從病患自主權看病患家屬參與醫療決定之權限

An Analysis of Patient Family's Authority to Participate in Medical Decision-Making

楊琇茹(Hsiu-Ju Yang)

指導教授 ： 雷文玫

中原大學/商學院/財經法律研究所/碩士(2004年)

https://doi.org/10.6840/cycu200400585

摘要

論文摘要
近幾年來，隨著各種人權運動的興起，例如病患權益運動、醫療消費者權益保護運動等等，以及醫學科技的進步，醫病關係逐漸發生改變，病患的自主權也開始受到重視。但是每個人在生病或受傷的時候，同時也是最脆弱無助的時候，往往需要家屬或朋友的照顧和陪伴。而在我國，家屬的確在醫療與健康照顧上扮演重要的角色。而且，家屬的重要性不僅反應在醫療與健康照顧上，我們的法律也十足地反應出這樣的文化，例如醫療法、醫師法、安寧緩和醫療條例等，都賦與病患家屬簽署手術同意書、麻醉同意書，及接受病情告知之權利。

家屬具有如此重要的角色跟我們講究個人自主權和隱私權的法學理論有扞格之處，我們該如何理解看待這樣獨特的文化現象，也就是說，我們一方面強調尊重個人自主權，一方面卻又在醫療上、法律上賦與家屬極大的重要性，則我們應該如何妥善解決這樣的問題？因此，本文想要探討的問題是，醫療決策過程中除了醫師與病患以外，病患家屬的地位如何？病患家屬對病患之醫療決定有何權限？

本文擬先從比較法的觀點，針對病患自主權在美國以及我國的發展，歸納出病患自主權的內涵。但有鑑於國內家庭具有特殊的社會生活文化及醫療現象，從而會出現病患自主權之規範與我國社會文化格格不入的結果，所以，本文擬引用法律社會學之觀點，希望對病患自主權這種自西方引進的概念加以批判反省。其次，本文亦一併引用社群主義之觀點來探討應否賦與家屬決定權之理由。

本論文認為，病患家屬何時能夠參與醫療決定？參與的程度有多大？應該以何機制制衡家屬權限？應視具體類型而定。為了調和成年具有意思能力病患之病患自主權，與病患家屬決定權，應該賦與病患家屬參與醫療決定的地位，但是，家屬不可以否決病患之最終決定。亦即是，醫師可以將病患之醫療資訊告知病患家屬，但是，是否同意接受醫療行為，應該尊重病患本人的決定。而為了調和成年欠缺意思能力病患之病患自主權，與病患家屬決定權，家屬在代理病患為醫療決定時，應該以病患之最佳利益為考量，做出符合病患最佳利益之醫療決定。至於未成年病患，為了尊重未成年病患之自主權，可以賦與未成年病患部分醫療決定權，而父母代理未成年病患為醫療決定時，必須以未成年病患最佳利益為考量，做出符合未成年病患最佳利益之決定。

關鍵字

病患最佳利益 ； 病患自主權 ； 告知後同意法則 ； 醫療決定 ； 醫療資訊隱私 ； 成年具有意思能力病患 ； 病患家屬 ； 未成年人 ； 法律社會學 ； 成年欠缺意思能力病患 ； 社群主義

並列摘要

Abstract
This Study is about patient family’s role in medical decision-making. It argues that complex moral reasons call for the participation of patient family. However, these moral reasons do not support a single model of the patient family’s authority for all patients. Rather, they suggest important differences among the roles of patient family should play in decision making for different kinds of patients: competent adults, incompetent adults, minors.

Briefly summarized, the differences in authorities are as follows: First, when the patients are competent adults, to harmonize patient’s autonomy and patient family’s interest both to protect the patient and the family itself, members of the patients’ family should have a participatory role in the medical decision-making, without depriving patient’s to make the ultimate decision. Second, in making decisions for incompetent adults, the patient family’s principal authority should be limited by the patients’ best interests. The patients’ family should try to ensure that the patient’s interests are understood and considered. Third, when the patients are minors, the patient family’s role is to construct, as well as to pursue, a reasonable account of the minors’ best interests.

The scheme of this study comprises seven parts as follows:
Chapter I is a preface, illustrating the motives, methods, limitations and realm of this paper.

Chapter II analyzes the rationale of patient autonomy, then, discusses the doctrine of informed consent.

Chapter III, the protection of confidentiality between physician and patient is a well established principle in medical ethics and law. Despite widespread acceptance, the confidentiality doctrine is not absolute. A physician may disclose his or her patient’s private medical information, pursuant to the patients’ agreement; or in cases where is it necessary to protect patient or public interests. But, under the law of Taiwan, the physician can disclose the patient’s medical information to patient family. Does this violate the patient’s privacy of medical information?

Chapter IV looks into various law and rationale in Taiwan that grants decision-making power to patients’ family. Patients’ family provides emotional and financial support and performs a wide range of caregiving tasks. The patient family plays an important role in patient’s life. Any account of the role of patient family in medical decision-making must take account of the fact that lives are shared. Not only do patients’ family have obligations to patients, but patients have obligations to their families. From the perspective of sociology of law and communitarianism this chapter analyzes the justification of patient family’s authority.

Chapter V, this chapter discusses the patient family’s authority, when competent adult patients and incompetent adult patients confront the medically indicated procedures, or non-medically indicated procedures, or organ donation.

Chapter VI, this chapter discusses the patient family’s authority, when minors confront the medically indicated procedures, or non-medically indicated procedures, or organ donation.

Chapter VII is conclusion. It concludes that it is important to find out the justification of patient family’s authority to participate in medical decision-making, but, more importantly, how do we determine an appropriate balance of patient’s interests and patient family’s interests.

並列關鍵字

privacy of medical information ； the doctrine of informed consent ； the patient's best interest ； sociology of law ； communitarianism ； competent adult ； minors ； patient autonomy ； patient family ； incompetent adult ； medicla decision-making

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