論病人自主權於我國法之體現與刑事爭議

A Study on Patient Right of Autonomy in Taiwanese Laws and Related Criminal Issues

唐子堯(Zih-Yao Tang)

指導教授 ： 王皇玉

國立臺灣大學/法律學院/法律學研究所/碩士(2017年)

https://doi.org/10.6342/NTU201701142

摘要

近年來，隨著「病人自主權」此一概念興起，人們逐漸跳脫傳統醫療父權主義下由醫師代替病人決定醫療處置之模式，轉為以病人為中心之醫病關係，卻也因此引發許多爭議。究竟「病人自主權」於我國法是以何種樣貌呈現，且相關刑事爭議又該如何解決，遂成為本論文之研究核心。

雖然「病人自主權」所涉及之議題範圍相當廣泛，然而在刑法領域中較常討論者為「病人身體法益之處分」及「病人生命法益之處分」兩部分。所謂「病人身體法益之處分」係指病人面對一般性醫療時所涉及身體法益之侵害，此時為保障「病人自主權」，醫師應善盡告知義務並取得病人之同意始得為醫療行為。本文除詳細探討「告知後同意」原則下之主體與對象、告知標準、告知內容、例外情況，以及違反「告知後同意」在刑法上之評價外，亦進一步提出相關建議。

「病人生命法益之處分」則涉及安樂死及尊嚴死等，此亦為我國近年來頗受國人重視之議題，且隨著《安寧緩和醫療條例》施行多年，及於2016年三讀通過且將於通過後三年施行之《病人自主權利法》的出現，更加增添此議題之討論必要性。本文先釐清安樂死與尊嚴死之概念，同時採比較研究法針對國外安樂死及尊嚴死相關法案之內容為比較，並探討我國《安寧緩和醫療條例》及《病人自主權利法》之規定，得知上開兩部法規範應為尊嚴死之體現，並對於規範不足之處進一步提出建議。此外，在刑法評價上則以此類病人不屬生命絕對保護之範圍、醫師不具救治義務、無作為可能性，或醫師具阻卻違法事由等，肯認該等行為之合法性，以同時保障「病人自主權」。

最後，整體檢討「病人自主權」於我國所面臨之現實困境後，基於良好醫病關係乃保障「病人自主權｣之前提，本文建議可藉由建立「醫病共享決策｣之方式改善現今冷漠之醫病關係，以確實建構「醫病協力下之病人自主權」。同時為解決現實中過度強調資訊提供之問題，得採取情境化分類方式，區分不同之告知後同意強度，以便病人得確實依其所需取得相關資訊，進而做出最終決定。

關鍵字

病人自主權 ； 告知後同意 ； 尊嚴死 ； 安樂死 ； 加工自殺 ； 生命法益處分 ； 安寧緩和醫療條例 ； 病人自主權利法

並列摘要

Deviating from the traditional physician-oriented treatment model, patient right of autonomy is turning into the core of modern medical treatment procedures. The purpose of this thesis is to discuss patient right of autonomy in Taiwanese laws and related criminal issues.

To protect patient right of autonomy, “informed consent” imposes a duty upon physicians to share information with their patients before getting consent. By analyzing the details of physician’s obligation to explain, including the subject and object of explanation, the contents of explanation, standard of explanation, exceptions of informed consent, and the the law effect of violation of informed consent in criminal law, the thesis provides some advices concerning current Taiwanese laws.

Besides, the issues on Enthanasia and Death with Dignity are valued recently in Taiwan, while Hospice-Palliative Care Act has come into force for many years, and Patient's Self-determination Right Act has been passed last year. To dicuss this, the thesis clarifies the concepts of Euthanasia and Death with Dignity at first. Then, the thesis adopts comparative method to compare the contents of foreign Euthanasia and Death with Dignity laws to find out Hospice-Palliative Care Act and Patient's Self-determination Right Act in Taiwan represent Death with Dignity rather than Enthanasia, and provides some advices concerning the two laws, too. In addition, the physicians who comply with the two laws will not be counted as assisted suicide or entrusted murder because of patients’ rights to dispose their lives exceptionally, no medical obligatios on the physicians, and the existence of affirmative defenses.

At last, the thesis suggest applying “Shared Decision Making” to improve the physician-patient relationship, and achieving personalized disclosure to tailor the disclosure process to the patients own values and informational needs. In other words, both the patients and the physicians should work together to get the best interests on the basis of the patient right of autonomy.

並列關鍵字

Patient Right of Autonomy ； Informed Consent ； Death with Dignity ； Enthanasia ； Right to Dispose of Life ； Assisted Suicide ； Hospice-Palliative Care Act

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