從「病人自主權」論國家對當代生殖科技於醫學臨床上運用的限制

The Implications of the State''s Restriction on the Clinical Application of Modern Reproductive Technology from Patient Autonomy''s Perspective

鄭舜介(Shuen-Jie Jeng)

指導教授 ： 高美英 ； 楊哲銘

臺北醫學大學/醫學院/醫學科學研究所/碩士(2002年)

摘要

面對近來生殖科技的突飛猛進，許多法律上的爭議一一出現，社會上不同的看法紛紛出籠莫衷一是，本文乃透過哲學的反思，立基於尊重病人自主權的思維，針對當代生殖科技可能面臨的立法困境，做一個結合醫學、法學、倫理學及社會學的初步探討。 本論文共分成七章，第一章為本文的緒論，其中將詳細介紹本論文的研究緣起、研究重要性、研究目的和研究問題。第二章則介紹本論文的研究設計與方法，其中包括研究架構、研究流程及研究方法。論文的第三章則詳細的介紹「病人自主權」的概念及內涵，並以歷史比較及文獻分析的研究方法比較歐、美、日等先進國家和我國在學術上、實務上的發展情形，論文的第四章則提及研究者提倡「病人自主權」的理由並論及「病人自主權」與憲法上「人性尊嚴」的關係，更進一步以論理分析及法理辯證的研究方式，討論到「病人自主權」的界線及其與人性尊嚴發生衝突時可能有的思維路徑及處理機制，論文的第五章則論及「病人自主權」與醫學倫理的關係，除了提出傳統倫理學上兩大重要理論，「實用論」及「義務論」外並提出美國生命倫理學家布群(Tom L. Beauchamp)與查得瑞斯(James F. Childress)所闡述的生命醫學倫理四原則，即尊重自主原則、行善原則、正義原則、不傷害原則，也介紹了日本學者森岡正博所提出「沒有根據的樊籬」及「根源性安全感」的概念，並試圖利用這些傳統及晚近的倫理學理論，討論其運用於當代生殖科技時可能有的思維路徑。本論文的第六章則講到在當代生殖科技下，「病人自主權」的修正與適用，並舉出胚胎權、代理孕母、無性生殖、基因治療四種近來最受爭議的生殖科技，分別討論這些生殖科技背後所衍生的法學、倫理學及社會學上的爭議，及目前法令政策不當之處，文章的結論即第七章則提出作者為因應生殖科技新時代的來臨，對於現行法律體系制度的調整建議，以作為社會結構與法律體系的因應調整基礎，為創造一個美麗的人文科技島預作準備。

關鍵字

病人自主權 ； 生殖科技 ； 人性尊嚴 ； 胚胎權 ； 代理孕母 ； 無性生殖 ； 複製人 ； 基因治療

並列摘要

When facing the rapidly developed reproductive technology recently, it still exists in some legal controversies with diversified perspectives in society without any generally consented consensus. This article focuses on the probable issues arisen by the contemporary reproductive technology, through the philosophy reflection with the basement of the special reverence to patients’ autonomy, so as to perform the initial discussion with the integration of medical and legislation fields. This thesis is divided into 7 chapters. Among them, the chapter 1 is the foreword with its detailed introduction for the basement, importance, goals and issues of this article. The chapter 2 is to introduce the design and methodology for this mentioned research, including research framework, research process, and research methodology. Regarding the chapter 3, it will introduce the detailed conception and context about the patient autonomy, together with the historical comparison and documentary analysis methodology to compare the practical and academic development between domestic practitioners and those of advanced countries like Europe, USA and Japan. The chapter 4 will discuss the reason for patient autonomy advocated by the researchers as well as the correlation with human dignity mentioned in the Constitution. It will implement further discuss about the boundary of patient autonomy, together with the human dignity’s possible reasoning paths and resolving mechanisms when clash happening, with accordance to the research patterns of reasoning analysis and legislation dialectics. The chapter 5 of this article will focus on the correlation between patient autonomy and medical ethics, in addition to the two illustrations of major medical ethics theories such as “utilitarianism” and “deontologism”, it also proposes 4 principles of medical ethics elaborated by the American ethics experts like Tom L. Beauchamp and James F. Childress, namely “respect for person”, “beneficence”, “justice”, and “ nonmaleficence”. Furthermore, it also demonstrates the conceptions of “groundless enclosure” and “originality safety sense” proposed a Japanese, Dr. “Masahiro Morioka” and it attempts to discuss the possibly existent reasoning paths for contemporary reproductive technology by employing these traditional and newly developed ethics theories. The chapter 6 will, under the atmosphere of contemporary reproductive technology, concentrate on the modification and applicability of patient autonomy and also illustrate 4 most controversial issues in reproductive technology like “embryo right”, “surrogate motherhood”, “asexual reproduction” and “gene therapy” with the respective discussions against the controversies in legislation, ethics and sociology arisen behind the reproductive technology, along with the inadequate legitimate policies currently. The chapter 7 is the conclusion to propose authors’ adjustment commentary against the legislation systems in order to make wholesome preparations for the advent of new era propelled by the reproductive technology and it will be viewed as the adjustment foundation for upcoming societal structures and legislation systems in an effort to create a well-organized arrangement for a brilliant humane and cultural technology Formosa.

並列關鍵字

patient autonomy ； reproductive technology ； human dignity ； embryo right ； surrogate motherhood ； asexual reproduction ； cloning man ； gene therapy

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