死亡協助與刑事責任

Assisted Dying and Criminal Liability

系所名稱：法律學系在職專班法律專業組 學位別：碩士 畢業學年：95年 指導教授：陳子平 自1960年Kouwenhoven醫師發明心肺復甦術（CPR）以來，不論是民眾或是醫學界產生了是否需要救到死亡為止的爭議，人是否擁有拒絕醫療的權利，或是死亡的權利逐漸引起社會的重視。1976年美國加州通過自然死法案，乃至1990年美國國會通過病人自主法案（PSDA），所興起尊嚴死（自然死）的觀念，又與多義性的安樂死一詞有所混淆，這二者間之異同以及分類，長期以來困擾了醫學界、法律界、以及社會大眾，以致於過猶不及之情形偶有所聞，往往影響末期病人追求善終之美意。因此，為解決此名詞及分類之爭議，以利病人追求善終，本文建議以「死亡協助」一詞，取代安樂死與尊嚴死（自然死）之用語及定義上之歧異，同時參考醫療實務、法學評價、以及民眾接受及理解程度，建議將其分為：「積極的死亡協助、間接的死亡協助、消極的死亡協助、以及植物人死亡協助」等四大類，同時在此用語及分類下，考察國際社會及我國死亡協助之發展現況。就國際間死亡協助發展現況而言，本文分別以荷蘭（積極的死亡協助代表性國家）、美國（消極的死亡協助代表性國家）、澳洲（北領地，世界第一個積極的死亡協助合法化之國家）、以及日本（亞洲國家，具有司法實務價值積極的死亡協助合法化判決）等四國為例，來分析國際社會死亡協助之態度。在分析死亡協助之國際發展現況後，則討論我國法律對此議題的相關態度及檢討，包括：（1）死亡協助於我國刑法上的效應；（2）我國醫療專業法規對死亡協助的態度、合法化類型及要件分析；以及（3）死亡協助在我國之困境及檢討。首先，從刑事責任的角度來分析與檢討此四類型死亡協助於我國刑法上之效應。「積極的死亡協助」由於爭議過大，原則上不得阻卻其違法性，但不排除在特殊個案及一定要件下，透過司法判決而取得合法性；「消極的死亡協助」，以及「間接的死亡協助」，在符合一定法律要件下，應得阻卻其違法性；至於「植物人死亡協助」，若病人於昏迷前有預立生預囑，而且意識回復之可能性微乎其微，應許透過國家立法下，有合法化之可行性。其次，我國與死亡協助相關之醫療專業法規，主要為「人體器官移植條例（採腦死說）」以及「安寧緩和醫療條例（肯認末期病人具有消極的死亡權利）」。在此專業法規下，賦予病人三種合法化的死亡協助類型及要件，包括：「末期病人於本人清醒時簽署意願書，或最近親屬於病人昏迷時簽署同意書，不施行心肺復甦術」、「末期病人本人同意，終止或撤除原先施予之心肺復甦術」、以及「腦死病人，基於器官移植之需要，由本人或家屬同意，終止或撤除原先施予之心肺復甦術」。再者，由於安寧緩和條例為我國死亡協助最重要之法律規範，且自八十九年施行至今已逾六年，不論就醫療實務或法律規範層面，均呈現不少問題與爭議，值得未來修法加以檢討，包括：（1）安寧緩和醫療條例名稱以及定義之檢討；（2）末期病人與無效醫療之定義、分析與檢討；（3）病人最近親屬代理決定與順位之適法性；（4）預立醫療委任代理人與法定最近親屬同意權之優先性；以及（5）不施行，與終止或撤除心肺復甦術之意義與爭議等。本文並針對此爭議加以分析與檢討，並提出未來修法之相關建議。最後，本文認為惟有尊重病人的生命自主權，透過「病情告知」以及「知情同意」之方式，加強醫病雙方之溝通、提升病人對生命自主權的掌握與認知、加強自然死觀念的宣導，以及推動預立生預囑及預立醫療委任代理人等制度，才能使病人在面對死亡時，能達到「死者安寧，生者安慰」之善終境界。

This article discusses the issues of euthanasia and natural death, including the situations in the Netherlands, USA, Australia, and Japan, and the criminal liability and related attitude in Taiwan. To avoid the confusion and misunderstanding, the term of assisted dying is adopted instead of the terms of euthanasia and natural death. Within the definition, there are several classifications used to describe different forms of assisted dying, namely active, indirect, passive, and persistent vegetative state（PVS）assisted dying. According to the definition and classifications, the Netherlands is the only country which permits active assisted dying, while the USA is the main country which allows passive assisted dying, withholding and withdrawing life – sustaining treatment. The Northern Territory of Australia is the first place in the world to pass laws about active assisted dying, and Japan is the legalized country of active assisted dying by judicial judgment.Based on the criminal liability in Taiwan, passive and indirect assisted dying are legal, but active and PVS assisted dying are illegal. Besides, the Human Organ Transplant Act and Hospice – Palliative Care Act（Natural Death Act）are the most important medical treatment – specialized laws about passive assisted dying. Under these two laws, there are three legalized types of assisted dying, including withholding life – sustaining treatment of the terminal patient by the consent of the patient or family, withdrawing life – sustaining treatment of the terminal patient by the consent of the patient himself, and withdrawing life – sustaining treatment of the brainstem death patient based on the need of the organ transplantation by the consent of the patient or family. Although the Hospice – Palliative Care Act has been implemented for over six years, there are still several debates, such as the denomination and definition of the act, the concept of the terminal patient and medical futility, the validity of statutory surrogate, the priority between the durable power attorney and statutory surrogate, and the controversy of withholding and withdrawing life sustaining – treatment. Therefore, some discussions and recommendations in this article are alleged for the reference of law revision in the future. In conclusion, we hope everyone feels peaceful and respected when their lives come to the end.