論病人自主權－我國法上“告知後同意”之請求權基礎探討

本文藉著探討台灣如何在法體系上繼受美國法上的「告知後同意」法則(the doctrine of informed consent)來研究當前生命倫理學中的一個重要的概念－「病人自主權」。究竟何爲「病人自主權」？我國現行法制中，是如何看待病人自主權？對病人自主權的保護爲何，是否充分？本文從管制法（醫師法、醫療法）、侵權行爲法、契約法三大面向來分析。研究發現，我國現行法中並沒有對「病人自主權」有清楚的定位，雖然從醫師法、醫療法，以及契約法中都可推導出醫師之說明義務，但嚴格論之，並無法由其推導出病人自主權。本文認爲，要建立我國法上的告知後同意法則，最正確的理論基礎還是應該從侵權行爲法出發，直接承認「病人自主權」乃是侵權行爲法上所要保護之「權利」。因此，醫師執行醫療行爲，應取得病人之「同意」，否則構成侵害病人「身體權」之侵權行爲；在取得病人同意之前，醫師應盡一定之告知義務，以幫助病人作出同意與否的決定，否則構成侵害病人「自主權」之侵權行爲。「身體權」是消極的防禦權，「自主權」則是積極的請求權；兩者皆爲病人一身專屬之「人格權」，受我國侵權行爲法上第184條1項前段之保護。

關鍵字

告知後同意；病人自主權；侵權行為

並列摘要

This paper studies the issue that how can the Taiwanese tort law integrate the doctrine of informed consent so as to explore the very important concept in modern bioethics, patient autonomy. What is patient autonomy? How does the legal regime in Taiwan treat the concept of patient autonomy? Does patient autonomy receive enough attention and have sufficient legal protection? I tries to answer these questions by reviewing related regulatory laws, tort law, and contract law. Study revealed that the current laws in Taiwan do not have a clear assertion to patient autonomy. Doctors' duty to disclosure might be established through the relevant requirements of the Physician Act 2003, the Medical Practice Act 2005, and contract law, but those are not accurate and appropriate basis for patients' right to autonomy. The author argued for a direct acknowledge-ment of patient autonomy as a legal right protected by Tort law. Medical performance without a patient's consent would constitute a violation of the patient's bodily right; before the patient consent, doctors should disclose necessary information so the patient can make an informed consent, otherwise it would constitute a violation of the patient's autonomy right. ”Bodily right” is a negative right, and ”autonomy right” is a positive right. Both are protected by article 184, section 1.