病人自主權利法之倫理觀點與實務挑戰

本文探討病人自主權利法之倫理觀點與實務挑戰，介紹預立醫療照顧計畫及預立醫療指示之觀念，以生命倫理四原則來闡述其倫理正當性，介紹世界各國相關法規及英美專業醫學會相關倫理指引，評析病人自主權利法之特色並探討其施行可能面臨之挑戰。作者指出，本法在於落實病人得於特定臨床條件時拒絕維生醫療之消極權利，與主張積極權利之積極安樂死或協助自殺有所區別；本法實施將有助於保障病患之醫療自主權與相關權益。

關鍵字

預立醫療計畫；預立醫療指示；醫療委任代理人；尊重自主；消極權利；積極權利

並列摘要

This paper investigates the ethical perspectives and practical challenges of the Patient Self-Determination Act. The concepts of advanced care planning and advanced directive are introduced. The four principles of bioethics are adopted to justify the Act, and relevant legal regulations and professional guidelines in Western countries are introduced. Then the characteristics of the Act and the challenges could be encountered in its practice are analyzed. The authors point out that only negative right in refusing life sustaining treatment is protected in this Act, not the positive right in demanding active euthanasia and assisted suicide. The actualization of this Act can enhance the protection of patient autonomy and their medical welfare.

並列關鍵字

advance care planning ； advance decision ； durable power of attorney ； respect for the autonomy ； negative right ； positive right

參考文獻

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王志嘉：末期病人生命身體法益的處分-談安寧緩和醫療條例立修法後的現況與展望。醫療品質雜誌2015;9:90-6。[Wang CC: The legal rights of terminally ill patients- on the current state and future prospects of hospice palliative care act. Healthcare Quality 2015;9:90-6.]"

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被引用紀錄

張沐晨、曾煥棠（2021）。護理人員對病人善終醫療自主權認知及在職教育的需求。健康科技期刊，7(2)，1-12。https://doi.org/10.6979/TJHS.202103_7(2).0001

劉士煒（2018）。從病人自主權論積極安樂死。臨床醫學月刊，82(5)，681-687。https://doi.org/10.6666/ClinMed.201811_82(5).0126

黃俐禎、李春蘭（2023）。一位出血型中風病人面臨生命自決困境之護理經驗。新臺北護理期刊，25(1)，128-137。https://doi.org/10.6540/NTJN.202303_25(1).0012

洪翠蓮、謝依靜、張麗珍（2022）。透過敘事會談方式協助悲傷中的癌末病人家屬。安寧療護雜誌，26(2)，165-177。https://doi.org/10.6537/TJHPC.202203_26(2).05

張丞淯、陳怡如、黃淑鶴（2021）。推展「預立醫療照護諮商（ACP）」參與促進失智症個案接受安寧療護的機會。安寧療護雜誌，25(2)，124-142。https://doi.org/10.6537/TJHPC.202103_25(2).03

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病人自主權利法之倫理觀點與實務挑戰

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