病人自主權利法今上路：淺談善終權

PATIENT AUTONOMY ACT HIT THE ROAD: A BRIEF COMMENT ON THE RIGHT TO A GOOD END

黃耀德 ； 方偉任 ； 謝伯璋 ； 怡霖 ； 林宸瑀 ； 陳麗雲

《台灣醫學人文學刊》 20卷1&2期 (2019/12) Pp. 54-73

摘要

《病人自主權利法》是最近通過並於今年開始實施的新法，有望解決末期病人、處於不可逆昏迷狀況、永久植物人狀態、極重度失智和經中央主管機關公告病人疾病狀況難以忍受、無法治癒且當時醫療水準無其他合適解決方法等情形時，有預立醫療決定終止、撤除或不施行維持生命治療或人工營養及流體餵養之全部或一部，得以善終的權利。過去《醫療法》第六十條及《醫師法》第二十一條，均規定醫療機構與醫師無例外之緊急救治義務。在《安寧緩和醫療條例》三次修法之後，末期病人得以拒絕心肺復甦術或維生醫療，而醫師於緊急狀況下不救治亦得阻卻違法。然而，非末期病人在性命危急時即便已事前預立醫療決定，醫師仍然必須要救到底，病人則無拒絕維持生命治療的權利。本文稍加說明《病人自主權利法》與已在施行之《安寧緩和條例》、外國「安樂死」的異同，並引敘國內實務案例評析，希望藉此法案之生成與執行，可使醫病關係和諧、病人權利自主、資源分配得宜、責任歸屬清晰。

關鍵字

病人自主權利法 ； 安寧緩和條例 ； 善終權 ； 安樂死

並列摘要

Patient Autonomy Act is the latest law executed this year. Trying to solve when patient is terminally ill, in an irreversible coma, in permanent vegetative state, suffering from severe dementia, or other disease conditions, announced by the central competent authority, that shall meet all of the following requirements that the conditions or sufferings are unbearable, that the disease is incurable and that there are no other appropriate treatment options available given the medical standards at the time of the disease's occurrence. An option which he or she can decide to terminates, withdraws or withholds life-sustaining treatment and/or artificial nutrition and hydration. In past Medical Care Act article 1 and Physicians Act article 21 are determined medical institutions and physicians have obligation to rescue lives without exception. After third amendment of Hospice Palliative Care Act, physicians can claim affirmative defense when terminal patient refuse CPR or life-sustaining treatment in emergency situation. However, non-terminal illness patients don't have right to refuse life-sustaining treatments even though he or she sign-off Advance Decision. This article compare similarities and differences between Patient Autonomy Act, Hospice Palliative Care Act, and Euthanasia via domestic cases. Expect the promotion of medical relationship and autonomy rights as act implementation.

並列關鍵字

Patient Autonomy Act ； Hospice Palliative Care Act ； Right to a Good End ； Euthanasia