論臺灣病人自主權之現狀與挑戰

A Research of Present Situation and Challenges of Patients' Autonomy in Taiwan

張婷(Ting Chang)

《法令月刊》 68卷3期 (2017/03) Pp. 122-139

https://doi.org/10.6509/TLM.2017.6803.05

摘要

本文宗旨在於分析病人自主，國際趨勢已將其定位為人權之行使，且明定自主之範圍，此對醫病關係造成影響。在臺灣，歷經「醫療法」、「安寧緩和醫療條例」與「病人自主權利法」之法制發展，於此時即將施行「病人自主權利法」之前夕，有必要回顧與展望病人自主此一主題。主管機關、醫療機構、醫事人員及病人與家屬在面對病人自主時，所考量的面向各異，包含有限醫療資源之分配公平與效率最大化、秉持病人安全進行風險管理以減少醫療糾紛、尊重病人自主之前提為不牴觸醫療自主且醫師須已善盡法定義務、病人、家屬與醫事人員等及早參與並溝通價值觀以釐清病人意願等。無論各主體以何面向審視病人自主，亦無論彰顯病人自主之方式為簽署意願書或預立醫療決定，皆與社會上針對生命教育之重視與落實程度息息相關。本文認為全民健康保險在臺灣提供一舉世矚目安全的醫療環境保障，為迎來全亞洲第一部「病人自主權利法」創造條件。而下一步即為考驗臺灣社會於落實病人自主之際，所進行生命教育之奠基與耕耘。

關鍵字

病人自主權利法 ； 病人自主 ； 安寧緩和醫療條例 ； 預立醫療決定 ； 意願書

並列摘要

The theme of this article is to analyze patient autonomy. Patient autonomy has been positioned as human right and scoped by the international trend, thus has caused influence to the physician-patient relationship. In Taiwan, the legal development of patient autonomy has been through several laws such as the ＂Medical Care Act,＂ ＂Hospice Palliative Care Act,＂ and ＂Patient Self-determination Act.＂ Before executing the ＂Patient Self-determination Act,＂ it's necessary to look back and look forward this patient autonomy issue. Parties like competent authority, medical care institutions, medical personnel, patients and relatives consider the patient autonomy issue in different perspectives, which includes the following: fair distribution of limited medical resources and efficiency maximization, risk management to reduce medical malpractices to uphold patient safety, the premise of respecting patient autonomy is not to contradict medical autonomy and physicians should obey their legal duties, and patients, relatives, and medical personnel, etc. should participate and communicate values earlier to clarify patients' needs. No matter which perspective each party uses or whether letter of content or advance medical decision is signed to highlight patient autonomy, it's highly related to the level of valuing and implementing life education in the society. This article considers that national health insurance has provides a world known safe medical environment protection in Taiwan and this creates a good condition to come up with the first ＂Patient Self-determination Act＂ in Asia. The next step challenges the foundation and cultivation of life education when implementing patient autonomy in Taiwanese society.

並列關鍵字

Patient Self-determination Act ； Patient Autonomy ； Hospice Palliative Care Act ； Advance Medical Decision ； Letter of Intent

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