論醫療法制區分一般與特殊拒絕治療權之必要性

The Necessity of Differentiating the Ordinary and Extraordinary Right of Refusing Treatment in Medical Law

我國安寧緩和醫療條例與病人自主權利法允許病人在特定條件下拒絕涉及生死的醫療干預。本文認為此一權利為特殊拒絕治療權，與不涉及生死的一般拒絕治療權有所區別，並主張此兩種權利應予以不同之規範。楊秀儀稱這種作法為「區別說」。他認為，任何心智健全的成年病人都可無條件地拒絕任何醫療措施，區別說既不必要，也不可行。
本文第壹部分先說明本文問題意識與文章結構。第貳部分則探討拒絕治療權的性質，下分兩節，第一節先說明楊秀儀的自主標準及其主張，第二節則對其觀點進行評論。第參部分探討區別說之可行性與必要性，下亦分兩節，第一節指出「區別說」具可行性；第二節則指出，區別一般拒絕治療權與特殊拒絕治療權並予以不同規範有其必要。第肆部分為全文總結。

The Hospice Palliative Care Act and the Patient Right to Autonomy Act in Taiwan entitle patients the right to refuse life-sustaining treatments under certain conditions. Referring to this right as the“extraordinary right of refusing treatment,”Hsiao-Chih Sun differentiates it from the“ordinary right of refusing treatment,”which does not cover life-and-death situations and argues that these rights should be regulated differently. However, Hsiu-I Yang has published several papers opposing this view and calling it“the differentiation theory.”Yang argues that any adult patient of sound mind can unconditionally refuse any medical treatment, including life-sustaining treatment (Claim A), and that the patient’s right to refuse treatment is not limited by the stage and kind of disease (Claim B). On these grounds, she maintains that the differentiation theory is unnecessary and, judging from the accounts of some clinical cases, even questionable in its plausibility.
In response to Yang’s arguments, this paper discusses the differentiation theory in four parts. The first part introduces the controversial issues and structure of this paper. The second part examines the nature of the right to refuse treatment. This part is further divided into two sections. The first section explains Yang’s views on the criteria of patient autonomy and her two claims (A & B). The second section comments on these views and develops this paper’s standpoint about the nature of the right to refuse treatment. The plausibility and necessity of the differentiation theory are explored in the third part, which is again divided into two sections. The first one contends that in the Jehovah’s Witness case cited by Yang, the differentiation theory has no issue of ambiguity and is, therefore, plausible. It is then in the second section pointed out that the ordinary right of refusing treatment and its counterpart, the extraordinary one, involve different basic rights protection and conflict, and accordingly that the differentiation theory is necessary both in terms of the criteria of patient autonomy on the subjective side and the stage and kind of diseases on the objective side. The fourth part is the concluding remark.