用法律強制人勇敢？論新興傳染病大流行下健康照護者之救治義務

Can being brave be enforced by law? Health Care Providers' Duty to Treat in Pandemics

對抗SARS及COVID-19大流行的經驗顯示，有效應對新興傳染病仰賴健康照護者有高度意願持續提供病人照護。但在公衛危機下照顧染病者及有暴露風險者，健康照護人員必須承受資訊不足下被感染的風險，還要面臨對家人、未感染的病人、已感染的病人及保護自己的義務衝突。雖然健康照護專業倫理向來承認救治義務（duty to treat），但面對重大傷害或死亡風險時，這個義務有無界限？社會又要如何在公衛危機時確保照護人力？為回答上述問題，本文先討論救治義務之倫理起源與理論基礎，分析當前臺灣法律上對救治義務的規範架構，並提出規範策略上之建議。本文認為傳染病大流行下健康照護者的倫理上救治義務，將依照風險高低、依賴照護程度及個人意願而變動，如何促進自願性的義務履行始為規範關鍵。醫師法第24條及傳染病防治法及子法雖提供傳染病大流行下徵調醫事人力的法源依據，但有課與健康照護者不明確法律義務的缺陷與執行上困難，長遠而言更將傷害專業利他精神，不利社會確保與期待健康照護者在公衛危機下履行專業義務。建議法律規範重心應先確立自願性提供照護之原則，並透過多層次促進義務履行的策略，包括專業倫理義務之討論、機構制定有助義務履行的政策及法律上的支持性措施，才能長久維繫可靠的醫療人力。

Experience in the fight against the SARS and COVID-19 pandemics shows that effective responses to emerging infectious diseases depend on health care providers' high willingness to continue providing patient care. However, when caring for the infected and those at risk of exposure in a public health crisis, health care workers have to risk being infected with insufficient information. They also face the conflict of obligations to protect their family members, uninfected patients, infected patients, and themselves. Although the professional ethics of health care has consistently recognized the duty to treat, is there any limit to this duty in the face of the risk of significant injury or death? How can society ensure a care workforce during a public health crisis? To answer these questions, this paper first discusses the ethical origin and theoretical basis of the duty to treat, analyzes the current legal framework of the duty to treat in Taiwan, and provides suggestions on the regulatory strategy. This paper argues that the ethical duty to treat during a pandemic will vary according to the level of risk, the degree of care dependence, and personal wishes. Although Article 24 of the Physician Law and the Law on the Prevention and Control of Infectious Diseases and its sub-laws provide the legal basis for deploying medical personnel when emerging infectious diseases strike, there are shortcomings in the lack of clear legal obligations and the difficulty in implementation, which in the long run will harm professional altruism and detrimental society to ensure and expect health care providers to fulfill their professional obligations in a public health crisis. To maintain a reliable health care workforce in the long run, it is preferred to encourage the voluntary provision of care. Multi-level strategies may be adopted to promote the duty to treat, including setting ethical expectations, crafting institutional policies, and providing legal support and protective measures.