生前预嘱法治化的现实挑战及制度路径初探

Preliminary Exploration of the Realistic Challenges and Institutional Paths of Legalization on Living Wills

我国生前预嘱研究与实践起步晚、经验少,全国性立法尚属空白。生前预嘱与医生救治义务和患者利益最大化原则之间存在价值冲突,生前预嘱与近亲属决定不一致时存在执行难题。生前预嘱本质是患者对身体权的处分,符合风险自担的个人责任原则。“完整自主权”“先前自主权”理论为生前预嘱的合法性提供了理论基础。立法应确立生前预嘱的优先效力;明确订立条件,将适用范围界定在患者可预见的、未来因延续生命而带来的难以承受痛苦的范围,通过医疗辅助告知、见证、公证制度作为效力保障;将生前预嘱纳入医疗保险凭证体系,以达公示效果;规定违反生前预嘱的法律责任,保证预嘱执行。

The research and practice of living wills in China started relatively late with less experience,and there is still a blank in national legislation.There are value conflicts between living wills and doctor’s duty to provide treatment and the principles of maximizing the patient’s benefit.There are also implementation difficulties when the living wills are inconsistent with the decisions of the close relatives.The essence of living wills lies in the patients’right to make decisions about their own bodies,aligning with the principle of personal responsibility for taking risks.The theories of“complete autonomy”and“prior autonomy”provide a theoretical basis for the legitimacy of living wills.This paper proposes that the legislation should establish the priority effect of living wills and clarify the conditions for establishment.It also should define the scope of application to situations involving foreseeable and unbearable pain due to the life-extension treatments,taking the medical assistance notification,witness and notarization systems as the effect guarantees.It should incorporate the living wills into the medical insurance voucher system for publicity notification and stipulate the legal responsibilities for violating the living wills to ensure their implementation.