醫助自殺合法化的倫理反思

Ethical reflection of the legalization of Physician-Assisted Suicide

楊雅君(Ya-chun Yang)

指導教授 ： 李瑞全

國立中央大學/文學院/哲學研究所碩士在職專班/碩士(2012年)

摘要

醫生秉持濟世救人的職責，尊重病人的自主性，末期病人面對無效醫療痛苦時，是否有權利請求醫助自殺的倫理性仍有爭議。本論文主要探討醫助自殺的合理性，藉由奎爾提出符合醫助自殺模式的條件為主軸，對於罹患無效醫療的末期病人，仍具有理智與行為能力者，可主動要求醫生開立致死藥物，尋求尊嚴死亡，是謂「醫助自殺」，進而衍生醫助自殺合法化後的問題提出倫理反思。美國華盛頓州採取公投通過尊嚴死法案，醫助自殺形成公共政策後所遭遇的問題，從不同學者觀點分析贊成與反對醫助自殺的立場。
第二章從奎爾醫生的個案研究，罹患急性白血病的黛安請求醫助自殺，必須符合醫助自殺模式的七項條件。學者貝參提出九項符合醫助自殺的要件，再與奎爾的醫助自殺模式作相同處與相異處作一比較。整合柯沃肯協助病人自殺模式與奎爾所提出醫助自殺的模式，分析其優缺點。
第三章主要從自律原則的觀點，探討醫助自殺的道德性，論證醫助自殺可以是合乎理性的規範。從康德的人性尊嚴與自律原則來探討醫助自殺的爭議性，康德認為自殺是要被譴責的，假設醫助自殺不同於自殺，自律原則與生命價值有何衝突議題。以生命價值為主軸，反對醫助自殺的學者與理論，同樣強調人性尊嚴。所以，醫助自殺必須透過深思熟慮的規範之後，才能在道德上成為可接受的醫助自殺。
第四章在雙重效應原則，認為醫助自殺造成病人縮短生命是好的效果，大於病人的痛苦，所以致命藥物產生的副作用只是不好的結果，病人因而可以解脫。贊成醫助自殺的學者認為，讓病人擁有死亡的權利，不再繼續忍受疾病態來的痛苦，醫助自殺可以是理性的選擇。
第五章擬就醫助自殺合法後會遭遇到議題，濫用產生的滑坡效應、末期病人宣稱請求醫助自殺的權利、社會差異與醫生的角色轉換與醫病關係的轉變四方面來探討醫助自殺合法化後，將會面對現實的問題，而這些問題會如何影響我們對醫助自殺的觀感，想想如何制定適合我國國情的醫療制度。

關鍵字

滑坡效應 ； 自律原則 ； 人性尊嚴 ； 醫助自殺模式 ； 醫助自殺

並列摘要

Saving the world uphold the duties of physicians who respect autonomy of the patients. Terminally ill patients suffering have the right to die. PAS is still controversial. This paper mainly discusses the rationality of physician assisted suicide. By Quill’s patterns that meet the conditions of PAS for patients’ suffering invalid. They still have the ability to act and take the initiative to ask the doctor to open up lethal drugs. The dignity of death is that "physician assisted suicide", and then derived legalized medically PAS reflection on the issues raised. In the U.S, the state of Washington, Death with Dignity encountered public policy problems after the formation of PAS. From the viewpoints of different scholars are in favor of and against the position of PAS. From Dr. Quill, suffering from acute leukemia, Diane’s PAS, and her case must meet the seven conditions. Beauchamp’s nine models in PAS are in line with the elements of Dian model. To help patients commit suicide, Kevorkian proposed model and Quill’s model. I’ll analyze its strengths and weaknesses.
From the principle of self-discipline views of the morality of PAS can be demonstrated rational norms. From Kant''s principles of human dignity and self-discipline explore the controversial medical assistant suicide. Kant thinks suicide is to be condemned if medically assisted suicide is different from suicide. The value of life as the main, opposed to scholars and medically PAS. The theory is emphasized on human dignity. Therefore, medically assisted suicide must be considered through the specification before it can be morally acceptable medical assistance to commit suicide. In the principle of double effects that cause the patient medically assisted suicide It is a better life shortening effect than the patient''s pain. So side effects of drugs are a bad result. In favor of medically assisted suicide scholars believe that the patients have the right to die, not continuing to endure the pain of the disease. PAS can be a rational choice. To be legitimate medical PAS after the suicide encounter issues: abuse resulting landslide effect, terminally ill patients commit suicide claimed the right to die, differences of the doctor''s role changing, the doctor-patient relationship. Legalized PAS will face the reality of the problems and how these issues affect our perception of medically assisted suicide. Think about how to formulate suitable for Taiwanese health care system.

並列關鍵字

slippery-slope ； the principle of autonomy ； human dignity ； model of Physician-Assisted Suicide ； Physician-Assisted Suicide

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