論拒絕醫療之正當性─台灣安寧緩和醫療條例之評析

The Legitimacy of Right to Refuse Treatment─Legal Analysis of the Hospice Palliative Care Act in Taiwan

黃瓊慧(CHIUNG-HUI HUANG)

指導教授 ： 劉幸義

國立臺北大學/法律學院/法律學系/碩士(2008年)

摘要

因為安樂死的定義眾多不一，可能會造成溝通對談上的困難與混亂，所以本文先就為何採取「拒絕醫療」、「終止醫療」以取代安樂死的理由分析及說明，透過比較各國對於「醫療」、「拒絕醫療」、「終止醫療」、「照護」的概念及範圍以及提出本文立場。本文以道家為例透過文獻分析為何個人自我決定拒絕醫療前應立定一本土堅實之倫 理基礎以說明拒絕醫療的正當性。除末期病人外，本文認為經十八個月植物人（PVS,persistent vegetative state）症狀後被確定裁定為植物人再經十八個月都同樣植物人狀態、昏迷指數6以下的長期依賴氣切照護病人，及長期臥床不須使用呼吸器之病人經十八個月都同樣昏迷指數6以下，雖仍不符合「末期病人」，但依其意識清醒時長期間的思索且瞭解後，清楚再以書面表達拒絕醫療意願，本文認為應貫徹此病人之自我決定拒絕醫療，法律不應對之設限，仍應終止（含撤除）其人為之醫療（含點滴等營養水分之補充。

雖然在本文所主張健全生死觀的社會共識還未形成前、拒絕醫療的正當性還未達成前，不可否認對於植物人及長期依賴呼吸器病人之終止醫療仍難被接受，難以成立本文所主張之不帶有不作為殺人概念之「終止」，雖如此本文仍須一試，經過此過程後也應能瞭解這不是非黑即白、贊成或反對的問題。最後，評析台灣安寧緩和醫療條例及提出修法及配套措施建議。

關鍵字

拒絕醫療 ； 終止醫療 ； 自然死

並列摘要

Because the definition of euthanasia is not clear may cause the confusion in the communication. Therefore, the reason for "refuse treatment" and " termination of life-sustaining treatment" to replace the euthanasia in this paper is first and foremost. And that, based on Taoism as an example of the legitimacy that the self-determination to refuse treatment in local ethical. Except the dying patient, through 18 months persistent vegetative state(PVS) symptoms were identified PVS and next another 18 months have the same PVS symptoms, and the long-term care patients under 6 point of the Glasgow coma scale (GCS) rely on the Tracheotomy, and the bedridden do not need to use oxygen mask patients as the same as 18 months under 6 point of the GCS, but according to a clear advance death planning I believe that patients should refuse treatment and their life-sustaining treatment should be terminated.

Before the social consensus this paper advocating has not yet formed and the legitimacy of refusing treatment has not reached, it is undeniable that termination of life-sustaining treatment is difficult to be accepted. Nevertheless, still had to try and through this process should also believe such a thing like “Nothing is but right or wrong”. Finally, legal analysis of the Hospice Palliative Care Act in Taiwan and has some suggestions to modify the Act.

並列關鍵字

refuse treatment ； termination of life-sustaining treatment ； natural death

參考文獻

5.Emanuel Ezekiel J. ，柳麗珍譯，《臨終之醫療倫理》，台北：五南，1999/01/01。

13. Singer Peter A. 辛格/蔡甫昌/，《臨床生命倫理學》，醫院評鑑暨醫療品質策進會：金名圖書總經銷，2003.09.24。

15.Zaner Richard M./詹納/蔡錚雲/龔卓軍譯，《醫院裡的危機時刻:醫療與倫理的對話》，台北：心靈工坊，2004.03.26。

35傅偉勳，《死亡的尊嚴與生命的尊嚴》，台北：正中書局，2004年10月5版。

37蔡甫昌，《醫學倫理小班教學:案例與討論題綱》，醫院評鑑暨醫療品質策進會出版：金名圖書總經銷，初版 2006。