醫療法上之得未成年人同意與親權濫用

Abstract

本論文以處理未成年人之醫療決定權為核心，並藉由文獻回顧、比較分析、以及案例研究之方法撰寫，試圖討論未成年人在醫療領域的自我決定權，以及討論父母權利在個案中應受到的限制。 未成年人之醫療決定涉及多方利害關係人，其中最主要的即為父母、國家，以及未成年人本人。父母能代替未成年人行使醫療同意權係源於父母之親權。親權實為一種利他權利，其目的除為了維護家庭自治外，亦是因為家庭是未成年人開展人格最重要的場所，未成年人在家庭中健康成長的權利不應被任意剝奪。國家對未成年人醫療決定的介入，則是基於國家對未成年人的保護義務（parens patriae）。因未成年人無法如成年人般捍衛自己的權利，故在未成年人之權利被第三人侵害時，須由法院介入保護，以落實法律對未成年人權利之保障。至於未成年人本人是否對涉及自身的醫療行為有決策權，則有爭議，我國現行法制並未對未成年人的醫療自主權加以承認。然而，自主權應是人性尊嚴之核心內涵，未成年人不應被剝奪自我決定之可能。又從比較法之觀點，可發現英美等國並未完全否定未成年人之醫療決定權，而是從案例法中分別衍生出 “Gillick Competence”及「成熟未成年人原則」等概念，在個案中承認已具備理解力、智力、成熟性之未成年人可自為醫療決定。 本文藉由三種主要爭議案型，即耶和華見證人拒絕輸血案、男童割禮、活體捐贈案例，試圖從個案中探討未成年人得否自為決定，其能力門檻應如何定義，父母之行為是否構成親權濫用，國家是否應對父母親權加以限制，各關係人間之意見應如何調和，以及未成年人之最佳利益究竟為何等。期盼藉由本文之撰寫，能提供對未成年人權益更完善的保護，並在立法上，在法院實務上，都能提供落實未成年人權益更好的改進方向。

This thesis, written through methods of literature reviews, comparative analysis, and case studies, focuses on the medical decision-making concerning minors, trying to discuss minors’ rights of self-determination in medical field and to discuss the limits of parental rights in each case. The medical decision-making of minors involves several interested parties, including parents, state, and minor him or herself. Parents can make medical decisions for their minor children because of their parental right. Parental right is a right of altruism. The reason of the existence of parental right is to maintain family autonomy, and to let the minors be raised in family, which is the best place for one to develop his or her own personality. The reason the state intrudes into the medical decision concerning minors is due to the concept of “parens patriae”. Because minors can’t defend their own rights, when they are infringed by a third party, state must intrude to provide protection for minors, otherwise the rights of minors written in statutes can’t be carried out. As to whether a minor can make medical decision for him or herself, it still remains a controversial issue, since the medical law in our country doesn’t admit the right of self-determination of the minors. However, self-determination is the core concept of human dignity, so the minors shouldn’t be deprived of this right. And from the perspective of comparative law, both the British law and the American law admit the medical decision-making right of minors who have enough understanding, intelligence and maturity, with British law developing the concept of “Gillick competence” and American law developing the principle of “mature minors” through case laws. Through the cases of the refuse of blood transfusion of Jehovah’s witnesses, male circumcision of infants, and live donation, this thesis tries to figure out whether a minor can make his or her own medical decision? How to define competence? Whether parents’ conducts constitute abuse? Can the state limit the rights of parents? How to coordinate the different opinions of these interested parties? What exactly is the content of the best interest of minors? Hoping that through this study, a more comprehensive protection of the rights of minors can be given, and a better direction of improvement both in the field of court practices and legislation can be pointed out.