由「病人自主權利法」立法歷程論生命自主權之限制

On the Limitation of Life Autonomy by the Legislative Procedures of the Patient Right to Autonomy Act

以生命本質的立場而言，個體擁有生命的決定權，然而，在台灣「病人自主權利法」卻是近期透過法律，經由國家立法的隱含假定，賦予病人得以自主選擇醫療方式。儼然，決定自身如何面對生死的權利，彰顯生命自主權的本質是訴諸法律而來的福祉。那麼由少數人的組合、溝通妥協形成的有限條文，是否可以期待透過醫療上「知情同意」的義務，解決生命自主的困境，而不致成為得以規避他者的責任。為梳理這個議題，本文進而檢視「病人自主權利法」立法歷程，發現斧鑿條文的議事過程，令人難以忽視存在個別立法委員主導、偏重政策移植、偏重黨團的政治協商、偏重專業人士意見、偏重議事效率的妥協，以及偏重授權行政機關等現象。這個結果，可能導致限縮法律適用對象與效力，名義上為保護病人自主權利，卻是阻卻醫療機構或醫師的醫療義務與責任的主客體錯置現象。最後本文主張，法規條文之有限性，確實解決了特定的社會問題，看似保障了人有選擇自然死的權利，實際上，執行生命自主權的諸多限制，仍須仰賴執行者生命中蘊涵的關懷，得以預測生命窮盡時的需求及所需的關照，進而促發圓滿生命自主的喜悅。

From the standpoint of the nature of life, individuals have the right to decide on life. However, the Patient Right to Autonomy Act in Taiwan is a law through the national legislation, giving patients the option to choose their own medical treatment. Determining how to face the right of life or death, highlights the essence of autonomy and our well-being by resorting to the law. If the “right to survive or die” is to be won through the consensus of the legislation, then it is doubtful whether the limited provisions formed by the combination of a few people and communication can be expected to resolve the self- determination of life and the sorrow of loved ones through the medical “informed consent” obligation. In order to comb through this issue, this article further examines the legislative procedures of the Patient Right to Autonomy Act and found the process full of defects. In the process a single legislator leads the motion, there are a lot biases in policyimplementations, political consultations depending on the party line, On certain professionals opinions, and compromise on the efficiency of the proceedings, as well as the emphasis on the authorizing administrative agencies. This result may lead to the effectiveness of the act in the name of protecting the patient's autonomy, but instead it is protecting the medical institutions or physicians from their medical obligations and responsibilities. Finally, this paper argues that the limited nature of the provisions of the Act does solve some specific social problems. It seems to guarantee that people have the right to choose to die naturally. In fact, the implementation of autonomy at the end of life still depends on the how the caring professionals meet the needs of terminal patients.