心智障礙者的避孕、絕育和人工流產：從生育自主和最佳利益保護出發

The Contraception、Sterilization and Abortion of Intellectual Disabilities : Based on Reproductive Autonomy and the Best Interests

林佩劭(Lin, Pei Shao)

指導教授 ： 林昀嫺

國立清華大學/科技管理學院/科技法律研究所/碩士(2015年)

摘要

心智障礙者得否進行避孕、絕育和人工流產等不生育決定，涉及到心智障礙者能否充分理解及做成有效醫療決定能力之問題。
在實施醫療行為時，為尊重病患自主權，實務上均要求踐行告知後同意程序。一個有效的告知後同意，必須奠基在充分理解能力上，然因心智障礙者理解能力限制，實務上家屬時有為其代理生育醫療決定之必要，進而衍生許多細微難分之界限爭議。
考量不生育決定對於心智障礙者基本權可能產生之重大影響，本文將聚焦在不生育決定，分就有無違反意願兩方面進行討論。藉由生育自主及最佳利益兩個概念檢討現行法制，並將未成年人與心智障礙者進行比較分析，在納入心智障礙者本身特殊因素後，對於我國法律體系定位及架構進行修正，以期在不同類型之不生育決定，對家屬做成代理醫療決定及國家介入界限將產生如何之影響提出檢討建議。
本文認為，若能就心智障礙者不生育決定議題建立起明確標準，將使心智障礙者之照護者、醫療從業人員免於面對人道精神考量困難、減少醫病關係衝突、釐清相關倫理爭議，進而確保心智障礙者之生育自主與最佳利益保護。

關鍵字

心智障礙 ； 生育自主 ； 代理決策 ； 家屬參與醫療決定 ； 最佳利益 ； 避孕 ； 絕育 ； 人工流產

並列摘要

This thesis explores whether intellectual disabilities can influence the individual decisions on reproduction treatments, such as contraception, sterilization, and abortion, and discusses whether people who are intellectually disabled can fully understand the nature of such treatments and effectively conclude their decisions.
In regards of patient autonomy, medical practitioners have adopted the Procedures of Informed Consent, requiring proposed treatments to be acknowledged by involved patients who are fully aware of the nature and consequences of the treatments. However, family members often decide on whether to implement the medical measures on behalf of the intellectual disabled due to their incapability, which creates disputes and issues as such surrogate decision-making mechanism does not strictly match the aforementioned procedures.
Considering the essence of non-reproductive treatments and the significant consequences that the involved intellectual disabled might sustain, this study will focus on intellectual disabled’s non-reproductive decisions and explore further to learn whether it is against their will to adopt such reproduction treatments. This study proceeds by reviewing relevant laws and regulations on reproductive autonomy and the best interests of patients, further comparing circumstances of the intellectual disabled to that of the minor, and put special factors into consideration, such as challenges an intellectual disabled may face when in similar conditions. This study also examines the relation between surrogate decisions under current Taiwanese laws and the non-reproductive decisions within national boundaries.
Based on the finding, the study suggests that clear standards on contraception, sterilization, and abortion adopted by the intellectual disabled ought to be established in order to ensure their best interests and reproductive autonomy. In addition, such standards can also erase the concern of medical professionals on ethical controversies and ease the rising tension within doctor-patient relation.

並列關鍵字

Intellectual Disabilities ； Reproductive Autonomy ； Surrogate Decision ； Patient Family's Authority to Participate in Medical Decision-Making ； The Best Interests ； Contraception ； Sterilization ； Abortion

參考文獻

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