從醫病關係看安樂死與協助自殺

由於醫療以及科技的進步，人類對於生死的掌握似乎已經快要可以超越自然定律，但是生命的意義是否在於不顧一切的存續殊值存疑，尤其當疾病、傷痛已經對當事人造成難以負荷的痛苦時，更值得吾人反思生命的意義。隨著高齡化社會發展，臨終照護、病患自主、安樂死等議題更是許多已開發國家必須面臨的問題。處理安樂死或協助自殺等相關議題時，因涉及病患生命終結之不可回復性且對醫療專業有高度依賴性，如何在保護生命與病患自主間取得平衡，是最迫切的重點。從他國立法經驗中，以透過完善制度設計找到兩者之間的平衡點。其中，醫病關係即扮演不可或缺的角色，尤其在現今主流的醫病共策中，病患是共同做出決策的主體之一，醫師不再單方面獨斷為病患判斷何為最佳醫療方案。兩者的關係在決策過程中的互動是一種動態的關係，隨著病情、需求或是信賴強度的差異都會有所改變。而當醫病共容成功的產出一個結果，就會是一個病患同意將照護責任交之於醫師，醫師也同意照護病患需求的共同結果。同時，醫師倫理發展出符合現代醫療模式的倫理規範，提出尊重自主、不傷害、行善及正義等四大原則，約束醫療群體於體系中的執業行為，這些意涵，能夠在安樂死與醫師協助自殺等具高度道德爭議的情形中提供相應的解決方法，透過倫理規範中的各個原則綜合適用，以減輕醫師決策壓力，降低錯誤決策的發生率。同時，為了避免醫師倫理規範淪為空談，法律對於賦予醫師相對應之告知義務以及保證人義務等法律義務。醫師的告知義務，讓病患能夠清楚知悉自身疾病情況以及選擇，以做出最符合自身利益之醫療決策，而保證人義務則確保醫師提供病患完整的照護流程，不致出現病患求助無門的情況。惟告知義務以及保證人義務之內涵仍需藉由實務發展出更具體之內容，尤其在安樂死及協助自殺等高度爭議議題中，醫師是否有義務向病患告知此等選擇並執行之更是尚未有統一見解。但若當法律將安樂死以及協助自殺合法化並將之視為醫療行為，本文以為醫師既然選擇進入醫療體系，基於其職業內化之義務及倫理，醫師即負有義務完整提供病患所有資訊及醫療選擇，不得因自身理念與之相背而拒絕執行。

關鍵字

醫病關係；病患自主；醫師倫理；安樂死；協助自殺；告知後同意；告知義務；保證人義務；安寧緩和照護

並列摘要

With the advancement of medical technology, it seems that people nowadays can defy nature when it comes to the matter of life and death. However, it is debatable that whether the meaning of life lies in extending the length of it against all odds, especially when illnesses and pains have made life become unbearable. As we step into aging society, issues like palliative care, patient autonomy and euthanasia are in urgent need of attention for developed countries. When we deal with euthanasia and assisted suicide, these issues involve irreversible decision of end of life and high dependency on medical specialty. To strike a balance between protecting life and patient autonomy is the key in question. From the experience of other countries, we have learned that it is possible to reach this balance through carefully designed system, in which the doctor-patient relationship plays an indispensable role. As shared decision-making has become the mainstream, instead of unilaterally deciding what is best for the patient, doctors need to make decision with the patient. Meanwhile, ethicist have developed medical ethic theories that are comparable to modern medicine, which bind the medical community for their practice. These ethic principles assist medical practitioner in making decision in the face of highly controversial issues like euthanasia and assisted suicide, which lower the risk of making mistakes. Also, the law has developed corresponding legal obligations such as duty to inform and duty to act, so that the patient will not be ignorant while receiving treatment or receive no treatment at all. The substantial content of duty to inform and duty to act would still take time to develop. When facing controversial issues like euthanasia and assisted suicide, whether doctors are obligated to inform the patient of these options or even provide such treatment has not yet reach consensus among medical and legal professions. Nonetheless, if the law has legalized euthanasia and assisted suicide and treated them as part of medical treatment, it is my opinion that as part of medical community bond by medical ethics and the law, doctors are obligated to provide all medical information and options for the patient, and should not refuse to do so based on their personal beliefs.

並列關鍵字

doctor-patient relationship ； patient autonomy ； medical ethic ； euthanasia ； assisted suicide ； informed consent ； duty to inform ； duty to act ； palliative care