，2016年1月至2019年3月發表於臺灣學術期刊。34篇論文納入分析，彙整病主法之優點和困境。

結果：依病主法主題歸納理想與現實的病人自主。分析文獻探討議題分布，以預立醫療照護諮商（ACP）與預立醫療決定（AD）議題居多（29.41%），維生醫療次之（15.29%），依序為醫師意願與免責議題（11.76%），五類臨床條件議題（11.76%），病人知情同意與選擇（11.76%），醫療委任代理人（11.76%）機制，拒絕醫療權之程序（8.24%）。

結論：本文反思病主法在實踐上困境，期能提供未來修正走向參酌。

 

Objectives: We assessed the advantages and disadvantages of executing the Patient Right to Autonomy Act (PRAA), also referred called the Hospice Palliative Care Act (HPCA), in Taiwan; this is the first law in Asia regarding the topic of death with dignity.

Methods: We searched the Airiti online library for Taiwanese academic journal articles published between January 2016 and March 2019. We used the keyword ""patient autonomy"" and identified 54 articles, 34 of which were includedin our analysis. We reviewed the articles to determine the advantages and disadvantagesof enacting the PRAA.

Results: Discussions on the topic of patient autonomy were summarized. Discussions were determined to pertain to the following topics: new advance care planning (ACP; 29.41%), advance directives (AD) ordecisions(15.29%), physicians’ willingness (11.76%), operation of five clinical conditions (11.76%), patient informed consent and choice (11.76%), the health care agent (HCA) mechanism (11.76%), and refusal of medical rights (8.24%). These results raise the following questions: What types of patients and clinical conditions are eligible for the PRAA? How can communication be improved to ensure patients’ informed choice? Can HCAs make judgments for patients will? What subsequent measures can be taken if physicians refuse to execute patients’ will?

Conclusions: This paper reconsiders the practical dileman of implementing the PRAA and provides potential directions of future amendments.