生命權與善終權之交互作用與衝突妥協

The Interaction and Compromise of the Right to Life and the Right to Hospice

我國社會人口變遷迅速，人口結構急速老化及少子化之雙重發展趨勢下，老人及長期臥病者之照顧需求與日俱增，對於個人、家庭乃至於整體社會皆與此息息相關，若未能妥善處理，將是重大生存問題與生存權危機。本文將以生命權保障為原點，次以老病者長期照顧制度之給付保障為繼，最終面對生命終點前之醫療自主決定權與界限為分析，並提出個人見解與建議。必須強調者為，本文探討重點並非死亡權，而是優雅老去與臨終自主權。 依據憲法第15 條生存權保障，國家應建立相關制度予以保障，憲法第155條又規定，國家為謀社會福利，應實施社會保險制度，係以實施社會保險制度作為謀社會福利之主要手段。憲法增修條文第10 條第7 項規定，國家對於身心障礙者之保險與就醫、無障礙環境之建構、生活維護與救助，應予保障；同條第8 項又確立國家應重視社會救助、福利服務、國民就業、社會保險及醫療保健等社會福利工作。憲法分別於第二章基本權利與第十三章基本國策之社會安全及增修條文第10 條等，先後就不同面向，要求國家應該提供人民符合人性尊嚴之生存延續保障。其中社會福利事項，屬國家為實現人民具人性尊嚴之生活照顧，所應盡之照顧義務，故除中央政府外，與人民生活關係更為密切之地方自治團體，自亦應共同負擔（參照地方制度法第18 條第3 款第1 目）。因此，如何妥適規劃長期照顧法制及臨終自主決定制度等議題，對於國家與全體人民而言，亦趨重要。

The rapid demographic changes in Taiwan's society, the rapid aging of the population structure and the dual development trend of declining birthrates, the need for care of the elderly and the chronically ill is increasing day by day. This is closely related to individuals, families, and the entire society. If it is not handled properly, it will be major survival issues and survival rights crisis. This article will take the protection of the right to life as the starting point, followed by the payment protection of the long-term care system for the elderly and the sick, and finally face the medical autonomy and boundaries before the end of life as an analysis, and put forward personal opinions and suggestions. It must be emphasized that the focus of this article is not the right to death, but the right to age gracefully and dying autonomy. According to Article 15 of the Constitution of the Republic of China, the state should establish relevant systems to guarantee it. Article 155 of the Constitution also stipulates that the state should implement a social insurance system for social welfare. The implementation of the social insurance system is the main method for social welfare. Article 10, Paragraph 7 of the Amendment of the Constitution stipulates that the state shall guarantee the insurance and medical treatment of the physically and mentally disabled, the construction of a barrier-free environment, the maintenance and assistance of life. Paragraph 8 of the same article also establishes that the state should attach importance to social welfare work such as social assistance, welfare services, national employment, social insurance, and medical care. The Constitution is divided into Chapter 2 basic rights and Chapter 13 basic national policies, social security and Article 10 of the Amendment of the Constitution, etc., with different aspects successively, requiring the state to provide the people with human dignity survival and continuity guarantee. Among them, social welfare matters belong to the state’s obligation to take care of the people’s life with human dignity. Therefore, in addition to the central government, local autonomous organizations that have a closer relationship with the people’s lives should also be shared (refer to Article 18, Subparagraph 3, Item 1 of the Local Government Act). Therefore, how to properly plan the long-term care of the legal system and the end-of-life autonomous decision system is also becoming more important for the country and the entire people.