家屬代理為永久植物人進行維生醫療決策

Making Life-Sustaining Treatment Decisions for Persistent Vegetative State Patients by Family Members as Surrogate

永久植物狀態（PVS）因本質上不屬於末期，在我國無法由家屬代為拒絕施行維生醫療，但此種無法與外界有意義地互動、且需全天候專業照護的處境，病人可能並不願意以此種形式維持生命。維生醫療既為醫療處置，病人理應對其有知情同意和拒絕的權利。然而，由於PVS病人屬於無決定能力者，且若終止維生醫療將導致死亡發生，衍生諸多醫學倫理與法律上的爭議。面對此實務困境，關於如何為PVS病人進行維生醫療決策，各國發展出相應的倫理與法律框架，其中包拮由家屬代理決策之作法。本文即探討容許以家屬代理決策的美國、加拿大與瑞士，借鏡其維生醫療決策之流程與實務，提供我國未來發展相關政策之參考。

Patients in a persistent or permanent vegetative state (PVS), by definition, do not fall within the category of terminal illness under current Taiwanese law. As such, their families are not legally permitted to refuse lifesustaining treatment on their behalf. Yet the condition—characterized by a complete absence of conscious interaction with the external world and a reliance on continuous health care—raises serious ethical concerns. Many patients, if capable of prior reflection, may not have chosen to persist in such a state of existence. Life-sustaining treatment, as a form of medical intervention, presupposes the ethical and legal norms of informed consent and the right of refusal. However, PVS patients lack decision-making capacity, and the withdrawal of such treatment is tantamount to allowing death to occur, circumstances that invite complex ethical and legal disputes. Confronted with these challenges, jurisdictions around the world have developed normative frameworks to guide decision-making in such cases, including mechanisms that permit surrogate decision-making by family members. This article examines the ethical and procedural models employed in the United States, Canada, and Switzerland, where family proxy decisions regarding life-sustaining treatment for PVS patients are legally and ethically recognized. By analyzing these comparative approaches, the paper aims to offer principled guidance for the development of policy and legal reform in Taiwan.