末期病患善终权之真实意思表达及其认定

Terminal Patients'True Meaning Expression of the Right to a Good End and Its Identification

近年德、日等地善终权研究重点转向病患的意思真实及其表达。意思真实表达需要满足有效告知、具备同意能力、不存在意思瑕疵三个要件。刑法视域下善终权不适用代理规则。死亡直接阶段病患真实意思容易认定;非死亡直接阶段病患处于丧失意识状态,在无生前预嘱的情形下,需特定法益主体进行事前判断,以恢复可能性和存活时间作为实体容许要件,并适用推定同意确定病患真实意思表示。我国在建立生前预嘱制度时,可建构意思真实表达的体系化结构,对于无预立医疗决定+无意思表示病患,允许有限制地适用推定同意规则。

In recent years,the focus of research on the right to a good end in Germany and Japan has turned to the the patient's true meaning and its expression.The true meaning expression needs to meet the requirements of effective notification,having the ability to agree,and not having the defect of the meaning.And the agency rule is not applicable to the right of good end from the perspective of criminal law.It is easy to identify the patients'true meaning in the immediate stage of death.In the absence of a living will,a specific le⁃gal interest subject is required to make a prior judgment,taking the possibility of recovery and the time of survival as the physical per⁃missible conditions,and applying constructive consent to determine the true expression of the patient's intention.When we establish the living will system in China,we can construct the systematic structure of true expression of intention,and allow the limited application of the presumed consent rule for patients with no prior medical decision and no intention expression.