自殺與自殺防治之倫理分析

近8年來自殺在台灣十大死因穩居第九位，自殺防治已成為台灣之重要議題。本文首先從西方歷史角度探討自殺之倫理評價；除了Stoic學派主張自殺之容許性外，西方在基督教興盛後，強調自殺違反神律及自然律，但隨著啟蒙時期強調個人理性自由後，自殺、精神異常、社會變動及父權主義之關係逐漸成為論述之焦點。本文以現代法治國制度為基礎，從社會防衛、保護個人與尊重自主等三個角度分析，指出在不同歷史文化中，支持與反對自殺之生命倫理學陣營中，皆存在有條件容許自殺、甚至稱許自殺之例子，因此並非所有自殺皆是自殺防治之正當對象，故主張整合社會政策之宏觀調整與精神衛生系統，或許更能實現同時尊重自主與保護個人之自殺防治政策。

關鍵字

自殺；自殺防治；加工自殺；倫理

並列摘要

Eight years ago, suicide became the ninth from top cause of death in Taiwan and this rendered suicide prevention an urgent issue. Firstly, in this study, we examined various ethical evaluations of suicide in western history. The early Stoics embraced the permissibility of suicide, but as Christianity prevailed, suicide became a violation of the Ten Commandments and of Natural Law. During the Enlightenment, arguments in favor of rationality and liberty signified a transition involving the tangled relationship between suicide, mental illness, social change and paternalism. Based on the assumption that society is based on the rule of law, we next analyzed the ethics of suicide and suicide prevention from the perspectives of respect for autonomy, social protection and protection of the individual. We argue that conditional acceptance of suicide and even praise of suicide has existed in various societies across different cultural and historical backgrounds. Even the camp that is strongly against suicide is unable to neglect the fact that suicide might be permissible on some occasions. Thus, it is not always ethically justified to intervene when a person wishes to commit suicide. In order to satisfy both a respect for autonomy and the protection of the individual, it is advisable to integrate macro-adjustment of the country's social policy with an individualized approach to suicide by the mental health system.