病人生命身體法益的處分－兼論死亡協助與刑事責任

Natural Death、Assisted Dying and Criminal Liability

王志嘉(Chih-Chia Wang) ； 羅慶徽(Ching-Hui Loh)

《安寧療護雜誌》 15卷1期 (2010/03) Pp. 63-80

https://doi.org/10.6537/TJHPC.2010.15(1).5

摘要

由於國民自我意識的提升，在醫療上病人的自主權越來越受到重視，近年來國內相繼發生醫療團隊積極急救病人而引起醫療爭議的案件，造成不小的震撼。綜觀這些爭議，從醫學倫理與法律的觀點分析，主要涉及「病人的自主權（生命身體法益的處分）」與「醫師緊急救治義務」的界限，若就病人及社會觀點分析，涉及到生命價值、生死態度、生活品質、與尊重自主等層面，目前仍是醫學倫理與法律的難題。
關於病人生命身體法益的處分，不論在醫療或法律實務上都能接受且較無爭議的情形，係病人是末期病人時，得在尊重本人意願，或是在其昏迷、無法清楚表達意願等情況下由家屬依病人真意，簽具不施行心肺復甦術的意願書或同意書，這部分在法學界向來所稱爲「消極的死亡協助、尊嚴死」，在醫學界稱以「自然死」爲名稱，在我國，2000年安寧緩和醫療條例的立法後，相關的爭議已逐漸減少。
目前在醫療實務上比較困擾的議題，包括：一、末期病人應該如何解釋，腦死的病人是否爲末期病人；二、末期病人最近親屬是否可以簽具同意書，要求終止或撤除已施予的心肺復甦術，或是病人家屬可否要求進行腦死判定要求拔管，也將於本文分析討論。
最後，除了病人生命身體法益的處分所涉及的爭議外，在醫療實務上必須注意「醫病溝通」的問題，因爲醫病之間對於善終的討論與避諱，無可諱言的至今仍存有障礙，造成醫病間的認知有所不同，此部分應該透過醫學教育與醫病溝通著手，以避免潛在的醫療糾紛。此外，從家屬的觀點，照顧多重疾患的長者，係巨大的壓力，容易身心俱疲，日前也曾聽聞南部發生媳婦悶死婆婆後自首的案例，其實這部分應該係靠社會福利制度解決，不應由家屬以及醫療團隊承擔，惟在社會福利制度未健全時，此痛苦無疑的由家庭獨自承擔，也間接影響醫療團隊的決策。

關鍵字

死亡協助 ； 安樂死 ； 自然死 ； 安寧緩和醫療條例

並列摘要

The purpose of this article is to discuss the relationships and the attitudes of the euthanasia, natural death, and the criminal liability in Taiwan. The term, assisted dying is adopted instead of using the terms, euthanasia and natural death in order to avoid the confusion and misunderstanding. There are several classifications used to describe different forms of assisted dying, namely active, passive, and indirect assisted dying.
Based on the criminal liability in Taiwan, passive and indirect assisted dying are legal, but active assisted dying is still illegal. Besides, the Human Organ Transplant Act and Hospice Palliative Care Act（Natural Death Act）are the most important medical treatment laws about passive assisted dying. Under these two laws, there are three legalized types of assisted dying, including withholding life-sustaining treatment of the terminal patient by the consent of the patient or family, withdrawing life-sustaining treatment of the terminal patient by the consent of the patient himself, and withdrawing life–sustaining treatment of the patient with brainstem death in the condition of the organ transplantation by the consent of the patient or family.
Although the Hospice-Palliative Care Act has been implemented for about ten years, there are still several debates, such as the denomination and definition of the act, the concept of the terminal patient and medical futility, and the controversy of withholding and withdrawing life sustaining-treatment.
In conclusion, we hope everyone feels peaceful and respected when his or her r life comes to the end.

並列關鍵字

assisted dying ； euthanasia ； natural death ； Hospice Palliative Care Act