台日兩國器官移植法制研究—以器官移植決定權的憲法問題為中心

Comparative Studies of Organ Transplant Between Taiwan And Japan-- Focused on the Transplant Self-deciding Rights

賴怡君(Yi-Chun Lai)

指導教授 ： 李建良

國立臺灣大學/法律學院/法律學研究所/碩士(2011年)

https://doi.org/10.6342/NTU.2011.02265

摘要

器官移植乃當個人的器官受有病痛或損害，已無法充分發揮其功能時，自他處摘出的器官植入患者的體內，使其代行該器官之功能；損己利他的本質，又因涉及腦死爭議，在生死學、倫理學、法學、醫學等領域都是深刻的課題。正因其特殊性，相較於其他醫療行為，更具強調器官移植決定權的必要性。醫療領域的自己決定權，隨著患者權利運動的高漲，正式向父權主義挑戰，本於生命倫理中尊重自主原則的實踐，以實踐以人為本的醫療為核心目標。
我國器官移植的醫療技術發展甚早，台灣自1987年人體器官移植條例立法以來，因應社會事件數次修正，逐漸放寬捐贈條件，器官移植也漸受國人接受。日本於1997年制定臟器移植法，因採取最嚴格的捐贈承諾條件的限制，雖移植醫療先進但移植數非常少，高度仰賴海外渡航移植飽受國際組織批評，面臨內外壓力下首次大幅度修法。修法後放寬器官捐贈承諾條件與台灣法制相似，兩國法制各有長處，日本法細緻地區分腦死判定的承諾及捐贈承諾深值得我國參考。
器官移植決定權於台灣憲法及日本國憲法上如何定位，日本透過憲法十三條幸福追求權確立了自己決定權的憲法地位，患者的自己決定權也獲得實務肯認。反觀我國憲法，生體移植決定權實涉及身體權、身體自主權之體現，死體移植決定權的行使與人格自律密不可分，皆應透過憲法第二十二條確認其價值及憲法地位。我國人體器官移植條例對個人的器官移植決定權設下例如親等限制、捐贈年齡等重重限制，器官移植涉及個人身體、生命的核心部分的決定權，若無重大公益目的，無法合理化父權主義對自己決定權的設限；另一方面，於法律規範的灰白地帶，應透過國家保護義務體系的建構以保障器官移植決定權，希冀我國的器官移植法制，得更保障個人生前意思決定，落實生命倫理中最根本的尊重自主，使捐贈者的意志得超越生死的界限，遺愛人間。

關鍵字

醫療父權 ； 生命倫理 ； 器官移植決定權 ； 臟器移植法 ； 憲法概括基本權

並列摘要

Organ transplant means that an organ removed from other people is implanted into a patient’s body to act as the original organ when the patient’s original one is hurt or injured and can not fully function. Due to its essence of altruism as well as its involvement in the dispute on brain death, organ transplant has become a profound issue in terms of philosophy of life and death, ethnics, jurisprudence and medical science etc.
It emphasizes more necessity than other medical transplant decisions just because of its particularity. With the upsurge of patients’ right movement, patients’ self-determination in the medical field is officially challenging to paternalism. Based on the practice of respecting principle of autonomy in bioethics, human-centered medical practice becomes the core purpose.
Medical technology on organ transplant developed very early in Taiwan. Since the legislation of Organ Transplantation Act of Taiwan in 1987, organ transplant was gradually accepted after it had been revised several times due to social events and donation requirement had been gradually relaxed. Japan formulated Organ Transplantation Act of Japan in 1997; the medical technology was advanced but the number of transplantation was few since the restriction of the most severe donation commitment requirement was adopted. Highly dependent on oversea sail transplant, Japan was violently criticized by international organizations; faced with the stress at home and abroad, it revised the law substantially for the first time.
The revised law in relaxing organ donation commitment requirement is similar to that of Taiwan, but the legal systems in both countries have strong and weak points. Japan’s detailed division of commitments on donation and brain death decision are worthy of our attention.
As for the positioning of living donor transplants decision and dead body transplants decision in the Constitution of Taiwan and the Constitution of Japan, Japan established the status of patients’ self-determination constitution and patients’ self-determination right was also actually approved in accordance with the 13th article of the right to pursue happiness. In terms of the domestic constitution, living donor transplants decision involves the embodiment of bodily rights, right not to be injured and the autonomy of body; the implementation of dead body transplants is inseparably related to self-discipline on personality; and the value and constitutional status of those mentioned above should be confirmed pursuant to the 22nd article of the Constitution of Taiwan.
Organ Transplantation Act of Taiwan has imposed restrictions such as kinship, age for donation and others on the organ transplant decision. Since organ transplant involves the decisions of personal body and the core of life, it’s impossible to rationalize the paternalistic limitation on self-determination if there is no key public objective. On the other hand, national protection obligation system should be established to guarantee the organ transplant decision for the gray zone of legal norms. It’s hoped to ensure the unrealized individual decisions and to implement the fundamental principle of respect for autonomy in bioethics by means of the domestic legal system on organ transplant, which makes donors’ will surpass the boundary between life and death and spreads love to the world.

並列關鍵字

Medical Paternalism ； Bioethics ； Transplant Decision ； Organ Transplantation Act ； Non-Enumerated Fundamental Rights of Constitution

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