理想與現實之間的病患自主—來自德國的經驗

對許多人而言，能夠有計畫地安排並實現自己的人生命運，是對於一個成功且具有品質的生命所不可或缺的。根據德國法的理解，每個具備同意能力的病患都有權去拒絕任何一個治療行為，即使可能在醫學上是性命攸關的治療行為時，亦同。對於自主的理解，是要讓每個病患都能嚴肅地看待其個人的需求以及其個人的資訊利益；而這就需要一個對於現行模式的轉變：從一個「客觀真實」走向一個「互為主觀的真實」。對此，我們就不能不去承認一個「拒絕知悉的權利」，而這個想法已經在德國的基因診斷法中受到了承認。在德國，雖然「病患預立醫療決定」已經透過法律予以確立，但仍有解釋上的難題存在；此外，自主的難題也會發生在：由於與決定時期的長期間隔，決定者通常在事後並未說明當下的意願是否仍與當初的決定相符，甚至也存有撤回的可能性。因此，我們就必須認真思考一個問題：病患自主在此是否會成為所謂的「自主安慰劑」？從自決權對於「自然的」死亡結果是否也能推導出一個「（幫助）自殺權」，在德國是個最新而且充滿爭議的討論議題。原本德國刑法不處罰幫助自殺，但為了對抗諸如Dignitas這類自殺中介組織的影響，德國立法者在2015年底增訂了「業務上之幫助自殺罪」。然而，這個規定在自決權的範圍內是否合憲，則是受到不少質疑。

關鍵字

病患自主；拒絕知悉權；病患預立醫療決定；自決權；自殺協助

並列摘要

For many people, it seems to be essential for a successful and valuable life to be able to arrange and realize one's own life destiny. According to the understandings of the German law, each patient with the authorization ability is entitled to refuse any medical treatment, even when this medical treatment is vital. The understanding of autonomy forces each patient to take his own needs and individual information interests seriously. This requires changes to the current paradigm, namely from an ＂objective＂ to an ＂intersubjective concept of truth＂. Due to this reason, we have to admit ＂the right not to know＂, which has been recognized by the Convention on Biomedicine in Germany. Although ＂advance healthcare directive＂ has been anchored in the German law, the problem of interpretation still exists. Additionally, in view of the long period of time after the decision-making time, the decision-maker usually does not explain whether his current will still conforms to the original decision, which also could possibly be withdrawn. Therefore, we must seriously consider the question: whether the patient autonomy will become an ＂autonomy placebo＂? Whether ＂the right to (assisted) suicide＂ can be generated from the right to self-determination with the result of natural death is a new and disputable topic in Germany. The assistance to suicide was not punishable by the previous German Criminal Law. However, in order to prevent the influences of the organizations for assisted suicide such as ＂Dignitas＂, a new crime ＂businesslike assistance in suicide＂ was introduced by the lawmakers of Germany at the end of 2015. However, this provision is questioned whether it is in conformity with the constitution in terms of the right to self-determination.

並列關鍵字

patient autonomy ； the right not to know ； Advance healthcare directive ； the right to Selfdetermination ； assisted suicide

參考文獻

BMBF-Projektgruppe "Recht auf Nichtwissen" (2016). Empfehlungen zum anwendungspraktischen Umgang mit dem "Recht auf Nichtwissen", MedR 34, S. 399-405.

Google Scholar

Burchardi, Hilmar (2008). Die Intensivmedizin, 10. Aufl., Berlin u.a. Соеppicus, Rolf (2011). Offene Fragen zum „Patientenverfügungsgesetz“, NJW, S. 2085-2091.