醫師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 Physicians

永久植物狀態（persistent/permanent vegetative state, 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，其中包括將此類決策視為醫療決策，應由主治醫師行使決定之作法。本文探討英國、法國與荷蘭由醫師行使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。

Since a persistent/permanent vegetative state (PVS) is not, by nature, considered a terminal condition, family members in Taiwan are not permitted to refuse life-sustaining treatment on behalf of the patient. However, in such a state-where the patient is unable to meaningfully interact with the outside world and requires around-the-clock professional care-it is possible that the patient would not wish to sustain life in this manner. As life-sustaining treatment constitutes a medical intervention, patients should rightfully have the authority to give informed consent or to refuse such treatment. However, since patients in a persistent vegetative state lack decision-making capacity and the withdrawal of life-sustaining treatment would result in death, this issue raises numerous ethical and legal controversies. In response to this practical dilemma, various countries have developed corresponding ethical and legal frameworks for making life-sustaining treatment decisions for PVS patients. Among these approaches is the view that such decisions constitute medical decisions and should therefore be made by the attending physician. This article examines the physician-led decision-making models in the United Kingdom, France and the Netherlands, with the aim of providing insights into their processes and practices as a reference for the future development of relevant policies in Taiwan.