病人善終自主權之研究－－借鑑臺灣法規範反思大陸立法之趨勢

A Study on Patient Autonomy-Take Taiwanese Medical Legislation as an Example for Reconsidering the Development of Medical Legislation in Mainland China

當個人身患絕症遭受疾病痛苦折磨時，其如何走向終點及社會作何反應，則是全人類所共同面對的重大終極問題之一。病人自主核心利益實為病人如何善終問題。病人善終自主權是指病人在罹患絕症時能夠依據自己真實意願，自主決定在醫師協助下自然而無痛苦或較小痛苦走向生命終點的權利。從病人善終自主權利現階段發展情況來看，其實質為病人拒絕維生醫療權。目前，病人善終自主權遇到了新的挑戰：一是醫療提供者終止醫療的權利與病人繼續維生醫療延長生命的權利之間的衝突；二是未成年病人有無善終自主權的問題；三是如何平衡孕婦善終自主權與胎兒生命權利之間的對立。臺灣形成了比較系統的、完善的醫療法律體系，安寧緩和醫療條例與病人自主權利法是保障病人善終自主權的專法。安寧緩和醫療條例允許末期病人可以立意願書選擇安寧緩和醫療（包括拒絕CPR），賦予「末期病人」自然善終的法源，是臺灣第一個直接規範「善終自主權」的成文法。病人自主權利法是亞洲第一部病人善終自主權利法，再次昭示「拒絕醫療是病人基本權益，是普世人權」，本法最大特點是擴大了善終自主權適用主體範圍，為五種特定情形。通過比較發現，兩部專法立法主軸始終未變，皆為實現病人善終自主權。在探索如何解決人類終結生命實現善終的終極命題上，二者皆起到積極的推動作用，表現上各有千秋。大陸醫療法律體系缺少醫療法，拒絕維生醫療權尚未明定，建議借鑑臺灣法規範反思大陸立法之趨勢，提出大陸迫切需要制定醫療法與安寧緩和醫療條例，以保障大陸人民所缺失的善終自主權。

This is an important and final issue for all human beings, in which the person decides how to end his life when he or she suffers from disease. The core interests of patient autonomy is how to life ends appropriately. Patient autonomy for life ends appropriately is the right to person decides voluntarily to end his or her life with physician-assisted suicide for his or her incurable illness. The essence of right is to refuse treatment. Now, Patient autonomy is facing the new challenge: first, the conflict between the physicians' power to make decision to terminate treatment and patient or patient's family requirements to go on treatment; second, if juveniles have the right of life ends appropriately; finally, the counterpose with pregnant women and fetus. There are Hospice Palliative Care Act and Patient Autonomy Act in Taiwan for patient autonomy of life ends appropriately. Hospice Palliative Care Act permits terminally ill patients to refuse the Life-sustaining treatment (LST) withholding or withdrawing according to letter of his or her intent or advance directives (AD), so, this is the first time for Taiwan to have a statue covering the subject of LST. Patient Autonomy Act is first in Asia for life ends appropriately, which broadens patient' scope for five specific circumstances, especially not limited terminally ill patients. Comparing Hospice Palliative Care Act with Patient Autonomy Act, we can infer that they all have ultimate aim to realize patient autonomy for life ends appropriately. They take an active role in realizing human's life ends appropriately, which has its own merits. Mainland China lacks medical law in medical legal system and has no the right to refuse treatment definitely. The paper suggests that take Taiwanese medical legislation as an example for reconsidering the development of medical legislation in Mainland China. Medical Law and Hospice Palliative Care Act are most urgent for Mainland China to protect patient autonomy of life ends appropriately now.