從儒家的觀點省察病人自主權利法的限制：以永久性植物人為例

Confucian Perspective on the Limitation of the Patient Right to Autonomy Act in the Case of Permanent Vegetative State Patients

醫療科技的不斷進展，為許多病人帶來治癒的希望，但也產生了各種過往沒有出現過的倫理難題。例如，各種維生醫療的使用，固然讓危急的病人存有一線生機，但當病人已沒有任何治癒的希望，這些醫療處置可能只是延長其瀕死過程，甚至只是增加他們的痛苦。雖然民國89年制定的安寧緩和醫療條例，已可讓末期病人透過簽署意願書，選擇安寧緩和醫療或作維生醫療抉擇，但對於罹患其他嚴重疾病、且亦沒有治癒希望、但尚未是末期的病人，例如處於永久性植物人狀態的病人，安寧緩和醫療條例仍未能讓他們從其所處的困境中解脫。因此，民國105年制定、並於今年（108年）開始施行的病人自主權利法，為此類飽受疾病煎熬的病人提供了一條出路。病人自主權利法除申明了病人的知情權、選擇權和決定權外，同時規定當病人處於該法所列的五種臨床條件，包括永久性植物人狀態時，可透過預立醫療決定，選擇終止、撤除或不施行維持生命治療或人工營養及流體餵養。雖然相比於安寧緩和醫療條例，病人自主的確擴大了病人的自主權，為末期病人外的其他某些特定類型的重症病人提供更多的選擇，但事實上是否能充分解決他們以及其家人所面對的難題，仍有待商榷。本文的目的，即在於藉由國內一宗相當著名的植物人案例──王曉民的遭遇，反思病人自主權利法的限制，並從儒家的觀點和參考國外相關案例，提出修訂建議。

The continuous advancement of medical technology has brought hope for their cure for many patients, but it has also produced various ethical problems that have not appeared in the past. For instance, the use of various lifesustaining treatments may give a chance to keep alive to critically ill patients, but may also prolong their dying process or may even increase their suffering if they have no hope of healing. Although the Hospice Palliative Care Act enacted in 2000 in Taiwan have enabled terminally ill patients to choose palliative care and to decide not to receive or withdraw from life-sustaining treatments by signing a letter of intent, patients who are not yet in the final stage but may be irreversible, such as patients in a permanent vegetative state, have not been able to free themselves from their predicament through this Act. Hence, the Patient Right to Autonomy Act enacted in 2016 and begins to implement this year, provides a way out for such patients suffering from their disease. In addition to affirming patient's right to know, choice and decision, the Act also stipulates that patient may choose to terminate, withdraw or not receive life-sustaining treatment or artificial nutrition and hydration through advanced decision when the patient is in the five clinical conditions listed in the Act, including permanent vegetative state, Although the Patient Right to Autonomy Act, compared to the Hospice Palliative Care Act, does expand patient autonomy and provide more choices for certain types of critically ill patients other than terminal patients, whether it is able to adequately address the problems encountered by them and their families is still open to question. This paper aims at reviewing the limitations of the Patient Right to Autonomy Act through a reflection on the case of Wang Xiao-Min, a well-known medical vegetative state patient in Taiwan, and proposing some revisions of the Act from the Confucian point of view and reference to other relevant foreign medical cases.