加工自殺罪刑與預立醫療決定之交錯與正當性之研究

從當今先進諸國整體法律系統設計綜觀來看，若欲回答個人在生存權受憲法保障之外，是否得以享有死亡暨善終選擇權的法哲學與倫理學問題，則必須得回歸到憲法關於人性尊嚴的基本權的討論。除了依據憲法第 8 至 22 條中明列對生命權之保護外，尚另有基於人類就於自身肉體處置之自由權、人性尊嚴、以及欲擺脫病痛與醫學治療折磨之「自主決定權（Personal Self-determination）」之考量。但無論如何，在當今加工自殺罪仍為我國《刑法》各罪之一的現實下，《刑法》免責立法明文化之前，仍有若干法律議題、規範內容及相關配套，仍待法界討論與改進；這是法學界與醫學界所要共同努力、共同對話、以建立共識與共同語言的課題。過去《醫療法》第 60 條及《醫師法》第 21 條，均規定醫療機構與醫師無例外之緊急救治義務，使得醫師本於救人的職志，不得不與死神奮戰到底 1 。但隨著時代的進步與轉變，且伴隨《病人自主權利法》與《安寧緩和醫療條例》的通過，且行之有年，自然死與善終的觀念已廣為現今社會所接受，消極的安樂死幾乎成為全民的共識。觀察此二法立法目的，《安寧緩和醫療條例》為「為尊重末期病人之醫療意願及保障其權益」、《病人自主權利法》為「為尊重病人醫療自主、保障其善終權益，促進醫病關係和諧」，從立法涵蓋主體與客體之範疇來看，顯現二法間重疊性甚高，後法《病人自主權利法》除擴大適用主體之範圍、也提供了使病患得以選擇更多不同安寧照護之方式，亦側重解決《安寧緩和醫療條例》遺留下來、懸而未決的臨終醫病關係問題。因此，如今關於「安樂死是否合法化」、「醫療實務上之幫助自殺是否除罪化」之議題爭議，則多半侷限在醫師對病患進行「積極安樂死」是否可得法規明文化這一部分，至今仍於倫理與法律上之爭執不斷。對於一個無法治癒的病人，或在病人尚未陷入無法治癒之絕症前，是否在一定程度內，給予自主權利決定，或經病人清楚表達意願後，預定未來是否繼續或放棄治療，以及在何等程度內可給予死亡協助，遂成為當代醫療與法律的重要議題。

關鍵字

安樂死；加工自殺罪；病人自主權利法；安寧緩和醫療條例

並列摘要

For answering the question of whether an individual has the right to choose to die with dignity, we should observe the legal system in Taiwan from constitutional law overall. In addition to declaring the individual as the subject of rights and respect for the right to life in accordance with Articles 8 to 22 of the ROC Constitutional law, there are also considerations based on human dignity. In order to properly resolve the freedom, human dignity, and the "self-determination" of patients to get rid of the pain and medical treatment. Contemporary medical technology, giving people alternative opportunities for making different choice between life and death, bioethics has started another wave of reconstruction of the concepts of "suicide" and "self-determination in terminally ill". But in any case, in the reality that the crime of death assistance is still a crime in our country. Before decriminalization, there are still several legal issues, and related supporting facilities that still need to be discussed and improved by the legal and medical circles must work together. In the past, the " Medical Care Act" and the "Physicians Act" stipulated that medical institutions and physicians had the duty of emergency treatment without exception. As a result, physicians are trained to maintain health and fight illness. However, as the times progress and change, and with the passage of the " Patient Right to Autonomy Act" and the "Palliative Care Act", and after years of practice, passive euthanasia has almost become the consensus of the whole people. Now, there are disputes about "whether euthanasia is legalized" and "whether assisted suicide is decriminalized in medical practice", are mostly limited to the part of whether the doctor can practice "active euthanasia" to patients. There are still constant disputes over ethical and legal doctrines. For an incurable patient, whether to grant autonomous rights to a certain extent, and whether and to what extent death assistance can be granted, has become an important issue of contemporary medical treatment and law.