胎兒治療倫理與法律規範之探討

The study of Ethics and Regulations of Fetal Therapy

趙澤維(Tse-Wei Chao)

指導教授 ： 雷文玫

中原大學/商學院/財經法律研究所/碩士(2007年)

https://doi.org/10.6840/cycu200700078

摘要

論文摘要
本文的研究為胎兒治療的倫理與法律議題。胎兒治療與一般治療的差異是，胎兒治療無可避免的必須經由母體，孕婦的身體自主權可能會受到限制。因此在胎兒治療中最大的倫理爭議是，當胎兒有接受治療之必要時，孕婦有無權利拒絕接受治療。另一個層次的問題是，當孕婦有拒絕接受治療，法律上可否強制孕婦接受治療。目前我國法律尚無明確規範，本文的目的則在於勾勒出胎兒治療的倫理與法律規範輪廓。隨著胎兒手術等胎兒治療技術的持續發展，有朝一日該技術會進步到可以帶給的胎兒的利益勝過於孕婦所承受之風險。孕婦可能會在國家與社會保護胎兒利益的壓力，被強制要求接受胎兒治療，包括侵入性較大的胎兒手術。
然而拒絕接受治療的權利在美國是被聯邦最高法院承認為憲法第十四增補條款所涵蓋。告知後同意法則也強調個人的自主以及醫生在進行醫療行為前必須合理的對病患揭露相關訊息。既然孕婦也是一個心智健全的成年人，當其面臨胎兒治療時，告知後同意法則此時也應該適用。此時，究竟應該如何調和孕婦與胎兒之間的衝突？
從禁止孕婦吸菸、強制剖腹生產、禁止強制捐增器官、骨髓及血液及其他現存法律規定強制接受治療的法理，本文認為，法律原則禁止對個人身體進行違反意願侵入的內涵，強制孕婦接受胎兒治療除非有更堅實的正當性基礎，否則必須被禁止。由於接受胎兒治療的作為係為一積極作為，本文認為，原則上孕婦無接受治療的義務，僅有在為避免胎兒產後重大缺陷或拯救其生命所必須，且在不增加孕婦顯著額外的風險前提下，孕婦才有接受治療的道德義務。但即便如此，在任何情況下，此一義務仍不應該是法律義務。畢竟強迫孕婦接受治療，尤其是胎兒手術，是對孕婦身體的強制侵入，破壞孕婦對自身身體完整性的權利。孕婦即使有義務要保護胎兒，我們也找不到強而有力的依據，來要求孕婦要有一個積極的義務，去忍受身體的侵入，特別是法律上的依據。
因此本文主張，針對胎兒治療的法律規範，必須將告知後同意原則的精神與內涵納進。禁止強制孕婦接受治療，包含以刑事手段迫使孕婦接受治療都必須在禁止之列。國家對於孕婦是否接受胎兒治療，僅能以較緩和的諮商輔導方式介入。

關鍵字

胎兒治療 ； 告知後同意 ； 身體自主權 ； 胎兒手術 ； 身體完整性

並列摘要

Abstract
This research mainly focuses on the ethic and legal issues of fetal therapy. Fetal therapy is different from ordinary medical treatment because one cannot treat the fetus without invading the pregnant women’s bodily integrity. Hence, the main ethical considerations in fetal therapy is when a fetal therapy is necessary to save the fetus’ life, can the pregnant woman refuse fetal therapy? The other question is when a pregnant woman refuses fetal therapy, can courts or the law compel pregnant women to undergo fetal therapy? There is no law to regulate fetal therapy in Taiwan. My study is to draw the outline of ethics and laws of fetal therapy.
Fetal surgery techniques may soon improve so that the benefits to the fetus may outweigh the risks to the pregnant women. Under the pressure of social and government to protect fetus’ lives, pregnant women may be compelled to undergo treatment including surgical intervention.
In the United States, the right to refuse medical treatment is a constitutional right protected by a right to privacy and self-determination found in the penumbras of the Fourteenth Amendment. The doctrine of informed consent rooted in respect of autonomy also requires doctors to disclose information about a proposed procedure to the patient. Since pregnant woman is an adult with sound mind, the doctrine of informed consent should apply to her when she faces fetal therapy. In this case, how can we better harmonize the maternal-fetal conflict in fetal treatment?
Through analyzing ethics and laws about pregnant women’s smoking, mandatory cesarean sections, organ donation, or blood donation, this thesis argues that only when there is sound justification can a state compel a pregnant woman to undergo fetal therapy. Because undergoing fetal therapy is an affirmative action, pregnant women should not be compelled to accept fetal therapy unless it is to save the fetus’ life or to correct serious disabilities doesn't increase extra risk to pregnant women. But even so, it shouldn't be legal duty, because compelling pregnant women to undergo fetal therapy, especially fetal surgery, invades women's body and violates the body integrity of them. Even if a pregnant woman has a duty to protect her fetus, there is no strong legitimacy, especially legal legitimacy, to ask her to burden a duty to undergo body intervention.
Therefore, I argue that the legal regulations of fetal therapy should include the doctrine of informed consent. Compelling pregnant women to undergo fetal therapy and penal means must be forbidden. The only suitable way for the government to affect pregnant women's decisions to fetal therapy is through providing counseling.

並列關鍵字

physical autonomy ； fetal therapy ； body integrity ； fetal surgery ； informed consent

參考文獻

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