互為分靈體──超脫「病人自主」與「病方自主」的兩難

Interhorcruxicity: Beyond the Individualism-Familism Dichotomy Regarding Patient Autonomy

《病人自主權利法》於2019 年上路，其「自主」意涵歷經辯析協商，終體現「病人為主，親屬為輔」的共識。在這背後能否有堅實的倫理學基礎？處在東西方文化交叉口的我國醫學與法律倫理界，能否超脫「西方個體主義」與「東方家庭主義」，發展出既保障個體權益，又兼顧人情紐帶的新自我／自主觀？我們或可參考西方近年的「關係式自主」，在本土脈絡下提煉出自身觀點。本文以筆者身為醫師的個人經驗出發進行敘說探究，提煉出「互為分靈體」理論：互為分靈體指人與重要他人，成為彼此存放回憶、情感、期望、身分認同之容器（分靈體），是故人我界線具重疊性和漸層性，且不盡然等於身體界線。因此，不論親屬對病人的治療計畫表達看法，或病人主動將親屬的感受納入考量，均屬正當；同時，病人的主體性和優先性也得到確保。互為分靈體不單為《病人自主權利法》共識提供倫理基礎，更具醫療諮商應用價值。

The Patient Right to Autonomy Act, enacted in 2019, is the first “patient-centered” act in Taiwan. Until then, the meaning of “autonomy” had gone through a long-standing debate. Although a consensus acknowledging the primacy of the patient’s will as well as the assistant role of the patient’s family was finally achieved, the tension between western individualism and eastern familism remains far from resolution. Some scholars maintain that “relational autonomy” would be a suitable ethical basis for this consensus and a midway between the two ideologies above. We should be aware, however, that “relational autonomy” has its roots in the western context and should not be transplanted to Taiwan without modifications. Indeed, it is necessary for Taiwan to develop its own version of relational autonomy which tackles particularly the individualism-familism dichotomy. This article proposes the idea of “interhorcruxicity” as the core of such a version. Formulated through narrative inquiry into my experience as a physician, interhorcruxicity depicts the fact that we all store our memories, emotions, expectations, and identities in significant others, by which we make them our “horcruxes.” (Here I use J. K. Rowling’s fictional object as a metaphor.) Reciprocally, we become their horcruxes as well. The boundaries between the self and significant others, therefore, are not lines but gradient zones, and are not always equal to boundaries between bodies. It is then ethically legitimate for the patient’s family to express concern about how the patient treats their own body, and for the patient to take their family’s opinions into consideration. Meanwhile, the patient’s subjectivity and primacy are both guaranteed. This new idea of self and autonomy not only lays an ethical foundation to current legal consensus but also provides health professionals with a useful lens through which they can look into the complicated patient-family dynamics and bring out the best in both parties.