预约善终的法律机制——台湾地区“病人自主权利法”评析及启示

Analysis and Enlightenment of “Patient Autonomy Act” in Taiwan

为充分保障病人医疗自主权,台湾地区新立"病人自主权利法"。该法以病人医疗自主、善终、医患和谐为基本理念,使病人在无决定能力时仍能实现自主权并赋予优先知情决定权,采用尊严死的善终模式,允许病人拒绝维生医疗,同时也关注医患关系,维护医疗专业自主。该法建立了预立医疗决定制度,病人可以通过预立医疗照护咨商,与医疗人员及家属充分沟通后,签署预立医疗决定,就接受或拒绝维生医疗做出选择。该法对我国大陆卫生法制具有诸多启示,包括应明确病人自己决定与家属代行决定的关系,区分拒绝维生医疗权与安乐死、医助自杀,赋予预先医疗指示法律效力,兼顾国家利益和医疗服务者权利。

In order to fully protect the patients＇ health-care autonomy,Taiwan recently enacted the＂Patient Autonomy Act＂. The Act reflects three basic ideas： patient self-determination,good death and harmony between doctors and patients. The patient self-determination idea endows patients with autonomy in the case of incapacity and prioritized right of informed decision. The good death idea adopts the death with dignity mode,which allows patients to refuse life sustaining procedures. The harmony idea focuses on the relationship between doctors and patients,taking into account the medical professional autonomy. The Act establishes the legal system of advance directive,which allows the patients to decide to receive or refuse life-sustaining treatment and artificial nutrition and hydration by making an advance directive after the advance health care counseling with a full communication with medical staff and the patient＇s relatives. The Act has great enlightenment significance to the mainland＇s health legal system,which includes identifying the relation between patient＇s self-determination and family＇s surrogate decision-making,differentiating the right to refuse life sustaining procedure from euthanasia and physician-assisted suicide,endowing advance directives with legal effect,balancing patient autonomy with national interests and health care providers＇ rights.