台湾地区安宁疗护立法的改革与启示

Lessons from Hospice Care Legislation Reform in Taiwan Region

历经近30年实践,台湾地区已形成较为成熟的安宁疗护立法。为克服改革前“安宁缓和医疗条例”的适用困境,2019年开始在岛内施行的“病人自主权利法”通过扩大安宁疗护的适用范围、明确病人最新医疗意愿的认定依据和设定安宁疗护决策执行中的医方免责情形,支持特定临床条件下的非末期病人预先做出安宁疗护决策。从实施效果看,改革后的台湾地区安宁疗护立法在保障病人善终权益、促进医患关系等方面更具优势,但在可行性上仍有不足。以台湾地区制度实践的得失为参照,中国内地应在患者权利保护法的框架下推进安宁疗护立法,并在立法理念上强调以协助决定范式促进临终患者医疗自主的实现。以此为基础,中国内地立法原则上应将安宁疗护的适用对象限定为末期患者,承认患者的拒绝维生医疗权,在患者安宁疗护意愿的认定和执行环节体现对医方专业自主的尊重,并结合监护制度完善安宁疗护的替代决策规则。

After nearly 30 years of practice,Taiwan region has developed relatively mature hospice care legislation.To address the application challenges of the pre-reform“Hospice and Palliative Care Act”,the“Law of Patient Autonomy Rights”,implemented in 2019,expanded the scope of palliative care,clarified the basis for determining patientslatest medical wishes,and established liability exemptions for healthcare providers executing palliative care decisions.This law empowers non-terminal patients under certain clinical conditions to make advance palliative care decisions.From the perspective of implementation,the reformed palliative care legislation in Taiwan region has shown strength in safeguarding patientsend-of-life rights and enhancing doctor-patient relationships.However,issues of feasibility persist.Drawing on the successes and challenges of Taiwan region's institutional practice,the Chinese mainland should advance palliative care legislation within the framework of patient rights protection law.The legislative approach should focus on supporting decision-making to promote the medical autonomy of terminal patients.Moreover,mainland legislation should primarily limit the applicability of palliative care to terminal patients,acknowledge patientsrights to refuse life-sustaining treatment,respect the medical professionalsautonomy in recognizing and executing palliative care wishes,and improve alternative decision-making rules in conjunction with supervisory legal systems.