台灣民眾與醫事人員對輔助死亡及生命末期醫療決策之態度研究

Abstract

本研究旨在探討台灣民眾與醫事人員對輔助死亡（包含安樂死與醫師協助死亡）之態度，並從醫學倫理與制度層面分析其背後之影響因素與政策意涵。隨著醫療科技進步延長生命歷程，以及個人自主意識抬頭，輔助死亡已成為臨終醫療決策中備受關注之議題。然而，其合法化涉及複雜之倫理衝突與制度挑戰，亟需多面向之整合分析。 本研究採用橫斷式問卷調查設計，針對一般民眾及醫事人員進行資料收集與統計分析，並結合系統性文獻回顧與醫學倫理四原則進行理論探討，同時輔以德國、法國與英國之比較法分析，檢視不同制度發展路徑對臨終決策之啟示。 研究結果顯示，台灣民眾對安樂死與醫師協助死亡之支持度分別達82.3%與74.6%，顯示社會整體對自主終結生命具有高度接受度；然而，影響其態度之因素包括教育程度、宗教信仰及是否曾有親人因重病離世之經驗。相較之下，醫事人員整體對輔助死亡仍持較保留態度，反映專業倫理與臨床實務考量之影響。此外，研究發現，在末期與非末期情境下，民眾對各種臨終醫療決策之支持程度存在顯著差異，顯示情境因素對倫理判斷具關鍵作用。 從倫理分析觀之，自主原則雖於現代醫療決策中日益重要，但仍須與不傷害原則、行善原則與正義原則進行平衡，特別是在經濟資源不足與社會支持缺乏之情境下，病人之選擇可能受到結構性限制而影響其自主性。制度層面上，《病人自主權利法》雖提供法律框架，然實務上仍面臨可近性不足、執行困難及資源分配不均等問題。國際比較顯示，各國多採「強化安寧療護並審慎討論輔助死亡」之發展模式。 本研究認為，輔助死亡之制度發展不應取代安寧療護，而應在完善照護體系之基礎上，作為極端情境下之補充性選項。對台灣而言，未來政策方向應優先提升安寧療護可近性、優化病人自主制度之落實機制，並促進社會公共對話，以建立兼顧個人自主、痛苦減輕與生命尊嚴之倫理與制度平衡。

This study aims to investigate attitudes toward assisted dying—encompassing euthanasia and physician-assisted dying—among the general public and healthcare professionals in Taiwan, and to analyze the underlying ethical and policy implications. With advances in medical technology prolonging the dying process and increasing emphasis on individual autonomy, assisted dying has emerged as a critical issue in end-of-life decision-making. However, its legalization raises complex ethical dilemmas and institutional challenges that require comprehensive multidisciplinary analysis. A cross-sectional survey design was employed to collect and analyze data from both the general public and healthcare professionals. In addition, a systematic literature review and an ethical analysis based on the four principles of biomedical ethics were conducted. Comparative legal analyses of Germany, France, and the United Kingdom were also included to provide insights into different regulatory approaches to assisted dying. The findings indicate that support for euthanasia and physician-assisted dying among the Taiwanese public is high, at 82.3% and 74.6%, respectively. Key factors influencing attitudes include educational level, religious beliefs, and prior experience with the death of a family member due to serious illness. In contrast, healthcare professionals tend to be more cautious or opposed, reflecting professional ethical concerns and clinical considerations. Furthermore, public attitudes vary significantly between terminal and non-terminal scenarios, suggesting that contextual factors play a crucial role in ethical judgment. From an ethical perspective, while the principle of autonomy has gained prominence, it must be balanced against non-maleficence, beneficence, and justice. In particular, structural constraints such as economic hardship and lack of social support may compromise the authenticity of patient autonomy. At the institutional level, although the Patient Right to Autonomy Act provides a legal framework in Taiwan, practical challenges remain, including limited accessibility, implementation barriers, and unequal distribution of resources. International comparisons reveal a common trend of strengthening palliative care while cautiously addressing assisted dying. This study concludes that assisted dying should not replace palliative care but be considered a supplementary option under highly restrictive conditions, particularly when existing care systems fail to alleviate suffering. For Taiwan, future policy development should prioritize improving access to palliative care, enhancing the implementation of patient autonomy mechanisms, and fostering public dialogue. Such efforts are essential to establish an ethically sound and balanced system that respects autonomy, alleviates suffering, and preserves human dignity.