生命末期之合法選項與未竟之需

The Legal Choices and Unmet Needs of End-of-Life Decisions

當前台灣社會逐漸步入高齡化，與長期照護及生命末期相關之倫理法律問題受到重視。過去安寧緩和醫療運動與相關立法之推進，使得我國在死亡與臨終品質國際調查報告中，有不錯的名次表現。然而有關安樂死與醫助死亡的立法訴求卻不曾間斷，引起相關立法單位與主管機關之關注。本文探討現行我國法律制度下，做為國民於面臨生命末期時可能選擇之各種選項、並進行分析，包括法律所許可之三種情境，包括：（一）依據安寧緩和醫療於生命末期時拒絕維生醫療；（二）依據病人自主權利法藉由「預立醫療決定」於五種法定醫療情境下拒絕維持生命治療與人工營養及水分；（三）具充分決定能力者選擇自主停止飲食（VSED）。以及法律上尚未許可之兩種情境，包括：（一）安樂死與醫師協助死亡；（二）未被判定為末期之植物人於無意願表達，也未獲法浣許可下，被終止維生醫療與人工營養。作者期望經過本文之分析，可提升醫療人員對於生命末期病人於合法選項下的照護觀念及品質，並推廣國人對於安寧緩和醫療條例與病人自主權利法之認知與利用。另一方也寄望我國醫界、學界、社會能審視「兩項未免之需」，硏議探討適合我國發展之醫療執業模式與醫學指引，並帶動相關立法以保障全民生命末期之健康福祉，及保護醫療人員執業之專業倫理與合法性。

As Taiwanese society steadily transitions into an aged population, ethical and legal issues surrounding long-term care and end-of-life decision-making have garnered increasing attention. The advancement of the hospice and palliative care movement, alongside progressive legislation, has contributed to Taiwan’s commendable ranking in international assessments of death and dying quality. Nonetheless, public calls for the legalization of euthanasia and physician-assisted suicide persist, drawing the attention of legislative bodies and regulatory authorities. This article examines the current legal framework in Taiwan with respect to end-of-life options available to patients. It provides a systematic analysis of the legally permissible avenues, which include: (1) the refusal of life-sustaining treatment under the Hospice Palliative Care Act in the terminal stage of illness; (2) the execution of an Advance Decision under the Patient Right to Autonomy Act, enabling refusal of life-sustaining treatment and artificial nutrition and hydration in five specific clinical scenarios; and (3) voluntary cessation of eating and drinking (VSED) by a competent individual. In contrast, the article also addresses two currently prohibited practices: (1) euthanasia and physician-assisted suicide; and (2) the withdrawal of life-sustaining treatment and artificial nutrition in patients diagnosed as being in a persistent vegetative state who have neither expressed intent nor obtained court approval. Through this analysis, the author seeks to enhance healthcare professionals’understanding of legally sanctioned end-of-life care pathways and to promote broader public awareness and informed utilization of the Hospice Palliative Care Act and the Patient Right to Autonomy Act. At the same time, the paper calls upon the medical community, academia, and society at large to engage in reflective discourse on these ''two unmet needs,'' and to explore contextually appropriate clinical models and ethical guidelines. Such efforts may inform future legislative development, aiming to uphold the dignity and welfare of individuals at the end of life while safeguarding the ethical and legal integrity of medical practice.