善終服務的法律調整模式及選擇邏輯

善終服務立法在比較法上經歷了從安樂死立法整體受挫，到自然死和安寧療護立法獲得成功，再到向協助自殺和安樂死合法化漸次拓展的過程。這種發展根源於死亡的醫學化和多元化的世俗死亡觀間的相互作用，根本任務是要衡平生命保護和個體自決。善終服務立法已經形成了以醫療自主權為基礎的，自然死立法與安寧療護立法或合一、或分離的自然死服務立法模式以及以事實上的死亡自由和醫療援助為基礎的不具有醫療性質的速死服務立法模式，後者包含協助自殺模式和安樂死模式。我國法不應承認所謂的死亡權。未來我國立法應采安寧療護與自然死立法合一模式，在承認末期患者有權拒絕維生醫療、預立醫療指示和獲得安寧療護的基礎上，對安寧療護的服務物件、意願表達和實施程式等作出明確規定。

The development of legislation on 'good death' service in comparative law has experienced a process from the avoiding euthanasia legislation in many countries to the success of natural death and palliative legislation in many countries, and then to the gradual expansion to the legality of assisted sui-cide and euthanasia in a few countries. This development is rooted in the interaction between the medical-ization of death and the pluralistic secular view of death, and its fundamental goal is to balance life pro-tection and patient self-determination. Different legislative models have formed, including the model of separation or integration of natural death and palliative legislation based on patients' right to medical self-determination, the assisted suicide model and euthanasia model based on de facto freedom of death and medical assistance. In China, refusing to recognize the legality of assisted suicide and euthanasia does not constitute a violation of the PRC Constitution. In the future, China's legislation should focus on palliative care, adopt the legislative model of integrating palliative care and natural death legislation, and makes clear provisions on the service objects, expression of will, implementation procedures while recognizing the terminally ill patients have the right to refuse life support medical treatment and obtain palliative care.