胚胎植入前基因檢測之規範模式研究

Models of Regulation of Preimplantation Genetic Diagnosis

林怡君(Yi-Chun Lin)

指導教授 ： 林子儀

國立臺灣大學/法律學院/法律學研究所/碩士(2009年)

https://doi.org/10.6342/NTU.2009.10017

摘要

胚胎植入前基因檢測(preimplantation genetic diagnosis , PGD)係針對人工體外受精所創造出來的胚胎，於植入母體子宮前，檢測胚胎之染色體或基因之技術。確認胚胎之性別以避免X染色體性聯遺傳疾病，以及檢測與孕婦年齡有關之染色體數量異常，係進行胚胎植入前檢測最常見之原因。近年來，胚胎植入前基因檢測不僅被用以避免遺傳性疾病，更被用以選擇某些特殊性狀，例如以救助手足為目的之表面抗原配對。此外，將胚胎植入前基因檢測應用於非治療性之目的，例如純為社會或文化原因之性別選擇之案例，亦漸漸增加。
胚胎植入前基因檢測之應用，並非全無爭議。關於此等技術應用之規範，涉及許多重要之憲法價值。支持對胚胎植入前基因檢測之使用不加以管制之最強大理由，在於欲施術父母之生殖自由，政府對胚胎植入前基因檢測進行管制，可能涉及對人民生殖自由之限制。而支持胚胎植入前基因檢測之使用應加以管制之理由，包括受毀棄胚胎之保障、經由選擇所生出之子女對己身未來自由選擇之保障、避免特定疾病性狀對於社會上罹患該等疾病者可能造成之歧視，以及可涵括所有上述利益之人性尊嚴保障。以上所述種種權利、價值之權衡，顯示此等議題所涉及之利益之重要性，其道德兩難之衝突性，以及共識之達成於多元分歧社會之困難性。
目前我國針對胚胎植入前基因檢測之規範，僅有人工生殖法加以間接之規範，且立法者或由於己身專業能力之不足，或由於如何解決此爭議之社會共識不足，故無法全面以立法管控，而藉由「醫學正當理由」此一不確定法律概念之認定，將是否允許以胚胎植入前基因檢測為目的之人工生殖之決策權限，委諸主管機關衛生署為之。於實踐上，衛生署之監督寬鬆，甚至完全繫諸醫療機構倫理委員會之自律，於決策時難以妥適考量上述諸種重要價值之平衡。
為提升對胚胎植入前基因檢測應用管制之決策正當性，本論文建議納入審議式民主之理念，以提升管制胚胎植入前基因檢測之正當性。將審議式民主參與應用於胚胎植入前基因檢測管制決策程序之討論，不僅可達成資訊溝通與多元價值之激盪與增進公民知能之效果，更可藉此於醫療科技發展與進步之此刻，促使民眾思考生醫科技背後錯綜複雜之倫理與價值問題，增強決策之正當性。

關鍵字

胚胎植入前基因檢測 ； 生殖自由 ； 胚胎 ； 人工生殖法 ； 審議民主 ； 公民會議

並列摘要

Preimplantation genetic diagnosis (PGD) is a technique of testing embryos created by in vitro fertilization for a particular chromosomal or genetic disorder prior to implantation. Sexing an embryo to avoid X-linked disorders and testing for age related aneuploidy (an abnormal number of chromosomes) are the most common reasons for PGD. Lately, PGD is used not only to avoid genetic disorders, but also to select for certain characteristics, such as matching tissue type for a therapeutic purpose of an existing sibling. In addition, the demands to use PGD for fully non-medical purposes, such as sex selection of embryos solely for social or cultural reasons, are increasing.
The use of PGD is controversial. The regulation of PGD is related to a great number of substantial constitutional interestes. The most important reason not to regulate PGD is prospective parent’s reproductive liberty. The regulation of PGD by the government may be considered as restricting people’s reproductive right. On the other hand, the reasons to regulate PGD include the protection of embryos, the protection of potential children’s right to an open future, possible harm or offense to disabled, and the most important one ─ human dignity. It is for the above-mentioned rights and interests that the study of PGD regulation is important and controversial, and they also explain why it is hard to get a common consensus in diverse society.
To date the only PGD regulation in our country is through the indirect Artificial Reproduction Act. Full legal regulation remains impossible due to legislators’ lack of expertise or deficiency of social consensus on how to resolve the controversies. PGD is currently approved by the Department of Health based on the uncertain legal concept of “legitimate medical reason”. In practice, since the supervision of Department is loose and often merely depends on the self-regulation of the ethical committee in medical care institutions, the decision is hardly made with proper consideration of all important factors.
The thesis suggests the inclusion of deliberative democracy theory to increase the legitimacy of the regulation of PGD. Deliberative public participation in the discussions of PGD regulation shall enable communication of information, stimulations by multi-values and increase of citizen intellect. Meanwhile, deliberative public participation shall also encourage the public to reflect on the complicated ethical and value issues resulted from the modern development of medical technology, which can reinforce the legitimacy of the regulation.

並列關鍵字

preimplantation genetic diagnosis ； PGD ； reproductive right ； embryo ； Artificial Reproduction Act ； deliberative democracy ； citizen consensus

參考文獻

林國明 (2007)，審議民主實踐的多元模式，臺灣民主季刊第4卷第3期。

孫效智 (2007)，人類胚胎之形上與道德地位，國立台灣大學哲學論評第34期。

雷文玫 (2007)，人類胚胎的法律地位：為何人類胚胎不該是權利主體，人文及社會科學集刊，第19卷第1期。

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