尊嚴死的權利：論病人自主權利法

《病人自主權利法》作為亞洲第一部病人自主權利專法，明文訂定允許特定病人作維生醫療抉擇，以消極安樂死之方式，讓病人在死亡邊緣時，免於無效醫療，有尊嚴地逝去。然而法制面而言，《病人自主權利法》之配套行政措施尚未明確，且觀諸各國經驗，執行面細節對於立法成效的重要性不容忽視。就實體權利而言，我國尊嚴死應開放到哪些適用對象，如何定義，和臨床醫療情形息息相關。程序面而言，醫療委任代理人的權限究竟只是病人單純的表意使者，或是具有代替病人決定的權利？病人自主權利法並未規定罰責，若醫院或醫師拒絕執行病人的意願，應如何處理？如何進行溝通以利病人進行知情選擇？諸多問題尚未隨立法而完全解決。本文以比較法之方式，呈現日本、韓國、美國奧勒岡州、加州之法制環境現況，期能為我國臨終法制提供適用上困難之出路及未來立法可能之修正走向。

關鍵字

病人自主權利法；安寧緩和醫療條例；尊嚴死；自主權；臨終法制

並列摘要

As the first law in Asia on the death with dignity issue, the Patient Right to Autonomy Act expands patients' rights on the choice of life-sustaining treatments. Patients in the edge of death can prevent futile medical care and die with dignity through passive euthanasia. However, the Patient Right to Autonomy Act was passed without compatible administrative regulations. There is no set solution to reconcile the possible contradiction in medical practice and procedural problems. According to other countries' experience, the details of execution are essential to the effect of a legislation. For example, what kinds of patients are eligible for the rights and procedures? How to define the patients? These are questions highly related to clinical judgements. Health care agents are just messengers to patients' will, or can make judgements for the patients? There is no sanction provisions in the Patient Right to Autonomy Act, so how to proceed if hospitals or physicians refuse to execute patients' will? How to enhance communication to enhance patients' informed choice? In order to identify and solve the issues, this research reviews the legal models in Japan, Korea and the United States surroundings on the issues to find a way to ensure the right of self-determination of the elderly could really be fulfilled from the perspective of law and makes contribution to enhance Taiwan's legal environment for patient's autonomy.